Diamond Certified Companies are Rated Highest in Quality and Helpful Expertise.

  • Why this rating is the most accurate.
  • Our editors gather deep company info.
  • Performance is Guaranteed.

Diamond certified companies are top rated and guaranteed

Why Trust Diamond Certified Health and Employee Benefits Insurance Firms Rated Highest in Quality?

Photo: Bay Area Health Insurance Marketing, Inc. (2017)

You are the customer. If your goal is to choose a health and employee benefits insurance firm that will deliver high customer satisfaction and quality, you’ll feel confident in choosing a Diamond Certified employee benefits and health insurance company. Each has been rated Highest in Quality in the most accurate ratings process anywhere. And you’re always backed by the Diamond Certified Performance Guarantee. Here’s why the Diamond Certified ratings and certification process will help you find a top-rated employee benefit and health insurance company and is unparalleled in its accuracy, rigor and usefulness:

1) Accuracy: All research is performed by live telephone interviews that verify only real customers are surveyed, so you’ll never be fooled by fake reviews.

2) Statistical Reliability: A large random sample of past customers is surveyed on an ongoing basis so the research results you see truly reflect a Diamond Certified company’s top-rated status.

3) Full Disclosure: By clicking the name of a company above you’ll see the exact rating results in charts and read verbatim survey responses as well as researched articles on each qualified company.

4) Guaranteed: Your purchase is backed up with mediation and the Diamond Certified Performance Guarantee, so you can choose with confidence.

Click on the name of a Diamond Certified company above to read ratings results, researched articles and verbatim customer survey responses to help you make an informed decision.

More than 200,000 customers of local companies have been interviewed in live telephone calls, and only companies that score Highest in Quality in customer satisfaction–a 90+ on a 100 scale–as well as pass all of the credential-based ratings earn Diamond Certified. By requiring such a high score to qualify, the Diamond Certified program eliminates mediocre and poorly performing companies. Read detailed information about the ratings and certification process.

Read moreRead less

DIAMOND CERTIFIED EXPERT CONTRIBUTORS IN THE San Francisco – Insurance – Health & Employee Benefits CATEGORY

David Hodges is a 30-year veteran of the insurance industry and vice president of Vantreo Insurance Brokerage, a Diamond Certified company since 2002. He can be reached at (877) 301-2017 or by email.

David Hodges

diamond certified contributor profile and expert article

David Hodges: A Leading Role

By James Florence, Diamond Certified Program Reporter

SANTA ROSA — As a young actor, David Hodges was naturally excited about landing the lead role in a San Francisco theatrical production. However, he didn’t realize that this experience would set the stage for something much bigger. “While preparing for a production at the Curran Theater in San Francisco, another cast member and I carpooled from Santa Rosa every night for rehearsal,” he remembers. “He was an insurance agent, and over the course of riding with him for several months, he convinced me to start selling life insurance.”

David says his experience as an actor benefited him greatly in his subsequent career. “One of the things I learned from acting was the art of listening. A director once told me to stop acting and start reacting—to listen to how a line was being said and respond honestly. That was one of the best pieces of advice I’ve ever received, and it’s something I regularly apply in my profession.”

Today, as vice president of Vantreo Insurance Brokerage, David says his favorite part of his job is finding solutions to his clients’ problems. “I think an insurance broker’s job is similar to that of a mechanic or doctor in that it requires an ability to listen, diagnose and repair problems. By talking with my clients and determining their needs, I’m able to fix the things that aren’t working for them and enhance those that are.”

A resident of Sea Ranch (where he lives with his wife, Nancy), David says his favorite part of living and working in the Bay Area is his unique daily commute. “I’m a pilot, and every morning I fly my plane from Sea Ranch to Santa Rosa for work. It’s a really scenic flight, starting over the ocean and then going over Sonoma County forests and vineyards. It’s a nice thing to wake up to—plus, it only takes me 15 minutes to fly to my destination, whereas it takes about 90 minutes to drive.”

Outside of work, David engages in a variety of pastimes, from hunting and golfing to writing music and gardening. However, he says a substantial portion of his free time revolves around aquatic activities. “The ocean is a big part of my life. I have a boat in Bodega Bay and enjoy going fishing and abalone diving with friends.” Additionally, David says he looks forward to family get-togethers during the holidays. “Nancy and I have five grown children, and we all get together for Christmas and Easter, which is always a lot of fun.”

In his life and career, David espouses the importance of having the right motivation. “I take an ‘if it’s not broken, don’t fix it’ approach to my job,” he explains. “If someone asks me for a second opinion after getting a quote from another broker, if it looks good, I tell them so and walk away rather than try to be a salesman. Obviously, being an insurance broker involves sales, but at the end of the day, you’re supposed to be solving problems, not trying to gain at the expense of your clients.”

When asked the first thing he’d do if he could retire tomorrow, David says he wouldn’t. “I’ll never retire—working is enjoyable to me. However, I do have plans to work less than I do right now. I’ve been mentoring a young man in the business, so by the time I’m ready to cut back, he’ll be prepared to take on some of my workload.”

Ask Me Anything!

Q: What’s your favorite restaurant?
A: St. Orres in Gualala—it’s a French restaurant that serves a lot of wild game.

Q: What’s your favorite thing to do on a rainy day?
A: Stay inside and watch the ocean. We have a great view of it from our home, so I love to just sit there with a hot drink and try to spot whales and porpoises.

Q: What’s one website you visit on a daily basis?
A: Facebook, because all my kids are on it.

Q: Do you have a favorite movie?
A: Yes, and it’s considered one of the worst movies of all time by most critics: “Dune.” My second favorite movie is “Forrest Gump,” and my third is “It’s a Wonderful Life.”

Q: What’s your favorite thing to eat for breakfast?
A: Chicken fried steak, eggs over easy, wheat toast, hash browns and a cup of coffee.

Read more

Keeping in Compliance with the Affordable Care Act

Shares

SANTA ROSA — If you’re a small business owner, you understand the importance of financial organization. In the age of the Affordable Care Act, it’s more important than ever for businesses to be proactive about compliance with federal regulations, which… Read more

Expert Video Tip

Video: Avoiding Pitfalls with the Affordable Care Act

Shares
Complete Video Transcription:

SANTA ROSA — Host, Sarah Rutan: If you’re a business owner, you’ll want to be aware of upcoming changes to the Affordable Care Act and how… Read more

SELECTED PHOTOS FROM THESE TOP RATED COMPANIES

View Comments
Shares

INDUSTRY INFORMATION AND RESEARCHED ARTICLES BY THE DIAMOND CERTIFIED RESOURCE

  • Kaiser Permanente

  • Blue Shield

  • Health Net

  • Allied

  • California Choice

  • Guardian

  • Lincoln Financial

  • Blue Cross

  • Liberty Mutual

  • Anthem Blue Cross

Western Health Advantage Insurance
Anthem Blue Cross
Humana Insurance
Aflac Insurance
Unicare
United Health Insurance
WellPoint Insurance
Health Care Service Corporation (HCSC)
American Family Insurance
Assurant Health Insurance
Unum Insurance
Kaiser Permanente
The Hartford Insurance
Guardian Life (GLIC)
American General Insurance
Aetna Insurance
Cigna Insurance
Blue Shield Insurance
Highmark Insurance
Medicare Insurance
Medicaid Insurance
Medi-Cal Insurance
Kaiser Foundation

dental insurance
medical emergency insurance
vision care
travel health insurance
individual health insurance plans
family health insurance plans
limited benefit health insurance
short-term health insurance
unemployment insurance
workers’ compensation insurance
flexible spending accounts (FSA)
small business health insurance
self-employed health insurance
group health insurance
employee benefit health insurance
catastrophic health insurance
supplemental health insurance
long-term health insurance
HMO (health maintenance organizations)
managed care insurance
fee-for-service health plans
POS (point-of-service) health insurance plans
PPO (preferred provider organizations)

Barbary Coast
Bayview District
Bernal Heights
the Castro
Cole Valley
Cow Hollow
Diamond Heights
Duboce Triangle
Eureka Valley
Excelsior
Financial District
Fisherman’s Wharf
Fort Mason
Glen Park
Golden Gate Park
the Haight
Haight-Ashbury
Hayes Valley
Hunters Point
Inner Richmond
Inner Sunset
Jackson Square
Japantown
Laurel Heights
Marina District
Mission District
Nob Hill
Noe Valley
North Beach
Outer Richmond
Outer Sunset
Pacific Heights
Potrero Flats
Potrero Hill
Presidio
Rincon Hill
Russian Hill
San Francisco
Sea Cliff
South of Market Street (SOMA)
Sunset District
Telegraph Hill
the Tenderloin
the Presidio
Treasure Island
Twin Peaks
Union Square
West Portal
Western Addition

94101
94102
94103
94104
94105
94107
94108
94109
94110
94111
94112
94114
94115
94116
94117
94118
94119
94120
94121
94122
94123
94124
94125
94126
94127
94129
94130
94131
94132
94133
94134
94140
94141
94142
94146
94147
94157
94158
94159
94164
94165
94166
94167
94168
94169
94170
94172
94188

California Department of Consumer Affairs (DCA) (www.dca.ca.gov)
National Association of Health Underwriters (NAHU) (www.nahu.org)
National Association of Insurance Commissioners (NAIC) (www.naic.org)
International Foundation of Employee Benefit Plans (IFEBP) (https://www.ifebp.org)
American Benefits Council (ABC) (www.americanbenefitscouncil.org)

Know What You Want
What Do You Want from Health Insurance and Employee Benefits Providers?

Before taking the time to interview and vet different employee benefits providers in San Francisco, spend a few minutes thinking about what you and your employees want in terms of health insurance, other employee benefits, rates, packages and customer service.

Make a list of your wants and needs. To do this, ask yourself the following questions and write down your answers:

  1. Do I want a Diamond Certified health insurance and employee benefits company that is rated best in quality and backed by the Diamond Certified Performance Guarantee?
  2. What is my goal regarding health insurance and other benefits for my employees? (For example, employee retention, happier employees, lower cost than existing health insurance, better health insurance and employee benefits packages than existing plans, reward good employees, etc.)
  3. What is my budget for employee benefits and health insurance coverage?
  4. What kind of health insurance and benefits packages am I looking for? (This may include comprehensive health insurance, catastrophic illness coverage, disability coverage, unemployment insurance, HSA accounts, flexible spending accounts, vision care, dental care, COBRA, retirement or 401k plans, etc.)
  5. What type of care and services do I expect from San Francisco employee benefits companies in Nob Hill, North Beach, the Sunset District, SOMA and the Bayview District and my town?
Read moreRead less
What To Ask In Person
Use the Phone to Talk with Employee Benefits Providers in San Francisco

Now that you know what you want from your health insurance and employee benefits company, make some phone calls and ask some of the better companies in Bernal Heights, Bayview, Richmond District and Nob Hill or the city where my business is located.

Sample questions you may want to ask include the following:

  1. Has your health insurance company earned and maintained a Diamond Certified rating?
  2. What type of health insurance packages do you offer? Do they include vision care, dental care, catastrophic medical problems, and HSA or FSA funds?
  3. Do you offer other employee benefits such as long-term retirement and 401k plans, unemployment insurance, supplemental insurance, etc.
  4. Do you offer group discounts for companies that purchase several packages at once?
  5. Do you offer the plans and service, or are you a broker that  sells plans outsourced by other insurance companies?
  6. If I or my employees have questions about their insurance plans, employee benefit plans or coverage, will we call you for assistance, or will we have to deal with another company?
  7. Do you serve companies in Barbary Coast, Golden Gate Park, Haight-Ashbury, Laurel Heights, Outer Richmond, Telegraph Hill,Sea Cliff, Potrero Flats, the Presidio or other small towns? Or are these locations too far from your home office?
  8. What is the average budget range for your plans?
  9. How long has your health insurance and employee benefits company been serving San Francisco?
Read moreRead less
  • What To Ask References
    Learn About San Francisco Health Insurance Companies from Other Customers

    It’s best to choose among Diamond Certified health insurance and employee benefits providers because all certified companies have passed an in-depth ratings process that most other companies can’t pass. If you want quality from an employee benefits provider in San Francisco, you can have confidence choosing a Diamond Certified company. That’s because Diamond Certified reports are available online for all certified companies, and you’ll never be fooled by fake reviews since all research is performed in live telephone interviews of actual customers.

    If you can’t find Diamond Certified health insurance benefit providers within reach, you’ll need to do some research on your own. In that case, it’s wise to call references provided by the companies you’re considering working with. You should know, however, that references provided to you by San Francisco employee benefits companies in the Tenderloin, the Excelsior District, and Bernal Heights and beyond are not equal in value to the large random sample of customers surveyed during the Diamond Certified ratings process.

    So if you do call references on your own, ask for a list of the San Francisco employee benefit companies’ 10 most recent customers. This will help avoid them giving you the names of only customers they know were satisfied.

    Then, call each of the references and ask questions to learn more about the insurance brokers and employee benefits providers you are considering hiring. Some questions you may want to ask are written below.

    1. Were you satisfied with the performance of _(company name)_ health and employee benefits company and their products?
    2. What type of insurance, employee benefits and services did they provide for you?
    3. Were you pleased with the turn-around time between when you signed up and when your employee benefits plans came into effect?
    4. Were they able to provide the employee benefits and health insurance packages that you hoped to provide to your workers?
    5. Was this employee benefits and health insurance provider able to work within your budget?
    6. Do you feel the price was fair for the packages you received?
    7. If your company is based in a smaller town such as Noe Valley, Rincon Hill, Glen Park, the Castro, Cow Hollow, Eureka Valley, Japantown, Inner Sunset District, Potrero Hill, was this San Francisco employee benefits firm able to meet your needs?
    8. Were you happy with the communication from this San Francisco employee health insurance provider?
    9. What is the best part of dealing with this company?
    10. Is there anything you don’t like about this company or their services?
    11. Would you contract with this employee benefits provider and employee health insurance company again if you had the choice?
    12. What else should I know about this company before making a hiring decision?
    Read moreRead less
  • Review Your Options
    Signing a Contract with the Best Employee Benefits Services in San Francisco

    The Diamond Certified symbol has been awarded to companies that scored Highest in Quality in an accurate ratings process.

    Before deciding on the best health insurance and employee benefits providers in San Francisco for you, it’s important to review your notes and consider the following questions.

    • Is there one San Francisco employee benefits company that stands out above the rest in terms of being able to meet your needs, budget, expectations and timelines?
    • Did one local employee health insurance and benefits company seem to care more about meeting your needs than the others?
    • Did one company offer a better range of packages or more complete set of choices for your employees?
    • Do the employee benefits companies communicate clearly, quickly and effectively?
    • Do you feel comfortable signing a contract with one of the San Francisco health insurance and employee benefit providers you interviewed?
    Read moreRead less
  • How To Work With
    Getting the Best Employee Benefits and Health Insurance Packages in San Francisco

    Whether you’ve narrowed down your choices to the best San Francisco health insurance and employee benefits company for you and your business, or are still interviewing a few good firms, follow the helpful tips below to get great package deals and the solid coverage you and your employees need and deserve.

    • Meet with the San Francisco employee benefits and health insurance company representative and discuss your needs, those of your employees, and all of your expectations.
    • Ask the insurance company whether they can meet your needs and how you can proceed to come up with a contract that address all of your needs, those of your employees and of the employee benefits company.
    • Ask for and carefully review the list of available packages and employee benefits menus. See that the cost and services meet your needs before moving forward.
    • Request a contract that will protect you and your San Francisco health insurance and employee benefits provider, whether you’re in Pacific Heights, North Beach, Excelsior District and the Sunset District or another area.
    • Your agreement is final when you sign the contract, so never sign a blank or incomplete estimate, and don’t feel pressured to make a quick decision. While timely contracts are important to lock in rates and options and to start coverage for your employees, you should always have time to read over and feel comfortable with your options.
    • Find out how you and your employees should deal with questions, comments, concerns or coverage issues in the future, whether you’re in a large city like the Tenderloin, the Excelsior District, and Bernal Heights or Chinatown, Diamond Heights, Duboce Triangle, Hunters Point, the Mission District, Twin Peaks, Western Addition, Bayview District.
    • Ask if your San Francisco employee benefits company will come in to your office to present the available packages (if your employees get a choice on which coverages they receive) or the details of the plans you’ve chosen for your workers.
    Read moreRead less
  • Be a Good Customer
    Easy Ways You Can Be a Good Health Insurance and Employee Benefits Client

    It’s the responsibility of your health insurance and employee benefits providers to put together health insurance and employee benefit packages that meet your budget and requests and still cater to the overall needs of your employees.

    But your role as employer means that you also play a big part in the success of choosing and purchasing employee benefits. Here are a few simple steps you can take to be a good customer when signing agreements with San Francisco health insurance and employee benefits providers in Nob Hill, North Beach, the Sunset District, SOMA and the Bayview District and the rest of the Greater Bay Area.

    • Let the employee benefits providers know what you want from the health insurance and other benefits packages you arrange for and specific ways they can satisfy your expectations.
    • Stay friendly, polite and focused on the job. Handle questions, concerns and even disagreements with professionalism and honesty.
    • Before you hire health insurance and employee benefits companies in San Francisco, restate your expectations and goals, and reiterate to the health insurance and employee benefits providers representative your understanding of the agreement. Most problems with local health insurance and employee benefits providers occur because of a breakdown in communication. By being clear about your expectations and theirs, you can avoid most conflicts.
    • Ask your health insurance and employee benefits providers if you should call to check on the progress or if he will call you with updates.
    • Be sure your service representative has a phone number where they can reach you with questions and updates.
    • Return calls and emails promptly to keep the health insurance and employee benefits coverage on schedule.
    • Pay for the benefits and insurance coverage promptly.

    Why would you choose to take these steps in order to be a good customer?

    Local health insurance and employee benefits providers in San Francisco appreciate customers who are straightforward, honest and easy to work with. Your good customer behavior sets the tone from your end and creates an environment conducive to a good relationship with employee benefits providers in Nob Hill, North Beach, the Sunset District, SOMA and the Bayview District and beyond. Things may very well go smoother and any problems may be more easily resolved.

    Read moreRead less
Check The Work
Compare the Final Employee Benefit Coverage with Your Original Agreement

Before you send in the first payment or sign a final release, review the invoice from your health insurance and employee benefits company and ensure that you and your employees are getting all services, coverages and items promised in your original agreement.

Now is the time to address questions and concerns, and to make sure that you are getting what you were promised and that the services and packages arranged for meet your needs.

The invoice you receive should include the following for your protection.

  • The health insurance and employee benefits providers’ name, physical address and state license number.
  • A complete list of all services and packages provided.
  • The total cost for the health insurance, employee benefits, and other services or packages.
  • A written explanation of any warranties or guarantees.
  • A detailed document addressing cancellation or changes to the employee benefit packages if any can or need to be made by you, the broker or the insuring company.
Read moreRead less
Written Warranties
Popular Kinds of Employee Benefits Available in San Francisco and Beyond

You can often find any type of employee benefit or health insurance coverage you want from local health insurance and employee benefit providers in San Francisco, including Bernal Heights, Bayview, Richmond District and Nob Hill and other areas. The list below shows you which types of services and insurance coverages are most popular.

Individual Insurance Plans
These plans cover just the individual employee for health insurance matters and medical care. Their dependents and families are not eligible.

You can often find any type of employee benefit or health insurance coverage you want from local health insurance and employee benefit providers in San Francisco, including Bernal Heights, Bayview, Richmond District and Nob Hill and other areas. The list below shows you which types of services and insurance coverages are most popular.

Individual Insurance Plans
These plans cover just the individual employee for health insurance matters and medical care. Their dependents and families are not eligible.

Family Health Insurance Plans in San Francisco
Family health insurance plans cover the employee, their spouse and their dependent children. These plans may be fully covered by the  hiring company or a portion of the benefits may be paid by the employee themselves.

Dental Insurance Packages
Dental insurance is a popular coverage type, including care for the employee and their dependents. This may include preventative care, orthodontic care, oral surgery and other medically necessary dental care.

Vision Care Insurance Coverage Packages
Vision care, like dental insurance, isn’t covered under most medical employee benefit plans, but it can be added on to packages by employers. This will cover eye exams, glasses and contact lenses, eye surgeries and other vision care.

Unemployment Insurance
Unemployment insurance is a policy that guards against sudden or unexpected unemployment through no fault of the employee (meaning they cannot have been fired or let go for conduct, lack of work, etc.). These plans may be set up by employers to prevent employees from facing fiscal uncertainty due to downsizing or other factors that cannot be prevented by the employer or the employee.

Group Health Insurance for Businesses in San Francisco
Group health insurance is the most popular type of health insurance available through employers. These plans are often set up through the employer at a discount to cover all employees and their dependents.

Supplemental Health Insurance
Supplemental health insurance plans are add-on insurance policies that take care of people who miss work due to accidental injury or unexpected illness. Some plans cover additional medical fees, while others pay out cash to help employees continue to pay for housing, food and other expenses they may have trouble covering if they are unable to work due to injury or illness.

Life Insurance
Life insurance pays out after the death of an individual to that person’s designated beneficiaries.

Flexible Spending Accounts (FSA)
FSAs allow holders to set aside pre-tax money for common medical costs. These funds must be used by the end of the term-year. Allowed services may include copays for doctors’ visits, hospital fees, medical test costs, rehabilitation, physical therapy, dental care, orthodontic care, inpatient rehabilitation care for alcohol and drug addiction, vaccines and immunizations.

Health Savings Accounts (HSA)
Health savings accounts allow holders to save for future medical costs. Money put in the account is not subject to federal income tax when deposited and can build up and be used in the future.

Read moreRead less
Top 10 Requests
Popular Kinds of Employee Benefits Available in San Francisco and Beyond

You can often find any type of employee benefit or health insurance coverage you want from local health insurance and employee benefit providers in San Francisco, including Bernal Heights, Bayview, Richmond District and Nob Hill and other areas. The list below shows you which types of services and insurance coverages are most popular.

Individual Insurance Plans
These plans cover just the individual employee for health insurance matters and medical care. Their dependents and families are not eligible.

Family Health Insurance Plans in San Francisco
Family health insurance plans cover the employee, their spouse and their dependent children. These plans may be fully covered by the  hiring company or a portion of the benefits may be paid by the employee themselves.

Dental Insurance Packages
Dental insurance is a popular coverage type, including care for the employee and their dependents. This may include preventative care, orthodontic care, oral surgery and other medically necessary dental care.

Vision Care Insurance Coverage Packages
Vision care, like dental insurance, isn’t covered under most medical employee benefit plans, but it can be added on to packages by employers. This will cover eye exams, glasses and contact lenses, eye surgeries and other vision care.

Unemployment Insurance
Unemployment insurance is a policy that guards against sudden or unexpected unemployment through no fault of the employee (meaning they cannot have been fired or let go for conduct, lack of work, etc.). These plans may be set up by employers to prevent employees from facing fiscal uncertainty due to downsizing or other factors that cannot be prevented by the employer or the employee.

Group Health Insurance for Businesses in San Francisco
Group health insurance is the most popular type of health insurance available through employers. These plans are often set up through the employer at a discount to cover all employees and their dependents.

Supplemental Health Insurance
Supplemental health insurance plans are add-on insurance policies that take care of people who miss work due to accidental injury or unexpected illness. Some plans cover additional medical fees, while others pay out cash to help employees continue to pay for housing, food and other expenses they may have trouble covering if they are unable to work due to injury or illness.

Life Insurance
Life insurance pays out after the death of an individual to that person’s designated beneficiaries.

Flexible Spending Accounts (FSA)
FSAs allow holders to set aside pre-tax money for common medical costs. These funds must be used by the end of the term-year. Allowed services may include copays for doctors’ visits, hospital fees, medical test costs, rehabilitation, physical therapy, dental care, orthodontic care, inpatient rehabilitation care for alcohol and drug addiction, vaccines and immunizations.

Health Savings Accounts (HSA)
Health savings accounts allow holders to save for future medical costs. Money put in the account is not subject to federal income tax when deposited and can build up and be used in the future.

Read moreRead less
Glossary Of Terms
Glossary of Employee Benefits and Health Insurance Coverage Terms

accumulation period
The period of time during which the insurance policy holder’s eligible medical expenses  count toward their minimum deductible.

Also known as: deductible period, deductible accumulation period

age limit
Some insurance policies, especially life insurance policies, have age limits above which they won’t accept applications for or renew insurance policies.

Also known as: insurance age limit, age limit for insurance policies, age limit for insurance eligibility

alternative medicine
Medical practices or forms of medical treatment defined as alternative medicine may include those not generally recognized by the medical community. Alternative medicine may include acupuncture, homeopathy, aromatherapy, naturopathy, and other Eastern or non-traditional medicines. Many insurance companies do not provide insurance coverage for alternative medical treatment.

Also known as: Eastern medicine, non-traditional medicine, homeopathy, homeopthic medicine, naturopathy, acupuncture, chiropractic care

ambulatory care
Medical care diagnosis, certain forms of treatment, surgery and rehabilitation that are provided as outpatient services. These may or may not be covered at different rates than other types of medical care.

Also known as: outpatient care, ambulatory medical treatment

annual coverage limit
The dollar limits insurers will pay over the course of a year. Most of these plans are being phased out and may not be permitted as of January 1, 2014.

Also known as: annual health insurance coverage limits, annual coverage limits, annual limits

approved health care facility or program
A medical facility, hospital, program or clinic approved by a holder’s health insurance plan. These approved health care providers, facilities and programs are authorized to provide specific services for specific medical conditions covered by insurance.

Also known as: approved health care program, approved health care provider

benefit
Any  medical service, treatment or supply (including prescription medications and equipment) covered by health insurance plans is known as a benefit.

Also known as: insurance benefit, benefit plan, insurance benefits

benefit level
The maximum amount the health insurance company will pay for a specific benefit.

Also known as: maximum health care benefit, maximum insurance benefit

benefit package
The package of medical and health-related services and supplies health insurance companies cover for holders of health insurance plans are benefit packages.

Also known as: insurance benefit packages, package of insurance coverages

cafeteria insurance plans
Cafeteria health insurance and benefit plans are those that allow employees to choose which benefits and insurance coverage they most want. Most insurance cafeteria plans available through employers show a list of prices and allow employees to choose whichever coverages they want as long as they fall under a certain total cost limit.

Also known as: cafeteria health insurance plans, a la carte insurance plans

COBRA
Federal legislation that allows employees and/or employees’ dependents to continue to receive group health insurance coverage through the employer’s health insurance plan, at the individual’s expense after termination of employment.

Also known as: Consolidated Omnibus Budget Reconciliation Act of 1985, COBRA insurance coverage

certificate of coverage
A document given to insured individuals that describes the benefits, limitations and exclusions of coverage provided by the insurance company.

Also known as: certificate of insurance coverage

co-payment fees
S
pecific charges insurance holders pay for medical services or supplies before insurance kicks in to cover the rest of the fees.

Also known as: co-pay, copays, copay

deductible
A specific dollar amount health insurance companies require insurance plan holders to pay before the health insurance plan begins to make payments. Not all health insurance plans require a deductible, but most do.

Also known as: insurance deductible, deductible amount

dependent coverage
Health insurance coverage for spouses and unmarried children of insured individuals. Age and other restrictions may apply.

Also known as: dependent health insurance coverage, coverage for dependents

drug formulary
A list of prescription medications covered by health insurance plans.

Also known as: approved drug list, prescription formulary

flexible spending account
FSAs allow holders to
set aside pre-tax money for common medical costs. These funds must be used by the end of the term-year. Allowed services may include copays for doctors’ visits, hospital fees, medical test costs, rehabilitation, physical therapy, dental care, orthodontic care, inpatient rehabilitation care for alcohol and drug addiction, vaccines and immunizations.

Also known as:  FSA

HMO plans
HMO plans require insured members to use providers from a certain list of primary care doctors. The primary care doctor will refer out to other HMO specialists if additional treatment or specialty care is needed.

Also known as:  Health Maintenance Organization

health reimbursement account
Health reimbursement accounts allow
employers to set aside funds for health care costs accrued by their employees. These funds reimburse covered services paid for initially by employees.

Also known as: HRA, HRA accounts, reimbursement medical plans

health savings account
Health savings accounts allow holders to save for future medical costs. Money put in the account is not subject to federal income tax when deposited and can build up and be used in the future.

Also known as: HSA, high-deductible health savings accounts

health assessment
A health survey that measures your current health, health risks and quality of life. Some insurance plans require holders to undergo a health assessment before coverage begins to establish a baseline for expected health care needs and costs.

Also known as: health assessment tests, insurance health assessments

long-term insurance
Health insurance coverage set over a set amount of time is known as long-term insurance.

Also known as: term insurance

medically necessary health care
Services, supplies or prescription drugs needed to diagnose or treat medical conditions are known as medically-necessary health care.

Also known as: medical necessity, medically necessary care

non-network provider
A healthcare provider who is not part of an insurance plan’s authorized provider network. Costs for care provided by out-of-network providers may be higher than in-network providers, or  may not covered by insurance providers.

Also known as: out of network provider, NNP, OONP, non-authorized provider

short-term insurance
Insurance that covers certain services for a set short time period, usually six months or less.

Also known as: short term insurance coverage, short term medical insurance plans

Read moreRead less
Frequently Asked Questions
FAQ Pertaining to Employee Benefits and Health Insurance Coverage For Companies

Q: Why choose Diamond Certified health insurance and employee benefits providers?
A: Diamond Certified helps you choose a health insurance and employee benefits providers with confidence by offering a list of top-rated local companies who have passed the country’s most in-depth rating process. Only health insurance and employee benefits providers rated Highest in Quality earn the prestigious Diamond Certified award. Most companies can’t pass the ratings. American Ratings Corporation also monitors every Diamond Certified company with ongoing research and ratings. And your purchase is backed by the Diamond Certified Performance Guarantee. So you’ll feel confident choosing a Diamond Certified health insurance and employee benefits providers.

Q: How much will employee benefits cost my company?
A: That depends on the employee benefits and packages you choose to provide. Providing health insurance, retirement packages and other benefits is voluntary, but it can have both financial and non-financial results when it comes to recruiting and retaining top-quality employees. Talk with a local health insurance and employee benefit provider to find out which options are available to you and your employees and what these packages and menus cost. A good employee benefit and insurance provider will help you weigh the pros and cons of providing health insurance and employee benefits to your workers.

Q: What is COBRA?
A: COBRA coverage is a continuation of health insurance coverage after an employee leaves a job. It stands for the Consolidated Omnibus Budget Reconciliation Act, which became law in 1986. This program requires covered employees to be allowed to continue their health insurance, and those of their spouses and dependents, when they might otherwise be lost due to leaving a job or another circumstance.

Q: How can I save money on employee benefits and health insurance coverage?
A: Good employers can find better employee insurance rates by speaking with quality insurance providers about their needs and options. Cut-rate insurance companies will usually give you plans that are lacking in quality, so you may be happier and get a much better value by getting your employee benefits and health insurance coverage through a reputable company. Some ways employee health insurance and benefits companies can  help lower rates is by offering plans with increased deductibles, voluntary benefits that pay directly to employees, and tailoring plans to fit employee needs and wants.

Q: Am I required to provide health insurance for my employees?
A: No, small businesses with fewer than 50 employees are not required to offer employee health coverage. However, many do and it is possible to find affordable, quality employee health insurance plans that keep your workers happy and won’t break the budget.

Q: Do I have to cover the entire costs of my employees’ benefits?
A: No, and it may be a mistake to do so. Most employers choose plans that require employees to pay some deductibles and even contribute toward the cost of their insurance for dependents. This can help lower overall costs, as it encourages employees to use their benefits more wisely. Others ask employees to pay a co-pay or contribute toward the coverage of a spouse that makes more than a certain amount or who has insurance available through their own employer. You may well be able to afford better overall employee benefits and health insurance plans if you ask your employees to contribute sightly toward their rewards.

Q: Can I tailor my employees’ benefits packages to remove items they don’t want or value?
A: You may, in many cases. Talk with your insurance provider to see if there are plans you can choose among that offer only the services and benefits your employees want and use. Ask your employees which benefits they like and want, and see if you can stop paying for the less desirable benefits. It’s not worth paying for something no one wants. You may find that cafeteria plans, in which employees are allowed to choose their own benefits from a list with a fixed amount they may spend.

Read moreRead less