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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.
  • 50 or fewer contracts. Total Health Care USA has pre-packaged and priced benefit plans for commercial groups with anticipated enrollment of 50 or fewer contracts. There are four series to select from, 321 Series, T300 Series, 521 Series or T500 Series. A Deductible benefit option is offered on each of the above series as well. An employer may select a dual option within the series for group coverage.

  • 50 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. Employer groups in this size category 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.

Below, you will find the Benefit Plan Descriptions for each series.


Select POS

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 PPOM (Cofinity) and Out-of-Network options allow members the ability to see any provider, but at a greater out of pocket cost.

POS: Benefit Plan Descriptions

 Title
Select HIGH09 Benefit Summary
Select MID09 Benefit Summary
Select LOW09 Benefit Summary

POS: Member Handbook, Certificates of Coverage

 Title
Member Handbook
Select LOW09 Certificate of Coverage
Select MID09 Certificate of Coverage
Select HIGH09 Certificate of Coverage

HMO

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.

HMO: Benefit Plan Descriptions

 Title
521 Benefit Plan Series
T-300 Benefit Plan Series
321 Benefit Plan Series
T-500 Benefit Plan Series

HMO: Member Handbook, Certificates of Coverage

 Title
Member Handbook
Certificate of Coverage

HMO Deductible

Total Health Care’s deductible plan is designed to give employers even greater control of rising health care cost. Members have the same benefits as the THC USA HMO plan, but have a greater out of pocket cost.

HMO Deductible: Benefit Plan Descriptions

 Title
Deductible T-300 Benefit Plan Series
Deductible 321X Benefit Plan Series
Deductible T-500 Benefit Plan Series
Deductible 521X Benefit Plan Series

PPN (Physician Preferred Network)

Employer Groups looking for lower out-of-pocket cost, cost effective premiums and still offers flexibility, now has the option in using a specialized point-of-service plan. PPN (Physician Preferred Network) is a high performance physician network composed of specialty physicians that offer members the choice of physicians who practice more efficiently and provides a higher-quality of care. The plan eliminates the need for referrals and allows the member to seek medical treatment within the Total Health Care Network, PPOM (Cofinity) and Out-of-Network.

PPN: Benefit Plan Descriptions

 Title
HMO/PPN Summary of Benefits and Coverage
Select/PPN Summary of Benefits and Coverage

PPN: Member Handbook, Certificate of Coverage

 Title
Select/PPN Member Handbook
HMO/PPN Member Handbook
Cofinity Directory of Preferred Providers
Select/PPN Certificate of Coverage
HMO/PPN Certificate of Coverage
 Enrollment & Renewal 
 Group Rating & Benefits 

Helpful links

Download commercial provider directory
Cofinity (PPOM)
Cofinity Directory of Preferred Providers
Download UOP PPN Directory
 
Copyright © 2009 Total Health Care, Inc.