The Benefit Solutions Group offers two basic types of medical health insurance plans: Major Medical Insurance and Defined Benefit Plans, also called Limited Benefit Insurance and Indemnity Insurance. The descriptions below apply to the medical plans offered by The Benefit Solutions Group, and detailed information, rates and specific benefits may be accessed from the Benefit Plans section of this website. The purpose of this overview is to define common terms used in the insurance industry and to offer comparisons of the two types of health insurance available through this website and our agency.

Major Medical Insurance

Deductible - Out of pocket amount of medical costs paid by insured before insurance pays.
Co-Insurance - After deductible is met, percentage of eligible claims is paid by insurance company and lower percentage is paid by insured. (Often, this is an 80/20 or 70/30 percentage arrangement.)
Stop Loss - Set amount of out-of-pocket paid by insured before insurance company pays 100%.
Policy Limits or Lifetime Maximum - Amount insurance company will pay for eligible claims of an insured for a lifetime. (Usually $1,000,000 to $5,000,000)
Co-Pays - Specific or "set" amounts that insured pays for a doctor visit or for prescription medications. These amounts are co-pays.
Rate Factors - Rates are calculated according to gender, zip code and date of birth.
Medical underwriting - Applicants must qualify for this coverage in regard to health history and height and weight parameters, lifestyle factors such as smoking, and, in some cases, occupational risks.
Pre-existing Conditions - Medical conditions for which an applicant has been diagnosed and/or for which applicant is receiving or has received treatment.
Risk Analysis - The insurance company will either accept the pre-existing conditions with no conditions, decline coverage entirely, issue coverage with exclusions for the pre-existing conditions or require additional premium (also called a rate-up)
Rate-Up - Additional premium that is charged due to conditions that would increase the risk of an insured for requiring medical treatment. Examples of rate-up conditions are height/weight outside parameters set forth by health charts; lifestyle factors such as smoking; medical conditions for which insured has previously received treatment but is currently free of symptoms or condition is controlled.
Underwriting - Major Medical Insurance requires the submission of health history which is reviewed by insurance company Underwriters. The underwriting process determines the issuance of policies and any rate-ups that would be required to issue the policy. Please Note: Underwriting decisions are made according to the guidelines and policies of the insurance companies, and The Benefit Solutions Group can neither control nor influence the process.

Defined Benefit Plans/Limited Benefit Insurance/
Indemnity Insurance

Deductible - No deductible is required except for the Accident Injury benefit ($100 deductible)
Co-Insurance - None required, plan pays specific benefit amount as set forth in the outline of coverage
Stop Loss - None.
Policy Limits or Lifetime Maximum - No lifetime maximum. Policy limits are set forth in outline of benefits.
Co-Pays - Prescription drug co-pay. Insurance pays a set amount for doctor visits
Rate Factors - No rate factors apply. Rates are level regardless of age, zip code or gender.
Medical underwriting - Guaranteed Issue. Not subject to medical underwriting and no declines.
Pre-existing Conditions- Medical conditions for which an applicant has been diagnosed and/or for which applicant is receiving or has received treatment. Pre-existing conditions are accepted, but a 12 month waiting period is required before insurance pays claims related to conditions for which member has received treatment during the past 12 months.
Risk Analysis - Does not apply to these plans.
Rate-Up - No additional premium is charged for any factors. Rate-ups do not apply to these plans.
Underwriting - No medical underwriting is required.