Overview:
Group Health insurance is generally the core benefit for most employees. Over the past few years, most states have adopted state specific health insurance laws that allow small companies (2 to 50 lives) to more easily qualify for health insurance benefits without being asked medical questions. Further, in most states there are no pre-existing condition limitations in the small group market. Jolles Insurance represents the majority of players in the Maryland, D.C. & Virginia market place and assists employers in determining the most appropriate plan and design for their needs.
Why choose Jolles Insurance?
With over 20 years of specializing in the employee benefit market place, we use our experience and our independent agent advantage to help our clients find the best coverage for their needs. Save time, money and headaches when you let Jolles Insurance research the market place to find the right carriers and plan designs for you. And that’s not the only reason to place your trust in Jolles Insurance; we provide the following services:
· We meet with the administrator/owner for an initial consultation so that we fully understand the needs of the group. We assist in helping complete an employer fact finder. This tool helps us design a customized plan.
· We research the market place and determine the most appropriate carriers and plan designs to meet the needs of the employer.
· We provide the employer with recommendations that take in to account short-term, mid-term and long term planning.
· Once a decision is made we develop personalized materials to compliment the insurance company communications. These materials are designed to clarify contract language and assist employees in better understanding their benefits.
· We meet with employees, communicate benefits and represent ourselves in a way that promotes the employer and the selected benefit package.
· We provide ongoing communications concerning plan guidelines, benefits, and cost saving strategies.
· We make ourselves available at all times to assist when there are administrative issues such as billing, state or federal requirements.
· We provide a complete annual review two months prior to the group’s anniversary date. We review current coverage and assist in making changes when appropriate.
· We make ourselves available to all employees, following up on claim disputes, clarifying plan guidelines, and providing them the extra service needed to keep the plan running smoothly.
· We keep the employer informed on changes in the industry and new developments.
How are we paid?
In almost all cases, the insurance carrier has already built in a servicing fee for an agent. This fee is generally built in to the monthly cost regardless of the decision of a business owner to place the business directly with the carrier or through an agent. In essence, the value added services provided by Jolles Insurance will cost the client nothing more than if the client placed the business directly with the carrier.
Evaluating Your Needs
When evaluating your needs you should keep several things in mind:
1. One of the most important concerns most employees have is maintaining the important doctor relationships that are in place for themselves and their family members. Make sure that the provider network works well to match the needs of your employees.
2. Not all health plans will let you go outside the network. If this is important to you, make sure that your plan has an "out-of-network" benefit. In most cases, a carrier will allow two plan options for your employees. We recommend that, in addition to an HMO option, a second option allowing the freedom to select a non-network provider be available.
3. Make sure that provisions are explained well by your agent so that there are no misunderstandings. Jolles Insurance always suggests that a separate outline be provided to employees explaining any confusing areas of the coverage and offering important information to help employees get the most out of their benefits.
Check the drug benefits. A large percent of the cost of medical care is for drugs. Most health plans use a formulary system to determine which drugs apply to the lowest co-pays. Often, there are substantially larger costs to the insured for using non-formulary and brand name drugs. Make certain that this formulary is extensive enough before agreeing on a plan.
Purchase Information
Choosing between health care companies can be a very complex decision. Work with an experienced agent who knows the market well. Jolles Insurance represents most of the major players in the market place for Maryland, D.C. & Virginia. Our process for helping you find the right plan for your group will save you a lot of time and money. The best news is that we go through the same process every year prior to your renewal date to insure that the selected plan still represents the best alternative for your company.
As independent agents, we represent the majority of carriers in the Maryland, D.C., and Virginia market place. Here is a list of some of the leading group health providers that we work with:
Health Insurance Company links:
Aetna: www.aetna.com
Carefirst: www.carefirst.com
Coventry: www.chcde.com
Kelly: www.kaig.com
Cigna: www.cigna.com
Kaiser Permanente: www.kaiserpermanente.org
Preferred Health Network: www.preferredhealthnetwork.com
United Healthcare: www.uhc.com
Ancillary (Dental/Vision/Life/Disability) links:
United Concordia: www.ucci.com
Medical Life: www.med-life.com
Dental Network: www.thedentalnet.org
UnumProvident: www.unumprovident.com
Metropolitan Life: www.metlife.com
Standard Life Insurance: www.standard.com
Group Health Products
Group health plans are broken down into two broad categories: Traditional & Managed Care. Over the past decade, managed care plans have dominated the market place. Group health plans can be funded in one of three ways: Full Funded, Partially Self-Funded, and Self-Funded. In most cases, groups under 100 participants should be full-funded. In general terms, the group pays the premiums for the specific plan design and the insurance company is responsible for funding the eligible claim payments. For groups that have greater than 100 employees, consideration should be given to Partial Self-Funding. In general terms, the group pays for stop loss coverage. With stop loss coverage, the company takes on some responsibility of funding for some of the potential claims expense. However, the carrier providing the stop loss coverage provides blanket coverage to protect the employer from the larger claims that are above a specified deductible. Self-Funded plans are reserved for very large groups that can sustain the potential large claims risk.
No matter the funding option used, the features of the plan are still the same.
Product Definitions
PPO plans
HMO plans
POS plans
Fee-for-service plans
Preferred Provider Organizations (PPOs) have made arrangements for lower fees with a network of health care providers. PPOs give their policyholders a financial incentive to stay within that network. With a PPO, you can refer yourself to a specialist without getting approval and, as long as it's an in-network provider, enjoy the same co-pay. Staying within the network means less money coming out of your pocket and less paperwork.
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Health Maintenance Organizations (HMOs) are the least expensive, but also least flexible type of health plan. In exchange for a low co-payment (or sometimes no co-pay at all), lower premiums and minimal paperwork, an HMO requires that you only see its doctors, and that you get a referral from your primary care physician before you see a specialist.
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Point-of-Service (POS) are similar to PPOs, but they introduce the gatekeeper, or Primary Care Physician requirement of an HMO. You'll need to choose your PCP from among the plan's network of doctors. As with the PPO, you can choose to go out of network subject to the plans schedule of costs for out of network services.
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Fee-for-service or indemnity coverage is rarely selected due to the substantially higher costs. Under this type of health coverage, you have complete autonomy when it comes to choosing doctors, hospitals and other health care providers. You can refer yourself to any specialist without a referral or required use of a specified network.
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Group Life Insurance Click here for group life quote
Overview:
Group life insurance is very similar to individual life insurance. There are several advantages to group life over individual life insurance. First, group life does not generally require any medical questions and is guaranteed issue up to a specified amount. Second, because all eligible employees are provided coverage regardless of their health history, administration of the group health plan is very simple.
Contrary to popular belief, group life insurance is rarely less expensive than individual life insurance for a health person. This is largely because, when underwriting individual life insurance, the insurance company has the ability to look closely at the proposed insured and fully evaluate the risk. Therefore, if you are healthy and want to get the best deal on life insurance, we recommend that you apply for an individual life policy. Most advisors recommend an amount between 5 to 10 times your salary. We can assist in evaluating how much coverage you might need and research the market for the most advantageous policy.
Dental Coverage for Employer Groups
Dental coverage is available to employer groups as either group insurance or on a voluntary payroll deducted basis. When an employer-provided group dental plan is put in place, most dental providers require that a substantial percentage of the employees participate on the plan. In many cases, Jolles Insurance is able to design a dental program that is cost effective to both the employer and the employees. Additionally, in most cases, Jolles Insurance can structure a dental program that will provide several options allowing for employees to select the most appropriate coverage for their personal needs.
Jolles Insurance, as an independent agency, represents many of the leading group dental programs available to companies with 2 to 200+ employees. Among the carriers we represent are: Guardian, CareFirst Blue Cross Blue Shield, Humana, MetLife, Delta Dental. Call us for information about tailoring a program that meets your needs.
There are a lot of alternatives to designing group dental plans. As in group health, dental can be structured as PPO’s, HMO’s and POS. Additionally, multiple plans can be offered. For more information on selecting dental coverage for your group, click here for a dental quote
Group LTD, Group STD, Payroll Voluntary Benefits, Executive Benefits
For information on Group LTD, Group STD, Group AD&D, payroll deducted voluntary benefits, and Executive Benefits, please contact Jolles Insurance directly.
Health Insurance Portability & Accountability Act (HIPAA)
HIPAA provisions are imposed upon group health plans and issuers. Eligibility for an individual's enrollment in a group health plan is determined according to the terms of the health plan and the rules of the issuer, but not according to an individual's health status or that of an individual's dependent. These rules and terms must comply with all applicable State laws. For further information go to: http://cms.hhs.gov/hipaa
