General Motors Minority Dealers Association has partnered with Newtek Insurance to provide you with right insurance coverage at the right prices. Newtek offers insurance products in all fifty states. Our programs are underwritten by multiple carriers who have been afforded A.M. Best "A" ratings. Our Business Service Specialists are available to help you understand your exposure and provide you with advice on the most economical way to protect your business.
Why You Need Group Health Insurance
Health insurance is purchased for the same reason you buy other kinds of insurance: to protect you financially. Without health insurance coverage, you will have to pay for health care out of pocket at the time of service. This cost can easily become many thousands of dollars for serious illnesses. With health insurance, you protect yourself and your family in case you need unexpected or very expensive medical care.
What Is Health Insurance
Health insurance plans vary from carrier to carrier, but the intent is to pay or reimburse you for medical costs if you need to seek medical care due to sickness or injury. Many plans provide wellness benefits and will also pay for annual physicals. Market-based health care systems such as that in the United States rely primarily on private health insurance.
Types of Health Insurance Coverage
There are several varieties to choose from. These options include traditional fee-for-service plans (FFS), health maintenance organizations (HMOs), point of service plans (POS), and preferred provider organizations (PPO). Each plan has unique features to consider before making the appropriate choice.
FFS plans are the traditional type of health care policy where insurance companies pay fees for the services provided to you that are covered by the policy. FFS plans are advantageous because they offer the most choices of doctors and hospitals. You can choose any doctor you wish, change doctors at any time, and visit any hospital throughout the country.
However, with FFS the insurer only pays a portion of your doctor and hospital bills. You pay a monthly premium as well as a yearly deductible (ranging from $500 to $5,000) that is paid out of pocket before insurance payments begin. In addition, not all health expenses count toward the deductible. It varies by policy.
After you have paid your yearly deductible you share the bill (called coinsurance) with the insurance company to receive your portion of payment. Most FFS plans have a “cap” that is reached when your out of pocket expenses (deductible plus coinsurance) total a certain amount (ranging from $1,000 to $10,000). The insurance company then pays the full amount in excess of the cap for the items covered by your policy (exclusive of your monthly premium).
HMOs are prepaid health plans geared toward members of a group seeking health insurance. As an HMO member, you pay a monthly premium plus a small per service co-payment in exchange for comprehensive care for you and your family. With an HMO your total medical costs will likely be lower and more predictable than with FFS health insurance.
HMO coverage may include doctors’ visits, hospital stays, emergency care, surgery, laboratory tests, x-rays and therapy. Because HMOs receive a fixed fee for your covered medical care, it is their objective to increase the use of preventative health services such as office visits, immunizations, well-baby checkups, mammograms, and physicals. HMOs are also preferred because they do not require claim forms for office visits or hospital stays.
While HMOs are the least expensive health plans, offering many valuable advantages, they are also the least flexible. You must choose a primary care physician (PCP) who provides most of your medical care. In order to visit a specialist a referral from the PCP is required. Lastly, HMOs require you to see only doctors in their network or they will not pay for your service.
A POS plan combines the care aspect of an HMO with the freedom of choice aspect provided by a FFS plan. The same as an HMO, a POS plan has a network of health care providers who treat you for a small fee or co-payment. Unlike an HMO, at the time of an injury or illness you can refer yourself to doctors outside of the preferred network and receive reimbursement for all or most of the bill.
POS plans tend to offer more preventative care and well-being services, such as workshops on smoking cessation and discounts to health clubs, etc.
The PPO is a combination of traditional FFS and an HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from. When an in-network provider is used most medical bills are covered. There is usually a small co-payment for each visit. Some services require you to pay a deductible or coinsurance similar to a FFS plan.
As with an HMO, a PPO requires that you choose a primary care physician, but in a PPO you can use doctors who are not part of the plan and still receive some coverage. When using out of network doctors you will have to fill out claims forms and pay a larger portion of the bill yourself.