Small business owners with fewer than 50 employees can choose a number
of different group plans for their employees that vary in cost, coverage
and "out-of-pocket expense" (the amount the patient must pay
up front for treatment). You can buy insurance directly from the insurer
or from insurance brokers.
Most group plans are comprehensive; they generally include hospitalization
costs, physician expenses, lab tests and x-rays. These are known as
"major medical" plans.
!
Make sure your group
plan has a high maximum coverage, usually between 1 and 5 million dollars.
!
Your policy should
be "guaranteed renewable". A non-cancelable policy which won't
raise your premium is also desirable, but harder to find.
!
Find out about your
prospective health plan's policy on "pre-existing conditions".
These are conditions diagnosed by a doctor within a certain time, i.e.
six months, prior to the effective date of your new coverage. If the
condition existed within that period of time, the plan may not cover
it. Some group plans will cover pre-existing conditions after one year
without treatment.
Types of Group Health Plans
Some of the most reasonable plans are HMO's, or "health
maintenance organizations". These require that the employer pay
a monthly premium.
HMO Advantages:
- The employee doesn't have to pay a "deductible" (the amount
one must pay before they will be insured)
- Out-of-pocket expenses for doctor's visits are low, normally between
$5 and $10.
HMO Disadvantages:
- Patients can only use health-care providers within the HMO's network
of providers
- There is usually little or no prescription drug coverage
- Since they are in essence "hired" by the HMO, some doctors
might limit your treatment in order to cut costs for their HMO client
PPO's ("preferred provider organizations") are a slightly
more costly type of plan with more flexibility. In addition to a monthly
premium from the employer, they require the employee to contribute a
certain amount toward a set deductible (usually $500-2000) before they
will be covered by the plan. The higher the deductible, the lower the
monthly premium. A lower deductible might be better for those who frequently
get sick. Most plans insure on an 80/20 basis; for each dollar above
the deductible, the insurer pays eighty cents to the employee's twenty
cents.
PPO Advantages:
This type of plan lets the employee use doctors outside the PPO network
at an additional cost.
PPO Disadvantages:
Out-of-pocket expenses for some procedures like MRI's and lab work
may be high, depending on the "negotiated fee" settled on
between the provider and the referring doctor.
Florida HMOs and PPOs
Consumer Reports has recently rated the following insurers favorably:
Blue Cross/Blue Shield of Florida
Humana
United Healthcare
Dental Insurance and Wellness Plans
Employers can also purchase dental plans and "wellness" (preventive
health) plans for their workers. Dental plans usually pay 80-100% of
the charges.
