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We work in the small group medical area.  By definition, in most states this means employer groups of under fifty employees.  These policies are usually guaranteed issue without many companies offering coverage for pre -conditions. Plans are  almost always in conformity with the ACA (Obamacare to many people). To qualify for coverage the following conditions apply:

  1. This has to be a bona fide business.  A lemonade stand on the corner may be a business but will not qualify.

  2. Most insurance companies will require that 75% of the Eligible employees enroll for coverage. Eligible means the employee:​​

    • ​Works 30 or more hours weekly

    • Has satisfied a waiting period set by the employer.  90 days is the maximum

    • He/she is not covered under another group such as a spousal employer group

  3. The employer is usually required to pay a minimum of 50 % of the enrolled employee’s premium

    • ​The employer is not required to pay any of the dependent’s portion

    • The employer may establish a plan allowing the employee to pay his/her premium with before tax dollars.  This saves taxes for both the employee and employer

  4. No medical questions will be asked of the employee or his/her dependents

Working in Office

Another option is available to employer groups and it is a partially self-funded plan.  These plans gained in popularity in recent years for several reasons.

Specifications are the same for eligibility as with the conventional plan but there are several differences:

  1. These plans are underwritten meaning the company will ask medical questions of the employee and his/her dependents.  This is totally confidential without allowing information to the employer

  2. Initially we will rate out preliminary premiums based upon age and gender

  3. Each employee will call a hotline to the insurance company who will question them about medical history and prescriptions

  4. The company will come back with a final offer with premiums level for the year

  5. The premiums consist of several moving parts however the final premiums do not move during the policy year

  6. At the renewal, the insurance company will look at the premiums VS the claims and if all looks well, there is a credit against premiums for the following year.  If the employer wants to drop coverage, he/she is free to do so but they will lose any potential premium credit

  7. Benefit wise the product is the same or better  for medical care as any plan with a network.  One company has a product which will allow the employee to use any doctor who takes Medicare.  This gives them a vast amount of providers

We would be happy to provide proposals to any interested employer.  We do need to meet on the phone or in person if desired.  Multiple benefits are available and the employer may choose to offer several options to their staff.  To do a quote we need to following information:

  1. Name and address of employer

    • ​What the company does

    • Zip code and zip code of satellite offices

    • Name of current group carrier if any as well as existing plan benefits

  2. ​Census of employees by age, gender, zip code and coverage they want, ee only, family, children only spouse only​

  3. What type of types of benefits are they seeking

    • ​HMO or PPO

    • Multiple plan benefits

    • Optional benefits-dental, group life, short or long term disability

  4. ​Any serious pre-existing condition with employees or dependent they are aware of​

Generally it takes a week to ten days to prepare quotes.

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