Employee Benefits,
& Group Health Insurance

What is a premium?

A premium is the monthly cost of keeping your insurance policy in effect. Health Insurance premiums are determined by a variety of factors, including your medical history, your age and your gender.

What is a deductible?

A deductible is an amount of medical expenses you are responsible for paying before your insurance starts covering you. A common deductible is $1500 – this means you would be responsible for paying the first $1500 in medical bills before your carrier begins to pay on your behalf. Having a higher deductible usually means you enjoy lower monthly premiums.

What is coinsurance?

Coinsurance is an amount of the cost of a medical service that you are responsible for paying. Unlike a co-payment, which is a fixed-dollar amount, coinsurance is expressed as a percentage. For example, many insurance plans have 20% coinsurance for hospital costs – meaning you pay 20% of the total cost of a trip to the hospital after deductible.

What is a Health Savings Account?

Health Savings Accounts aren’t health insurance plans. Instead, they are a financial tool designed to help make your healthcare more affordable. The money you deposit in an HSA is tax-free. You don’t pay taxes on qualified withdrawals, either. In effect, it’s like getting extra money from the government to pay for healthcare. To open an HSA, you first have to purchase an eligible high deductible health plan.

COBRA: This acronym refers to the Consolidated Omnibus Budget Reconciliation Act of 1985. This law requires group medical plans with twenty employees or more to offer participants the option to receive continued healthcare benefits for 18-36 months after the cancellation of their coverage due to loss of job.

Deductible: A deductible is part of the cost of health insurance that needs to be paid by the group before insurance covers any medical expenses. The amount of the deductible that is paid by the group can have an effect on the amount of premium that is paid for a health insurance policy.

HMO: Health Maintenance Organization. HMO’s are popular health benefit programs in which you’ll pay monthly premiums in return for managed coverage for your checkups, hospital stays, doctors’ visits, surgery, emergency care, preventive care, lab tests, and X-rays. If you join an HMO, you will have to select what’s called a “Primary Care Physician” who will be responsible for coordinating your healthcare and making any referrals to specialists that you require. You’ll also have to use doctors, hospitals and clinics who are members of your HMO plan’s network.

In-network: Healthcare facilities or providers who are members of your health plan.

Medicaid: This is a joint state/federal health insurance program that is administered by the state. It provides health coverage for low-income people, especially pregnant women, children and the disabled.

Medicare: This is a federally-sponsored healthcare program that offers coverage for medical and hospital care primarily to those over the age of 65.

Primary Care Physician: Most HMOs and POS plans will require you to select one family physician, pediatrician or internist to monitor your health, treat most of your health problems, and refer you to specialists when necessary.

Small Business Health Insurance: This is a type of healthcare coverage that is available to businesses employing between two and fifty employees. It offers discounted premiums to employees and tax advantages to small business owners; also in most cases, the coverage cannot be denied.