PROVIDER PAYMENT PORTAL
Employers & Agents

Selecting A Benefit Plan

Total Health Care USA offers a variety of benefit options for employers with 2 or more employees located in southeast Michigan. Our marketing staff is available to answer questions and to assist potential clients in selecting the best benefit option for the employer group. Employer groups receive an “adjusted community rate” (ACR) based on anticipated enrollment, industry, and the average age of the group. To generate a quote we will need a current group census and the primary SIC for the covered population.

The Plans

  • HMO Plans


Our traditional Health Maintenance Organization (HMO) offers comprehensive health care to its members. Preventive and wellness services are emphasized. Each plan gives its members high quality care with an emphasis on prevention, while helping employers contain costs. Our Marketing Department will work with employers and agents to design a benefit plan that best meets their needs.

 

  • Select POS Plans


Employers and Agents who are looking for cost effective coverage with greater flexibility than our traditional Total Health Care plan, should consider Total Health Care Select.  Select is a Point of Service Plan (POS) that combines the comprehensive benefits of our HMO plan with the flexibility of a POS plan.  The plan eliminates the need for referrals and allows members to choose a provider at the time of service.   Select members can seek medical treatment from within the Total Health Care network at a lower cost.  The Cofinity / First Health and Out-of-Network options allow members the ability to see any provider, but at a greater out of pocket cost.

Are You A Small Group Or Large Group?

Small Groups

50 or fewer contracts. Total Health Care USA has pre-packaged and priced benefit plans form commercial groups with anticipated enrollment of 50 or fewer contracts. There are four HMO (Health Maintenance Organization), three POS (Point of Service) and two PPN (Physician Preferred Network) series to select from. A deductible benefit option is offered on each of the HMO series as well. An employer may select a dual option within the series for group coverage.

 

Large Groups

51 or more contracts. Commercial groups with anticipated enrollment of 50 or more contracts may select one of the pre-packaged plans, or reconfigure a benefit option to create an “employer specific” plan. One of our Account Executives will consult with the employer or agent-of-record, to tailor a benefit plan that complies with Michigan’s Office of Financial and Insurance Services regulations, and is within the administrative capabilities of Total Health Care.