Group Major Medical

What is Group Insurance?

Insurance coverage purchased by an employer for the benefit of the employees…
Expenses covered are those which result from a nonoccupational sickness or accident…
Premiums paid by the employer are tax deductible as ordinary business expenses…
Premiums paid by the employer and benefits received by the employee are Exempt from Federal Taxation…

Common Ways Group Insurance is Marketed

Insurance Company -> Agent -> Employer
Insurance Company -> Wholesaler -> Agent -> Employer
Insurance Company -> Employer

Types of Funding Available

Fully insured, single employer contracts and multiemployed contracts...
Self-funded or partially self-funded, single-employer or multi-employer contracts…
Fully-insured or self-funded, multi-employer trusts, associations and purchasing groups…
Full-insured or self-funded Union Trusts…

Types of Insurance Programs

Indemnity Programs

Fee-for-Service

Managed Care Programs

Point of Service (POS)
Provider Organizations (PPO)
Health Maintenance Organizations (HMO)

GMS Group Overview (PDF)

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