INSURANCE OFFERED:

- Individual Health Insurance

- Small Group Health Insurance

- Large Group Health Insurance

- Medicare Supplements

- Term and Permanent Life Insurance

 

 

 

Q&A

What is Life Insurance?

Life Insurance offers a way to replace the loss of income that occurs when someone dies (usually the person who produces the majority of income in a family situation). It is a contract between you as the insured person and the company or "carrier" that is providing the insurance. If you die while the contract is in force, the insurance company pays a specified sum of money income tax free to the person or persons you name as beneficiaries.

 

Do you really need Life Insurance?

If there is someone who would suffer economic hardship if you died, then you need life insurance. Funeral expenses, probate and administrative fees, outstanding debts and paying for the children's education are costs that must be considered. Life insurance can provide the financial security needed to give you peace of mind.

 

What is the difference between Whole and Term Life Insurance?

The two basic types of life insurance are permanent life insurance and term life insurance. The main differences between the two types lies in the length of time for which coverage is provided, and whether the policy offers a cash value -- a set amount of money available if you terminate the policy before its maturity or before your death.

 

What is an Annuity?

An annuity is a savings plan that provides primary or supplementary retirement income. It is an insurance contract that serves the opposite purpose of the death benefit of a life insurance policy. An insurance company pays annuity benefits while you are alive.

 

What should I expect from a professional insurance advisor, and how can I evaluate my current one?

An advisor will guide you through the complex task of choosing appropriate coverage at an affordable cost. The following is what you should expect from a professional insurance agent. Use this checklist to evaluate your current advisor. Your professional insurance advisor should:

 

    • Work with you to evaluate your needs for insurance coverage.

    • Explain the details of different insurance plans.

    • Make specific recommendations and tailor plans to suit your special needs and budgets.

    • Review your plans periodically to update coverage and limit costs.

    • Serve as your advocate and advisor in dealing with insurance companies, doctors and hospitals, and government

      agencies involving claims, services and regulations.

    • Help you as a business owner communicate benefits packages to employees and demonstrate how various

      provisions can complement personal and government financial plans.

 

Should I buy insurance online?

Buying health insurance benefits is different than buying books and music. Benefits are complex and they are critically important. Health care coverage protects both a family's health and its finances. Purchase the wrong book, and you're out a few dollars. Purchase the wrong health care coverage, and the consequences are far more significant. Remember, if you buy health insurance online, there may be no advisor to explain benefits, no advocate if problems arise and no counselor to help you make the right coverage choices.

 

How does a professional insurance advisor stay current with the numerous plans and changes in today's marketplace?

Insurance advisors are licensed and regulated by state insurance departments. Prospective advisors receive training regarding insurance and applicable laws before taking a qualifying exam for licensing. The majority of states now require continuing education to maintain license status. Many career insurance advisors belong to the National Association of Health Underwriters (NAHU), which offers seminars, workshops, courses and other educational forums to ensure members meet the highest standards of client service. NAHU also requires members to subscribe to a strict professional code of ethics.

 

How is individual insurance different from group insurance?

Individual health insurance is, quite simply, coverage that an individual purchases for himself and/or his family. The Affordable Care Act (ACA) has made significant changes to how individual insurance policies are rated and the benefits that these policies provide. Individual insurance policies and provisions are also regulated by the state where the policy is purchased.

 

Individual policies are often purchased with the advice of a professional insurance producer due to the complexity of coverage offerings and the premium cost. With the advent of the ACA, a professional insurance producer’s expertise may be even more critical since insurance policies have changed so dramatically.

 

Whether or not a person has a pre-existing medical condition is no longer a factor when purchasing individual coverage. Since a person’s medical condition is not a factor, individuals are limited to certain times when they can enroll in coverage. A person must enroll during an open enrollment period to gain coverage for the year. There are limited opportunities to purchase coverage at other times during the year as a result of a special enrollment right.

 

Individual insurance policies in 2014 may be purchased through an exchange or “marketplace” or they may be purchased outside of the exchange. Irrespective of whether a policy is purchased inside or outside the exchange, polices must cover the same set of Essential Health Benefits. The richness of the benefits under the plan is defined by a metal tier. These tiers are based on the percentage the plan pays of the average overall cost of providing essential health benefits to members:

 

    • Platinum plans are the most generous and more expensive. These are designed to pay as much as 90% of medical

      expenses

    • Gold plans are designed to pay 80% of medical expenses

    • Silver plans are expected to pay 70% of medical expenses

    • Bronze plans are expected to pay 60% of medical expenses.

 

It’s important to note that the metal tiers reflect what the plans will pay on average. These percentages are not the same as coinsurance, which calls for an individual to pay a specific percentage of the cost of a specific service.

 

Another category of individual plan is the catastrophic plan. A catastrophic plan must meet the requirements of the metal plans, but benefits are very limited. Catastrophic plans are an option for individuals under the age of 30 or others who have received a “hardship exemption” from the exchange due to other health coverage being deemed unaffordable.

 

Since medical services can be quite costly, the insurance premium for individual coverage is small compared to the amount an insurer may have to pay for claims. For example, a comprehensive individual insurance policy may cost $4,000 for a 30-year-old male for a year (actual premium costs vary by geographic area, metal tier selected and other factors, this is an estimate for comparison purposes only). Treatment costs for a broken leg that needs surgery (lower leg fracture surgery) are estimated to cost a total of $15,581 by the Healthcare Blue Book.

 

What is employer group health insurance coverage?

Group health insurance coverage is a policy that is purchased by an employer and is offered to eligible employees of the company (and often to the employees' family members) as a benefit of working for that company. A group health insurance plan is a key component of many employee benefits packages that employers provide for employees. The majority of Americans have group health insurance coverage through their employer or the employer of a family member. One of the advantages for employees in a group health plan is the contribution most employers make toward the cost of the health coverage premium – in many cases, employers pay one-half or more of the monthly premium for an employee. Another advantage is that most employers have established Premium Only Plans (often called POP plans) that allow employees to pay any employee-required contributions to premiums on a pre-tax basis. Between the employer contributions, which aren’t taxable for employees, and the POP plan, employer-provided health insurance is significantly subsidized due to these tax breaks.

 

Are all employer group health insurance policies the same?

Historically, insurance has been regulated in large measure by each state. Therefore, the laws regarding health insurance offered by the different types of employers can vary significantly from state to state. However, with the implementation of the Affordable Care Act (ACA), the federal government also regulates insurance. This is particularly true for individuals purchasing coverage on their own as well as for smaller employers with 50 or fewer employees.

 

Also, different types of employers may offer different benefit plans. Millions of Americans work for small employers, which for health insurance purposes are generally those with 50 employees or less. Millions of other Americans get their health insurance coverage through large employers. Generally, those are businesses with more than 50 employees. The laws about how coverage can be issued to large groups are different than those for small groups, and the way that premium rates are determined is also different.

 

What are the coverage requirements for small employer plans?

At this time, small employers are not required to offer health insurance to employees. Many do so because they believe that health insurance coverage is a valued employee benefit that helps employers attract top employees and retain them. State and federal laws apply to varying degrees – again based on factors including the number of employees, the type of business and whether an insurance company is providing the coverage.

 

The Affordable Care Act requires that insured small group plans offer health plans that meet certain benchmarks. The benchmarks are represented by the metal levels of platinum, gold, silver and bronze. Each metal level tier plan is designed to provide the same average level of benefit to an enrollee.

 

The tiers are based on the percentage the plan pays of the average overall cost of providing essential health benefits to members:

    • Platinum plans are the most generous and more expensive. These are designed to pay as much as 90% of medical

      expenses

    • Gold plans are designed to pay 80% of medical expenses

    • Silver plans are expected to pay 70% of medical expenses

    • Bronze plans are expected to pay 60% of medical expenses.

 

It’s important to note that the metal tiers reflect what the plans will pay on average. These percentages are not the same as coinsurance, which calls for an individual to pay a specific percentage of the cost of a specific service.

 

There are other myriad requirements that apply to group health in addition to those required by the ACA. There are laws that address benefit communications (ERISA), claims appeals (ERISA) and portability of coverage (HIPAA) among others.

 

Both the ACA and the federal HIPAA law mandate that no matter what pre-existing health conditions small employer group members may have, no small employer or an individual employee can be turned down by an insurance company for group coverage. This requirement is known in the insurance industry as “guaranteed issue.” In addition, each insurance company must renew its small employer health plan contracts every year, at the employer's discretion, unless there is non-payment of premium, the employer has committed fraud or intentional misrepresentation, or the employer has not complied with the terms of the health insurance contract.

 

Small employers may purchase insurance plans that are provided through the new SHOP markets operating in each state or in the market outside the SHOP. Health insurance plans that are offered in the SHOP exchange are generally also available in the market outside of the SHOP. It’s important to note that an employer that wishes to claim the Small Business Health Insurance Tax Credit must purchase a SHOP-based plan.

 

Your state’s Department of Insurance or other state agency that regulates insurance in addition to a professional insurance broker licensed to sell and service insurance in your state is also a good resource for information.

 

 

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ABOUT US

Contact DMG Services Inc for your Insurance or Property Management needs

Address: 6824 Wayne Ave

Lubbock, Texas 79424

 

Telephone: 806.794.9798

Fax: 806.771.8798

 

 

 

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