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Group Health insurance
is similar in form to individual health insurance. The primary differences are the conditions under which a person my apply and the requirements for acceptance. Before applying through a group a person must satisfy the waiting periods and employment requirements of the group. However, once an application can be made the conditions for acceptance are usually less strict than with an individual policy. Also, certain protections under the law are available for members of group policies that are not available to owners of individual plans. 

Group Health insurance is not necessarily a guarantee of coverage. There are many rules, set forth by federal and state law, which must be followed closely in order to obtain coverage. An insured always must make certain that he or she has followed the law, to the letter, in order to provide maximum protection. In other words: Don't assume you have coverage, talk to a qualified agent! 

When evaluating your needs you should keep several things in mind: 

  • Some health plans have networks of doctors, make certain that yours is in it. 

  • Not all health plans will let you go outside the network, if this is important to you make sure that your plan has an "out-of-network" benefit. 

  • Check for coverage of routine medical care. Not all plans cover "routine checkups" or cover them only in small amounts. 

  • Check the drug benefits. Forty percent of the cost of medical care is for drugs. Some health plans use a formulary system to determine which drugs they will pay for. Make certain that this formulary is extensive and that your doctor is willing to prescribe off of the formulary if necessary. 

There are many companies that underwrite group health insurance. Choosing between them is a complex decision. We can lay out the process and the choices in detail, but to do so really requires a conversation with an experienced agent who knows the market. Fortunately, we have plenty of them; just let us know the best way to get in touch with you. 

We carry everyone! Here is a list of all the group health providers we can shop for you: 

  • Aetna/U.S. Healthcare 

  • American Medical Security 

  • Anthem Phoenix 

  • Blue Cross/Blue Shield of Michigan 

  • Cigna 

  • Fortis/Time 

  • Humana 

  • John Alden 

  • Kaiser Permanente 

  • Prudential 

  • Mutual of Omaha 

  • Principal Healthcare/Principal Mutual 

  • Starmark/Trustmark 

  • The New England/Great West 

  • Unicare 

  • United Healthcare 

We make sure you fully understand the differences of the plans so that you can make the best decision for your company in a quick and efficient manner. We also thoroughly assist you in the enrollment process to conserve your valuable time and follow-up with employee education. If you need additional services, such as cafeteria plan administration or payroll administration, we can assist you in these areas as well and make sure your benefits package works properly with these services. 

  • Preferred Provider Organizations (PPOs) are one step over the managed care border. PPOs have made arrangements for lower fees with a network of health care providers. PPOs give their policyholders a financial incentive to stay within that network. With a PPO, you can refer yourself to a specialist without getting approval and, as long as it's an in-network provider, enjoy the same co-pay. Staying within the network means less money coming out of your pocket and less paperwork. Preventive care services may not be covered under a PPO. 

  • Health Maintenance Organizations (HMOs) are the least expensive, but also least flexible type of health plan. They also tend to be geared more toward members of group plans than individuals. In exchange for a low co-payment (or sometimes no co-pay at all), low premiums and minimal paperwork, an HMO requires that you only see its doctors, and that you get a referral from your primary care physician before you see a specialist. If you can still pick up the phone, you'll probably need to get clearance before you can visit the emergency room. 

  • Point-of-Service (POS) are similar to PPOs, but they introduce the gatekeeper, or Primary Care Physician. You'll need to choose your PCP from among the plan's network of doctors. As with the PPO, you can choose to go out of network and still get some kind of coverage. In order to get a referral to a specialist, though, you usually must go through your PCP. You can still choose to refer yourself, but it'll mean more hassles and more money coming out of your pocket. 

  • Fee-for-service or indemnity coverage was the norm. Under this type of health coverage, you have complete autonomy when it comes to choosing doctors, hospitals and other health care providers. You can refer yourself to any specialist without getting permission, and the insurance company doesn't get to decide whether the visit was necessary.


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8888 Commerce Rd.   |    Commerce Twp., MI    48382    |    Phone:  248.363-1600    |    Fax:  248-363-2129 

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