Benefit Specialists of NY

Group Health

Perhaps the most complex and rapidly changing employee benefit that employers face is health insurance. Offering a quality health plan and staying on top of this ever-changing marketplace is critical.

We’re uniquely qualified to deliver the highest value.

With our exceptionally wide range of choices and comprehensive product knowledge, Benefit Specialists of NY can offer you a plan that carefully analyzes your needs and then delivers maximum value and coverage for your insurance dollar.

Whether it’s plan type, community-rated or experience-rated quotes, or our MultipleChoice option—an outstanding product you’ll only get from Benefit Specialists of NY—we’ve got a solution that will custom fit your health insurance need.

Plan types

Indemnity and Comprehensive: Traditional coverage that includes deductible and co-insurance; freedom to choose any doctor.

Preferred Provider Organization: Allows members to use any network providers without referrals. Also allows out-of-network access.

Point-of-Service: Members can access in-network care by designating a Primary Care Physician (PCP) and getting referrals to see specialists. Also allows for out-of-network access.

HMOs: Members access care from within a network by designating a PCP and getting referrals to see specialists.

Community-Rated/Experience Rated

Community-Rated Plans: All employers of 50 or under in New York State are in the community pool where rates are based on a larger group.

Experience-Rated Plans: Employers over 50 can be either community-rated or experience-rated (your rates are based on your claims experience).

MultipleChoice: An exclusive product of Benefit Specialists of NY. MultipleChoice offers employers the option of offering multiple health and dental plans to their employees and receive one bill covering all plans.

For more information, contact a Benefit Specialists of NY representative.

Group Health Glossary:

Indemnity
Generally covers bills from any participating provider. Some services are subject to annual deductible and coinsurance. Typically has broad coverage, high lifetime limits and freedom of choice of doctors. May have to submit claim forms and wait for reimbursement. Does not encourage preventive care like HMOs.

Comprehensive
A form of indemnity coverage. However, all services are subject to deductible, then coinsurance.

Preferred Provider Organization (PPO)
A looser form of Managed Care (weak gatekeeper concept). Establishes a network of providers who agree to supply care at discounted rates. Members pay a small co-payment (no deductible or coinsurance) when utilizing a network provider. PPOs also allow members to utilize non-network providers, but must pay deductibles/coinsurance similar to indemnity plans. There is no requirement to designate a primary care physician and no claim forms when utilizing the network.

Point of Service Plan
Similar to PPOs in that it allows members to choose "in network" providers or, for a lower level of benefit, go "out of network". There is a requirement for a Primary Care Physician who directs all the patient's care within the network. Small co-pays and no claim forms apply for "in network" services. Deductible/coinsurance/ claim forms apply "out of network".

Health Maintenance Organizations (HMOs)
Traditional managed care (strong gatekeeper concept). Member must select a Primary Care Physician who oversees all medical care. For a fixed monthly premium, covers most services a member needs, but controls which providers supply these. Features include small co-pays, no claim forms and the encouragement of preventive health care. Disadvantages include restricted network of providers and need for referrals or authorization.

Community-Rated Plans (Small Groups)
Effective August 1, 1993 the State of New York passed Community Rating Laws, which effect the small group health insurance market. All employer groups with 2-50 employees are in the “community pool”. Essentially, this means that all companies within a given geographic area have access to a carrier’s identical plan at the same rates. Renewal rates are then based on the claims experience, etc. of all the employers in the community pool, not the individual employer’s.

Experience Rated Plans (Large Groups)
Employers with 50 or more employees can choose to be “experience-rated” with certain carriers. This means that your rates are based on various factors such as your own claims experience and the demographics of your employees. Your actual rates can be lower or higher than a comparable community rated health plan depending on these factors.