Medical insurance is one of the most common employee benefit program offered by employers and it is usually the most expensive plan. Medical plans available to employers are based on the group size and use the terms "small or large group" as the two most common categories. Groups with 2-50 employees are considered small groups and groups with more than 50 employees are considered large or "true" groups. The regulations that apply to medical plans will vary by state.
Horizon Agency, Inc. has contracts with and represents most of the companies providing group medical coverage to employers. Medical plans can be very confusing to employers and employees so it is important that you use the services of a qualified benefit professional or consulting firm to assist the company and its employees in determining what the best plan design is, what it should cost, and what provider can best deliver the services required. The expertise offered by Horizon representatives provides you total exposure to the medical market without the need to talk with several different company representatives.
Items to consider relative to medical plans include the following:
- Long term costs of the plan
o To employer and employee
o How can plan costs be contained
o How much must an employer pay of the plan costs
- Should the plan be fully insured, a 105 plan, or self insured
- Type of plan - HMO, PPO, open access; managed care, indemnity
- What level of coverage should be provided
o Coinsurance levels
o Plan Benefit Maximums
o Out of Pocket Maximum costs to employees / families
o Integration with cafeteria plan