Offeringgroup healthsolutions to employers.
Now more than ever, employers need an advocate to assist them in understanding how the Affordable Care Act (ACA) affects them, as changes to policies and procedures are guaranteed. This affects insurance coverage, healthcare providers service, cost, and ultimately, YOU! Most employers do not have an in-house specialist to keep up with all of the changes. With Messer Financial Group, you don't have to wade through this confusion on your own. We are industry experts and it is our responsibility to educate you, the client, on how to protect your business and ensure that you are compliant with the guidelines pertaining to the ACA.
Our 97% client retention rate is proof that the services we provide are superior. Let our clients tell you about it!
The Basics of Group Plans
Coverage underwritten on members of a natural group, such as employees of a particular business, union, association, or employer group. Each employee is entitled to benefits for hospital room and board, surgeon and physician fees, and miscellaneous medical expenses. There is a deductible and a Coinsurance requirement each employee must pay.
There are four fully-funded Medical Plans available and one Level Funded option:
- PPO - Preferred Provider Organization
- You are allowed to self-refer to any provider in the network. When using the in-network providers, the higher level benefit is received. This may be as much as 90% after the deductible. The benefit level for providers out of the network is typically 70% to 80%. Pre-authorization requirements must be met in or out of network. Providers in and out of network usually have a Doctor Office Copay
- POS - Point of Service
- Very similar to an HMO in-network plan. It uses a "gatekeeper" (Primary Care Physician or PCP) to refer cases to other in-network providers. Deductibles usually only apply to out-of-network care. Co-insurance is either 90% or 100% for in network providers. Services received out-of-network are typically paid at the 60% to 70% level. There are exceptions...typical an emergency while away from network providers or treatment required from specialists not available in-network
- HMO - Health Maintenance Organization
- The HMO uses a Primary Care Physician to direct all health care. No benefits are available outside of the provider network except when there is an emergency. HMO plans focus on wellness and preventive medicine and is the highest level of managed care.
- Indemnity Traditional Coverage
- The insured individual is free to use the doctor, clinic, or hospital of their choice. Both a deductible and a co-insurance apply and there are normally no co-pays for doctor office visits.
Long Term Coverage begins after a 60 or 90 day elimination period. Funds replace appoximately 50% to 66% of the employees income. Benefits can be from two to age 65.
Preventive Care - This plan normally pays 100%. A small deductible may apply.Basic Services - This plan is usually paid at 80% after a small deductible. It covers, but is not limited to, fillings, restoration, extractions and sealants.
Major Services - Usually paid at 50% after a small deductible. Examples of coverage include crowns, inlays, bridges, periodontic work.
Why is vision health important? You only get one set of eyes. Take care of them.
Your eyes not only affect how you see, but how you feel. Caring for your vision can lead to a better quality of life.
The plan will cover an employee for a flat amount equal to one, two, or three times the employee's annual salary. The employee may purchase additional coverage if desired at his/her own expense. Dependent family members may or may not be covered.
Our financial specialists can help you implement solutions to life insurance needs of any kind. Whether you are looking for a low cost way to ensure the well-being of loved ones, or to put a tax-sheltered investment in place that allows for maximum contributions, we can find the right fit for you. Out life insurance products range from Term Life to Universal and Variable Universal Life, and we represent over fifteen carriers.
How Does Level-Funding Work?
Level funding offers the same coverage and protection as fully-funded insurance plans, with the opportunity to get a refund on any un-used claims dollars. How does that work? The same as fully-funded insurance plans – a large portion of your premium dollars are put into reserves to pay claims. With level-funding plans, if your group has a healthy year they keep the claims dollars at the end of the contract term. Level-funded can be coupled with a PPO, POS, and HMO service platforms.
Reference Based Pricing (RBP)- a reimbursement calculation utilizing the Medicare allowance and mark up value; a reasonable level of reimbursement to medical professionals. RBP is rapidly gaining in popularity as a method to help clients control healthcare costs.