Frequently Asked Questions

Table of Contents

1. How to choose a health plan?
2. Can I buy health insurance for less if I go directly to the insurance company?
3. What are my options for making my first payment? 
4. How do I change my group insurance?
5. What is a HMO?
6. What is a POS?
7. What is a PPO?

How to choose a health plan?

Choosing a group medical plan should never  be difficult for you. When examining a health plan

• look to see their financial strength

•  present A.M. Best rating

•  whether it is JCAHO accredited

• whether it is NCQA accredited

• what services will it cover

• what services will it not cover

• its appeal process for denied claims

• how fast it pays claims

• medical rates

• affordability for employees

• managed care options for employees, (i.e. HMO/PPO) 

• plan accessibility

• complaints

• member services

• available locations

• renewal rates

• rate guarantee

• underwriting guidelines

• ID Cards

• and Web Access.

We conduct this type of research daily, so you don't have too. 

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Can I buy insurance less if I go directly to the Insurance Carrier ?

No, the rates will be the same if you go through an Insurance Agent. Additionally, by going direct you lose the added security of the agent's influence with that insurance carrier. Do not fight this battle alone - let the experts help! 

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What are my options for making my first payment?

For any contract to be considered by the insurance carrier, an initial binder check will need to be forwarded along with other group or individual applications. Do not cancel your present coverage until you are given written confirmation from the new insurance carrier of your policy acceptance.

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How do I change my group insurance?

We provide our clients with an "early warning system." Three months prior to your scheduled renewal, we canvas the marketplace for alternatives to your present coverage. Should you need to make any changes, you are prepared well in advance. This allows you to make an informed decision and not a mistake.

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What is an HMO?

HMOs both finance and deliver health care services. Instead of paying a health care provider each time a service is delivered, HMO subscribers agree to pay periodic fees. In turn, HMOs provide for virtually all their subscribers' covered health care needs. Most HMO Plans require the subscriber to make a small copayment for some HMO services. Each HMO develops its own rates and benefits, although certain HMOs that are regulated by federal law must provide at least the basic health services required by law. HMOs accept the risk of providing covered health care services. Thus, they have an economic incentive for monitoring utilization and costs. 

HMO  providers contract with insurance carriers and agree to provide specified medical services at predetermined prices. Due to the large volume of potential business that HMOs bring to the table, they are often able to obtain favorable pricing for services rendered.

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What is a PPO?

Under a Preferred Provider Organization arrangement, health care providers (physician and hospitals) agree to pre-negotiated service rates with those who contract for their services (employers and insurance companies) in return for an increased pool of patients, faster claim processing or both.

In most cases, employees covered by a PPO plan are free to choose any physician or hospital they wish , but are given financial incentives to use the services of preferred providers. For example, subscribers who use a preferred provider may have no deductible and a copayment of only $10 per office visit, plus extra services such as well-baby care and other preventive care services. Those who use nonparticipating physicians may be subject to a $250 or $500 deductible and/or 30% coinsurance and recieve no extra coverage.

PPO benefit plans may also find greater acceptance by employees because they permit a broader choice of physicians than HMOs and other managed care plans. 

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What is a POS?

Point of Service (POS) plans are hybrids of HMOs and PPOs. Under most  POS plans, employees have an increased flexibility of choosing providers from within or outside the plan's provider network. Most plans require you to select a Primary Care Physician (PCP) which will control your medical care and refer you to other providers within the plan network.

Most POS networks are actually the same network as that of the affiliated HMO plan. As long as the subscriber chooses an in-network physician for health care services, the fees, in addition to the fixed,  prepaid costs, are those of the HMO. Although, subscribers do have the ability to opt out of the network, but deductibles and coinsurance levels would apply to all services, similar to the PPO or Traditional Indemnity setting.  

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Copyright © 2000, Commercial Benefit Services, Inc. All rights reserved.
Revised: August 17, 2000 .