Medical Services

Fully Insured Medical

A plan where the employer contracts with an insurance carrier to assume financial responsibility for the enrollees’ medical claims and for all incurred administrative costs.

Self-Funded Medical

A plan offered by employers who directly assume the major cost of health insurance for their employees. Some self-insured plans bear the entire risk. Some are self-administered. Other self-insured employers contract with insurance carriers or third party administrators for claims processing and other administrative services. All types of plans (PPO, EPO, HMO, and POS) can be financed on a self-insured basis.

Partially Self-Funded Medical

Whether you are fully insured or partially self-insured, an underwriter estimates claims for the coming year for your group based on claims history and other standard processes. In a partially self-funded plan, the employer pays the insurance carrier only for administrative costs and for medical claims that are actually incurred. If the claims incurred are less than the underwriter expected, the employer pays less than a fully insured plan would have cost.

Professional Employer Organization (PEO)

PGM facilitates access to an Employee Leasing Company that provides a service under which an employer can outsource employee management tasks such as employee benefits, payroll, workers’ compensation, recruiting, risk/safety management, and training and development. It does this by hiring the client company’s employees, thus becoming their employer of record for tax and insurance purposes.

Sole Proprietor Medical

Insurance for a single proprietor.

Individual Medical

Individual health insurance is coverage that an individual purchases for themselves and their family. Individual insurance policies and provisions are regulated by the state where the policy is purchased.

Medicare Supplement and Drug Plans

Group and Individual Medicare Supplement Insurance policies are private insurance policies that pay Medicare coinsurance, co-payments, and deductibles that the Medicare insured otherwise would have to pay himself or herself. Some Medicare Supplement Insurance policies also pay for costs not covered by Basic Medicare.

RX Carve Out

Under a carve-out plan, prescription drug coverage is handled separately from other medical coverage, either self-insured with a third-party administrator or through a different insurance carrier. The goal is to bring more specific expertise to the management of prescription benefits and to save money while providing needed medications.

Discount RX Card

Discount Rx Cards can be provided which will give employees access to pre-negotiated discounts on prescription medication.