Solutions
 

GROUP Products

Medical (Full & Self Insured)
HMO, PPO, POS, HRA’s and HSA’s
Dental, Vision, Long Term Disability, Short Term Disability
Term Life

Group Products are provided by the employer. The employer contributes to the cost of the benefit. The employer must contribute at least 50% single rate. These benefits terminate when the employee leaves his employment with the company.

Medical Insurance
Fully Insured – Is when the provider assumes all the risks for the group; such as claims and profits.
Self Insured – Is when the group assumes some or all of the risks for their group; such as claims and profits.


Voluntary Products

Voluntary Benefits are products which the employer does not need to contribute to the cost of the products. It is up to the employee if he wishes pay for the benefit. These benefits can be payroll deducted.


Dental
Universal Life
Vision
Critical Illness
Disability
Mini-Medical
Accident
Long Term Care
Cancer
Accident
Term Life


INDIVIDUAL PRODUCTS

Individual Products –There are many insurance products available for the individual. If you are someone whose employer does not provide benefits, self employed, or between jobs there are options for you. If you have children reaching the age of 18 and will be off the parents insurance or graduating from collage there are benefits for them as well. These benefits can be a temporary or permanent


Medical
Dental
Vision
Cancer
Accident
Universal Life
Term Life
Disability
Long Term Care

 


Medical, Dental and Supplemental
Insurance Carriers


Group Access does business with these major insurance carriers. All of these carriers are “A” rated by the Department of Insurance. Each carrier provides benefits that are designed to meet the products they represent. Most insurance companies offer several different products but some are more specialized in select benefits.

Aetna
AFLAC
AIG
Allstate/American Heritage
American Fidelity
American Medical Securities
American Public Life
Ameritas
Assurant
Blue Cross/Blue Shield
Brokers National Life
C.N.A.
CT Group
Cigna
Colonial
Coventry
United Healthcare

* Group Access is appointed with all the major providers.

Fortis
Genworth/Professional Ins. Corp
Golden Rule
Great West
Guardian Life
Health Market
Humana
Jefferson Pilot
John Alden
Kaiser
MLI/Dearborn
Met Life
Mutual of Omaha
Principal Financial
Reliance Standard
Shenandoah Life

What Is?

Disability Insurance

If you can’t work because of a sudden illness or injury, you can still be financially secure. Supplemental disability income can help to ease the burden when your paychecks stop. As you recover, disability insurance can help you have enough to cover your bills, support your family and protect your hard earned savings. A monthly benefit you choose, up to a percentage of your income

Accident Insurance
An accident can wreak havoc on your savings if you’re not prepared.
That’s why there’s accident insurance. It gives you a cushion to help cover medical expenses and living costs when you get hurt unexpectedly. On an average three are 11 unintentional-injury deaths and about 2,330 disabling injuries every hour during the course of a year. Nearly 1 in 8 people sought medical attention or suffered at least one day of activity restriction because of an injury. Accident insurance can pay you a lump sum benefit for on –or off –the job accidental injuries, plus some medical benefits. Because accident insurance is supplemental, it works in addition to other insurance you may have. You can use the policy on its own or to fill a gap left by your other coverage.

Cancer Insurance
No one likes to think about getting cancer but it will still affect 1 in 2 men and 1 in 3 women. While you may not be able to prevent the disease, you can help protect yourself from its cost. Cancer insurance can help you:

  • Manage the high expenses of treatment
  • Preserve your savings
  • Protect your family from financial hardship
  • Concentrate on getting well





Critical Illness Insurance

Do you know someone who has had cancer, heart disease or a stroke? 33% of all families deplete all or most of their savings because of a critical illness. The US Department of Housing and Urban Development reports that 50% of foreclosures are the result of homeowners suffering a critical illness.

  • Two-thirds of heart attack patients don’t make a complete recovery. Stroke is a leading cause of serious, long-term disability in the US. 50 – 70% of stroke survivors regain functional independence, but 15 to 30% are permanently disabled.
  • 1 in 2 men and 1 in 3 women have a risk of developing cancer. However, 52% of all cancers diagnosed have a relative survival rate of 5 years.

Life Insurance
Because you work hard for your family, it makes sense to be sure they’re financially protected – in life and death. This is where term life insurance helps out. It gives you:

  • Peace of mind that your family will be taken care of
  • The ability to purchase affordable insurance for your dollar.



Universal Life Insurance will give you:

 

  • Fund value that earns competitive interest rates
  • A potential source of money for future goals



Mini-Medical
For Individuals, for groups or a benefit bridge for Groups.
Purpose:
o Cost effective solution for the uninsured
o Great for people who have been turned down or rated up by other insurers
o Perfect to use underneath HDHP (High deductible health plan)
o Allows for part time, seasonal and new hire coverage.
o More cost effective than COBRA

A health insurance plan designed to provide basic benefits for health care needs such as:
o Physician’s office visits
o Diagnostic x ray and outpatient lab tests
o In-hospital stays and Surgical procedures
o Emergency room visits and Child wellness visits
o Some plans provide Prescription card options.


Medical Insurance
Fully Insured – Is when the provider assumes all the risks for the group; such as claims and profits.
Self Insured – Is when the group assumes some or all of the risks for their group; such as claims and profits.

HRA’s - is a Health Reimbursement Account which is a medical plan that the employer decides how best to maximize their savings and Employee health benefits care. This is not portable. Same network of health care professionals and hospitals and the same preventive care coverage. Same medical plan options and same pharmacy plan options.

HSA’s – is a Health Savings Account which is a high-deductible health plan which you, the consumer owns the HSA funds and decides when and how to spend them. HSA dollars can be used tax-free for all eligible medical expenses. They are also portable from one employer to another. First dollar coverage for preventative care is standard on most plans.

HMO’S - A plan that has “network systems” treats each network independently; typically meaning that an insured CANNOT “cross” Networks to receive in-network care; thus, all care – including PCP referrals and INS self-referrals – must be obtained from the same network system. It is the PCP’s responsibility to ensure that the patient is receiving benefits from in-network providers excluding self-referrals.

PPO’S - It is the patients responsibility to ensure they are abiding by plan rules and/or limitations. The patient is encouraged to verify that the provider is currently “participating” as of the date of service. A participant is considered out of network if they seek care from a non-participating provider – or do not adhere to the rules of the plan; out of network benefits are paid at a reduced coinsurance % (from in network benefits), may have a higher deductible (from in network benefits) and are subject to UCR (usual customary rates). Referrals are NOT required unless the employee is seeking out of network care (subject to each carrier’s requirements) or mental health/substance abuse treatment.
POS – Is a HMO that has an indemnity (out of network) benefit attached to the plan; works the same was as an HMO in network, although in a “dual option” the POS may have reduced coinsurance % for in network benefits. An Open Access HMO product and pays its providers in the same manner as an HMO, but to the typical consumer, acts as a PPO. However, Open Access HMO’s cannot be referred to as PPO’s. Referrals or PCP’s are NOT required for Open Access HMO’s for in network benefits.


Dental
There are 3 types of dental plans.

DHMO – You must use their network of providers. The plan pays only for procedures which are listed in the benefit and will only pay MAC (Maximum Allowable Charge) If the doctor charges over the MAC, you will be responsible for the difference.
Indemnity - You can use any dentist. Type 1, Preventative Procedures, pays 100%, Type 2, Basic Procedures pays at 80%, Type 3, Procedures pays at 50%
PPO- You must use their network of providers. The plan pays only for procedures which are listed in the Benefit and will only pay MAC (Maximum Allowable Charge) If the doctor charges over the MAC, you will be responsible for the difference.










Vision
A plan which provides a benefit plan with a schedule of allowances showing precisely what’s paid for each covered service. Most plans will pay for lenses, contact lenses, the exam, and have frame allowance.

Group Short Term Disability
A plan designed for the employer to provide to its employee’s a short term disability benefit. Ranging from day 1 coverage to 6 months usually. This benefit is a group policy and if the employee leaves the company, the benefit terminates.

Group Long Term Disability
A plan designed by the employer to provide to its employee’s a long term disability benefit. Ranging from 3 months to age 65 usually. This benefit is a group policy and if the employee leaves the company, the benefit terminates.

Group Term Insurance
A plans designed by the employer to provides to its employee’s life insurance for the employee in case of death. This benefit is a group policy and if the employee leaves the company, the benefit terminates. This benefit typically is a small benefit ranging from $10,000 to $25,000.



Interested in a Quote

If you are interested in a quote for medical or benefits, below is a summary of the information needed to obtain a quote for your group.

  • Information need to obtain a quote for a potential client.
  • Name of group
  • Address of the main location of the group
  • The county that the main office resides
  • Nature of business or SIC code.
  • A census of all full-time eligible employees; (census to include gender, date of birth, city, state and zip code, and how they might participate in the benefit requested) [for groups over 20 will need to know of any COBRA participants] (a copy of the last billing statement per benefit will provide some info)
  • Requested effective date for the new coverage.
  • The employer contribution for each benefit to be quoted
  • Information regarding current benefits; name of carrier, how long with current carrier, plan summaries for each benefit
  • GROUPS 2 to 99; It is beneficial to know of any health concerns in the past few years for any employees or dependants that may take coverage. Without this information quoted rates can look very good but once the group is underwritten the rates can increase to more than 50%.
  • GROUPS 100 and over; Information required by the insurance carriers is 2 years of claims experience (claims vs premium by month) and shock claims (a claim of $10000.00 or more) The carriers will ask for details on any known health concerns in the past few years for any employee or dependants that may take coverage that incurred claims of more than $10,000.

This information is needed to obtain the most accurate quote possible for the group.


Please contact us if you have more questions or want a quote.
benefit@groupaccessinc.com