Summary of Florida Group Health Coverage

In order to stay competitive in todayýs working environment employers need to offer a health package to their employees. Group health insurance in Florida can be offered to companies with a minimum of 2 employees. It has been very difficult for Florida companies both small and large to offer group coverage to their employees due to the rising cost of health insurance. Employers are now, more than ever, left to the test to find group coverage at a reasonable cost. The industry is moving away from traditional low cost HMO plans and steering more towards open access PPO plans. The major difference is the PPO plans make the consumer share more in the first dollar cost of their health expenses through deductibles and coinsurance.  Plus the HMO plans are no longer associated with cheap premiums. The Health Savings Account has been popular among Florida companies.  This revolutionary plan has allowed companies to decrease their cost as much as 35% in some areas. Make sure you keep all your options open as you look to establish or replace the plan for your company. Floridian quote has been guiding employers through the difficult process for years. If you would like your no obligation proposal emailed to you today please Click here to request a quote.

Different Type of group plans

The Following are the different type of group plans you will commonly see in Florida:

1.                  Traditional indemnity plans, which are now often called fee-for-service plans; 

2.                   PPO or Preferred Provider Organizations;

3.                   POS or Point-Of-Service plans;

4.                   HMOs or Health Maintenance Organizations.

No one type of health care plan is better than the other. It really depends on your needs and preferences. Some people enjoy the autonomy offered by fee-for-service plans, while others prefer the low costs associated with closed-panel HMOs. Also, as health insurers compete for business, distinctions among the types of plans may blur.

Preferred Provider Organizations (PPOs)

One step over the managed care border is the Preferred Provider Organization. PPOs have made arrangements for lower fees with a network of health care providers. PPOs give their policyholders a financial incentive to stay within that network.

For example, a visit to an in-network doctor might mean you'd have a $10 co-pay. If you wanted see an out-of-network doctor, you'd have to pay the entire bill up front and then submit the bill to your insurance company for an 80 percent reimbursement. In addition, you might have to pay a deductible if you choose to go outside the network, or pay the difference between what the in-network and out-of-network doctors charge.

With a PPO, you can refer yourself to a specialist without getting approval and, as long as it's an in-network provider, enjoy the same co-pay. Staying within the network means less money coming out of your pocket and less paperwork. Preventive care services may not be covered under a PPO.

Point-of-Service (POS)

Point-of-service plans are similar to PPOs, but they introduce the gatekeeper, or Primary Care Physician. You'll need to choose your PCP from among the plan's network of doctors.

As with the PPO, you can choose to go out of network and still get some kind of coverage. In order to get a referral to a specialist, though, you usually must go through your PCP. You can still choose to refer yourself, but it'll mean more hassles and more money coming out of your pocket.

If your PCP refers you to a doctor who is out of the network, the plan should pick up most of the cost. But if you refer yourself out, then you'll probably have to deal with more paperwork and a smaller reimbursement. You may also have to pay a deductible if you go outside the network.

POS plans have all the benefits of a PPO but normally run off HMO doctor networks. The HMO network typically has better cost and there for the POS is a more efficient way for employers to buy health coverage.  

Health Maintenance Organizations (HMOs)

Most of the time, when you talk about HMOs, you're really talking about closed-panel HMOs -- the least expensive, but least flexible type of health plan. They also tend to be geared more toward members of group plans than individuals.

In exchange for a low co-payment (or sometimes no co-pay at all), low premiums and minimal paperwork, an HMO requires that you only see its doctors, and that you get a referral from your primary care physician before you see a specialist. If you can still pick up the phone, you'll probably need to get clearance before you can visit the emergency room.

An HMO may have central medical offices or clinics, or it may consist of a network of individual practices. In general, you must see HMO-approved physicians or pay the entire cost of the visit yourself. HMOs have the best reputation for covering preventive care services and health improvement programs.

Why small employers in Florida should offer health coverage to employees

For one, small employers in Florida who offer health benefits will achieve greater employee recruitment and retention. It is hard to compete with the big boys with out a health benefit. So offering some type of coverage is necessary if you want to attract quality employees.

Another major benefit is 100% of the health insurance premiums you pay to cover your employees are a business deduction? That can be a significant advantage to individual or family coverage.

Finally, group coverage for Florida small employers is guaranteed issued coverage. So people who can not get insured under a family plan may have no choice but to enroll in a group plan. Therefore it could be viable for an employer to offer group plans just to keep their good employees with them.

Find out if offering group health may be an affordable option for you. An expert advisor can help review your options and find the program that is right for your company. Click here for your free no cost quote.

Florida Rules about Small Group coverage that you should know about

1.     Most carriers require at least 70% of eligible employees to enroll. You can exclude part time employees that work less then 25 hours and newly hired employees. Employees that are on another group plan through a spouse are exempt and donýt hurt your requirement percentage.

3.     Employers must pay 50% of the employeeýs premium.

4.    Carriers rate up or down 15% of the premium based on the health status of the group.

5.   HIPAA preexisting rule -If the employee does not have prior coverage with in 63 days from the start of the new group policy, there is a 12 month wait on preexisting conditions. A preexisting condition is defined as something you have been seen for with in the last 6 months. It is up to the insurance companiesý discretion to utilize their HIPAA right. However it is normal practice for them to cover minor expenses and decline the major expenses. Maternity does not apply to this rule.

We hope this information was useful to you. Please call us today to learn how to offer a Group health plan to your company for an affordable price. 866-307-3393.