Group Insurance Information

Below you will find descriptions about different insurance options for groups. These types of coverage are commonly referred to as Employee Benefits.

If you're ready for group coverage, send us an e-mail with our Group Census Sheet filled out.
You can also fax it to (719) 578-5572.
With this information in hand, IME's brokers will be able to help in the search and selection of appropriate coverage.

Click on one of these topics to learn more:

Health Insurance

Group Coverage

  • A group policy is offered by an employer and is administered through the employer.
  • Certain tax documents are necessary to show employment statuses, tax ID information, legal legitimacy of company, etc.
  • Policies are issued for 12 months and are usually annual renewable policies.
  • This is a medical health insurance policy for owners and employees. It can be offered to family members (spouse, children, step-children, etc.). Whether or not the plan is offered to employee dependents can be decided by the employer/owner.
  • For new employees, a waiting period may apply where coverage does not begin immediately after hire.
  • These products go through the underwriting process,
    • For group sizes between 2-50 employees the underwriting process focuses on the group as a whole and guarantees coverage to all members if a policy is issued. Small group policies are referred to as guarantee issue.
    • Larger groups (with more than 50 employees) go through underwriting and medical history and plan utilization factors are taken into account before a policy is issued.
  • Group Coverage can be health insurance only, but is often bundled together with life, dental, vision, disability and long-term care insurance to provide a comprehensive benefit package for employees, thus the term Employee Benefits.

Long-Term Medical Planning

  • Long Term Care policies can be issued as either individual or group coverage, but are transferable (or portable) if issued under a group policy.
  • Group long-term care policies are very cost effective and provide significant coverage for employees who may not be able to afford a plan in the individual market due to cost.
  • Each policy is designed by the insured to assist them in planning for their long-term medical needs if they become disabled, terminally ill or are unable to perform acts of daily living.
  • Usually these policies are put in place to transfer the responsibility of major medical care from a spouse or family members to a medical professional.
  • The policy provides for coverage of medical and social services needs provided under the supervision of physicians and medical health professionals for persons with chronic diseases, disabilities or terminal illness.
  • Medical care can be provided in the person's home or can also apply to specialized care received in a licensed long-term care facility.
  • These policies cover medical health costs that exceed coverage provided by Medicare, supplements to Medicare policies, or medical health insurance policies that don't cover long term care or terminal illnesses.

 

Types of Health Insurance
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There are other types of health insurance plans not described here; however, these plan types are the most common. Other more complex plans follow the same basic structures.

HMO (Health Maintenance Organization)

  • The focus of the HMO is preventive medicine.
  • An HMO is a medical service plan in which specified medical service providers (doctors, nurses, therapists, hospitals, urgent care clinics, etc.) contract with the HMO to provide services. These medical providers are commonly employed by the HMO.
  • HMOs usually require the insured to have a PCP (Primary Care Physician) who acts as the "Gatekeeper" and the HMO uses a referral system.
  • The referral system is how the insured gains access to different specialists, clinics, medical facilities, etc.
  • The HMO is able to control costs through specific contracts with doctors, facilities and pharmacies.

PPO (Preferred Provider Organization)

  • An organization of medical professionals and hospitals who provide services to an insurance company's clients for a set fee.
  • PPOs do not use the referral system and don't require the insured to designate a PCP (Primary Care Physician).
  • The PPO uses a network system instead a "gatekeeper" and allows each member the freedom to choose providers - as long as they are in-network.
  • The insured must KNOW their NETWORK.

HSA (Health Savings Account)

  • An HSA is set up to function with a medical health policy called a HDHPs (High Deductible Health Plan), usually following the PPO or HMO format.
  • Plans are designed to help individuals save for qualified health expenses.
  • The HSA offers both the employer and the insured a tax incentive.
  • HDHPs put the initial costs of medical health coverage with the insured, this allows for decreased premiums.
  • Insured is allowed to set up the savings account to help offset costs and pay for qualified health expenses out of the HSA.
  • Bigger claims are covered by the insurance company once deductibles and OOP (Out-Of-Pocket) Maximums are met.
  • The HSA account belongs to the employee and the funds in the account stay with that employee even if they are no longer employed by the group or employer who originally helped set up the HSA/HDHP plan. The funds in the account can continue to be used for qualified medical expenses even if the employee (or former employee) no longer has the HDHP in place.

HRA (Health Reimbursement Arrangement)

  • The HRA is set up to function with a medical health policy which is usually a HDHPs (High Deductible Health Plan), following the PPO or HMO format.
  • These plans are only available to groups because the employer funds the HRA account and assists employees with health care costs by reimbursing them from the HRA.
  • Employees can roll-over unused balances at the end of the year.
  • HRAs are available to companies of all sizes and offer the employer a tax advantage.
  • The employer chooses which portion of the employees' costs to fund and makes contributions to the HRA account accordingly throughout the plan year.
  • Funds in the HRA account remain with the employer and do not transfer with an employee if they find employment elsewhere.

 

Life Insurance
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Key Man (or Key Person) Life

  • Life insurance policy covering the important, or key, employees or owners.
  • The policy owner is not the insured person, but the business.
  • Death benefits are paid to the business to assist during the transition after the loss of the key person.
    • Benefits can be used to supplement unearned projected revenue and offset the costs associated with filling the void of such a loss.
  • These policies are ideal for small business owners, partnerships, or companies where one employee brings in more revenue than any other earner.

Term Life

  • This is a type of policy that provides coverage for the length (term) of the policy and coverage expires unless the policy is renewed or converted.
  • Term policies provide the greatest coverage for the lowest premium.
  • These policies do not build any cash value and only provide a death benefit.

Whole Life

  • These policies are often called permanent protection policies - as long as premiums are paid, coverage continues for the life of the insured - or until age 100.
    • At age 100 the death benefit is paid out.
  • Whole Life policies build cash value and the policyowner can borrow against the policy's equity.
  • These policies are used in estate planning and are good tools for building long-term financial stability.

Universal Life

  • These policies are permanent protection policies - as long as premiums are paid, coverage continues for the life of the insured or until age 125.
    • At age 125 the death benefit is paid out.
  • The policy will build cash value and the policyowner can borrow against the policy's equity.
  • These policies are used in estate planning and can also be used as investment tools.
  • This is the best policy for someone interested in life insurance coverage with the most flexibility.

 

Dental Insurance
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Dental plans can cover everything from preventative care to orthodontia, crowns and bridges to periodontics. The type of coverage depends on the plan you select. Group plans provide an added benefit for employees at an economical cost to the employer.

Check out this Web site for information regarding oral health.

Tooth IQ

Group dental insurance may be purchased as a stand-alone benefit, meaning it is the only product purchased from a particular insurance company. However, many health insurance carriers provide dental insurance in conjunction with a group health policy. Some carriers offer discounts for purchasing multiple lines of coverage.The options vary by insurance company.


IME also works with several independent dental insurance carriers who make it simple to bundle dental coverage into a group's benefit package regardless of which health plan the group chooses.

In order to provide a quote for dental insurance give IME a call at (719) 578-5570 or send an e-mail to info@imebenefits.com.

 

Disability Insurance
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Disability Insurance Insures Your Income.

Group disability coverage is income protection insurance that helps cover costs and supplement the insured's income in the event of future disabilities, accidents, injuries, illnesses, pregnancy, etc. Disability insurance replaces the insured's income once a qualifying event occurs that prevents them from earning an income. Disability insurance is different from Workers Compensation in that the qualifying event does not have to be one that happens in the work place - although, it can be work related.

To determine the length of coverage and when income replacement should begin after the disabling event, the employer must decide on how comprehensive of a plan to put in place. Group policies can be purchased to provide coverage from the beginning of the disability and cover short-term costs and issues that arise immediately. This type of plan is commonly called Short-Term Disability (STD) insurance. STD insurance usually applies 0-90 days after the qualifying event. This type of policy can be used when Worker's Compensation does not begin immediately or a Long-Term Disability insurance policy doesn't begin until 90 days after an incident.

Long-Term Disability (LTD) insurance usually begins 90 days after a disabling event and will stay in effect for two to five years. Depending on the policy, LTD coverage can last all the way through age 65 - if the disability persists and becomes terminal. Since much of the American workforce is working past age 65, LTD policies now include an option called SSNRA - Social Security/National Retirement Age. This is for workers who will be affected by the national retirement age adjustments.

Disability insurance, both STD and LTD, usually replaces up to 60 percent of the insured's average annual income. Most group benefit packages include a combination of STD coverage with LTD coverage. The employer is free to design a plan to fit the group's needs.

For questions and quotes on group disability insurance please call (719) 578-5570 or send an e-mail to info@imebenefits.com.

 
 
 
 

 

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