M.A.M.I. Agency Presents to:
Company Name
Group Health Insurance Proposal
Name of Agent
08
M.AM.I. Group Health
Company Name 2008
Table of Contents
Section 1: Summary of M.A.M.I. Agency
Section 2: The Group Health Market
Section 3: Carrier 1
Section 4: Carrier 2
Section 5: Carrier 3
Section 6: Ancillary Benefits
Section 7: FAQs of Group Health Plans
M.AM.I. Group Health
Company Name 2008
Section 1
M.A.M.I. Agency
The M.A.M.I. Agency has over 30 years of market experience in both domestic and international health
risk in a worldwide market place. Throughout this time M.A.M.I. has been able to develop relationships
with some of the world’s largest and most influential health insurance carriers in both the individual and
group health markets.
As an expert in this field, M.A.M.I. Agency and its agents will always offer our clients a well rounded
view of the marketplace, including valuable money saving options that provide employers with the right
tools for making educated health care decisions for their organizations.
As such, we would like to accomplish the following goals with our presentation to you today:
1. Understand your particular business model and how health care management can play a pivotal
role in the success of your organization.
2. Convey to you a well articulated guide map of today’s health care markets.
3. Explore several options available to your organization from a variety of carriers to establish
which plan mix and carrier best serve your needs.
4. Thoroughly explain and review benefits of chosen plans to insure proper fit with the
organization’s particular census and needs.
5. Expand your understanding of Ancillary Benefits and how they can play an important role as a
motivator for your organization.
We believe that with these 5 points M.A.M.I. Agency can make a difference in the way your organization
utilizes its health insurance plans today!
Privacy
We hold our clients trust in the outmost of importance and will not disclose any information provided to
our agents unless asked to do so by an appropriate court of law.
We therefore encourage our clients to be as frank about their past experience as possible so that we
may do a more accurate assessment for their future.
M.A.M.I. and its agents are fully HIPA compliant, licensed, and insured.
M.AM.I. Group Health
Company Name 2008
Section 2
The Group Health Market
The Florida Department of Insurance is a highly active part of the Florida Department of Financial
Services, which thoroughly regulates the transaction of Health, Life, Accident, and Ancillary products in
the state of Florida. All agents must be licensed and appointed with an agency (also licensed) in order to
help in the transaction of Group Health Insurance1.
Some of the more popular reasons why employers choose to have a group health plan include:
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Guarantee Issue- Insurance companies must issue a policy to the applicant, regardless of
preexisting medical conditions2.
Pre Tax Premium Payments- Premiums paid are paid with pre tax dollars by both the
employer and the employee.
50% Employer Participation Minimum- Employer must contribute a minimum of 50% of
premium for each employee.
Ancillary Benefits- Dental, Vision, Workers Comp, Life, Short Term and Long Term Disability
all bundled into the same bill and carrier.
Employee Satisfaction- Lower employee turnovers due to availability of benefits
Structures for the Group Health buyer include:
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1
2
Health Maintenance Organizations (HMO) - These plans have two options (a) Open Access and
(b) No Access. What they refer to is whether or not a person must visit a Primary Care Provider
(PCP) before they may visit a specialist, the difference being that Open Access does not require a
PCP. These plans tend to be very comprehensive but only allow the member to stay within their
network (NO OUT OF NETWORK BENEFITS). These plans stress on preventative care and tend to
be the least expensive.
Preferred Provider Organization (PPO) - These plans do not require a PCP and allow the
member to visit any service provider in network for a covered reason up to the policy allowed
maximums. Out of Network service is mostly allowed yet will usually cover an amount less than
would have been covered if In-Network. These plans tend to be the most expensive yet offer the
members the most choice.
Point of Service (POS) - These plans are a hybrid between PPO and HMO. In essence they are an
HMO with Out of Network benefits. Theses plans are medium priced and offer more flexibility
than an HMO.
Certain exceptions may apply.
Companies are allowed to up rate up to 15% of quoted premium for guarantee issue.
M.AM.I. Group Health
Company Name 2008
Important Terms:
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Service Provider- the pre-established contractual arrangement between an Insurance Company
and a Hospital, Clinic, Doctor, Doctor’s Office, or any other Health Care facility providing
treatment.
Network- The aggregate arrangement by an insurance company with several Service Providers
in a single or different geographic region. Networks could be as small as a single county, tri
county or as large as state or even nationwide. Member’s of a network may use any provider in
that network and qualify as In-Network benefit use.
Primary Care Provider (PCP) - A registered and approved physician, usually an internist of
general practitioner, by an insurance company to be the “gate keeper” for members to access
other In-Network benefits (usually only required in an HMO with No Access).
Structuring Your Group:
A crucial determinant in the structure of a Group Health Plan is the size of the group itself. Several
Insurance Companies treat this criterion differently, but most agree to the following guidelines:
1. Groups smaller than 5 employees must purchase Workers Compensation (often directly from
the Insurance Carrier).
2. Groups of 1-9 Employees must submit full medical questioners for all of its employees.
3. Groups of 10+ must only submit employment and previous coverage information, as well as a
statement from the employer about any known medical conditions for the group.
While these criteria affect the pricing strategy for the entire group, the group’s economical demographic
or insurance usage may differ on an individual bases. For this very reason carriers allow the group to
pick from up to three different plans3 for the group. That is to say that an employer group could provide
a low deductible PPO for upper management, and comprehensive POS and or HMO plan for less use or
less income employees.
There are really a plethora of options to consider and it is our highest hopes that with our extensive
understanding of the market, in depth product knowledge, and dedication to service, that we will be the
Agency of your choice.
3
If available and depending on a minimum group size of 10
M.AM.I. Group Health
Company Name 2008
Section 3
Carrier 1
M.AM.I. Group Health
Company Name 2008
Section 4
Carrier 2
M.AM.I. Group Health
Company Name 2008
Section 5
Carrier 3
M.AM.I. Group Health
Company Name 2008
Section 6
Ancillary Benefits
Many carriers provide for other necessary insurance coverage to employers and their employees such:
 Dental Insurance- PPO and HMO plans that cover your routine and specialty dental services.4
 Vision Insurance- PPO and HMO network plans that cover routing eye care, exams, frames, and
other covered items.5
 Term Life Insurance- Life insurance protection for a limited period which expires without maturity
value if the insured survives the period specified in the policy.
 Short Term Disability-Short term disability (STD) pays a percentage of your salary if you become
temporarily disabled, meaning that you are not able to work for a short period of time due to
sickness or injury (excluding on-the-job injuries, which are covered by workers compensation
insurance).
 Long Term Disability- Provides a reasonable replacement of monthly earnings to insureds that
become disabled for extended periods of time due to accident or sickness.
4
5
Please see each individual coverage for specific benefits and summary, plans may vary according to carrier
Please see each individual coverage for specific benefits and summary, plans may vary according to carrier
M.AM.I. Group Health
Company Name 2008
Section 7
FAQs of Group Health Plans
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What is the minimum amount of employees required for a Group Health Plan?
One Person
What is the minimum amount of Employer contribution required to fund a plan?
50%
What is the maximum?
100%
Can my company have a PPO and an HMO?
Yes, an employer group can have up to three different plans as long as it has 10 or more
members.
Do I need worker’s compensation?
Yes
Does the Group Health carrier provide worker’s compensation?
No, most P&C carriers can provide worker’s compensation at a monthly rate
How can I lower my premiums?
The three easiest ways are: 1) Choosing a higher deductible 2) Lower Coinsurance 3) Choosing
an HMO instead of a PPO
M.AM.I. Group Health
Company Name 2008
A Group Health Presentation for
Company Name
By Name of Agent
M.A.M.I. Agency
1250 E. Hallandale Beach Blvd
Suite 408
Hallandale Beach, FL 33009
Tel 561-479-4377
Fax 561-479-4446
[email protected]
www.mamiusa.com