Connecticut Medicare & Health insurance Agent
Now Licensed in CT, ME, RI, NY and FL.
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.
Point-of-Service (POS)
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.
Dental Plans
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.
Vision Plans
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.
Life Insurance
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.
Term Policy
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.
Various PPO and HSA plans, plus WRAP plan, with varying deductibles and co-pays. Plans include Life and AD&D.
Plans that are limited to “minimum essential coverage” as required by the Affordable Care Act.
Provides Telemed & mental health services, as well as other wellness benefits and much more.
Plans that cover a variety of exams, diagnostic, preventative care and corrective services.
Accidents can happen at anytime. This policy pays benefits in addition to your regular health insurance.
Financial protection for the unforseen. Plans pays cash benefits for covered illnesses.
Pays cash benefits for approved hospital stays, includes surgical services, emergency room and more.
Gap policies are used to pay large deductibles on major medical health insurance.
Save BIG on both Generic and Brand prescription drugs, large pharmacy network.
Click here for Major Medical Health Insurance
Click here for Ancillary Health Insurance (Critical Care, Accident, Hospital, Telemed & More)
Click here for Dental & Vision Plans
Please fill out the following form and Jeanne Clark or Abby Willhoite will contact you soon.
Please fill out the following form and Jeanne Clark or Abby Willhoite will contact you soon.
Please fill out the following form and Jeanne Clark or Abby Willhoite will contact you soon.
Please fill out the following for and Jeanne Clark or Abby Willhoite will contact you soon.
Premier Enroll offers some clients a significant savings on Group Health and Employee Benefits. Note to shop on this platform, you will need our access code.
Please call our office at (860) 886-5126 for special pricing access code.
Once you have the code, please click the button below to go to Premier Enroll.
Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan is a limited benefit plans that pays a lump-sum payment directly to the insured.
When paid directly to the insured, cash payments help you, your family or your employees with out-of-pocket expenses and covers you when you are off work due to a hospital stay. There are no plan maximums, however the coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.
Surviving cancer and other critical illness is becoming increasingly common with the advances in modern medical technology. Critical Illness Insurance can help you, your family or your employees reduce the personal financial impact of the cost of fighting these illnesses or keeping up with everyday bills through that process. If you have a health insurance plan and/or disability insurance, Critical Illness Insurance will provide benefits in addition to your other coverage.
Some key features:
The benefits and riders offered are supplemental and are not intended to cover all medical expenses. Certain terms, exclusions and limitations may apply.
Accidents can happen anytime and bring unexpected costs not fully covered by medical insurance. Accident Insurance is very affordable and complements your major medical policy, in the case of an accidental injury.
Accident insurance helps to protect you, your family, or your employees from suffering through financial hardship due to a great deal of medical and out-of-pocket expenses that follow accidental injuries. Emergency treatment, hospital stays, medical exams, transportation and lodging needs are just a few of the expenses that accident insurance can help cover. Some policies can even pay benefits in as little as one day, based on time of claim submission.
Dental Plans
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.
Vision Plans
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.
A Preferred Provider Organization or PPO
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.
A Health Savings Account or 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.
Individual and family dental & vision plans or policies are relatively inexpensive and can be purchased any time of the year. Studies have shown that having access to dental and vision care promotes overall well-being. Regular dental and vision exams optimize eye and oral health, and can also detect serious underlying medical conditions. Some studies have even shown that people who have dental and vision insurance suffer less from depression, than those who do not have coverage.
Save 10% to 60% on dental care services with no caps and no waiting periods. Plus take advantage of additional savings available on Telemedicine, Vision, Rx and more! Plans can range from a PPO or HMO to Pre-Paid, Fee-for-Service, and Discount on a variety of diagnostic and preventative care services including:
-Cleanings | -Exams |
-X-Rays | -Filling |
-Orthodontia | -Glasses, Contacts |
-Lasik | -Emergency Care while traveling |
Disability Insurance protects your ability to earn a living during your working years. In other words, it protects one of your most valuable assets. And, this is pretty important considering that statistics show our chances are greater of becoming disabled than dying between the ages of 25 & 45. During the time you are unable to work due to a qualifying disability (illness or injury), the replacement of your regular income through a monthly benefit provided by disability insurance helps to maintain your pre-disability lifestyle.
Employers often provide standard short-term disability (STD) and long-term disability (LTD) insurance to meet federal guidelines. Individual disability income insurance can be customized to meet your needs and considers your occupation, age, income and other factors in determining your cost and monthly benefit payment amount.
Types of Disability Coverage
A standard Short Term Disability (STD) policy allows for income payments to begin after a two-week waiting period. Payments will continue to the insured until he/she recovers or maxes out the benefits. Thus, total benefits for a STD could last for anywhere from one month to two years, depending on the policy.
A Long Term Disability (LTD) policy allows for income payments to begin after a ninety-day waiting period, although it could be much longer depending on the policy. Once payments begin, they will continue far longer than STD. Thus, the total benefits for a LTD could last for a few years, up to age 65, or even for life.
Term Life is the most cost-effective type of life insurance. This simple, budget friendly life insurance solution is good for young people, families on a budget, and for people who may want to convert their term policy to a more permanent solution later down the road. You may also want to supplement a permanent life insurance policy. Generally, it provides the largest immediate amount of protection for the lowest cost and pays a death benefit upon your death.
How it works
Term Life covers you for a set period of time, provided you pay the monthly premium, or in some instances, a lump sum in advance. The policy will pay to the named beneficiary the face amount of the policy (set benefit and/or lump sum) upon death of the insured within the stated term. Depending on the policy, it may also make payments upon terminal or critical illness.
Medical travel insurance is typically very affordable and provides valuable medical coverage when traveling in the US or abroad, much like a regular health insurance policy. Most often these types of policies will cover care and services that are not typically covered by your regular health policy or Medicare.
Plan includes generic and brand drugs, 70% of generics are $10 or less. Preview plan list to see if you prescription needs will be covered. No maximums or deductibles.
Gap insurance provides benefits that supplement a low premium, high deductible major medical health plan. It works by paying a significant amount of the deductible. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible. You may find you save more money with a low premium high deductible health plan, along with the additional premium for gap insurance, when compared to one low deductible, high premium plan.
MEC plans generally cover preventive and wellness-related services and screenings, as well as treatments. They do meet the requirements as outlined under the Affordable Care Act (ACA), however, they are not considered traditional major medical coverage plans. MEC Plans are a more affordable alternative to an expensive Marketplace Health Plan that is not subsidized. MEC99 Plus adds additional wellness and financial protection benefits to the plan.
While these type of affordable plans do not meet the requirements of the ACA, they help you, your family or business and it’s employees control your healthcare costs by addressing the underlying chronic health and lifestyle issues that drive up healthcare. Improve overall health and wellness with the following benefits:
You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:
With today’s high cost of medical care, it is just no longer an option to go without healthcare insurance. One accident or illness can be financially devastating. You need to protect yourself and protect your family. In fact, according to a new study 66.5% of all personal bankruptcies that were filed were due to illnesses and accidents leaving individuals unable to work and strapped with medical bills. Whether you qualify for a subsidy or not, a comprehensive health plan can help you avoid financial ruin.
Additionally, Non-ACA alternatives such as Short Term Health Insurance, and/or Critical Care or Hospital Indemnity Plans will cost you about a third of what an unsubsidized major medical plan costs, and will protect your finances so you can focus on your health and getting better, should you have an accident or unexpected illness. Click here to learn more about NON-ACA Plans. Note that Non-ACA options, however, have limitations and in some cases, do not cover certain and/or preexisting conditions.
You can avoid the hassle of trying to find a plan on your own by letting our agent, Jeanne Clark, as a FREE resource to you, help you find a plan that meets your exact requirements.
An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.
An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.
Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your plan from the Marketplace will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.
Currently, most people are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any.
Following is a list of the states, as of 2019, that have mandated residents purchase qualifying health insurance (which is similar to the federal essential health benefits), or face a tax penalty when they file their income taxes.
California – the penalty for Californians who go without health insurance may be 2.5% of household income or $696 per adult (this number will rise yearly with inflation), whichever is larger.
Massachusetts – the tax penalty amount varies depending on your income, age and family size, but note the maximum penalty can be no more than half the price of the lowest premium plan available on the Massachusetts healthcare marketplace. For more information on Massachusetts health insurance mandates, click here.
New Jersey – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of annual income,. The penalty is capped at three times the adult penalty ($2,085), or the state average cost for a bronze-level plan, whichever is greater. For more information on New Jersey health insurance mandates, click here.
Vermont – Vermont has passed legislation that requires residents to have qualifying health insurance in 2020, but the penalty for non compliance has not yet been established.
Washington, D.C. – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,085), whichever is greater. For more information on Washington, D.C. health insurance mandates, click here.
In Connecticut, Access Health CT is the public health insurance Marketplace (also referred to as an “Exchange”) and is where you can purchase health insurance (also known as Obama Care) for you and your family. A plan from the marketplace is considered a comprehensive major medical plan and also contains the essential health benefits (see below) as established under the Affordable Care Act (ACA) law. When you purchase your health insurance through the marketplace, you are guaranteed issue regardless of any pre-existing condition and you may be eligible for a subsidy (premium tax credit) to help off-set high premiums. Our agent, Jeanne Clark, can help you determine if you qualify for a subsidy.
The essential health benefits are as follows:
Medicare annual open enrollment is October 15th through December 7th every year.
To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period.
NOTICE: Once you are eligible for Medicare, do not wait to enroll in a Medicare Part D Plan or you could end up paying a penalty every month.
Once enrolled in Medicare, if you wish to change or purchase Medicare plans you must act during the open enrollment period.
When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events: