Health insurance is a strong area for our practice.
Group Health Insurance
Depending on the carrier, a group can be classified as “small” if it is as small as a group of one or as large as a group of 50-100. Group health insurance is guaranteed issue, and it is a valuable benefit to employers and employees alike. Group Health coverage is always offered through businesses that wish to offer benefits to their employees.
Our firm excels in handling group business policies because of our CPR service. We Customize a program. We Personalize the benefits to the needs of the group, and we are highly Responsive to any and all concerns and problems.
Individual Health Insurance
Individual health insurance is purchased by individuals desiring coverage for themselves or their family. An individual or family that needs health coverage is generally in good health. If you have a preexisting condition — as defined by an insurance company — attaining coverage isn’t as simple. Insurance companies define a preexisting condition to be any condition that’s in your medical records that an insurance company has determined to be a condition that will result in them paying claims if they accept you as a new member.
Two examples of such a condition would be a type 2 diabetic or a recent heart attack survivor. Individual health insurance plans are available from a variety of companies, and we research a number of plans before making a recommendation specific to each client’s need and circumstance. All individual plans are subject to medical underwriting.
We also offer Medicare supplements and Advantage Plans. Medicare programs are becoming a larger part of the market because of our aging population. Somebody who is 65 today is young compared to 20 years ago, and because of that fact, there is a growing need for these products. Choosing a health insurance or Medicare plan can be very subjective.
The companies we represent are good companies; however, if we talk to 10 people, five will love one company and five will hate the same company. So it’s not a question of whether it is a good or bad company, it is a question of what company is best for you.
As an example, we had a client who was with United HealthCare and needed to have specific heart surgery performed at the Cleveland Clinic in Cleveland. It turned out that Aetna Health Insurance was the best to help him in that situation, so when his insurance was up for renewal, we transferred his coverage to an Aetna policy. His surgery was performed successfully, and he has returned to work and is doing well. This is just another example of how we perform CPR: We Customize, Personalize and are Responsive. The whole idea is to provide adequate protection.
We look at several areas when it comes to group health insurance although most of the same factors apply to individual health insurance policies, too. We look at the cost to the employer, the benefit that both the employee and employer will gain from the plan, and then the individual cost to the members themselves, and finally, the worst-case scenario for the employee.
Every member or individual needs to know the premium cost, what the deductible is and the maximum out-of-pocket expense for the plan. The combination of all three cost variables is the worst-case scenario for you. That total figure may amount to $7,000 to $15,000. If you have a bad year healthwise, you can count on the fact that you may maximize your worst-case scenario number. It might cost you $7,500 or $10,000, but it probably cost the insurance company anywhere from $500,000 to $750,000. Ultimately, you protect your assets by limiting your maximum exposure to your worst-case scenario figure, a risk that you decide to accept.
We look at health insurance programs in a pragmatic way trying to make sure the best value is given to the employer and employee.
One of the things our clients find valuable is that we are always accessible. Even after we sell a new health-care plan, we’re there to get them enrolled. We’re also there to help if they have an issue with claims or to clarify any concern or confusion they might have. A lot of what we do is educate and reeducate
our clients. We speak insurance. We know what the terms mean, what the jargon is, and we can interpret it for the individual or the employer.
Here are several services we provide: We conduct an annual review. Once you are our client, you will see us regularly. Once a year we go to all of our carriers to see what the market has to offer to make sure you still have the best value. There are two sides to this coin. Most people would love to stay with one health insurer for 10-20 years, but the reality is that every year rates go up. They can go up anywhere from 5 percent to 55 percent. Every year when you evaluate your health-care program, you have to look at the business decision as well as the benefit decision for the employer and the employee.
Physicians in the networks are another important factor in choosing a policy. Being able to pick your own doctor can be critical. In short, there are many things to consider when choosing a policy/carrier, and we try to make sure our clients have all the information they need to make the right choice.
