Group Health Insurance
Our sister agency, Dean Life & Health Insurance Agency, Inc., offers a full spectrum of Group Health Insurance Plans and Group Life and Disability Insurance. Low cost, fully automated administration for group Health Savings Accounts, (HSA), Health Reimbursement Accounts (HRA), and Flex Spending Accounts (FSA) also available.
Is your small business required to provide group health insurance to your employees as a result of the Affordable Care Act (also known as Obamacare)? Not sure? Call our group health insurance agents today at 410-838-3700 to discuss your options.
While there are dozens of different group health policies sold in the state of Maryland, there are three basic types of policies commonly in use: HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and Indemnity plans.
The Health Maintenance Organization group health plan allows subscribers to simply pay a small co-pay to visit a doctor, lab, hospital or other medical facility. As a HMO subscriber you must select a primary care physician (PCP) who participates with your HMO plan and you must see your PCP first for all medical needs. If a specialist is needed or if tests are required, you must get a referral from your primary care physician before seeking treatment.
Some HMO group health plans also offer out-of-network benefits where the subscriber may seek medical care outside the HMO network. Generally, an HMO plan with an out-of-network option will have a higher premium and using the out-of-network benefit requires significantly higher co-pays and/or deductibles.
The Preferred Provider Organization is simply a network of doctors and hospitals that have contracted with an insurer to provide care to its subscribers. As a PPO group health member you must use physicians and hospitals that are in the PPO network. However you do not have to select a primary care physician and you generally do not need referrals to see specialists as long as they are part of the PPO network. Some PPO plans require that a deductible be met before benefits are paid; however, it is more common to simply have co-pays for various physician, lab and hospital services.
The Indemnity plan, sometimes called a "traditional plan," generally provides the most freedom of choice in doctors and hospitals for the subscriber. However, unlike the HMO, a deductible will apply before benefits are paid and very often there will be an 80/20 cost sharing in addition to the deductible. This means the subscriber's responsibility could be the deductible plus 20% of the doctor or facility's bill. Most group health insurance policies have a maximum out-of-pocket limit after which the insurance company pays 100%. As always it is important to ask questions and make sure you understand potential out-of-pocket medical costs before purchasing any health insurance policy. If a subscriber is willing to pay smaller medical bills out-of-pocket and accept a higher deductible, significant premium savings can be realized.
Call Dean Insurance at 410.838.3700 for a quote on your individual or business insurance needs,
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