-
Group
Life and Accidental Death—Provides benefits
to the designated beneficiaries of an employee in the event of their
death. Additional group life can be offered through a voluntary program
on the life of the employee with ancillary coverage availability for
spouses and children being an option, if desired. Accident death and
dismemberment is an additional benefit with can be added providing
an additional payment if death from an accident occurs within a specified
number of days from the date of accident.
-
Group
Short and Long Term Disability—Provides
protection for an employee’s most precious asset – the
ability to earn money. Coverage is written for a percentage of salary
after a deductible period and pays for a specified period time. Short
term disability pays for periods of up to one year while long term
disability pays for longer periods of time generally up to the start
of retirement social security.
-
Group
Medical—Provides for the payment of medical
bills from most sources for the insured and their insured dependents.
The major exclusions include dental, routine vision claims for glasses
or routine exams and workers compensation eligible expenses. Coverage
is generally provided through the use of a “network” or
listing of providers. These are known as preferred providers who have
agreed to a set of charges which are usually less than normal in exchange
for having patients “steered” to their practice. Virtually
all plans today utilize some form of network and operate in some form
of the following plan:
-
Health
Maintenance Organizations (HMO’s)—A plan
built around a generally smaller group of providers who are dedicated
to keeping patients (insured) healthy. Coverage sought outside of
the group is generally NOT covered except in a medical emergency.
Most charges are cost shared through the use of co-payment by members.
-
Preferred
Provider Organizations (PPO’s)—These plan
s utilize a larger network of providers both hospital and physician.
Deductible are employed with co-insurance employed for larger claims
up to an annual maximum. Claim services obtained outside the network
are covered but with a larger employee share of the cost.
-
Point
of Service Plans (POS)—A hybred of HMO’s
and PPO’s, the there is a smaller group of in-network providers
but still allows out of network claims. The difference between in
network and out of network is generally larger.
-
Health
Reimbursement Accounts (HRA’s)—This is
usually a “high deductible health plan,” usually a $ 1,000.00
or more which employs an HRA which is employer funded to pay the first
$ xx.00 of annual medical claims. The idea is that since most employees
sustain claims under $ 500.00 per year that the account will pay for
those before the deductible comes into play. Employees spend their
own dollars much more carefully than they spend employer dollars causing
employees to shop for services and do what they can before spending
employer dollars. Plans generally contain preventive benefits and
prescription drug card coverage. Balances in the HRA’s not spent
at plan year end can be carried over to the following year in accordance
with the terms of the employers benefit program. Employees terminating
employment with the employer forfeit the unused portions accumulated
in their HRA accounts.
-
Health
Savings Accounts (HSA’s)—A recent addition
to the types of program is similar to HRA’s except that the
side account must be vested with the employee and maintain by a qualified
fiduciary. The program can have another supplemental pan to pay un-reimbursed
expenses and cannot by federal law have a prescription drug card.
Everything is subject to the HAS account and then the high deductible
and co-insurance to the annual stop loss maximum. The Federal government
sets the minimum limits for the plan’s eligible deductible annually.
-
Group
Dental and Vision—These plans function much
similar to medical plans in that almost all utilize a network of providers
or a list which afford higher benefit levels when services are obtained
from them. Both plans place emphasize preventive care with major services
of crowns or glasses covered on a discounted basis with the paying
a sizable portion of the charges. Dental orthodontics is an added
feature on some dental plans and generally only applies to children
under a specific age.
-
Group
Voluntary Programs, Worksite Marketing Programs—These
programs are usually offered as supplemental programs sponsored but
not paid by employers. They can include group life, disability, accidental
death, dread disease diagnosis or dread disease coverage plans. They
can include group home/auto or long term care programs. The advantage
is that they can contain more lenient underwriting for timely employee
enrollment, lower rates and payroll deduction.
