a presentation about The Role of a Broker in The Health Insurance Marketplace by James Restaino

The Role of a Broker in The Health Insurance Marketplace

 Why use a health insurance broker?

Whether it be choosing Jim and his company or just another broker, the important question is: why choose a broker?

The Health Insurance Marketplace

One of the reasons is because the health insurance marketplace has gotten so complicated than it was 25 years ago. It used to be just about finding a plan and making sure the cost is low. But nowadays outside of a very large product base, you have to abide by compliance.

Just recently, Jim was told to send out two other compliance letters that their clients need to give to their employees, or there's a $5,000 fine. He makes sure that they're compliant to avoid any unnecessary fees.

Choosing a broker

Most brokers don't go the extra mile. They sell the basic plans called the small group, fully funded market. Those are basic Horizon, Oxford PPO, EPO, and HMO.

On the other hand, Jim and his team use a quoting system to quote plans easily. There are a lot of other things out there in the marketplace that people don't sell but Jim and his team sell a lot of. 

HSA Market and Nat General

There’s the HSA market and Nat General as an example. Nat General is a company that rents the Aetna and Cigna directors. It gives the ability to go to Aetna and Cigna, which you can't do in the small group marketplace anymore. 

The other really good thing about Nat General, is they are the only carrier that will sign up a husband-wife group. As long as the spouse is on payroll, they will write the group. No other small group marketplace will do that. 

Level Funded Health Plans

Another really good thing about Nat General is they are set up like a level-funded product. You will answer a health insurance questionnaire. And what does that allow Nat General to do? It gives you very advantageous rates. Now, if you're not in good shape or you do have health issues, Nat General is not the carrier for you because they're going to ask for a health insurance questionnaire. But if you're healthy or if you're young, or even if you're 50 years old but healthy, you're going to get better rates with Nat General.

Why is a financial plan important to you and for your future? Learn more here: Why Is It Important To Have a Financial Plan? by Candido Rodriguez

One of the most difficult duties for business owners is to sit down and take time to plan for their finances. They're too busy taking care of the employees, taking care of the clients, and they never pay attention to their own stuff and they tend to postpone it. By the time they realize things, they have probably amassed some assets, have some credit card debt, or already did their will, they already have a checking account in place, brokerage account, investments, etc. However, everything is fractured and centerless. 


Reference-based Pricing

Another thing that Nat General offers is something called reference-based pricing, and that's another plan design that gives you no network. You can go to any state you want or any doctor you want in the state of New Jersey. It gives you cheaper rates plus the doctor gets paid based on a percentage of Medicare. That is a big change for someone who is not used to that, but more and more people start loving it.

Downside Protection

It also gives you downside protection. You'll have a maximum out-of-pocket as you would normally have, so you don't have to worry if the doctor doesn't take it. There’s a limit on what the doctor can charge and what you pay.



James Restaino is part of Relax Benefits. He is a Managing Partner/Broker at Specialized Health Services LLC, an Employee Benefits Company that specializes in group health insurance, life insurance, and dental/vision insurance servicing companies in New Jersey and New York. His ideal clients are companies that have at least 2 enrolled employees on Employee Benefits. With his 25 years of experience, he can help you find the right coverage for you or your employees.


James Restaino

Learn more about Relax Benefits!

Recommended Readings
Relaxteams.com is a platform featuring top professionals from your area. These professionals join teams of like-minded individuals with skills that complement each other. Each team meets via Zoom to tell their stories and cross-promote each other’s services leading to new business opportunities. Members realize they are #strongertogether so join a team today!
Follow us on social media!
Pinterest | Twitter | Instagram | Facebook | LinkedIn