GROUP HEALTH INSURANCE

Small and Large Employers have many plan offerings to choose from. RJS & Associates Insurance Services can help you select an option that works best for your business.

Premium rates for Group Health Insurance traditionally are based on:

1) the average-age of the employees 

2) the demographics of the Group (ie., how many males vs. females)

3) how an employee elects to enroll (ie., self, with a spouse and/or family)

and if a large employer (100+ employees)

4) claims history and other pertinent information.

Employee Benefits Designed to meet the needs of ALL types of Individuals and the Employers they work for!

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BASIC DEFINITIONS:

Deductible - A fixed dollar amount during the benefit period - usually a calendar year - that an insured person pays before the insurer starts to make payments for covered medical services that are subject to a deductible (example:  $1000-$5000).

Copayment - A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received (example: $20 office visit copay).

Coinsurance - A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount up to the maximum out of pocket (example: 20%).

Maximum out-of-pocket expense - The maximum dollar amount a member is required to pay out of pocket during a calendar year. Until this maximum is met, the insurance carrier and member shares in the cost of covered expenses. After the maximum is reached, the insurance carrier pays all covered expenses, often up to a lifetime maximum.

Primary care physician (PCP) - A physician who serves as a member's primary contact within the health plan. In a managed care plan, the primary care physician provides basic medical services, coordinates and, if required by the plan, authorizes referrals to specialists and hospitals (example: HMO’s plans like Kaiser).

Preferred Provider Organization (PPO)- A plan that allows a member so “self” refer to specialist and hospitals without the restrictions of Primary Care Physicians (PCP).

Pre-existing Condition-A condition that has been treated and/or continuously being treated within the last 5 years.  Insurance carriers can review and impose a 6-12 month waiting period towards claims of that "specific" condition from claims being paid under a group health plan. 

Still have questions? Please contact us anytime! We look forward to hearing from you.

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