Why Choose Southern Insurance Group For Your Group Insurance Needs?
For over 24 years, Southern Insurance Group has specialized in setting up quality low cost group health insurance policies for our clients in Clermont and all over the state of FL. Because we are independent agents, we will give you comparisons with all the top players in the group health insurance marketplace. Group health insurance is cyclical which means one year BCBS may have the best rates and products but then the next year another carrier takes the lead. Our job is to stay on track with the latest greatest benefits and pricing that each carrier offer and then recommend the best product to your company.
Other Tricks of the Trade
Did you know that insuring your dependent on a non-group individual plan is about 40% less than keeping them on the group plan? Many employers and employees aren't aware of this little known fact. Why is this important? Mainly because it is like paying a mortgage payment each month if you have to insure your entire family on a group health insurance policy. Matter of fact most of the group plans that I review have very few families covered under the plan as it is just too expensive to do so.
Why hasn't anyone mentioned this to me?
Usually the main reason is the agent that is handling your group health insurance does not offer individual plans. Because we are a full service agency in Clermont, we will figure out the most advantageous way to structure your Clermont group health insurance policy. Another factor is they won't want to recommend this to you if they don't handle or write individual policies as they don't want to lose control of the business. The more group insurance agents dealing with a company the great the chance that the employer will reward the agent who is saving the company and employees the most money with the business. Not always but more times than not this happens.
Why wouldn't everyone insure on individual policies instead of group?
First of all if you are an employee, you will need to stay on the group side especially if you want your employer to pay for a portion of your benefits. When it comes to dependents, that is a totally different story. I usually recommend whoever can qualify for the individual non-group plan to do so as the rates are so much better and whoever can't to remain on the group side. Keep in mind that if a family has several children, the rule of thumb is after 2 kids they should all stay on the group plan as the rates are the same on the group side for 1 or 5 kids. It makes no sense to insure one of the kids on the individual non-group plan and the remainder of the kids to go on the group plan for the reason mentioned above. If there is a spouse then just have the spouse apply for the non-group plan and have the primary employee take employee/children coverage and let the spouse be covered outside of the group plan on a non-group policy.
Here is another example of how to structure a group and individual plan. Let say the dad is covered under the group plan but we aren't sure what to do with the spouse an two kids. It is advisable to have the spouse and two kids apply on the non-group side as those rates will end up being around 40% less than insuring then on the group side. Lets say the wife doesn't get approved but the kids do or vice versa, whoever qualifies for the non-group should go that route as they will receive the savings and whoever doesn't will just need to stay on the group side.
Are there any disadvantages to going on a non-group plan?
As mentioned above, all non-group plans are subject to medical underwriting so if someone is in poor health then they need to stay on the group side. Anyone who is in decent health, will once again receive a sizable premium savings by insuring non-group.
Another argument for staying on the group side is maternity coverage. Group insurance includes maternity coverage which is one of the reason why it is so expensive for females. If you are wanting to have a baby relatively soon then the group benefits will typically pay better for the maternity expenses. you can add maternity to a non-group plan, however, if you do it will bring the premium back up to the group premium cost.
For all those females in child bearing years who do not want to have anymore children, they are paying for maternity in their group premium whether they want it or not. This is were a female can really cut down on her premiums by going on a non-group plan as they don't cover maternity expenses. The non-group plans cover complications of pregnancy or delivery but not the normal deliveries.
When you have the baby on the group side, after your post partdum check up and the babies 60 day check-up, it is recommended to then go on the non-group plan to reduce your monthly premiums.
Are non-group benefits worse than group benefits?
No they are just as good if not better in most circumstances. The above estimates of the 40% savings is comparing like group and non-group plans. Just like the group side, the non-group side has quite a few plans to choose from so of course chose the benefits that appeal to your need or utilization. We will walk you through your options and choices that are available to you so that this is as painless as possible.
Economy and your benefits
Due to the economy, group health benefits are scaling back with higher out of pocket expenses to the employee to get the premiums lower. Employers are going to low cost plans that offer basic benefits and then telling their employees that if they want to upgrade to a richer benefit plan that you can do so by paying the difference for that upgraded plan. All in all this is not terrible and I hate to say it but if your employer is offering benefits, they count your blessings as quite a few are phasing them out.
If the Obama legislation makes it mandatory for employers to provide benefits, employers are going to have to trim the expenses somewhere which may result in lower wages or fewer employees working for that company.
Southern Insurance Group Health Insurance is the most crucial part of a benefits package for obtaining and retaining the kind of employees you are relying on to help grow your business. It is no secret that in our current environment, it has become a challenge for small employers in Florida to maintain affordable health coverage for their employees due to ever increasing costs.
What you’ll discover in this report:
Eligibility Requirements: The Nuts and Bolts!
In order to be considered for group health coverage, a carrier will require that there be a minimum of two employees. The eligible employee is one who works on a full time basis with a normal work week of 25 or more hours for compensation. Each year an employer should verify that his group still meets the eligibility requirements for group coverage. A health insurance carrier reviews the application for compliance when a group starts a new plan, and may audit each year at renewal by requesting a certification form verified with a WR-30.
The following items are also necessary for compliance:
- At least 75 % of the employees must be employed in Florida
- Only 25 % can waive coverage without having other coverage elsewhere
- The employer must pay at least 10 % of the premium
- The employer has the right to decide on a waiting period for new employees to enroll in the plan - 0 to 6 months in Florida
Type of Group Plans Available
- HMO: This managed Care plan gives your employees the security of lower out-of-pocket expenses, comprehensive coverage and virtually no claim forms to fill out. Employees choose a primary care physician who will manage medical care and refer employees to specialists and hospitals within the network.
- POS: Your employees have the freedom to use the managed care network of physicians or choose doctors and hospitals outside the network. In network, the employees select a primary care physician (PCP) to coordinate their needs and to refer them to in-network specialists. By going out-of-network employees may encounter higher out-of- pocket expense and more paperwork.
- Direct Access: This open access plan provides employees with direct access to all primary care and specialists within the network without a referral. They do not need to select one primary care doctor. While employees have the freedom to choose from doctors and hospitals within the network, they may also go outside the network. By going out- of-network, they will encounter higher out-of-pocket expenses. Employers can choose from various plan designs to meet their budget and benefit needs.
- PPO: This preferred provider organization gives the employees the largest selections of network doctors and hospitals. If the employee uses the network, he receives a higher level of coverage; if he chooses out-of-network physicians or hospitals, he pays a higher share of the cost. Various plan designs are available.
- HSA: A Health Savings Account is like a 401K for health care. It is a tax advantaged personal savings or investment account that individuals can use to save and pay for their qualified health care expenses, now or in the future. Paired with a qualified high deductible plan, the HSA is a powerful tool that empowers consumers to be more actively involved in their health care decisions. Southern Insurance Group has the necessary knowledge and expertise to assist both employers and employees who are considering Health Savings Accounts.
- Dental Coverage: May be purchased as a stand alone plan or as a rider (an add-on) to a group health plan.
- Vision Coverage: May also be purchase as a rider (an add-on) to group health plans.
Office Visit Co-Payment: Employee payment for office visits (Options from $5-$50)
Deductibles: An amount that may be deducted by the insurance carrier from the total that they will pay toward hospital and other services, in-network and/or out-of-network (Options from $500-$2500)
Network of Participating Physicians: Doctors who are contracted with the plan
RX Coverage: Coverage for prescribed medications. Many plans include 50 % coverage. Tiered RX plans may be available for Generic/Name Brand/Non-Formulary Drugs (i.e. $10/25/50)
Guaranteed Issue: In Florida, no one can be declined due to a pre-existing condition. They may however, be subject to a pre-existing condition exclusion for six months if they have had a lapse in coverage of over two months.
COBRA or Insurance after work:
COBRA (Consolidate Omnibus Budget Reconciliation Act of 1985) requires businesses to extend their group health insurance coverage to an employee who leaves or is terminated for reasons other than cause. The employee must pay the premium to the employer, who in turn includes it with his monthly payment to the company.
In Florida, companies with two to nineteen employees must continue to provide coverage for twelve months after termination. The coverage must also be offered to the employee’s spouse and child. All potential beneficiaries must apply for continued coverage within 30 days of termination.
Additional considerations for the employer:
An employer must offer coverage to all eligible employees. Where the employer pays 100%, all employees must enroll unless they sign a waiver that they have other coverage. In plans where employees are asked to contribute, employees may waive coverage if they have other coverage or cannot afford coverage. However, if more than 25 % of the group declines coverage without other health insurance elsewhere, it will make the entire group ineligible as the group is not in compliance.
Today, more than ever before, employers need to understand the requirements in offering a group plan. Health insurance is becoming more complicated every day. At Southern Insurance Group, we are committed to educating employers and helping you to streamline your plans during these difficult economic times.