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Health

Open enrollment is 11/01/2020 – 12/15/20. November 1st applications will start a January 1st effective date.

Whether you are an individual or employer interested in buying coverage or just looking for a quote, there are several different plans out there. It is important to know the differences.

All of the plans are now categorized by Medal tiers: Bronze, Silver, Gold, and Platinum. Please keep in mind that if you are eligible for a tax credit, you can use that in any category; however, cost-sharing is only available in the Silver category.

Terminology

In-Network

This means your provider has a contract with the health insurance network/carrier, and he/she cannot charge more than the agreed amount for a service. Since there is an agreed amount, you tend to benefit your plan by using an In-Network provider.

Out of Network

This means that you are using a provider that is not contracted with your health insurance network/carrier; therefore, he/she can charge more than the network/carrier deems a reasonable cost for a service. 

You tend to get fewer benefits Out of Network rather than In-Network. You may be balanced billed for the difference between what the doctor charges and what the health insurance network/carrier deems to be reasonable on some plans.

Health Maintenance Organization (HMO)

This type of plan usually requires you to pick out a primary care physician. You will need to get a referral from that primary care physician to see a different doctor, such as a dermatologist. Referrals tend to be taken care of by the doctor and are usually electronic, which should eliminate inconvenience for you. 

You do not need a referral to be covered in the Urgent Care or Emergency Room. HMOs do not have any out of network coverage except for medical emergencies, and then you will be covered as though you are in the network. Typically, HMOs tend to have richer in-network benefits at a lower price since there is no out of network coverage. This plan will utilize the HMO network of doctors.

Exclusive Provider Organization (EPO)

This plan is similar to an HMO because it had no out of network coverage except for medical emergencies. This plan will require you to pick a Primary Care Physician (PCP); however, it will not require you to get referrals to see other in-network doctors. 

In other words, you may self refer inside of the network. This plan tends to be less in cost than a POS or PPO but more in cost than an HMO because referrals are not required. This plan typically will utilize the PPO network of doctors.

Point of Service (POS)

This type of plan will require you to choose a Primary Care Physician; however, you may go to any doctor outside the network. There will be higher plan paid benefits in the network versus out of the network to provide an incentive for people to stay in the network for their medical services. This plan will typically utilize the HMO network of doctors.

Preferred Provider Organization (PPO)

This type of plan does not require you to choose a Primary Care Physician. You may utilize the in and out of network benefits at your convenience. There will be higher plan paid benefits in the network versus out of the network to provide an incentive for people to stay in the network for their medical services. This plan will utilize the PPO network of doctors.

Health Savings Account (HSA)

This type of plan can be any of the above; however, it will have a high deductible and many out-of-pocket costs subject to the deductible typically not (for example, office visits, drugs, etc.). 

The deductible on HSAs is per family rather than per member to pay a higher deductible from the start. You can set up an HSA compatible savings account at your bank, which allows you to put pre-tax dollars into it to use toward the plan's expenses.

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Individual Quote Form

  • Please list the following for any family members looking for coverage:
  • Do you currently have health coverage? If so, what kind of coverage (employer, cobra, individual, etc)? Do you Qualify for group coverage offered through your employer or a spouses employer?
  • This field is for validation purposes and should be left unchanged.

Employer Quote Form

  • ***All of the information is also needed for each employee's dependents (spouse and children)
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Dental

A few things to know about dental insurance. Please keep in mind that there is a difference between employer dental benefits and individual dental benefits.

There are several types of plans:

Flat Fee: The insurance company pays a flat fee for each given service.

Fee Schedule: This is when the insurance company pays a given percentage for a service; you are responsible for the rest.

Maximum Allowable fee: The maximum fee allowed to be paid for a service by the insurer for in-network service. This allows for less of a balance bill at a dentist out of network.

In-Network fee: The fee schedule in which the insurer pays the average network fee for a service. Out of network, you are more likely to have a balance bill.

There are four classes of services: Preventative (Class I), Basic (Class II), Major (Class III), and Orthodontics (Class IV).

The coverage under each of these services tends to vary by carrier and plan type

There is typically no deductible on the Class I services (unless your plan has a lifetime deductible rather than an annual deductible)

Class II and III typically have a combined annual deductible. In other words, if you pay the deductible in Class II, you will not pay it again in Class III.

Class IV services typically do not have a deductible but rather a waiting period and a lifetime maximum (a cap on the amount a carrier will pay out in someone’s lifetime). Generally, these benefits are only applicable to those under 19 years of age. Not all plans have Orthodontics available, but this class is usually an added rider at an additional cost if this is available.

Examples of services:

  • Class I – cleanings, x-rays, fluoride (within an age limit)
  • Class II – fillings, simple extractions, root canals, periodontics, endodontics, etc.
  • Class III – crowns, bridges, and dentures

Employer dental plan

Please see below for some guaranteed issue employer dental plans and rates through one of the carriers we represent, Liberty Union – Appeal dental

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Employer Quote Form

  • ***All of the information is also needed for each employee's dependents (spouse and children)
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Life & Disability

There are several different forms of life insurance and several options that can be added to each policy; the below is a generalization of the most common forms:

Whole life is a policy that will follow you throughout your entire life. These policies can be taken out in different face value amounts, and they are made to follow you through your entire life; however, at a certain age (whatever the policy is deemed to go up to), for example, age 125, if you are still alive, you will get the face value on the policy. The proceeds from such a policy are typically used for burial expenses and other expenses that may be left behind. Whole life policies build cash value, which can be used to pay your premium after a certain policy point. The interest rate on these policies is guaranteed. You can also borrow against the cash value of such a policy, and the amount borrowed would come off of the face value of the policy.

There are a few different Universal Life types, and I have found the most common to be Universal Life with a guaranteed death benefit. This means that the policy will follow you through your entire life; however, at a certain age (whatever the policy is deemed to go up to), for example, age 125, the policy will end if you are still alive. The proceeds from such a policy are typically used for burial expenses and other expenses that may be left behind. This policy will build some cash value, but there is no guaranteed cash value like there is on a whole life policy. The cash value is usually much lower than a whole life policy because the interest rates given for this type of policy can fluctuate but are not guaranteed; however, there is a minimum amount that is guaranteed, thus the guaranteed death benefit.

you can also select how long you want to pay premiums; for several years or up to a certain age. For example, you could pay a policy up in 5 or 10 years to have no additional premium you would owe. This, of course, will cost more money for the 5 or 10 years then you would pay without this option.

Term life is a policy made to cover you for a certain number of years. Term life tends to be the lowest cost life insurance because it is not made to follow you through your entire life. For example, term life can be elected for ten years, 15 years, 20 years, or 30 years. Term life is usually elected to help cover expenses, such as a mortgage, in the case of an unexpected death. At the end of a term life policy, you could choose to continue the policy at a higher rate than you were paying. The reason someone would do this would, for example, be if a health status changed and medical underwriting could not be passed again.

This means that if you leave that place of employment, you will lose that life insurance coverage unless (if available) you select the option to convert the policy. These policies are not usually medically underwritten and tend to be guaranteed if the face value is under a certain amount. If your employer offers this coverage, it is a plus, especially if you do not think you could pass medical underwriting on an individual policy.

**It is important to know that there is a clause regarding a specified amount of time that must pass for coverage under certain circumstances on most life insurance policies. An example would be that there is a specified amount of time; you must have the policy before suicide would be covered if covered at all and not excluded. Some policies may rider certain things out entirely. Most policies have a two-year probationary or look back period, which means that, for example, if on your application you said you were a non-smoker. You died due to lung cancer within the two years. The insurance carrier could look back and investigate to find out if you were a smoker when you applied, and if in fact, you had lied on your application.

Many individual life policies are medically underwritten, meaning that you could be denied or your rate could be raised due to medical history; however, not all individual policies are medically underwritten. Pre-screens can be done on medically underwritten policies to determine if you would be denied coverage or to determine an estimated rate increase.

There are also additional options that can be added to some of the above policies, some of which are:

This is common on a term policy; however, it can be found on other policies during certain years on the policy. With this option, you typically pay about double in premium to have this option, but at the end of the term of your policy, if you are alive, you would receive your premium back.

This is automatically included in some policies and not in others. This option would waive your premium for a certain period due to certain circumstances. Some circumstances for waiver of premium could/maybe: a disability, loss of a job, etc.

This option will pay additional money to the beneficiary if an accident caused death. If there is dismemberment such as loss of a limb, loss of sight, or loss of a bodily part, the policy will pay a certain amount due to that loss.

Disability Insurance

Long and Short Term Disability can be purchased individually or through an employer. If it is purchased through an employer, it can be a voluntary plan (meaning the employees pay for the insurance themselves) or contributory (meaning the employer pays a portion of the premium).

Short Term Disability

Will provide a certain amount of income every week for a disability. Short term disability insurance is purchased upfront for a certain number of weeks of coverage, usually up to 26 weeks. In other words, when you choose your policy, you would choose a policy that will provide this weekly income for a certain number of weeks, for example, a policy that would provide 13 weeks of income or a policy that will provide this income for 26 weeks. The longer the policy will supply you with a weekly income, the more expensive it will be. You also pick how many after how many days of illness or accident the policy would kick in at. For example, the policy could start to provide you with benefits after the 1st day of an accident or 8th day of an illness.

The amount of weekly income it will provide is based on your salary. As a generalization, a policy will typically provide 66.67% of your income with a maximum weekly allowance.

Some short term disability policies may have a pre-existing illness waiting period, but many do not.

Long Term Disability

Disability will provide a certain amount of income every week/month for a disability. Long term disability insurance is purchased upfront for a certain number of weeks/years of coverage, usually up to 5 years or when social security starts. In other words, when you choose your policy, you would choose a policy that will provide this weekly income for a certain number of weeks or years, for example, a policy that would provide five years of income or income until social security would kick in. The longer the policy will supply you with a weekly/monthly income, the more expensive it will be. You also pick how many after how many days the policy would kick in. For example, the policy could start to provide you with benefits after 90 days or 180 days.
The amount of weekly/monthly income it will provide is based on your salary. As a generalization, a policy will typically provide 60% of your income with a maximum weekly/monthly allowance.

Most long-term disability policies may have a pre-existing illness waiting period but be sure to also look at the policy’s definition of a pre-existing illness.

Many people will choose to align the Short Term Disability and the Long Term Disability. In other words, many people will pick options that will allow the Long Term Disability to start with no gap after the Short Term Disability ends.

Please click on the below logo to see an example from one of the carriers we represent, which shows some employers paid guaranteed issue life, long and short term disability plans and rates.

Vision

Vision Insurance can be purchased as an individual benefit; however, as an individual benefit, most of the time, it has to be purchased with a dental plan from a carrier that offers both individual dental and individual vision. Not all carriers offer individual vision, just as not all carriers offer individual dental.

Group vision insurance can be voluntary, meaning the employee pays the premium for his/her coverage, contributory; meaning the employer pays part of the cost of the insurance, or non-contributory; meaning the employer pays the full cost of the insurance.

Vision insurance typically has four categories: exams, lenses, frames, and contacts. Rates can differ based on two plan factors: copays and frequencies. The copay is the dollar amount you pay out of pocket for that service (for example, you may have to pay $10 out of your pocket for an eye exam). The frequency is how often you can go for that particular service/item. For example, 12/12/24/24 would mean you can get an eye exam and lenses every 12 months, but new frames or contacts only every 24 months.

Although some do, most contracts only cover regular plastic lenses, provide limitations on the price of frames and contact lenses, and do not cover extras such as tint/anti-glare. Some plans also will cover contacts instead of glasses, so you may have to decide between one or the other being covered.

**There are networks when it comes to vision insurance, just like any other type of insurance. Stay in the network to avoid high out of pocket costs.

Some vision carriers we represent

You can get some individual quotes and sign up by clicking below:

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Global/Travel Insurance

We also sell travel policies for groups, individuals and/or students! Travel insurance can last for a short period (a few days) or a long period (several years). Travel insurance will provide you with extra protection when you are traveling out of the country.

When purchasing travel insurance, please be sure to know if your plan covers pre-existing conditions (some policies will and some will not). Also, be sure you know what your policy excludes, as some riders can be added on to cover things that would not be covered under the basic policy.