We offer insurance for groups, families and individuals that includes Health, Dental, Vision, Disability, Long-Term Care, and Life Insurance.
An individual health insurance policy is a medical plan for individuals. You may be a single parent needing affordable health insurance for yourself or just for your children. You may need family health insurance if you do not have group health insurance available from your employer You may be a student looking for a low cost - high deductible plan. Individual health insurance plans are also used as an alternative to the more costly COBRA options that you may have from an ex-employer. Early retirees also use an individual health insurance or family health insurance policy as a bridge to eligibility to Medicare.
Group health insurance is offered to business owners and small group employers with as few as X employees. Also available to group plans as well as individuals, dental and vision insurance provide an additional employee benefit.
TriSummit Insurance provides insurance services for specific eye care and eyewear benefits from the top vision insurance providers. Whether you want a comprehensive eye exam, eyeglasses, contact lenses, or laser eye surgery, TriSummit Insurance can help you to take advantage of your vision insurance benefits.
TriSummit also offers comprehensive dental insurance to employers and individuals. Learn what you need to know about dental insurance, with information on dental insurance plans and the types of treatments that are covered.
In addition to our primary health coverage we offers Disability, Long-Term Care, and Life Insurance.
Long-Term Care Insurance policies should be on the minds of many people, in particular those close to retiring and those who will need to take care of loved ones over a long period of time. Long- Term Health Care Insurance protects you, as well as those you love, in the event that extended health care is needed in your lifetime.
Disability income can help protect your most valuable asset, your ability to earn a living. Disability income insurance provides a monthly benefit for loss of income because of covered injuries or illnesses. After a predetermined time period, it typically pays a percentage of your income for as long as you're disabled, under your contract.
Life insurance has long been a staple in basic estate planning. The financial consequences of death can be devastating. Without life insurance, surviving dependents can suffer extreme financial hardship as a result of an individual's death. There exists the possible loss of future income as well as a number of sudden expenses that occur as a result of death.
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Health Insurance is insurance against loss by illness or bodily injury. Health insurance provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses. Policies differ in what they cover, the size of the deductible and/or co-payment, amounts of coverage and the options for treatment available to the policyholder. Health insurance can be directly purchased by an individual, or it may be provided through an employer. Medicare and Medicaid are programs which provide health insurance to elderly, disabled, or un-insured individuals. Individual and Family One person or family is covered with an individual health insurance policy. You purchase this kind of plan directly from a health insurance company rather than through an employer intermediary. Temporary Insurance Temporary Health Insurance is designed for individuals and families in-between insurance coverage. Or for those who don't want to pay high COBRA plan premiums while waiting for their new coverage to start. Coverage can become effective as early as tomorrow, be purchased for periods as short as 30 days or up to 180 days, and paid for in one single payment or easy monthly installments. Student Health Insurance Student Insurance is needed when a child or young adults health insurance is no longer covered as a dependent under their parents health policy, or when a student is required to have coverage but chooses not to participate in a college-sponsored plan. Current legislation covers students under family plans up to the age of 26 years old. Senior Health Insurance Medicare Eligibility: Initial Election Period- 3 months prior to the month you turn 65 or your disability month, the month of, and 3 months following unless your birthday is the first day of the month.Annual Election Period- November 15- December 31. You can make plan enrollments and disenrollment's in the Medicare Advantage and Part D programs. The effective date is January 1.Open Election Period- January 1-March 31. You can make one Medicare Advantage plan enrollment or disenrollment as long as there is not a Part D program addition or deletion. The effective date is the first date following the month of your plan change. Special Election Period- This is a year round 63 day election period which accommodates such events as moving out of a Medicare Advantage plan service, a Medicare Advantage plan leaves Medicare, or a beneficiary leaves a group health plan and enters Medicare past age 65. Medicare Supplement Plans A Medicare Supplement Insurance policy, also called a Medigap plan is private insurance that pays in varying degrees based upon a standardized letter grid of coverage ( A-N) that all insurance companies have to follow. The combination of certain plans will generally pay 100% of the Medicare approved amounts for health care costs and pay Part B medical excess charges. Plans are guaranteed renewable as long as premiums are paid. Your open enrollment period is the guarantee issue period starting from the first day of your 65 birthday month for 6 months. During this period you can not be denied coverage for pre-existing conditions. If you have had creditable non-Medicare health insurance past age 65, move out of a Medicare Advantage plans service area, or your Medicare Advantage plan leaves Medicare, you will have special guarantee enrollment rights, which last for 63 days past the date your health coverage ends Medicare Advantage Plans (Part C) Private Insurance that provide insurance for hospital and medical services in the form of HMO's, PPO's, and Private Fee For Service. These plans sometimes include prescription drug coverage. These plans pay instead of Medicare and work differently than Medicare Supplements, as the government pays private insurance companies to administer Medicare. It is important to check with provider network and plan acceptance. These Plans have guarantee issue with no underwriting; no pre-existing conditions, and requires no physical exam. A beneficiary must live in the plan's service area. Plans, benefits, and premiums can vary by your county of residence. Plan changes are subject to the appropriate Medicare election periods. Medicare Part D (Prescription Drug Coverage) Private insurance that provides prescription drug benefits. These benefits are subject to the same requirements set forth by the Department of Medicare and Medicaid, including the donut hole, formularies, and tiers of prescriptions. Enrollment is not required; however, a penalty can occur for not having creditable prescription coverage during Medicare eligibility. Low-income subsidy benefits are available, where premiums, co-payments, and the donut hole on prescriptions are reduced or eliminated. Guaranteed Issue Health Insurance If you have been turned down in the past for any reason we offer a Guaranteed Issue / No Medical Underwriting Health Plan. Current legislation offers state exchange plans. |
As an employer, benefits such as health insurance can attract the best and brightest to your company.The problem with providing health insurance for your employees is the cost. Health care costs are rising all for everyone for physicians, insurance companies, and consumers Businesses of all sizes have a variety of group health plans to choose from.
Consumer-directed health insurance plans are becoming a popular choice among small and large businesses. They're called consumer-directed because the policyholders take control of their health care dollars. These plans feature low monthly costs for you and your employee, along with tax-advantaged savings.
Health Savings Account (HSA) Plans. An HSA is a bank account where you and your employees can contribute tax-free income to be used for almost any health-related cost. If savings aren't used, the funds roll over to the next year and they build interest. Alongside an HSA, your employees will have catastrophic coverage with a high-deductible health plan which features low monthly premiums to fit your budget.
The most common plan compatible with an HSA is a managed care PPO with a high deductible. If you want to add an extra benefit for your employee, you can also contribute to a worker's Health Savings Account.
Managed care plans create networks of doctors, specialists, hospitals, and other health care professionals who provide discounted medical care. For you and your workers, that means lower monthly premiums, co-payments, and coinsurance.
Here are the most common managed care group health insurance plans:
A PPO or Preferred Provider Organization provides comprehensive health benefits from an extensive network of care providers. When your employees receive care from in-network doctors, they'll save money. But they also will have coverage with any physicians or specialists even if they're not in the preferred network. PPO plans with a high deductible are also compatible with Health Savings Accounts
An HMO or Health Maintenance Organization is one of the most affordable group health insurance options available. Your employees must go to doctors within the network and choose a primary care physician, but HMO networks typically include thousands of health care professionals in your state.
A POS or Point of Service group plan is a combination of the HMO and PPO. You'll choose a primary care physician, as you would in an HMO. But you won't have to get a referral for specialist care. Your employees will have group health insurance coverage with both in and out-of-network doctors and hospitals, just like a PPO.
Thank you for choosing TriSummit Insurance for your health care coverage needs.
To assist in your on-line application, make sure that you have all of your medical records nearby as well as the name, address and contact numbers for your physician or medical group recently visited. To begin your on-line application, please click on the health insurance company logo below.
After completing your application, do make sure that you receive a confirmation email that your application has been submitted for processing. Please let your TriSummit Insurance broker know with a quick email reply or phone call that you have received an application confirmation. New application processing and a possible offer of coverage may take 7 to 10 business days. Typically, you receive a letter in the mail with your application status.
On behalf of TriSummit Insurance - thank you. We appreciate your business and don't keep us a secret.
Dental insurance helps protect you from unexpected dental expenses and makes it easier to afford to keep up the regular checkups, cleanings and other preventive treatments you need to keep your mouth healthy. Like medical insurance, dental insurance provides benefits for a specific rate or premium. Different plan designs offer various levels of coverage and different choices in which dentists you can visit.
The major differences between dental insurance plans:
- the choice of dentists
- your out-of-pocket costs
- how dental treatments are paid
Most types of insurance, like a dental PPO, DPO, DHMO or prepaid plan, rely on a network of dentists. These participating dentists agree to perform services for patients at pre-determined rates and usually will submit claims for you. You'll usually pay less when you visit a network dentist.
Most (but not all) traditional indemnity or fee-for-service insurance products do not provide a network feature, so you may have to pay for services up front, file your own claims, and wait for the insurance carrier to reimburse you. However, there are advantages such as having the freedom to visit the dentist of your choice.
Smile PPO plan features
Blue Shield offers a range of affordable and comprehensive dental PPO plans available with or without Blue Shield medical plans. With our dental PPO plans, you have the freedom to choose any dentist you want. Your out-of-pocket costs are lower when you receive care from network dentists. With Blue Shield's broad dental network including nearly 20,000 general and specialty care dentists in California, you'll have access to one of the largest dental networks in California.2
Dental plan offered with Blue Shield Medical Plans3
The Dental PPO plan is an ideal choice to complement your Blue Shield medical plans. This plan provides you and your dependents comprehensive dental benefits at an attractive rate. While strengthening your overall health coverage, you also enjoy the added convenience of a single point of contact for your customer support.
Dental PPO Plan features (with a Medical Plan)
- Two annual teeth cleanings including X-rays and oral cancer screening covered at 100% when using network providers.
- Low co-payments for basic and major services.
- Fixed co-payments when using network dentists.
- No waiting period for diagnostic or preventive services (there's a 3-month waiting period for minor restorative services and 12-month waiting period for major restorative and orthodontic services).
- Orthodontic benefits for children and adults.4
- Coverage even when you use an out-of-network dentist.
- An individual annual deductible of $50 per member.
- A $1,000 per member, per calendar-year benefit maximum, of which $500 per member, per year can be used for non-network benefits.5
- Enhanced dental benefits for pregnant women.6
Dental plans offered independent of Blue Shield medical plans3
You can also enjoy the great value and protection of Blue Shield dental coverage, even if you don't enroll in a Blue Shield medical plan. Choose between a comprehensive SmileSM PPO,1,3 and an affordable Value SmileSM PPO,1,3 plan.
- Two annual teeth cleanings including X-rays and oral cancer screening covered at 100% when using network providers.
- Low co-payments for basic and major services.
- Fixed co-payments when using network dentists.
- No waiting period for diagnostic or preventive services (there's a 6-month waiting period for minor restorative services and 12-month waiting period for major restorative and orthodontic services).
- Orthodontic benefits for children and adults.4
- Coverage even when you use an out-of-network dentist.
- An individual annual deductible of $50 per member.
- A $1,000 per member, per calendar-year benefit maximum, of which $500 per member, per year can be used for non-network benefits.5
- Enhanced dental benefits for pregnant women.6
Value Smile PPO plan features
- Two annual teeth cleanings including X-rays and oral cancer screening covered at 100% when using network providers.
- Low co-payments for basic services.
- Fixed co-payments when using network dentists.
- No waiting periods.
- Coverage even when you use an out-of-network dentist.
- An individual annual deductible of $25 per member.
- A $500 per member, per calendar-year benefit maximum.5
- Enhanced dental benefits for pregnant women.6
Whether you're a Blue Shield individual and family plan member or not, there is a Blue Shield dental plan that's right for you. To apply for a Blue Shield Dental Plan contact your TriSummit Insurance broker directly.
*Pending regulatory approval.
1 Value Smile PPO and Smile PPO plans are underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).
2 Dental providers in California are available through a contracted dental plan administrator.
3 To be eligible for enrollment, you must be a California resident and under age 65 at the time of enrollment. If you had a Blue Shield IFP dental plan cancelled, you must wait 12 months from the date of cancelation before you can reapply.
4 The Dental PPO and Smile PPO plans cover orthodontic services with a fixed co-payment, which does not apply to your $1,000 calendar-year benefit maximum.
5 For each calendar year, you are responsible for all charges incurred after the benefit plan maximum has been reached.
6 The plan covers one additional routine adult prophylaxis for women during pregnancy. Dental PPO and Smile PPO additionally include one periodontal maintenance visit if warranted by a history of periodontal treatment and one course (up to four quadrants) of periodontal scaling and root planing for women during pregnancy with a documented existing periodontal condition.
The Advantages of Long-Term Care
If you are concerned about increasing health care costs, now may be the time to consider long-term care insurance.
What is Long Term Care?
Long-term care (LTC) insurance helps insure against the possibility of personal spending for nursing or custodial care. As the name implies, it provides benefits for the costs of "long-term care," whose services, primarily consist of nursing home care, assisted living facilities and home health care. Simply put, LTC insurance provides its holders with peace of mind. It eliminates the need to worry about the rising costs of health care and whether or not you will be able to afford the services you may need in the near future.
Why is LTC Insurance am important consideration?
With a rising number of people needing long-term care each year, policy owners can find assurance in the fact that they will be covered. Long-term care expenses can quickly add up considering an average nursing home stay is three years at an average cost of over $40,000 a year. This doesn't need to cause you to worry, however. Long-term care insurance provides relief for these expenses so as not to burden family members. Protecting against family dependence, LTC insurance enables you to maintain your hard-earned assets and have the freedom to use them as you wish, not as you must.
Medicare and Medicaid
While estimates differ slightly, it is generally agreed that Medicare pays for less than 8% of the nation's nursing home costs. With a detailed list of requirements that an applicant must fulfill before receiving limited coverage, Medicare is often not a viable option for long-term coverage.
As a welfare program, Medicaid isn't appropriate for many people either. It is designed to cover those who are unable to pay for their own medical care. In order to receive Medicaid benefits for nursing home care, patients are forced to "spend down" their assets to be considered impoverished. Recent legislation has made the practice of transferring assets to qualify for Medicaid illegal and punishable by fines and imprisonment.
Health Insurance Portability and Accountability Act
In August 1996, the Health Insurance Portability and Accountability Act (also known as the Kennedy Kassebaum Bill) was passed. It allows health care expenses (including LTC insurance premiums) exceeding 7.5% of adjusted gross income to be deductible (certain limits on what can be deducted are placed according to age). In addition to allowing deductions to be made for health care expenses, benefits paid out of certain policies are tax free.
Is LTC Insurance right for you?
The most important question to ask yourself when deciding whether LTC insurance is right for you is whether you are worried about long-term care expenses and the possibility of "runaway" health care costs. If the answer is yes, a policy that is not a financial burden may be right for you. There are many different degrees of coverage from which to choose. You can tailor a plan that is comfortable for you by determining your benefit period, benefit amount, waiting period and several other options.
You've spent your lives trying to build your assets. Now through long-term care insurance, we want to help you keep them.It is important to understand that policies are flexible to your personal needs. Please call if you would like to discuss whether long-term care insurance is the right choice for you.
The Surprising Facts About Long-term Care
| CHANCES OF NEEDING EXTENDED CARE (more than 90 days) |
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| One in Ten by Age 55: |  |
| Four in Ten by Age 65: |  |
| Six in Ten by Age 75: |  |
Source: American Health Care Association, 1994
- Every client should understand and anticipate the potentially significant expense associated with the need for long-term care
- The cost of LTC is paid for out of pocket nearly half (48%) of the time. Medicare pays only 8%1.
- Forty percent of American receiving long-term care are under the age of 652.
- American women face a 50 percent greater chance than men of entering a nursing home after age 653.
- Eighty-one percent of American families have already faced a long-term care crisis or expect to face one soon4.
- Assuming a monthly premium of $150 with an annual benefit of $36,000:
- Two months of benefits paid will equal two years worth of premiums.
- Six months of benefits paid will equal 10 years worth of premiums.
- One year of benefits paid will equal 20 years worth of premiums.
1Gaining Market Insights from the Ohio Long-Term Care Insurance Survey, Robert C. Atchley, Ph.D. and Mark S. Dormann, Ph.D., Journal of the American Society of CLU and ChFC, September 1994.
2ACLI Research Finding, "Who Will Pay for the Baby Boomers" Long-Term Care Needs?, Expanding the Role of Long-Term Care Insurance, April 1998.
3HIAA, November 19, 1998.
4Ronald Pollack, Executive Director of Families, USA.
As an employer, benefits such as health insurance can attract the best and brightest to your company.The problem with providing health insurance for your employees is the cost. Health care costs are rising all for everyone for physicians, insurance companies, and consumers Businesses of all sizes have a variety of group health plans to choose from.
Consumer-directed health insurance plans are becoming a popular choice among small and large businesses. They're called "consumer-directed" because the policyholders take control of their health care dollars. These plans feature low monthly costs for you and your employee, along with tax-advantaged savings.
Health Savings Account (HSA) Plans. An HSA is a bank account where you and your employees can contribute tax-free income to be used for almost any health-related cost. If savings aren't used, the funds roll over to the next year and they build interest. Alongside an HSA, your employees will have catastrophic coverage with a high-deductible health plan which features low monthly premiums to fit your budget.
The most common plan compatible with an HSA is a managed care PPO with a high deductible. If you want to add an extra benefit for your employee, you can also contribute to a worker's Health Savings Account.
Managed care plans create networks of doctors, specialists, hospitals, and other health care professionals who provide discounted medical care. For you and your workers, that means lower monthly premiums, co-payments, and coinsurance.
Here are the most common managed care group health insurance plans:
A PPO or Preferred Provider Organization provides comprehensive health benefits from an extensive network of care providers. When your employees receive care from in-network doctors, they'll save money. But they also will have coverage with any physicians or specialists even if they're not in the preferred network. PPO plans with a high deductible are also compatible with Health Savings Accounts
An HMO or Health Maintenance Organization is one of the most affordable group health insurance options available. Your employees must go to doctors within the network and choose a primary care physician, but HMO networks typically include thousands of health care professionals in your state.
A POS or Point of Service group plan is a combination of the HMO and PPO. You'll choose a primary care physician, as you would in an HMO. But you won't have to get a referral for specialist care. Your employees will have group health insurance coverage with both in and out-of-network doctors and hospitals, just like a PPO.
California Life Insurance Rights and Regulations
The insurance claims procedures and policy requirements for the benefit and protection of you, the consumer. California law guarantees consumers a "free look" period of at least 10 days on which to decline any life or health policy for a full refund. Many companies will even allow 30. The time limit will be stated on you policy. Claims procedures will also vary from company to company in California. However, all valid claims should be settled within 30 days of receiving proof of death. California law holds that after this time, the death benefit proceeds should begin accruing interest. Finally, California requires insurance companies to allow you a grace period of 30 days in which to pay an overdue premium without the risk of policy cancelation. However, California law extends some protections to insurers, too. Generally, while accidental death is covered from the effective date (subject to any policy limitations), suicide is not covered during the first two years, and any such claim will result only in a refund of premiums. Misrepresenting yourself on the policy or application can also legally result in denial of coverage. Premiums paid may or may not be returned based on the terms and conditions of the policy.