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There are a lot of considerations to make when looking for individual medical benefits. The following are features of the different plans available:

Health Maintenance Organizations (HMO)

Plans contract with specific doctors, medical groups and hospitals to provide members a defined set of comprehensive benefits, including preventive care. As an HMO member you select a primary care doctor from the list of doctors in the HMO’s network. Your primary care doctor will be the first medical provider you call or see for your medical conditions. Your primary care doctor will make any needed referrals to a medical specialist. Some HMO plans allow self-referral to a specialist in the network for an additional fee.

Advantages	Disadvantages
Very Comprehensive Coverage	All doctors & specialists must be in the same IPA or Medical Group.
Includes Preventive Care	Referrals to specialists for treatment must be obtained by primary care doctor first.
Lower premiums.	No out of network benefits.
Low co-payments	Utilization review required.
Includes Preventive Care
Fewer out-of-pocket expenses
No deductibles on most plans
No claim forms

Preferred Provider Organizations (PPO)

Plans consist of doctors, hospitals and other health care providers that have agreed to provide patient care at a reduced fee. Members may select any doctor or hospital in the network including specialists. Members may opt to go outside the network, however, their out of pocket cost may be substantially higher.

Advantages	Disadvantages
Freedom to choose any provider within the network.	Most PPO’s have deductibles.
No waiting for a referral to see a specialist.	Your coinsurance amounts will be higher than those of an HMO.
You make your own decisions about your health care rather than going through a gatekeeper.	Out of Network benefits are paid at a lower percentage.
PPO providers cannot charge you more than the contracted rate.	Certain procedures and hospital admissions still require pre-authorization.
No claim forms.	Waiting periods may be required for some services because of pre-existing conditions.

Point of Service Plans (POS)

Offer the member the choice of selecting an HMO type plan with its broad coverage and cost control or the services of a PPO network and/or out of network providers. POS plans let the member decide how much they are willing to pay for a particular service and let them decide which way to access care.

Advantages	Disadvantages
Very Comprehensive coverage.	Deductibles and copayments apply.
No deductible with HMO selection.	There are 2 or 3 different out-of-pocket maximums to be satisfied.
Low copayments with HMO selection.	Out of Network benefits are paid at a lower percentage.
Preventive care included.	Certain services are covered by accessing care in the HMO only.
Freedom of choice to access care in the HMO, PPO or out of network	Waiting periods may be required for some services because of pre-existing conditions.
No claim forms

Dental

Pre-paid (DHMO) Plans contract with specific dentists to provide members a defined set of comprehensive benefits. You select a dentist from their list of providers at the time of enrollment and you must see that provider for benefits. Typically, there are not waiting periods to satisfy before you can receive services and, there are no deductibles to satisfy. You pay only the copays associated with the services you receive. There are no annual maximums.

PPO plans consist of dentists that have agreed to provide patient care at a reduced fee. Members may select any dentist in the network including specialists. Members may opt to go outside their network, however, their out-of-pocket cost may be substantially higher. There are deductibles, waiting periods and annual maximums associated with these types of plans.

Vision

Vision care is an important preventive benefit for your employees at a very low cost to you. Most plans have a network of doctors that they contract with to provide you with the maximum benefits. On the average coverage includes a complete eye examination once a year, lenses once in a two-year period and frames once a year. Contact lenses are covered both for medically necessary and cosmetic situations. Laser Vision correction is also available for a discounted rate.

Long Term Care

What is Long Term Care?

It’s the type of care received either at home or in a facility, when someone needs assistance with activities of daily living (bathing, dressing, toileting, transferring, continence or eating), or suffers cognitive impairment.

With the current high cost of health care, very few people can afford the extended care that’s often needed with chronic illness, injury or advancing age. Despite a popular misconception, the need for long term care isn’t restricted to the elderly. In fact, many working-age adults have disabling injuries and illnesses, including arthritis, heart disease and mental impairment, as well as stroke and trauma, that require ongoing care.

Many people mistakenly believe that government programs will pay for their long term care, but that isn’t the case.

Medical insurance is designed to reimburse expenses associated with medical care, tests, medicines or other specific services. It does not cover most costs associated with long term care. Medicare covers only skilled or acute nursing care for a short period of time to people over age 65.

Lastly, assets must be depleted to welfare levels in order to qualify for benefits under Medicaid.

Unexpected events, as well as the aging process, can leave you in a vulnerable position both personally and financially. That’s why long term care (LTC) insurance is so important for anyone concerned about preserving financial security and independence if a lengthy disability occurs. Long term care insurance can’t make you invincible, but it can help you meet the financial obligations of a long term care situation.

MEDICAL INDIVIDUAL

It is Hoffman Brown’s pleasure to present you a quotation for individual major medical. We have a wide variety of highly competitive companies that can meet your needs. Please complete the information below and e-mail it back to us. If you have any questions, either e-mail us or pick up the phone and call. Service is what you should expect.

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