Health Maintenance Organization (HMO)
A Health Maintenance Organization (HMO) is a small group health plans that requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Members will designate a primary care physician who treats and directs health care decisions for the member. Additionally, the primary care physician will coordinate any referrals to specialties within the HMO network. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). Most HMOs charge a small co-payment depending upon the type of service provided.
Preferred Provider Organization (PPO)
Another option for small group health plans are a Preferred Provider Organization (PPO). With this plan, members save the most money on healthcare if they use providers within the PPO. Members will risk being covered for services if providers outside of the network are used. Deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits.
A Point-of-Service plan (POS) is a small group health plans that is a managed care plan with a twist, in that it combines some elements of both an HMO and a PPO plan. Like an HMO, participants designate a primary caregiver within the network. However, with a POS plan, participants may also use providers outside of network for health care services, but will pay a majority of the cost, unless the primary care provider has referred the out-of-network provider. In such a case, the POS plan will pay for the services.
Health Savings Account (HSA)
Many small group health plans benefit by having a Health Savings Account (HSA) feature that combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute, tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Then, the insurance will begin paying claims, once the deductible is satisfied. CLICK FOR IRS PUBLICATION 502 - Medical & Dental Expenses - CLICK HERE FOR IRS PUBLICATION 969 - Basic Info
Health Reimbursement Account (HRA)
A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax favored savings account. Employers contribute to the savings account, which can be used for to fund co-pays and other qualified expenses prior to the deductible being met. CLICK FOR IRS PUBLICATION 502 - Medical & Dental Expenses - CLICK HERE FOR IRS PUBLICATION 969 - Basic Info
Flexible Spending Account (FSA)
A Flexible Spending Account (FSA) is a cafeteria plan under Section 125 of the tax code and allows for benefits to be paid with pre-tax dollars which results in tax savings to both the employee and the employer.
The average working employee in America spends thousands of dollars annually on certain types of medical benefits, daycare expenses and transportation services. By participating in an FSA, an employee’s taxable income is reduced, which increases the percentage of pay they take home and allows them to pay for these benefits and services with the pre-taxed dollars, in essence giving them a discount on these services. Here’s how they work.
This tax-favored savings account is funded solely by the employee through regular pre-tax payroll deductions. Employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. Throughout the plan year, funds can be withdrawn from the account (tax-free) to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Some FSAs include work-related parking and transit costs. The administrator of the FSA account can issue a debit card that is tied to the FSA making it easy to use the account when needed.
Level (Shared Funding)
Shared Funding Plans allow small employers to take advantages of all the cost saving and benefit design features of a self-insured plan.
An employer will select any of the fully insured plans that the carrier offers. Then rates will be determined by the group’s claim history. Next, stop-loss insurance is added to protect against catastrophic claims. Since the carrier will handle the administration of the plan, there is no need to hire a separate vendor to handle claims and processing.
The premiums for shared funding plans are generally much lower than fully insured plans. That is because the employer shares some of the risk. Additionally, an employer may save even more by implementing wellness programs into the benefit programs. Our thorough plan analysis will help you determine if shared-funding is right for your company.
We can help you obtain the small business tax credit available to eligible employers through the Access Health CT Small Business, Connecticut’s Health Insurance Marketplace. Eligible employers may have thier premiums reduced by as much as 50%. We recommend you call us to determine your eligibility or use the Business Tax Calculator to find out if you qualify, and then give us a call or request a quote to the right. Your rates will be the same whether you use an agent or not. As your agent, you will enjoy free plan support year round.
Regular dental exams help employees stay healthier and more productive in the work place. And, studies show that simple routine visits to the dentist (which are usually covered 100% by insurers), help to detect serious underlying conditions such as heart disease and diabetes. The National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with Dental Insurance plans have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.
Dental Plans offer a variety of diagnostic, preventative care and corrective services including cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.
Similar to dental policies, vision plans are inexpensive and save money on routine exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Monitoring your eye health with regular exams also helps to prevent serious eye diseases like glaucoma and cataracts and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol.
Along with Health Insurance, Life Insurance is a key part of the benefit package for employees. Studies have shown that employees that feel financially secure are more productive, and experience higher job satisfaction. Life insurance a great tool for attracting top talent.
Life insurance provides for an employee’s final expenses, taxes, mortgage and even their children’s education as well as offering additional added benefits. Diversified Group Services, Inc. can help employers protect their employees and their employees’ families with a variety of different life insurance products.
Permanent Life Insurance
Life insurance that builds cash value and the savings can be tax deferred and/or borrowed against, if needed. These policies are known as Permanent Life Insurance.
Life insurance that does not build cash value, however, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Some policies may also make payments upon terminal or critical illness.
Short Term and Long Term Disability
National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package. Here’s how Disability plans typically work.
Short Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), STD will begin. Payments to the employee should begin after a two-week waiting period. They will continue until he/she recovers, or maxes out the benefits. This can be anywhere between one month to two years, depending on the policy.
Long Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD will begin. Payments to the employee should begin after a 90-day waiting period, depending on the policy. Payments will continue longer than STD–for a few years, up to age 65, or even for life.
With premiums and healthcare costs out-of-control, the following types of small business group health and employee benefits have become an affordable alternative for employers and help employees close gaps in coverage and offset healthcare costs. You can offer these benefits to your employees either fully sponsored, partially employer paid or on a voluntary basis.