In this area we address issues and questions that an employer may face when shopping for group health coverage. Browse through the list to learn more. If you have a concern or question that's not addressed here, please feel free to reach us on our toll-free number, or visit our "Contact Us" section to contact us by e-mail.

Q. What are the different types of small group coverage available and how do they differ?

A. Generally there are three types of coverage available for small groups (2-50). They are HMO, PPO, and MSA. See below for a brief description of each . . .

HMO: A Health Maintenance Organization provides very rich benefits - often extensive preventive care coverage and low out-of-pocket costs. Unless you have a Point of Service option or except in an emergency, there is typically no coverage for care from doctors or hospitals outside your HMO. Plans usually offer comprehensive benefits and affordable premiums with no deductibles and minimal cost- sharing (such as low copayments for doctor visits and other services). A Primary Care Physician, that you select from within the network, oversees all your care. Unless you have a direct access feature in your plan - your Primary Care Physician will coordinate referrals to specialists when necessary.

PPO: A Preffered Provider Organization is a network of physicians and hospitals that have agreed, by contract, to discount their rates to members. The networks are typically very large, and the members are free to seek care from any physician or provider within the network, including specialists without a referral. Members may also access non-contracted providers, but at a higher out-of-pocket cost. Typically PPO plans might offer some front-end copayments for such services as doctor visits and prescriptions. Most other covered services (i.e., inpatient hospital services and surgeries) are typically subject to a calendar year deductible and/or coinsurance (where applicable).

MSA: A Medical Savings Account (MSA) allows you to save money in a tax-deferred account opened in conjunction with a qualified high-deductible health plan. The idea behind MSAs is that purchasing a lower cost, high-deductible policy will save you money on your insurance premiums. In essence, you "self-insure" your day-to-day medical costs with the high deductible insurance plan protecting you against catastrophic medical costs. Money saved in your MSA account can be used to pay medical expenses not covered under your high deductible plan. Unspent money in your Medical Savings Account can be rolled over year to year and allowed to grow on a tax-deferred basis.

A. Each health plan has it's own philosophy on delivering medical care. Doctor's networks, specialist referral policies, consumer education, available prescription drugs and preventive health programs, differ from plan to plan. That's why it's important for you to compare each plan on the things that are important to you.

A. A Primary Care Physician is trained to manage your entire health care program. Primary Care Physicians typically include Family/General Practitioners, Internists, and Pediatricians. If you choose an HMO plan, you will usually be required to select a PCP from the available network. With a PPO plan, you usually are not required to select a PCP, and you are available to visit any physician within the network, however it is still a good idea to establish a relationship with a regular physician. Online Provider Directories are available from this site to assist you in searching for physicians and/or hospitals.

A. This will vary from plan to plan, but typically you may find options for Dental Coverage, Vision, Chiropractic Care, Employee & Dependent Life Insurance, and Short-term Disability.

A. This innovative option allows employees to pay for their share of health premiums before taxes. This saves employees money because their taxable income is reduced, so they pay lower personal taxes. Employers also enjoy considerable savings because workers' compensation costs and FICA payments are reduced.

A. A participation requirement is typically a percentage of your total eligible employees that must be enrolled in the group plan. This requirement will vary from plan to plan. An example might be - 75% of all eligible employees (excluding those that may waive off because they are insured through a spouse).

A. Again - this may vary from plan to plan. Typically, to be considered an eligible employee, there must be a formal employer-employee relationship which can be confirmed by demonstrating that the employer pays FICA wages and that wages are reported on a Federal W-2. Also the insurer may require that the employee, including a proprietor or partner, work a minimum number of hours per week on a regular basis (typically 30) to be eligible.

A. Customarily, you either have the option of coverage starting on the 1st or 15th of the month. This can also vary from plan to plan however - and it is possible that some plans might only offer start dates on the 1st of the month. If you are switching coverage, it is always prudent advice to never cancel any existing coverage until you have written confirmation or approval of coverage on the new plan.