Obtaining Coverage

Obtaining coverage is a joint project between you, the employer, and your professional employee benefits advisor. While it is easy to assume that all plans are identical, or that all carriers are alike, nothing could be further from the truth, and we can help you in understanding the differences between plans and carriers. Networks, payment arrangements, coverage areas, plan specifics, and numerous other variables are just some of the differences between health plans. Careful attention should be made to plan limitations and exclusions.

Once you have decided what general type of plan or coverage you'd like, accurate offers must be gathered so that you can determine what plans are best at meeting all your goals. To do this, an employee census is gathered and will include names, ages and/or dates of birth, gender, and family status. This census is used to generate pricing information for all of the plans under consideration. Position title, date of hire, annual salary, and notification of key employee status is often needed as well. For larger size groups, private health information may be requested to give you the best rates available. Some employees may have key doctor-patient relationships that may need to be maintained, and a list of key physicians can be helpful in selecting carriers. Lastly, information specific to you, the employer, such as SIC code, previous coverage, locations, and so on, is gathered to complete the proposal process.

Once all of this data is developed, a comprehensive analysis is done of the different plan details which, together with pricing and other pertinent information, such as doctor availability, will give you an idea of what plans you should look into further.

Once you've reviewed the plans available and made a selection that best fits your needs, the process of enrollment and underwriting begins. You should fully understand the process, including any documentation you may need to gather, the different forms that will be needed to be completed, the time frame in which the process will be undertaken for a specific effective date, and any required documentation you should have made available to you, such as Plan Description Forms and a Summary Plan Document, or a specimen Certificate of Coverage. We assist you with this process, making sure your group application package is complete and accurate before submitting to the carrier, reviewing with you the benefits you are purchasing, any optional coverage's available, and any limitations or exclusions that are present in the plans. We then enroll each employee individually, explaining the benefits and completing all required forms, including waivers if necessary, and explain any pre-existing conditions stipulations, providing complete benefit counseling in the process. Once all required forms and documentation is completed and submitted we manage the underwriting process through to completion.

After approval from the carrier, the plan will be installed, making sure that employee ID cards are correct, initial coverage's are guaranteed, and any additional notices or requirements are met. We monitor all new case issues for the first ninety days to ensure your satisfaction and to iron out any issues that may crop up during that time. [Back to Insurance 101]