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HEALTH INSURANCE PLANS
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Spetner offers a broad range of health insurance plans. We
help you choose the plan that best fits your company and your
employees, not only today but as your company grows. Your plan
can be customized through several funding options, including
Traditional Funding (“fully insured”), Minimum Premium
Funding, Administrative Services Only (ASO) and Stop Loss. |
Conventional Plans
- Open Access or Preferred Provider
Plans – give your employees a balance of cost savings
and access to care with great freedom of choice.
- Point-Of-Service Plans –
give your employees rich, network-based benefits with the flexibility
to access in- or out-of-network providers.
- Health Maintenance Organization Plans
(HMO) – give your employees a physician-driven plan
that provides rich benefits and maximum cost savings.
Consumer-Driven Plans
- Health Reimbursement Arrangement (HRA)
– a tax-favored account used to pay for medical care. Employers
fund 100 percent of the HRA. Funds can be used to pay medical
services covered under your high deductible health plan and some
services that are not covered under your health plan – all
with pre-tax dollars. Employees may accumulate unused funds and
carry them over year to year to pay for future healthcare needs.
- Medical Savings Account (MSA)
– a tax-favored account used to pay for medical care, as
well as to build up savings that may be used to pay future medical
expenses. Employers or employees fund the MSA. The employee owns
all monies contributed. Funds can be used to pay medical services
covered under your high deductible health plan and some services
that are not covered under your health plan. At retirement, an
employee’s account balance becomes a retirement plan.
Flexible Funding Options
- Traditional Funding –
allows employers to easily predict their cost by having a set
monthly premium based upon the level of coverage selected. This
type of funding may be referred to as “fully insured”
because the risk is completely held by the insurance carrier.
- Minimum Premium Funding –
allows employers to combine a fully insured, traditionally funded
plan with some of the features of an Administrative Services Only
(ASO) program. The employer pays a set monthly administrative
fee (usually a per employee fee) to the insurance carrier. Then
the employer funds the claims as they are incurred. The financial
risk for this program is shared between the employer and the insurance
carrier.
- Administrative Services Only (ASO)/
Self-Funded or Self-Insured Program – allows employers
maximum flexibility in plan design. An ASO contract is not subject
to most state laws or state premium taxes because there is not
a true insurance contract in force. The employer pays a set monthly
administrative fee to the administrator and also assumes full
financial risk.
- Stop Loss – allows self-insured
employers to limit their medical claim liability to a specified
amount.
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