The Otsego County Chamber, in partnership with NBT Insurance Agency, has brought BIG COMPANY BENEFITS to SMALL BUSINESSES.
HEALTH INSURANCE AND BENEFIT PLANS
The Otsego County Chamber insurance and benefit plans enlists products from major carriers that fit your company’s needs, be it health, dental, vision, life, or disability coverage.
With the implementation of the Affordable Care Act, the new overlying Federal Law, the market for health coverage is more difficult to understand. Below is a brief description of the different plan types that may help you understand how these work.
Our plans have one or all of the cost sharing provisions known as co-pays, deductibles and co-insurance.
CDPHP requires a sole proprietor to be an active chamber member for 60 days prior to health insurance effective date.
We have multiple plans that fit the needs of a wide variety of business models.
Health Maintenance Organization (HMO)
HMO plans are characterized by a regional closed network were services must be provided by a network provider. A primary care physician is chosen by each participant in the plan and referrals are required for services within the plan. These plans typically have most services subject to co-pays. Emergency care is provided as an in-network benefit even if that care is provided by an out-of-network facility. HMO plans do not have pre-existing condition exclusion.
Exclusive Provider Organization (EPO)
EPO plans have a regional network and, as is in the case with our plans, also have a broad national network. The EPOs regional and broader national network is a closed network and services must be provided by a network provider. There is no requirement to choose a primary physician and participants can see any provider in the network without a referral. These plans have services that may be subject to co-pays, deductibles and co-insurance. Emergency care is provided as an in-network benefit even if that care is provided by an out-of-network facility.
Preferred Provider Organization (PPO)
PPO plans have a regional network and, as is in the case with our plans, also have a broad national network. The PPOs regional and broader national network is an open network. This means that participants can see providers outside of the network and will still receive benefits from the plan, although at a reduced benefit level. Out-of-network services are subject to deductible and co-insurance and are subject to balance billing by the out of network provider. Plan benefits will be determined based on maximum allowable payment for the out-of-network service provided.
Participants will receive the highest level of benefits by visiting network providers. There is no requirement to choose a primary physician and participants can see any provider in the network without a referral. These plans have services that may be subject to co-pays, deductibles and co-insurance. Emergency care is provided as an in-network benefit even if that care is provided by an out-of-network facility.
High Deductible Health plans (HDHP)
Our qualified HDHP plans could be HMO, EPO or PPO plans and follow all the same broad rules as stated above. What differs is that they are subject to a high deductible. Other than preventive services, which will be covered in full, all other services are subject to the high deductible and then co-insurance or copays thereafter. The advantage of these plans is that the premium savings can be set aside into a tax advantaged Health Savings Account (HSA) to pay those deductible expenses tax free. The HSA is a separate component of a qualified HDHP that can be opened by the participant at a local bank or credit union.
Medicare Health Plans
If you think the Affordable Care Act is difficult to understand how about Medicare? As people transition to retirement and reach Medicare eligible age they find navigating the Medicare system and plan options another challenge.
There are multiple Medicare options from Original Medicare to Medicare Supplement Plans, also known as Medigap Plans, to Medicare Advantage Plans. The 2006 addition of prescription drug coverage for Medicare eligible individuals adds another layer of benefits that need to be considered.
Our members can reach out to our Chamber Benefits Administrator, the NBT Insurance Agency, to assist them in their Medicare Health Plan needs.
NBT Insurance Agency, LLC