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In what states do you offer health insurance policies?
At the present time, we offer Massachusetts-based Health Maintenance Organizations (HMOs) and Preferred Provider Organization (PPO) plans. All of these plans offer maximum benefits for services rendered by contracted providers and some also offer reduced benefits for services rendered by noncontracted providers. Additionally, all plans available through MDSIS-Spring provide emergency coverage nationwide.
Do you offer individual plans for health and dental insurance?
Currently, we offer group insurance policies for any size business and to independent contractors. Individual health policies may be obtained directly from the insurance carriers. Individual dental discount programs are readily available through a variety of companies and can be found easily on the Internet; however, none of these plans are endorsed by MDSIS-Spring.
Do all employees within an office have to be on the same plan design and benefit level?
Yes. Employees must be on the same plan design and benefit level if your office is a small group with between one and nine eligible employees. If a group has more than nine eligible employees, depending on the number of enrolled members, employees may be able to have more than one plan design. Please contact MDSIS-Spring at (800) 821-6033 to review the plan offerings for groups with more than nine eligible employees.
Are there any medical questions or pre-existing condition clauses associated with your medical or dental plans?
No. All of the plans offered by MDSIS-Spring are guarantee-issue plans. Groups can implement a policy on the first day of each month with no medical questionnaires and no pre-existing condition clauses. New groups, however, are required to show plan specific business documentation, such as tax returns, to verify that they are eligible for group coverage.
Who is eligible for health or dental insurance at my office?
Each health and dental insurance carrier has their own eligibility guidelines. Typically, permanent full-time employees who work at least 20 hours a week are considered eligible.
Is there a minimum contribution amount that an employer must pay towards the employee’s health or dental insurance?
Each health and dental insurance carrier has their own contribution guidelines. Typically, employers are required to pay a minimum of 50% of an individual policy and 33% of a family policy.
When can a group add employees onto the current health or dental plan?
New employees can be added to the plan once any probationary period has been fulfilled. A probationary period is determined by the employer and is the amount of full-time employment required before one is eligible for medical and dental benefits. If there is no probationary period, employees are added to the plan based on their date of hire. Existing employees who elected not to enroll during their initial eligibility period must wait to be added to the plan either during open enrollment (varies with each carrier) or at the time of a Qualifying Event (see definition below).
What is a Qualifying Event and why do I need one to join my employer’s group health or dental insurance?
Qualifying Events apply to employees who, for whatever reason, elected not to enroll in their employer’s group plan when they were initially eligible. Insurance carriers have enrollment guidelines in place to prevent abuse of the healthcare system. Employees cannot continuously enroll and disenroll in medical and dental plans whenever they want to because they need services performed. This would take advantage of the fact that there are no health questionnaires or pre-existing condition clauses required to enroll in any of the plans offered by MDS Insurance Services, Inc. If employees elected not to enroll during their initial eligibility period, they must wait until open enrollment, which varies with each carrier, or have a Qualifying Event. A Qualifying Event can be described as a life-changing event. Examples of Qualifying Events are marriage, divorce, birth of a child, adoption, or loss of previous coverage.
How long before we receive our identification (ID) cards?
ID cards are generated by the health and dental carriers and are mailed directly to the member’s home address. Depending on the insurance carrier, ID cards take between three to five weeks to arrive. In the interim, some insurance carriers allow a copy of the enrollment form to be used as a temporary ID card. Plans that allow members to use enrollment forms as ID cards allow this for limited services such as primary care physician visits and emergencies. All other services, such as specialist visits or prescription drugs, must be postponed or paid for out-of-pocket. Services that are paid for out-of-pocket may be reimbursable. For more information, contact your health or dental plan’s customer service department once the permanent ID card arrives in the mail.
When am I allowed to cancel my health insurance?
You can cancel your health insurance at any time.
How do I add or delete an employee from the office’s health or dental plan?
For additions, employees need to complete the appropriate enrollment form and submit it to our office via fax or mail. Depending on the insurance carrier and when the form is submitted, the first month’s premium may be required for enrolling employees. Employee terminations must be done in writing. Be sure to include the employee’s name, date, reason for termination, and the employer’s signature. The request can be faxed to our office at (508) 898-0068, or mailed to MDSIS-Spring Insurance Group, LLC, 200 Friberg Parkway, Suite 2006, Westborough, MA 01585.
What is the difference between an HMO, PPO, and POS plan?
Health maintenance organization (HMO): This is generally the most popular and the least expensive healthcare option of the three major types of plans offered by MDS Insurance Services, Inc. It is also considered by some to be the least flexible. In exchange for a monthly premium, members are entitled to doctor visits, preventive care, emergency medical treatment, and prescription drugs (if elected), all for various copayments. Upon initial enrollment, members are required to select a primary care physician (PCP) from a network of contracted physicians. A PCP is often regarded as a gatekeeper who takes care of routine medical needs, such as checkups and basic prescriptions. If necessary, the PCP issues referrals to specialists, who are also contracted physicians. As a general rule, members of an HMO will not receive any benefit for services received from a noncontracted physician. The only exception to this rule is in the event of a true emergency (a true emergency is determined by the HMO). Members of an HMO have nationwide emergency coverage; however, they must notify their HMO within 48 hours of their situation.
Preferred provider organization (PPO): PPO plans offer members more flexibility with slightly higher premiums than an HMO. A PPO allows members to receive care from either contracted or noncontracted physicians at their discretion without the need for a referral from a PCP. Typically PPO plans provide members with a financial incentive to receive care from contracted physicians by offering small copayments for such services. Services from noncontracted physicians are typically subject to a deductible and coinsurance. Coinsurance is the cosharing of costs associated with medical services. A common rate of coinsurance is 80/20, which means the insurance carrier would pay 80% of a claim and the member would pay the remaining 20%. Coinsurance does not typically begin until the member has satisfied any applicable deductibles. Some PPO plans also have deductibles for services by contracted physicians.
Point-of-service plan (POS): POS plans are considered to be a hybrid of HMO and PPO plans. Like an HMO, members select a contracted physician to be their PCP. The PCP coordinates a member’s care just like they would in a traditional HMO setting. However, like a PPO, a POS plan gives a member more freedom of choice by affording them the ability to seek services from noncontracted physicians. These services are then subject to a deductible and coinsurance. As with a PPO plan, coinsurance does not typically begin until the member has satisfied their deductible. Some POS plans also have deductibles for services by contracted physicians.
Who do I contact if I have a question about my group plan?
Please call MDSIS-Spring at (800) 821-6033, Monday through Friday, 8:30 a.m. to 4:30 p.m. Our knowledgeable team of licensed consultants will be happy to help with benefit, billing, claim, and many other issues.
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