Medical insurance
- Medicare Advantage Plans (MAPD)
- Medicare Supplemental Plans
- Prescription Drug Plans (PDP)
- Affordable Care Act (ACA), GetCovered, and Marketplace plans
- Dental and vision plans
St Florence Financial Group
Standard Operating Procedures
A reference guide to our insurance offerings, client support programs, required documentation, and commonly used insurance terminology.
Reference
Contact information
Fax(201) 639-3655
Address623 Eagle Rock Ave, Suite 4, West Orange, NJ 07052
Product offerings
Life insurance
- Indexed Universal Life Insurance
- Children’s Whole Life Insurance
- Final Expense and Burial Insurance
- Term Life Insurance
- Guaranteed Issue Life Insurance
Employer-sponsored insurance
- Group Voluntary Whole Life
- Group Health Insurance
- Group Disability Insurance
Retirement plans
- Annuities
Assistance programs
Eligibility requirements, limits, and benefits can change. Confirm current program rules and client eligibility with the appropriate state or federal agency before advising or submitting an application.
NJ FamilyCare — Extra Help Medicaid (ABD)
For eligible New Jersey residents, this program may support adult day care, transportation, over-the-counter benefits, dual eligibility, grocery assistance, and utility support.
Managed Long-Term Services and Supports (MLTSS)
A Medicaid-based program for people who meet health and financial requirements. It may require a Physician Certification Form and can provide more comprehensive long-term support.
Medicare Savings Program
A state program that may help eligible applicants pay Medicare Part B premiums and, in some cases, other Medicare costs.
PAAD and Senior Gold
New Jersey prescription assistance programs that may help eligible residents with premiums, deductibles, and pharmacy copayments.
Federal Extra Help (LIS)
A federal program that may reduce prescription drug plan premiums, deductibles, and copayments for eligible Medicare beneficiaries.
Required documents
For most applications other than federal Extra Help, collect the following when applicable:
- Proof of address
- Proof of income
- Government-issued photo ID
- Medicare, Medicaid, and other health insurance cards
- Bank statements from the last three months
- Birth certificate, U.S. passport, or green card
- Life insurance policy, if applicable
- Physician Certification Form for MLTSS, when required
Medicare enrollment guidance
Late enrollment penalties
Late enrollment penalties may apply when someone delays Medicare Part B or Part D enrollment without qualifying coverage. Part B penalties are generally calculated as an additional percentage of the premium for each full 12-month period without coverage. Part D penalties are generally based on the number of months without creditable prescription drug coverage. Confirm current rules, amounts, and exceptions with Medicare.gov or 1-800-MEDICARE.
Enrollment periods
Initial Enrollment Periods, General Enrollment Periods, Annual Enrollment Periods, Medicare Advantage Open Enrollment Periods, and Special Enrollment Periods can affect when a client may enroll or change coverage. Review the client’s circumstances and confirm the applicable enrollment window before making recommendations.
Plan availability
Plan benefits, premiums, provider networks, formularies, and availability vary by county, carrier, plan, and eligibility. We do not offer every plan available in every area. Refer clients to Medicare.gov or 1-800-MEDICARE for information about all available options.
Key terminology
Medicare
- Part A
- Hospital insurance that may cover inpatient hospital stays, skilled nursing facility care, hospice care, and certain home health services.
- Part B
- Medical insurance that may cover doctor visits, outpatient care, preventive services, and certain home health services.
- Part C
- Medicare Advantage plans offered by private insurers that provide Part A and Part B benefits and may include additional benefits.
- Part D
- Prescription drug coverage offered through Medicare-approved private insurers.
- Medigap
- Medicare Supplement Insurance that may help pay certain Original Medicare out-of-pocket costs.
- Creditable coverage
- Coverage expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
Medicaid and assistance
- Dual eligibility
- Eligibility for both Medicare and Medicaid.
- MLTSS
- Managed Long-Term Services and Supports, a Medicaid program for qualifying people who need long-term care services.
- Asset limit
- The maximum value of countable assets allowed for a particular program.
- Income limit
- The maximum income allowed for a particular program.
- Spend down
- A process in some Medicaid programs where medical expenses may reduce countable income.
Life insurance
- Term life insurance
- Coverage for a specified period, such as 10, 20, or 30 years.
- Whole life insurance
- Permanent life insurance that provides lifelong coverage and may build cash value.
- Universal life insurance
- Permanent life insurance that may offer flexible premiums, death benefits, and cash value.
- Cash value
- The savings component of certain permanent life insurance policies that may grow over time.
- Death benefit
- The amount paid to designated beneficiaries when the insured person dies.
- Underwriting
- The insurer’s process for evaluating risk and determining eligibility and premiums.
Insurance basics
- Premium
- The amount paid to maintain insurance coverage.
- Deductible
- The amount a policyholder may pay before coverage begins paying for covered services.
- Copayment
- A fixed amount paid for a covered health service.
- Coinsurance
- The percentage of covered costs shared with the insurer after a deductible is met.
- Network
- A group of contracted healthcare providers that may offer services at negotiated rates.
- Explanation of Benefits (EOB)
- A statement explaining how an insurance claim was processed and what the insurer paid.
Eligibility considerations
Insurance eligibility and underwriting vary by carrier and product. Common considerations include age, health history, lifestyle, occupation, residency or citizenship status, financial justification, policy type, family medical history, and prior insurance applications. Do not promise approval, coverage, benefits, or pricing before carrier review.