Group Health Insurance
Fee-for-Service or
Major Medical Health
Insurance Information
Fee-for-Service or major
medical group health
insurance provides benefits
up to a high limit for most
types of medical expenses
incurred, subject to a
deductible. Once the
deductible is met, this type
of group health insurance
plan will pay a percentage
of what is considered the
"Usual and Customary"
charge for covered
services. The insurance
company generally pays
80% of the Usual and
Customary costs and you're
responsible for paying the
other 20%, which is known
as co-insurance. If the
insurance company charges
more than the Usual and
Customary rates, you will
need to pay both the co
insurance and the
difference.
A New York Fee-for Service
group health insurance
allows your employee to
choose their doctor and
any hospital for their
medical services.

Usually, an employee will
have a deductible such as
$500 or more to pay each
year before the insurer
starts paying. The plan will
pay for charges such as
medical tests and
prescriptions as well as
from doctors and hospitals.
Fee-for-Service health
insurance coverage for
employer sponsored
employee benefits in NY
typically offer the following:
* Employers and employees
share premiums
* Employees have the
freedom to choose any
provider
* Insurance company pays
the allowable claim
Fee-for-Service plans also
offer some Managed Care
type of insurance options
that can assist your New
York small business in
reducing employee benefit
costs.
* Case Management
* Second Surgical Opinion
* Pre-admission Certification
* Special Benefit Networks
Fee-for-Service group
health insurance coverage
offer more choice of doctors
(including specialists, such
as cardiologists and
surgeons), hospitals, and
other health care providers
than managed care health
plans, such as HMO, PPO,
and POS. Fee-for-Service
employee health insurance
may not pay for some
preventive care, such as
check-ups, and is usually a
more expensive health
insurance coverage than
utilizing an HMO, PPO, or
POS plan in New York.
914-276-6000
800-498-1819
Click on the link below to
fill out a New York Group
Health Insurance quote form.
Direct Access Group Benefits, Inc.
© 2004, All Rights Reserved
(914) 276-6000
(800) 498-1819 toll free
(914) 401-9319 fax

189 Route 100
PO Box 590
Somers, New York 10589
Westchester County, NY
Group Benefits
Direct Access
Westchester County New York Insurance Agency