Individual Medical Insurance

Individual Medical Health Insurance Plans

Affordable Medical Plans for individuals

Requirements for One Person Group (OPG)

Our One Person Group (OPG) individual medical insurance is a new concept that offers an innovative way to offer quality medical health insurance to the self-employed and the small and mid-size employer. This medical health plan is designed especially for self-employed individuals, sole proprietors, and owners of small or mid-sized businesses.

1. We must be hired by the employer or self-employed person.
   
2. The self-employed individual or small business owner must be actively working at least 20 hours a week to his/her business. We recognize that in some cases there is variation in a person’s weekly work hours, but they should be actively working at such business at least 90 hours a month.
3. The person retaining us and his/her employees must have a legal right work in the U.S. and must have a valid Social Security number.
4. A self-employed individual must receive 1099 income or be an owner, partner or member of an LLC, Partnership, Sub S, or similar corporate structure.
5. The business must be operating to generate a profit. We recognize that for start-up business and because of current economic conditions this may not always but possible, and we may, at our discretion, make an exception in some cases.
6. The person should have sufficient cash flow to afford our fees. Generally, he or she should have a gross business income of at least $40,000 a year. We recognize that a spouse may be working, and there may be income from investments or other sources. In some cases, because of the timing of enrollment, the person will initially pay two months’ fees plus the set-up fee before he/she receives the first paycheck. In addition, he/she must have the cash flow sufficient to pay our recurring monthly fee in advance of receiving his/her pay.
7. The self-employed individual or business owner must currently be covered under an ERISA qualified medical plan. This is both an underwriting guideline and, is being required because in order for there to be coverage of pre-existing conditions, the individual must have had at least one years’ medical insurance coverage with another ERISA qualified plan, although there may be a gap in coverage provided that such gap does not exceed 63 days. Furthermore, because coverage under our medical plan will not take effect until the first day of the month after an individual has been on our payroll, the 63-day period for the waiver of pre-existing illnesses will include both this period plus any additional time he/she was without coverage prior to joining our program. We recognize that there may be reasons that an individual does not currently have medical insurance, and we may, at our discretion, make exceptions to this requirement depending on the facts of the situation.
8. AIM or other limited indemnity insurance, even if deemed to be an ERISA qualified medical plan, will not qualify for the above required coverage; however, we may, at our discretion, make exceptions to this requirement depending on the facts of the situation.
9. We require the family unit to be covered under our medical plan (i.e., employee and spouse or family coverage). An exception may be made in certain cases, such as where a spouse is receiving medical insurance under his/her employer’s medical plan.

10. We are prohibited by law from asking people their health history or making a decision to cover or not cover them based on age, sex or health history.