Traditional Health Insurance

Following are types of major-medical health plans you can purchase from one of our top carriers.  Note you must purchase your health plan during open enrollment – November 1st through December 15th.

Health Maintenance Organization Or HMO
An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.

Preferred Provider Organization Or PPO
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.

Health Savings Account (HSA)
An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.

Group Medicare/Retiree Plans

We help retirees and other eligible employees tackle the challenges of ever increasing premiums and health care costs with quality Medicare Supplements offered by our top national carriers. We offer a guaranteed issue “true group” approach.  The individual would need to have Medicare A & B.  The group plans acts as the “supplement” and provides for coverage some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.  The group Medicare plan can be sponsored by the employer but paid for by the individual, if the group chooses.  The individual can see any doctor and hospital without a referral for most plans.  There is no deductible for Rx coverage and includes coverage in the gap or the “donut hole.”

Group Life Insurance and Accidental Death and Dismemberment Insurance (AD&D)

It has been proven that employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. That’s why smart employers consider life insurance a key part of the benefit package, and a valuable tool in attracting top talent. A good life insurance policy provides for an employee’s final expenses, taxes, mortgage and more. Additionally, it may even pay for their children’s education.

We offer the following life insurance options, either as part of the employer paid main benefit offering, or on a voluntary bases.  Coverage is is typically for a flat amount or for up to 2x to 3x the employee’s salary, with the option for the employee to buy up the policy, and or include coverage for dependents (spouse and children). Typically there is no exam required up to a certain amount.  Coverage is portable when on a voluntary basis, meaning the employee can take the policy with them when they change employers.

Term Life Insurance 
This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

Permanent Life Insurance
A Term Life policy protects employees during their working years, however Permanent Life provides additional coverage that employees can utilize later in life. Employees can widen their safety net with premiums and benefits they can count on, as they don’t ever change.

Several advantages of Permanent Life include borrowing against the policy or building a tax deferred investment income, in addition to paying a death benefit.

Whole Life, Variable Life and Universal Life are all types of cash value life insurance. Cash value insurance is also known as permanent life insurance because it provides coverage for the policyholder’s entire life.

Group Disability Plans

When an employee is unable to work due to illness or an accident, the financial impact can be devastating for them. When this happens, Disability Insurance replaces a portion of your employee’s income, while they are unable to work. While worst case scenario might seem remote, employees are often surprised to learn statistics show chances of becoming disabled are greater than dying between the ages of 25 & 45. In fact, more than one in four 20-year-olds will experience a disability for longer than 90 days before the age of 67.

With these statistics, it is no wonder that national surveys continue to show that Disability Insurance remains of high importance for most employees as an affordable strategy to widen their financial safety net. Those who wish to purchase a wrap-around policy to augment their employer provided coverage may do so. Group disability insurance is a product you don’t want to purchase solely on price.  The employer really needs to understand the coverage and the language in the contract.  Our group disability experts can help you and your employees do that plus help select the right plan.  It is important that you understand the policy’s definition of disability, the offsets and the mandatory requirements.  For instance, some require mandatory rehabilitation, while others do not.

Lowery Benefits Services has a very close relationship with one of the largest disability insurance companies in the industry allowing expedited service, quick answers to any questions and education of their products.

Short Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Gap Plans

Gap benefits allow employers to strengthen the benefit package, while saving significantly on group health premiums. A Gap plan provides benefits that follow and augment a low cost, high deductible major medical and comprehensive benefit package, as it will pay benefits directly to the provider, up to a maximum amount.

With healthcare costs skyrocketing, employees with extensive or on-going medical issues and high out-of-pocket costs will value a Gap Plan.  Even when employees are required to pay for some or all of the Gap premium, an employee’s overall maximum out-of-pocket costs are greatly reduced with a Gap coverage.

Gap plans work by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.

Tax-Advantaged Employee Benefit Plans

Following are employee benefit plan options designed to save both employers and employees money on healthcare and premiums.  The plans are similar in some ways, but also vary, each having unique advantages and savings opportunities.

Health Savings Account (HSA)

A Health Savings Account combines a high deductible, lower premium group health insurance plan (HDHP) with an employee owned, interest earning savings account. Both employer and employee can contribute, with pre-taxed dollars, to the savings account. This effectively reduces the employee’s taxable income as well.  Tax free withdrawals are used directly by employee to help fund the deductible and other qualified medical expenses (including prescription, dental, and vision related healthcare).  Any unused contributions can roll-over to the next year, and the HSA is portable and stays with the individual, even when that person changes employers.  For all qualified medical expenses see See IRS Publication 502.

Health Reimbursement Arrangement (HRA)

A Health Reimbursement Arrangement pairs a high deductible, low premium health insurance plan (HDHP) with a tax-favored savings account to cover the high deductible.  The HRA is funded by the employer and money is distributed only when a claim is incurred, typically for co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.  HRA contributions are not considered income to the individual.  This type of arrangement helps both the individual and the business owner.  The individual gets financial assistance paying medical bills and the employer only pays money when a claim is incurred, plus gets a business deduction.

Premium Only Plan (POP) (Section 125 Plan)

A Premium-Only Plan allows employees to select, purchase and pay monthly premiums for their own individual insurance plan with pre-tax dollars.  Employees elect a set amount of wages to be deducted from each payroll to be used by the employer to reimburse the employee for the monthly premium.  Qualified benefit plans range from traditional health, dental and vision plans to supplemental health plans such as accident, cancer and or hospital indemnity plans.

Flexible Savings Accounts (FSA) (Section 125 Plan)

A Flexible Spending Account is a tax-favored savings account funded solely by the employee through regular pre-tax payroll deductions. The funds can be withdrawn, tax-free, to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Employees elect how much they want withdrawn from each pay period. By participating in a FSA, an employee always has cash to pay for these expenses, and as an added benefit, their taxable income is reduced which also increases the percentage of pay they take home.  One disadvantage of using an FSA is that funds not used by the end of the plan year are lost to the employee, known as the “use it or lost it’ rule.  In 2021, the maximum allowed per employee in a medical flexible spending account is $2750 per plan year.

Self-Funded Health Plans

A self-funded plan requires the employer to assume all the risk, paying all claims on the plan, and will often partner with a PPO to provide healthcare services for the plan. They will also hire a third-party vendor TPA to service the plan’s administration. In other words, the employer becomes the insurer.  Main advantages of self-funding are the savings in taxes and premiums the employer will enjoy, and also having more customization and control over the benefits that the plan offers.  Most plans include wellness and chronic disease management at no cost to the employee.

The downside of a self-funded health plan is the employer runs the risk of a large catastrophic claim and must purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers save a significant amount of money on premiums and other advantages.

Partially-Funded Plans (aka Level-Funded) are a variation of a Self-Funding and allows small employers to take advantage of all the cost saving and benefit design features of a fully self-insured plan, however, they share the risk with one of our top national carriers. The premiums for shared funding plans are generally much lower than fully insured plans. An employer may save even more by implementing wellness programs into the benefit strategy.

Fully-Funded Group Health Plans

What is a fully-funded health plan?

A fully-funded health plan is one where the insurance carrier assumes all the risk in exchange for a monthly premium.  The carrier pays all claims on the plan, and services the plan’s administration.  The main advantage of a fully-funded plan is the employer knows exactly what the plan is going to cost them.  The downside of a fully-funded health plan is when benefits go unused, the employer does not get any money back.

Following are types of fully-funded plans our top carriers offer:

A Health Maintenance Organization (HMO)
An HMO group health plan requires employees to appoint a primary care physician who directs treatment utilizing service providers affiliated with the HMO. HMOs offer access to a comprehensive package of health care for a low monthly premium. A small co-payment is often required for services, depending upon the type provided.

Preferred Provider Organization
PPO group health plans offer a vast network of quality healthcare providers and facilities. Employees save the most money on healthcare if they use providers within the network, as some services may be only partially covered or not even covered at all when outside providers are used. Also, many services may not be covered if deductibles are not first met, however, the plan includes important wellness and preventative services provided outside of the deductible with a small co-pay.

Point of Service Plans (POS)
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.

Cancer Plans

Cancer insurance is a safety net for your employees, designed to help them when they are fighting a cancer diagnosis.  With more than 2 million new cancer cases a year, this type of insurance is an important benefit option you can offer your employees to enhance and supplement your traditional health coverage.   Benefits (a lump sum) can be paid directly to your employee to help cover copays, deductibles, and other expenses that come with the long battle of fighting cancer.

Critical Care Plans

With the skyrocketing cost of healthcare, most people do not have enough savings to cover an unplanned illness or accident.  In fact, according to many studies, over 65% of all personal bankruptcies are caused by medical bills. Voluntary Critical Care Plans will allow your employees to focus on getting better by providing benefits that go beyond traditional employer sponsored health insurance, helping people to cover deductibles, copays, living expenses and more in the event of an unforeseen critical illness.

Some key features include cash benefits paid directly to the employee and plans to fit different levels of coverage/budgets.

Hospital Indemnity Plans

With the skyrocketing cost of healthcare, most people do not have enough savings to cover an unplanned illness or accident.  In fact, according to many studies, over 65% of all personal bankruptcies are caused by medical bills. Voluntary Accident Plans will allow your employees to focus on getting better by providing benefits that go beyond traditional employer sponsored health insurance, helping people to cover deductibles, copays, living expenses and more in the event of a sudden accident.

Some key features include cash benefits paid directly to the employee and plans to fit different levels of coverage/budgets.

Dental & Vision Plans

Employees always appreciate dental & vision coverage as part of the benefits package. We offer both dental and vision as part of the employer sponsored package or on a voluntary basis.

Dental Plans
Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Vision Plans
Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.

Accident Plans

Accidents can happen anytime. Accident insurance helps to protect employees from financial hardship due to a great deal of medical and out-of-pocket expenses that follow accidental injuries. For example, emergency treatment, hospital stays, medical exams, transportation and lodging needs are just a few of the expenses that accident insurance can help cover. In fact, some policies can even pay benefits in as little as one day, based on time of claim submission.

Hospital Indemnity Plans

A hospital indemnity policy is designed to supplement coverage to major medical, Medicare, and Medicare Advantage plans. With hospitalization costs soaring, hospital indemnity insurance is a very affordable strategy that helps people cover out-of-pocket costs when they have an expensive, unplanned hospital stay.

Hospital Indemnity plans have become very popular for individuals aged 65 to 84 who account for almost 30 percent of all inpatient hospital stays.  And, much research shows that original Medicare or MA plans do not cover the entire costs of these stays.

These policies are also a good fit for other, younger individuals as most people do not have enough savings to cover an unplanned illness or accident. In fact, according to many studies, over 65% of all personal bankruptcies are caused by medical bills.

How it works
Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan pays a lump-sum payment directly to the insured. The cash payment helps with out-of-pocket expenses and covers you when you are off work due to a hospital stay, allowing you to focus on getting better instead of worrying about bills. The coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.

Accident Plans

Accidents can happen anytime. Accident Insurance is very affordable and provides benefits in addition to your regular health insurance and/or disability insurance, in the case of a accidental injury. Accident Insurance can go a long way to protect you from financial hardship due to a great deal of medical, recovery and out-of-pocket expenses that follow accidental injuries.

In the event of a covered accident, Accidental Injury insurance pays benefits directly to you or anyone you assign. How you use the money is up to you. Cover deductibles and copays for primary care visits and physical therapy, emergency treatment, hospital stays, medical exams, transportation and lodging needs, along with other expenses that regular health insurance doesn’t cover when you have an accident. Some policies can even pay benefits in as little as one day, based on time of claim submission.

Vision Plans

Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on routine eye care, such as exams with dilation, eyeglass frames and lenses, contacts, and even offer big discounts on procedures like LASIK.

An estimated 11 million Americans have uncorrected vision problems, ranging from refractive errors (near- or far-sightedness) to sight-threatening diseases such as glaucoma or age-related macular degeneration. Vision insurance encourages people to take care of their vision and health. Regular eye examinations can also identify other health conditions, such as diabetes, that can affect the eyes even before the individual experiences noticeable symptoms.

For those who don’t have employer-provided medical benefits, many individual medical plans offer vision coverage as an add-on. You can also buy a separate individual vision insurance policy from VSP, voted one of the best carriers in the nation offering vision coverage.

Dental Plans

Individual dental plans are inexpensive and can contribute greatly in promoting overall good health. Studies have shown that regular dental exams can optimize oral health to prevent cavities and bad breath. In addition, they help to detect serious medical conditions such as heart disease and diabetes. In fact, studies have shown that dental insurance encourages preventive dental care, which saves an estimated $4 for every $1 spent by eliminating the need for expensive, invasive and painful procedures.

Most dental insurance plans cover:
-Twice-yearly cleanings and exams
-Annual x-rays
-Restorations (fillings and crowns)
-Periodontics (treatment of gum disease)
-Endodontics (root canals)
-Bridges and dentures
-Some also cover orthodontics. Many dental insurance plans let you see any dentist, while some use a network of dentists.

Types of dental plan coverage:
Most insurers offer managed care plans designed to encourage wise use of dental benefits, with lower out-of-pocket costs for preventive services such as exams, x-rays and cleanings. Many plans also offer benefits for orthodontics, but pay a lower percentage for orthodontics than for restorative services such as fillings, root canals, etc.

Indemnity Plans
Under this “traditional” insurance plan, the plan pays dentists ac­cording to a formula—usually a percentage of the dentist’s fee, up to a “usual and customary” maximum. The dentist can bill insureds for the difference, or copayment. Most plans also have patients pay a deductible per visit or per series of treatments as well.

Preferred Provider Organizations (PPOs)
A dental PPO consists of a network of providers who agree to accept a certain discounted payment for their services. PPO plans give insureds financial incentives to use these “preferred providers” by paying higher percentages of claims they submit than for those submitted by non-preferred providers. Insureds pay the uncovered portion out of pocket.

Dental Health Maintenance organizations (HMOs)
In an HMO, dentists agree to provide specified dental services to members in re­turn for a periodic per-capita payment—usually monthly. Payments do not depend on the number or type of services rendered, and the HMO accepts the financial risk for providing covered dental services to members.