The O'Neal Insurance Group has created a strong relationship with many of the finest insurance carriers serving Illinois, the Chicago area, yet while maintaining our primary focus of serving the employer's needs.
Most small businesses offering their employees Group Health insurance plans contribute towards the cost of the coverage. Some pay for all of the employees' premiums (for single coverage) and have the employees pay the premium if they need coverage for their families. Other Illinois small businesses pay a percentage of the total health insurance premium cost.
As the cost of health care continues to increase at a rate much faster than inflation, many large employers and small businesses in Illinois choose to have their employees make a contribution towards the cost of health insurance coverage.
Also, self funding the Prescription Drug portion of the Group Health Plan can potentially result in substantial health insurance cost savings. Contact us for information and to setup a self funded prescription drug plan for your Illinois business.
Managed Care vs. Fee-for Service
The health insurance plan that works best for your Illinois business is determined primarily by your location, the physicians and hospitals available through the health insurance plan, options offered by each insurance plan, and what your budget can accept.
Learn more about the types of Illinois Group Health Insurance Plans we can offer your business by clicking on a link below!
Managed Care:
Fee-for-Service:
Employee benefits are an important factor to any Illinois business in hiring and retaining a good work force. We can provide assistance to your benefit administrator in answering employees questions and requests pertaining to health insurance for groups of 20 or more. Every Illinois business needs to review their employee benefit health insurance plan to ensure that this major expense continues to offer the highest quality group health insurance.
HMO Plan Features (Illinois Group Health Insurance)
- Preventive care emphasis
- Primary care physician coordinates the total care of the employee
HMO Insurance Plan (Illinois Group Health Insurance)
An HMO group health insurance plan helps your Illinois business control health care costs through a closely managed plan with an emphasis on preventive care. Each employee selects a Primary Care Physician from a network of providers. The Primary Care Physician can coordinate the total care of the employee to help ensure appropriate care is received. An employee may also seek care from any provider in the network without a Primary Care Physician referral, subject to a higher out-of-pocket expense.
Subscribers to an HMO receive medical services from participating physicians, clinics and hospitals. An employee chooses a primary care physician from a list of participating doctors. That doctor is used for typical circumstances such as annual exams and usual health issues. If the employee needs to see a specialist, be hospitalized, or have lab or X ray work, their doctor will refer them to a provider or facility within the HMO system. Your employees doctor must give authorization for those services to be covered by your HMO. In other words, an employee must see HMO approved physicians and use HMO approved facilities or pay the entire cost of the visit themselves.
Similar to Point-of Service (POS) and PPO's, HMO's have made arrangements for lower fees with a network of health care providers and give their policyholders a financial incentive to stay within that network.
An employee may have to pay some portion of the cost (co-payment) for each office or hospital visit, such as $20 per doctor visit, regardless of what the services cost. Also, some services such as emergency room, mental health and chemical dependency services, may carry additional costs in an Illinois HMO health maintenance plan.
PPO Plan Features (Illinois Group Health Insurance)
- Convenient access to quality medical care for employees
- Large and diverse network available of primary care physicians, specialists, hospitals & clinics.
PPO Insurance Plan (Illinois Group Health Insurance)
A PPO group health insurance plan is recommended for an Illinois business desiring to offer their employees convenient access to quality medical care with effective medical management, a large and diverse network of primary care physicians, medical specialists, hospitals and clinics.
An employee can see any health care professional in the network any time they choose to make an appointment. They don't need referrals for specialists or other services as required in an HMO. An employee can see doctors or specialists outside your PPO network, however, your employees portion of the costs will be higher.
An employee may have to pay some portion of the cost (co-payment) for each office or hospital visit, such as $20 per doctor visit, regardless of what the services cost. Also, some services such as emergency room, mental health and chemical dependency services, may carry additional costs in an Illinois PPO health insurance plan.
POS Plan Features (Illinois Group Health Insurance)
- Preventive care emphasis
- Pays benefits for out-of-network care, but at a lower level
POS Insurance Plan (Illinois Group Health Insurance)
A POS or Point-of-Service group health insurance plan allows your Chicago, Illinois employees the option of accessing any medical provider without a primary care physician referral and receive the highest benefit level. Similar to an HMO, a POS stresses preventive care and offers closely managed benefits. A POS health insurance plan also pays benefits for out-of-network care, but at a lower level than for in-network care.
Costs that exceed the deductible are covered by a co-insurance plan in which your employee and the insurance company share the cost for services covered by the policy. Also, some services such as emergency room, mental health and chemical dependency services, may carry additional costs in an Illinois POS health insurance plan.
Fee-for-Service (Illinois Group Health Insurance)
Fee-for-Service or major medical group health insurance provides benefits up to a high limit for most types of medical expenses incurred, subject to a deductible. Once the deductible is met, this type of group health insurance plan will pay a percentage of what is considered the "Usual and Customary" charge for covered services. The insurance company generally pays 80% of the Usual and Customary costs and you're responsible for paying the other 20%, which is known as co insurance. If the insurance company charges more than the Usual and Customary rates, you will need to pay both the co-insurance and the difference.
Illinois Fee-for-Service group health insurance allows your employee to choose their doctor and any hospital for their medical services. Usually, an employee will have a deductible such as $500 or more to pay each year before the insurer starts paying. The plan will pay for charges such as medical tests and prescriptions as well as from doctors and hospitals.
Fee-for-Service health insurance coverages for employer sponsored employee benefits in Illinois typically offer the following:
- Employers and employees share premiums
- Employees have the freedom to choose any provider
- Insurance company pays the allowable claim
Fee-for-Service plans also offer some Managed Care type of insurance options that can assist your Illinois business in reducing employee benefit costs.
- Case Management
- Second Surgical Opinion
- Pre-admission Certification
- Special Benefit Networks
Illinois Fee-for-Service group health insurance coverages offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care health plans, such as HMO, PPO, and POS. Fee-for-Service employee health insurance may not pay for some preventive care, such as check-ups, and is usually a more expensive health insurance coverage than utilizing an HMO, PPO, or POS plan in Illinois.
Or you can speak with our Illinois Group Health Insurance agent specialist toll free at 877-808-2900 to discuss the features.
