Group Health and Dental Insurance

Today, businesses that want to attract and maintain high quality employees who will contribute to the success of the organization must provide employee benefits. Group Health Insurance is the first priority for employees and is the second largest expense for employers behind payroll.

The Mackoul Group of Florida provides expertise to employers both large and small on designing group health insurance programs that fit their needs and the corporate pocketbook.

Health insurance is expensive! Most group insurance plans have employees contributing to the cost of their benefits. The amount and formula vary. Additionally, today there are multiple choices in the type of plans offered by the insurance carriers.

The Mackoul Group of Florida helps employers both large and small with creative group health insurance solutions.

Below is a description of the types of plans that are available.

Fee-for-Service (or Indemnity) Plans: This is traditional plan that gives one the freedom of choosing any medical provider with a set deductible for the year. After a visit, either you or the provider will submit claim forms to the insurance company for processing. If your deductible for the year has been met, the Fee-for-Service plan will pay a percentage of the bill, usually about 70% or 80%* and you are required to pay the remaining 20% or 30%, this is known as coinsurance. The plan usually has an out of pocket maximum for individual and for the family which limits the total annual cost. However, this plan is the most expensive plan to purchase, and is becoming less and less common.

Managed Care*: Managed Care plans are those plans that provide health care services at a lower price. The reason for lower costs is that the insured must follow certain rules required by each plan.

Health Care Maintenance Organizations (or HMOs): With HMOs, you receive a wide range of health benefits for a set fee. Generally there are no deductibles – but most of these plans require a small CO-pay per office visit ($10-$25). These plans can require you to choose a primary care physician from their subscriber network. With HMO’s, you and your family members are required to seek a physician, other medical providers, specialists, and hospitals within the physicians within the network. Physicians and hospitals are not are not permitted out of network unless it is an emergency situation. HMO’s offer broad coverage but access is limited to in network providers. HMO’s are traditionally the lowest cost group programs.

Point of Service (POS): A POS is an HMO that has out-of-network benefits. Out of
network benefits are subject to a deductible and coinsurance before any benefits are
paid. This type of plan is more costly than an HMO.

Preferred Provider Organization (PPO): As with an HMO, you do have an
approved network of providers, though you are not required to select a primary care
physician. In addition, as with a POS you have out of network benefits that are subject
to the deductible and coinsurance. This type of plan is more costly then the POS.

* Plan design, benefits, deductibles and co-pays vary from company to company.

For a review of your Group Health Insurance or more information, email us at

For a Group Health and/or Dental Insurance Quote:

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