Author: Gavin Keiner

Group Medicare

We help retirees and other eligible employees tackle the challenges of ever increasing premiums and health care costs by purchasing a quality Medicare Advantage or Supplement.  While there are many options, the best coverage is a plan that leaves you with the least expenses, and has the lowest premium.

How Medicare Advantage Works

Rather than having Medicare Part A, B, and D separately, your eligible employees can roll all these benefits into one Medicare Advantage plan which may cost both you and your eligible employees less in premiums and healthcare costs.

How Medicare Supplements Work

Medicare Supplement Insurance policies complement your eligible employee’s original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.

Group Long Term Care Plans

Group Long-Term Care plans are becoming an increasingly common voluntary benefit offered by employers today. The prospect of long-term care is one of the most important issues your employees may have to face. The cost of long-term care is expensive and generally not covered by other employee benefits, disability or even Medicare.

If someone requires long-term care, it is not just an emotional strain but a financial one as well, impacting retirement savings and overall financial position.  Savvy employers know that access to additional resources can increase employee productivity when confronted with managing long-term care situations. Long-Term Care plans demonstrate to your current and prospective employees that your company cares about them–increasing the ability to attract and retain the very best talent.

Here’s how LTC Plans work:

Most LTC plans are designed to provide benefits for care through nursing homes, assisted living centers, home health care and adult day care.  These are services that are not typically covered by health insurance, disability insurance, or Medicare.

Employers can provide a base benefit while giving the employees the opportunity to “buy up” and obtain the level of coverage that they need for their families.

Tax Advantaged Benefit Programs

Premium Only Plans (POPs)

A Premium-Only Plan allows employees to purchase their own individual insurance with pre-tax dollars. In other words, employees can potentially save thousands annually in taxes and premiums combined.

Here’s how a POP works:
Employees elect a set amount of pre-tax dollars to be deducted from each payroll. Then, the employee purchases an individual health insurance policy from a carrier of their choice. Accordingly, the employee is responsible responsible for paying the monthly premiums directly to the carrier. Then, the employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars. After a thorough plan analysis, we can help you determine if a POP program would benefit you and your employees.

Flexible Spending Accounts (FSAs)

A Flexible Spending Account is a cafeteria plan under Section 125 of the tax code. In other words, it is a tax favored savings account and is funded solely by the employee through regular pre-tax payroll deductions. Accordingly, the funds (account) can be withdrawn tax-free to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Additionally, employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. For example, the average working employee in America spends more than $1,000 annually on these types of benefits. By participating in a FSA, an employee’s taxable income is reduced, which increases the percentage of pay they take home.

Group Life Insurance

Employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. Thus, you should consider life insurance a key part of the benefit package for your employees. And, also a valuable tool in attracting top talent.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, and mortgage. Additionally, it may even pay for their children’s education.

Permanent Life Insurance

This type of life insurance builds cash value which is sometimes used as collateral for loans, if needed. However, most employers only offer basic term life insurance (see below), but also offer permanent life insurance on a voluntary basis. Even so, employees appreciate the opportunity to widen their safety net.

Term Policy

This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

Dental & Vision Plans

We offer Dental and Vision Plans through many of our major insurance carriers. These plans are offered on a stand-alone (voluntary or employer-sponsored) basis or incorporated into the group health plan offering. Whether as voluntary or paid benefit, employees appreciate both dental & vision coverage as part of their Employee Benefits Package.

Dental Plans
Regular dental exams help employees stay healthier and more productive in the work place. Simple routine visits to the dentist, which are usually covered 100% by insurers, help to detect serious underlying conditions. The National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with Dental Insurance plans have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

Dental Plans offer a variety of diagnostic, preventative care and corrective services. These include cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Vision Plans
Similar to dental policies, vision plans are inexpensive and save money on routine exams. They provide eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Monitoring your eye health with regular exams also helps to prevent serious eye diseases like glaucoma and cataracts and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol.

Life Insurance

Along with Health Insurance, Life Insurance is considered to be a key part of the benefit package for employees. Besides being a valuable tool in attracting top talent, employees are happier and more productive feeling secure that their loved ones will be taken care of in the event of illness or an untimely death.

Whether an employer paid or voluntary benefit, a good life insurance policy provides for an employee’s final expenses, taxes, mortgage and even their children’s education as well as offering additional added benefits. We can help employers protect their employees and their employees’ families with a variety of different life insurance products.

Permanent Life Insurance
Life insurance that builds cash value and the savings can be tax deferred and/or borrowed against, if needed. These policies are known as Permanent Life Insurance.

Term Policy
Life insurance that does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Some policies may also make payments upon terminal or critical illness.

Disability Insurance

National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit.

Here’s How Disability Plans Typically Work

Short Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), STD will begin. It generally allows for income payments to the employee to begin after about a two-week waiting period. It will continue to pay the employee until he/she recovers or maxes out the benefits. This is usually anywhere between one month to two years, depending on the policy.

Long Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period, although it could be much longer depending on the policy, but will continue to pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Types of Dental Plans Available

DHMO

A DHMO health plan (Dental Health Maintenance Organization) is also referred to sometimes a Prepaid Plan and generally offers low premiums.  This type of dental insurance requires you to choose one dentist and dental facility, and pay a fixed dollar amount for services.

DPPO

A DPPO health plan (Dental Preferred Provider Organization) will allow you to choose a dentist and dental facility, however it will save you the most money on services if you select providers within the preferred network.  Copays apply and generally, a deductible must be met before the plan pays for services.  However, you may use a certain amount of preventative services (such as cleanings) annually outside of the deductible with a co-pay.

A FEE-FOR-SERVICE PLAN

A fee-for-service insurance plan allows you to choose a dentist and dental facility, however requires you to directly pay for services at the time the service is rendered.  You then submit a claim form to be fully or partially reimbursed, depending on your plan coverage.  Annual deductibles and co-pays apply.

DENTAL DISCOUNT PLANS

Dental savings plans are not dental insurance but do provide affordable dental services by offering discounts (as high as 60%) on most dental services. The savings depend on the treatment you need, as well as your location (since prices charged by dentists vary by location).  Instead of a premium, you pay a membership fee to have access to the network of service providers who are part of the dental savings plan.

HSA

A HSA is a tax advantaged savings account used for the purpose of paying deductibles, co-pays and co-insurance, therefore lowering your healthcare costs.  It works by letting you set aside money on a pre-tax basis to pay for qualified medical expenses, including dental.

What is Disability Insurance?

Statistics show that our chances of becoming disabled are greater than dying between the ages of 25 & 45.  During the time you are unable to work due to a qualifying disability, the replacement of your regular income through a monthly benefit provided by disability insurance helps to maintain your pre-disability lifestyle.

Employers often provide standard short-term disability (STD) and long-term disability (LTD) insurance to meet federal guidelines. Individual disability income insurance can be customized to meet your needs and considers your occupation, age, income and other factors in determining your cost and monthly benefit payment amount.

Who needs coverage?
Individuals who do not have disability through their employer can purchase an individual disability policy. Additionally, self-employed individuals who desire disability coverage can also purchase an individual policy. Even those who already have disability insurance through their employer, may wish to consider a “wrap around” disability policy to supplement their employer provided coverage.

What type of coverage is available?
A standard Short Term Disability (STD) policy allows for income payments to begin after a two-week waiting period. Payments will continue to the insured until he/she recovers or maxes out the benefits. Thus, total benefits for a STD could last for anywhere from one month to two years, depending on the policy.

A Long Term Disability (LTD) policy allows for income payments to begin after a ninety-day waiting period, although it could be much longer depending on the policy. Once payments begin, they will continue far longer than STD. Thus, the total benefits for a LTD could last for a few years, up to age 65, or even for life.

What is a Long Term Care Insurance Plan?

A Long Term Care Plan augments your health insurance or Medicare and pays for services associated with performing tasks required for daily living such as dressing, bathing, eating, getting in/out of bed, toileting, walking or other basic activities. These services fall under skilled care or personal care and are the types of services that regular health insurance, Medicare or Disability generally does not cover.

As stated, long-term care is usually not medical care and most often does not require a doctor or a nurse. In addition, the need for LTC is not always age related. In fact, statistics tell us that more than half of all individuals age 65 & over will need LTC at some point. Even so, it is important to note that roughly 40% of those receiving LTC today are between the ages of 18 and 64.

Why LTC Insurance?
Regular health insurance, Medicare or Medicaid typically will not pay for Long-Term Care services. The cost of LTC can quickly add up and burden those closest to you, both financially and emotionally. Purchasing a LTC plan can help you avoid those difficult situations, as well as give you the power you need to maintain control of your care, choosing the facilities that best suit your needs. Thus, instead of allowing welfare or the government to make your LTC decisions for you, you are in charge. Additionally, you should be aware that Disability Income Insurance is not designed to cover LTC expenses, but simply replaces part or all of your income during your working years should you become disabled. You need specific coverage to pay for long-term care needs.

Here are examples of what LTC policies may cover:

-Institutional Care: Nursing home, assisted living services, residential care facility, hospice care, adult foster home, respite care and more.
-Home Care: Home health care, adult day care, personal care, homemaker services, hospice care, respite care and more.

Types of Health Insurance Plans

Health Maintenance Organization Or HMO

An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.

Preferred Provider Organization Or PPO

A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.

Health Savings Account (HSA)

An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.

Wellness Benefits

Our carriers have invested heavily in researching and adding the right combination of preventative and wellness features to their base health coverage to help improve lives and lower costs all the way around.  These benefits generally have little or no additional costs, and include services like biometric screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and more.

Annual Open Enrollment:  NOV 1 TO DEC 15

If you are purchasing regular health insurance on or off the Exchange (Marketplace), the Affordable Care Act (ACA) requires you must do so during the annual open enrollment period. Failure to do so may result in your having no coverage for the following year and having to wait until the next year’s open enrollment to sign up for coverage.

Note you can purchase Short-Term Health, Travel Health and other Supplemental Insurance such as a Dental Plan, Critical Care or Disability Insurance Policy any time of the year.

Special Enrollment

You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:

-change in legal marital status
-a change in the number of dependents
-a change in place of residence and the current carrier is not available
-significant cost or coverage change
-a change in coverage of a spouse or dependent
-a COBRA qualifying event
-legal judgements, decrees and orders
-entitlement to Medicare or Medicaid

Premium Only Plans (POPs)

A Premium-Only Plan is a win-win solution for both you and your employees.  It allows allows employees to purchase their own individual insurance with pre-tax dollars, decreasing taxable income and increasing take-home pay.  It also reduces the employer tax liability and generally reduces premiums. In other words, both employees and employers can potentially save thousands annually in taxes and premiums combined.

HERE’S HOW POP WORKS.

Employees elect a set amount of pre-tax dollars to be deducted from each payroll. Then, the employee purchases an individual health insurance policy from a carrier of their choice.  Accordingly, the employee is responsible  responsible for paying the monthly premiums directly to the carrier. Then, the employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars.  After a thorough plan analysis, we can help you determine if a POP program would benefit you and your employees.