About At Work Benefit Co, LLC

Thank you for considering the @ Work™ Benefit Company, LLC to quote your health insurance. We begin by submitting your employee information to several carriers and once the quotes are received, we develop a custom proposal for your review. Before we begin, we would like to overview some of the plan definitions with general explanations.

If you should have any questions, please do not hesitate to ask. In addition to our service, we also work closely with each carrier and have established a relationship with their account managers. On occasion, we may involve them to assure all aspects of your health insurance experience; including plan design, rates and enrollment process are easily understood.

Please keep in mind that the descriptions and rates you receive will be for comparison and illustration purposes only. Final rates are determined by the carrier only after completed applications are submitted, and are based upon a variety of underwriting factors.

Health Maintenance Organizations (HMO)

• With some HMOs, you will pay nothing or a co-payment when you visit doctors and for various services
• Generally with an HMO, a patient will have a primary care doctor who will coordinate their care, including referring them to a specialist

Point of Service (POS)

• A POS plan has a network of physicians that are regional in nature. This network is best suited for companies who have employees in one geographical area.
• Generally, in a POS plan, providers may be open access or by referral from their primary physician.

Preferred Provider Organization (PPO)

• A PPO has arrangements with doctors, hospitals and other providers of care who have agreed to accept predetermined fees from the insurer for their services.
• If you go outside the PPO network, you will have to meet the deductible and pay coinsurance based on higher charges. You may also have to pay the difference between what the provider charges and what the plan will pay.

Health Savings Accounts (HSA)

• Preventive and wellness care are free or at a reduced rate. All other health care must meet the deductible first before the plan will pay.
• The deductible amount determines the amount that can be saved annually which rolls over year to year and can be spent on qualified medical expenses such as eye exams.

Helpful Terms:

• Co-payment – Amount paid for routine visit to primary care physician
• Deductible – Amount required to pay for non-routine services/hospitalization
• Co-insurance – Percentage paid by carrier and subscriber once deductible is met
• Prescription – Amount paid for medications by: generic/brand/formulary
• Out-of-pocket – Point at which carrier begins paying 100% of medical costs

Group Insurance enrollment requires several criteria and forms to be submitted at the time of application. Below is a list of general requirements as taken from our major carriers. Each carrier may have a slightly different enrollment process therefore the following is for information purposes only. Detailed requirements will be given to you once you have chosen a specific plan and carrier. @ Work™ will be there to assist you each step of the way to assure a smooth application process.

Criteria

• 75% of employees are required to participate. This can exclude employees who have coverage elsewhere. Most carriers require a minimum of 50% to enroll and 100% when the employer is paying 100% of the premium
• Actively-At-Work as a permanent full-time employee working a minimum of 30 hours per week
• For groups of 2-50, final rates may be adjusted due to health conditions and number of employees who actually enroll
• Retirees are not eligible for coverage
• Employee enrollment forms must be signed and dated for all eligible employees including those waiving coverage
• Minimum employer contribution toward the employee premium is 50%
• Quotes may be based on “packaged” products, stand-alone products may cost more

Forms

• Fully completed Employer Group Application
• Fully completed Employee Enrollment Forms for all eligible employees
• One month’s premium including Administration fee
• Billing Statement from previous carrier for the period up to the requested effective date
• Copy of original proposal, signed and dated
• Copy of employer’s most recent quarterly detailed State Wage and Tax report (DOL 4)*
  *if not required to file a DOL 4, other documents may be used to establish eligibility examples include IRS forms and Business Documents such as Articles of Incorporation

We hope this information is helpful and of course, we are always available to answer your questions and provide you with quality service because we are @ Work™ for you!

General Information