Things to Consider - Individuals & Families

Items to Consider

What is the best health plan for you and your family?

Choosing a health plan can be a confusing experience. Although there is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. We will try to guide you in simple terms. However, rather than just giving you answers, the best thing we can do is to make sure you are equipped with the right questions. The following booklets can help you make sense of all your health care choices and options:

There are three major things to consider, each with their own unique set of questions. By considering the questions thoroughly, you will arrive at the right plan for you and your family.
How affordable is the care (cost of care)?
How much will it cost me on a monthly basis?
Should I try to insure just major medical expenses or most of my medical expenses?
Can I afford a policy that at least covers my children?
Are there deductibles I must pay before the insurance begins to help cover my costs?
After I have met the deductible, what part of my costs are paid by the plan?
If I use doctors outside a plan's network, how much more will I pay to get care?
How often do I visit the doctor and how much do I have to pay at each visit?

Do the included services match my needs (access of care)?
What doctors, hospitals, and other medical providers are part of the plan?
Are there enough of the kinds of doctors I want to see?
Where will I go for care? Are these places near where I work or live?
Do I need to get permission before I see a medical specialist?
Are there any limits to how much I must pay in case of a major illness?
Is the prescription medication which I need covered by the plan?
Does the plan cover the expenses of delivering a baby?

Have people had good results when covered by a specific plan (quality of care)?
How do independent government organizations rate the different plans?
What do my friends say about their experience with a specific plan?
What does my doctor say about their experience with a specific plan?
Your Guide to Choosing Quality Health Care * shows how you can use information about quality to improve the quality of health care services you and your family receive. It describes quality measures including consumer ratings, clinical performance measures, and accreditation-what they are, where to find them, and how to use them. The Guide has checklists, questions, charts, and other tools to help you make the health care decisions that are right for you.

Things to Consider - Group

Choosing a health plan for your company can be a large responsibility. The following are some of the things to consider when choosing a group plan. Please call us for further assistance.

1)    How to know if your business meets the basic qualification for group insurance

  • You must have a minimum of 2 employees or owners to qualify for a group health plan.
    These 2 people may be:
    • Employer and Employee
    • Two Partners
    • Two Officers of a Corporation.

  • If you have employees, you will need to provide a copy of your most recent DE-6 (State Quarterly Wage Report). This will be used to verify eligible employees. For partnerships or corporations, you will need a business license, articles of incorporation or other documents that can verify the legitimacy of your business and the participation of all people to be covered under the group health plan.

2)    What else should I know before I review plans and request a quote

  • Minimum employer contribution must be at least 50% of the employee only premium.
    The employer is not required to contribute to the premium for dependents.

  • Generally, 75% percent of all eligible employees must enroll under the group plan.
    (Exceptions are made in specific situations.)

  • Rates will vary based on the size of your group, age of employees, geographical location, overall healthiness of employees, as well as other factors. Many insurance companies offer a one-year rate guarantee on the monthly premium.

  • Eligible employees are any employees that work 30 or more hours per week for the company. The employer may elect to include employees that work 20 or more hours per week. If an employee is already covered under another group health plan, they are not included in the 75% minimum eligibility factor.

  • No employee may be denied coverage due to pre-existing conditions for qualifying group health plans.

  • Most companies have options in which they allow employees to choose from a variety of plans.

  • When you enroll in a new group health plan, you will need to decide the length of time that a new hire must be with your company before he/she can be added to the group health plan.