GROUP MEDICAL BENEFITS:

Group medical & prescription drug benefits are provided by a business as a benefit to the employees and their families.  Employers may offer medical and prescription benefits to help retain and reward their high quality employees.  Typically the employer pays a portion of the costs and the employee’s share is usually deducted
from his or her paycheck.   

Our agency will work with a small business to place the insurance company which best suits the needs of the business and the employees.  We are appointed with many insurance carriers as each company has their target markets.  Before we contract with any insurance carrier, we review their reputation, quality of the contracts, premium renewal histories, quality of administration, and claims paying reputation.  Below is the list of our small group carriers for groups of 50 or less employees.    

At Business Health Insurance Services, we strive to go above and beyond.  Any licensed insurance agent can quote and set up your plan.  Many times, this may be the only service you receive.  We understand that most ing a full time human resource person would not be practical.  We would like to help out with your human resource administrative issues. Here is a brief list of some
of the supplemental services our clients receive. 

  1.   New employee enrollments and open enrollments during an open enrollment period.

  2.   Employee meetings after a carrier change or at the business owner’s request.

  3.   Employees can call us directly with any claim issues or benefit questions.

  4.   We send out COBRA or IL Continuation election packages for employee terminations.

  5.   Fast and courteous response to all phone calls or e-mails.

  6.   Offer a full understanding of the state & federal laws to protect our clients.

Small businesses are not required to offer a group medical & prescription drug plan.  However, if a group medical plan is implemented, there are many state & federal laws which must be strictly followed.  Here is a brief list of some of the most common laws for small businesses.

  1.   Health Insurance Portability & Accountability Act  (HIPAA)

  2.   Consolidated Omnibus Budget Reconciliation Act  (COBRA) 

  3.   Illinois State Continuation  (for groups under 20 employees)

  4.   Employee Retirement Income Security Act (ERISA)

  5.   Illinois new business and renewal rate practice laws

Each of the laws listed above were implemented for everyone’s protection.  Part of our service is to show our clients how to use these laws to their advantage.  Even more important, we make our clients fully aware of the laws and the consequences for non compliance.

GROUP LIFE INSURANCE:

It is common for an employer to offer a small amount of group term life insurance for the employees.  Many
times a minimum amount of group life insurance is required by the insurance company providing the medical and prescription drug coverage even if the employee is waiving the medical and prescription drug benefits. 
Accidental death & dismemberment is usually included with the life benefit at the same face amounts.

Most insurance company’s minimum amount of life insurance & accidental death is $15,000.  Amounts up to a $50,000 benefit which premiums are paid by the employer are tax deductible and the benefit not taxable to the employee’s family.  Any life benefits above $50,000 and premiums paid by the employer are still tax deductible, but the premium amounts above the $50,000 benefit must be reported as imputed income to the employee if the death benefit is to be income tax-free.

It is common that an employer implement a group term life insurance plan which may be in direct correlation to the employee’s salary.  This type of plan is usually done as a “standalone” plan and not linked to the medical and prescription drug plan.  There may also be small amounts of life insurance for the employee’s spouse and children.

One advantage of group life insurance is the ease of acceptance.  Typically most insurance companies will automatically enroll an employee without any medical underwriting.  For employees with more serious medical conditions, this can be a very inexpensive way of obtaining some life insurance.

The main disadvantage of group life insurance is the portability.  Since the acceptance is based on the employee’s employment status, the insurance is canceled when employment terminates.  Currently there are no continuation laws regarding group life insurance.  We encourage our individual clients to purchase personal life insurance to supplement the group life benefits and maintain the necessary protection if the employee changes employment.

GROUP DENTAL INSURANCE:

Group dental insurance is not a mandatory benefit and is not offered by all employers.  Dental insurance can be set up as a “standalone” plan or linked to the group medical, life, and prescription drug plan.  Dental insurance is considered to be the 2^nd most requested benefit by employees.

Group dental insurance can be offered in a DMO (Dental Maintenance Organization), PPO (Preferred Provider Organization), or a traditional plan.  The most common type today is the PPO plan, although some companies still offer the traditional plan.  Both a PPO and traditional plan usually offer benefits in 4 category types.

Type 1 (Preventative):  This benefit typically allows the employee and family members to visit the dentist every 6 months for routine check ups and cleanings.  Usually, there is no deductible and benefits are paid @ 100%.

Type 2 (Basic):  Basic services typically are fillings, emergency treatment, and extractions.  Some dental plans include root canals and gum treatment in the basic category or offer it as a “buy up” option from the major category.  There is usually a small deductible (ex. $50) and benefits are usually paid at a high percentage (ex. 80%).

Type 3 (Major):  Major services typically are crowns, bridges, dentures, inlays and maintenance of bridges and crowns.  There may be a waiting period for these benefits depending on the circumstances.  These benefits are also subject to a deductible and paid at a smaller percentage (ex. 50%).

Type 4 (Orthodontics):  Orthodontic services are usually available to only groups of 10 or more employees.  Orthodontic benefits typically cover only dependent children and not adults.  There may be a waiting period and there is usually a lifetime maximum benefit.

Group dental insurance typically has a maximum annual benefit per insured person.  The maximum benefits can range from $1000 to $3000 annually depending on the size of the group and the dental insurer.  These maximums only pertain to preventative, basic, and major services.

GROUP DISABILITY:

Group short term disability insurance is an optional benefit typically linked to a group medical & prescription drug plan.  It is designed to provide a portion of the employee’s weekly pay while they are off work due to a non-occupational sickness or injury.

The most common short term disability plan implemented is referred to as a 1-8-26 benefit plan.  This means an employee is eligible for benefits the first day for an injury, after 8 days for sickness, and a maximum benefit period of 26 weeks.  In addition, there is usually a maximum benefit regardless of the employee’s income.  The premiums paid are tax deductible and the benefits received taxable to the employee.

Long term disability benefits are not usually provided by small businesses.  Our agency generally recommends that our individual clients purchase an individual long term disability policy which typically offers better benefits with premium guarantees.

GROUP VISION BENEFITS:

Group vision benefits are not usually available for small businesses with less than 10 employees.  These benefits can be linked to a medical & prescription drug plan if the insurance carrier offers these benefits.  It can also be written as a standalone plan as long as there is enough participation.

The most common form of benefits is a vision discount program.  Most insurance carriers will partner with VSP.  VSP has negotiated rates & fees with vision specialists on the national level.  The vision discount programs are included on most medical and prescription drug plans with no additional cost.  You can check the participating providers in the VSP network by clicking on the icon provided in the left column.