Florida Large Group Health Insurance

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Large groups are companies having more than 50 employees eligible for employee benefits. Eligible is defined as an employee working more 30 hours per week and having passed the employee waiting period. Companies may exclude part-time, seasonal, temporary and casual employees. I will use the term, company, to refer to the business carrying the insurance on their employees.

Large group plans, unlike small group are not guaranteed issue. Large groups are subject to medical underwriting. A company can be declined or rated based on the prior claims experience. Large groups typically have employee rates that are composite rated. The rates could be two, three or four tier. Two tier is a rate for employees and a rate for families. Three tier might also break out a rate with dependents. Four tier would usually be an employee rate, employee and spouse rate, employee and children rate and employee, spouse and children rate (family). With a composite rate the insurance company or HMO has calculated a rate that would apply to an employee regardless of age, sex or location.

The final composite rate is usually determined by the actual group of enrolled employees. This can make getting a precise rate quote difficult if not impossible in some cases. A business won't know exactly the census of enrolled employees until they enroll. This is one of the reasons quotes have a disclaimer stating that the actual final rate is determined by enrollment. The larger the business looking for insurance the less this matters. Very large companies can receive accurate rate quotes upfront.

Past claims history plays an important role in determining if an insurance company is willing to offer insurance and at what rate. Underwriters will want to have as much information as possible. Sometimes insurance companies will quote without having this, but the danger is, the information would be asked at enrollment. If there have been health problems, the underwriter may decide to decline or rate up the company. Benefit personnel could find themselves in a predicament caused by agents anxious to get the company to commit, only to have an underwriter decline or raise the rate. Plans are usually scheduled to replace an existing health plan at renewal, leaving the company little opportunity to look elsewhere. It is wise to be sure the agent is provided good information and be sure the agent also gives the information to the insurance company.

Insurance companies have different participation requirements. Some insurance companies are more flexible than others are. All insurance companies are looking for the business to participate by contributing to the premium. Most want the company to contribute at least 50% of the employee only. Some also want the company to contribute towards the dependents, spouse and family. The bottom line is all insurance companies are looking to make a profit. This means collecting more premium than the amount paid for claims. Greater employee participation helps this happen.

Large group health insurance plans can have different choices. This might include an HMO, POS and PPO. Flexible funded plans have been available for 20 years and can often be custom designed to fit the business.  There might be one or more of each depending on the size of the business.

Voluntary plans as well as group are usually available for dental, short and long-term disability, life and vision plans. Group plans will have stronger benefits, but require a higher participation. Voluntary plans typically allow 25% participation and are not as strong. Both plans with company participation and without can be found.

I have census forms available to fax if your business would like quotes. It is important that I know the type of plans and benefits you are looking for and the information as mentioned above. I look forward to hearing from you.

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To discuss your company's needs, please contact:

John K. Arnold
Florida Health Insurance
Group, Employee Benefits & Individual Health Insurance Specialist
Website Address  www.floridahealthinsurance.com
E-Mail: John K Arnold    

Phone: 407-592-0311 (Best number to reach me)
Phone: 407-830-0259
Fax:     407-386-7053

If outside the US, it is best to e-mail as we can respond more quickly.  Thanks.

Let me know how I can help you.

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