What is a Broker
A Broker is a licensed insurance agent and an authorized representative of various insurance companies. This enables the broker to present insurance plans from many companies in a side by side manner. A Broker is able to give you an overview of insurance carriers and their products with impartiality. The broker is in a position to help educate the pursuer of insurance and can be a mediator between the insurance company and the insured.
Our service is free to you. We are Insurance Benefits Specialists. Health insurance premiums are determined by the insurance company and regulated by every state. You will not find a lower premium for any of the insurance plans quoted by us. No one can offer a lower premium. The difference is in the service you receive.
Our Commitment to You
The health insurance industry has gone through many changes in the last 15 years. Governmental changes and mandates have increased premiums dramatically. Colorado House Bill 1210, 1355, 1311 and the Health Insurance Portability and Accountability Act (HIPAA), and other state regulations, have increased costs to consumers by at least 35%. Most recently the Colorado State legislation passed House Bill 1335, which will also damage the small group insurance marketplace by forcing carriers to offer equal premiums to all those insured in the same age bracket.
Employers face difficult decisions when choosing a plan that they and their employees can afford. A trend toward Preferred Provider Organization (PPO) plans and Health Savings Account (HSA) plans emerged about 4 years ago. PPO plans are not all-inclusive like Health Maintenance Organization (HMO's), however by incorporating a plan with a high deductible and adding a supplemental plan; employers may bring down monthly premiums. Supplemental insurance plans help pick up hospital expenses that might not be covered by medical (or workers compensation) insurance. In turn, HMO plans are now being offered with a variety of deductibles and coinsurance for inpatient hospitalization.
Our commitment to our clients is never ending. We know employees are confused about health care benefits and don't have the time to deal with escalated claim issues. We will assist your company when dealing with claims issues and questions; enrollments; concerns; administration; terminations and COBRA - as much you want us to be involved. We realized a long time ago, most insurance companies can be a pain in the neck. In our attempt to distinguish ourselves from other brokers, we make a constant effort to help you with any insurance problems. Believe it or not, we are on your side!
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Types of Group Health Plans
How health plans work
The type of health plan you join can affect what is covered, what you pay, and the doctors and hospitals you can use. The big difference in types of health plans is whether they have a network: the group of doctors, hospitals, and other health care providers who serve people in a specific health plan.
What is a Network
Networks have providers who have met standards set by the health plans. If you are in a health plan with a network, to pay the least and get the most benefits and coverage, you have to use the doctors, hospitals, and other providers in the network.
HMO - Health Maintenance Organization
If you use the network, there are advantages in cost and coverage. As long as you use the doctors, hospitals, and other providers in the HMO network, the HMO pays for all covered services. You usually pay a co-payment when you get care.
Most HMOs ask you to choose a doctor or clinic to be your primary care provider, or PCP. Your PCP takes care of most of your medical needs.
In many HMOs, in order to see a specialist or other providers in the network, you must talk to your PCP to get approval for a "referral." Women have direct access to an obstetrician/gynecologist for their reproductive or gynecological care.
- Points to consider:
- More health care services may be covered that are not usually covered by traditional insurance, such as preventive care
- Premiums and out of pocket cost are usually less.
- If you choose to see a doctor or other provider who is not in the network, you will have to pay the full cost.
- You will have very little paperwork.
- Premiums and out of pocket cost may be less.
- HMOs participate in quality improvement projects with physicians and hospitals.
- Providers' credentials are verified.
POS - Point of Service Option
You don't have to use the HMO network, but there are advantages if you do. In HMOs with a POS option, you can use the plan as an HMO or as a fee-for-service plan.
- Points to consider: If you use only a Provider who IS in the HMO network.
- You will pay less when you get care.
- You get full HMO benefits/coverage.
- You will have very little paperwork.
- Points to consider: If you use only a Provider who IS NOT in the HMO network.
- You will pay more when you get care.
- Fewer health services may be covered and some services may not be covered at all.
- You generally have to file a claim.
- Providers' credentials are verified.
PPO - Preferred Provider Organization
You don't have to use the PPO network, but there are advantages if you do. PPOs are similar to traditional fee-for-service health insurance, except they have network. PPOs give you the choice of using any doctor or other provider you want, or using one who is part of their network.
- Points to consider: If you use only a Provider who IS in the PPO network.
- You will pay less when you get care.
- More health care services may be covered.
- You will have very little paperwork.
- Points to consider: If you use only a Provider who IS NOT in the PPO network.
- You will pay more when you get care.
- Fewer health services may be covered and some services may not be covered at all.
- You generally have to file a claim.
Traditional Fee for Service - Coinsurance Plan
This type lets you use any doctor or hospital, but usually cost you more.
These plans are called "fee-for-service" because doctors and other providers receive a fee for each service such as an office visit, test, procedure, or other health care service. There is usually a "deductible," which is the dollar amount you must pay each year before the insurance company begins to pay. And when your insurance does pay, you usually have to pay a portion of the cost yourself (for example, 20 percent of the charge.)
- Points to consider:
- You will have no limitations on choice of providers.
- You may pay more when you get health care (office visits, hospital stays, etc.)
- There is more paperwork, such as filing claim forms to get payment for services covered by the insurance, and keeping track of payments toward the deductible.
- Preventive services may not be covered.
- Premiums and out-of-pocket costs may be more.
- Your insurer may or may not send reminders to you or provide special resources, such as special programs for people with a chronic illness.
Colorado Legislation
House Bill 02-1353: Terminations (timely terminations).
Insurance carriers can choose to amend current contracts with a new clause, which will change the manner of handling termination of employees. House Bill 02-1353 becomes effect January 1, 2003 stating insurance companies must receive timely notification of employee terminations
- "every contract between carrier and a policyholder shall contain a provision that requires a policyholder to pay premiums:
(a) for each individual covered under the policyholder's policy through the date that the policyholder notifies the carrier that the
individual covered under the policy is no longer eligible or covered; (b) through the date that the policy holder notifies the carrier
that the policyholder no longer intends to maintain coverage for the group through the carrier."
This means that if an employee is termed 1/25/09 the insurance carrier must receive termination notice by the end of the month in which the employee became ineligible (i.e.1/31/09). The employer (policyholder) will be responsible for payment to the carrier for any date later than the end of the month in which the employee is ineligible until the date the carrier is notified. Removing dependents from an employee's coverage falls under the same rules.
As many of you use our services to terminate or cancel dependents from employee's coverage, this new legislation makes it necessary to make a procedural change. If close to the end of the month, as a precaution, please notify the insurance carrier directly and also our office of any terminations or cancellation of dependents. We will continue to send out a back up termination notice to the carriers. Then we confirm the member's termination with the carrier. Some carriers take as long as two weeks to amend the termination.
When faxing carriers remember to include the following information:
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