Group
Products 
Group
Insurance
Group insurance, a major component of employee
benefit plans, provides an insurance technique of considerable
economic, social, and political significance. The components
of group insurance are: medical / health, dental, vision, life
insurance, short and long term disability and increasingly
long term care insurance.
Group
Health Insurance
Health insurance is one
of the most important benefits employers provide to employees
in that employees depend on and use their health benefits frequently. The
cost of providing this benefit often represents a significant
part of most group medical plans it is important to distinguish
the different types.
Indemnity
/ Fee for Service (FFS)
This is the traditional
type of health insurance with FFS you can choose your own physicians
and hospitals. The insurer reimburses providers by paying “reasonable and
customary” or “usual charges”. Most
of these plans require a deductive and coinsurance on your
part.
Preferred
Provider Organization (PPO)
Similar to indemnity
/ fee for service, but with a network of providers (physicians
and hospitals). You
are free to choose a physician or hospital from a preferred
provider list. When
you use preferred providers you will pay less in deductibles,
co-payments and co-insurance than if you use providers not
in the network.
Health
Maintenance Organization (HMO)
A Primary Care Physician
(PCP) must be selected from a network at the time of enrollment. This
PCP will manage all medical / health care. In
order to see a contracted specialist or receive services from
a hospital a referral must first be obtained from the PCP except
in cases of life threatening emergency. No
benefits are provided if you go outside the network oh HMO
providers. The
co-payments you are responsible for in an HMO are typically
very low.
Point
of Service (POS)
Similar to an HMO you
must select a PCP that will manage your health care from the
network. Benefits using the network are very similar to HMO
benefits with very low co-pays. However,
you may receive services outside the network but with higher
co-pays, co-insurance and deductibles.
Group
Dental Insurance
Today
over 55% of all businesses offer dental insurance either totally
or partially
paid by the employer. Like group medical insurance, dental
can be indemnity / fee for service or the newly evolving Preferred
Provider Organizations (PPO) and Dental Maintenance Organizations
(DHMO), which work like group medical HMO’s. All dental plans
emphasize preventive care while many provide coverage for major
procedures and orthodontic.
Group
Vision
Another new, evolving
and popular employee benefit is vision care. Vision
plans can be either indemnity / fee for service provider organizations
(PPO) or discount programs through selected retailers.
Group
Life Insurance
Group Life insurance
and accidental death and dismemberment are incorporated in
most employee benefit plans. The
amounts can vary widely from employer to employer but most
often you will see two formulas for the amount of benefit:
- A percentage of an employees annual
income, typically 1, 1 ½ or 2 times.
- A classed approach with different amounts
for each class, typically owners / officers, management
/ supervisors and all remaining employees.
Group
Short and Long Term Disability Insurance
Disability benefits are
payments that provide income when an employee can no longer
work due to an illness or non-work related accident. Short
term disability covers a percentage of an employees income
(typically 67-70 % to a weekly maximum benefit} to a maximum
duration of 13 to 52 weeks. Long-term disability coverage
normally will provide benefits to age 65 or 70 while providing
60-70
% of an employee’s monthly income to some specified amount.
Contract language and definitions of disability can vary
widely from carrier to carrier and be liberal to stringent.
Be aware,
many employers and employees have been hurt by not understanding
the ramifications of the contract language in the policy
they purchased.
Long
Term Care
Long-term care provides
coverage if you have a chronic illness or disability that leaves
you unable to care for yourself for an extended period of time. You
can receive long term care in a nursing home or your own home. Long-term
care insurance can be used not only for seniors, but persons
of any age who have been in an accident or suffered a debilitating
illness. Long-term care is the fastest growing employee benefit.
Articles
of Interest:
*These
artilces are in PDF format, and require
the Adobe Acrobat Reader for viewing.
 Click
here to download Free Acrobat Reader
Having
Trouble Viewing Articles?
|
