COMPLIANCE & ADMINISTRATION
In today’s fast changing employee benefit industry, employers are bogged down with more and more complex rules and regulations.
As our client, we provide value added expert services to help you keep up with the day-to-day administration of your programs, and guide you through the maze of requirements that come with sponsoring a benefit program.
COMPLIANCE & ADMINISTRATION
In today’s fast changing employee benefit industry, employers are bogged down with more and more complex rules and regulations.
As our client, we provide value added expert services to help you keep up with the day-to-day administration of your programs, and guide you through the maze of requirements that come with sponsoring a benefit program.
ONLINE BENEFIT TECHNOLOGY
As our client you’ll have access to automation that helps you to be more compliant, and helps employees to maximize benefit usage.
Developed by benefit pros, Employee Navigator is one of the most efficient, all-in-one HR & online employee benefit manager/portals on the market.
HEALTHCARE REFORM
For employers, complying with the ACA can be costly and difficult, especially with it’s constant amendments and rollbacks, which are likely to continue. We can help.
We are continually monitoring and updating ourselves on constantly changing healthcare reform and have designed our services to help keep our clients compliant and informed.
HEALTHCARE REFORM
For employers, complying with the ACA can be costly and difficult, especially with it’s constant amendments and rollbacks, which are likely to continue. We can help.
We are continually monitoring and updating ourselves on constantly changing healthcare reform and have designed our services to help keep our clients compliant and informed.
The Professionals at Innovative Benefit Solutions Inc. will assist you in complying with the requirements of the Affordable Care Act in many ways.
-Design benefit coverage to meet the requirements of the ACA
-Assist with tracking hours
-Ensure eligible employees are offered coverage
-Assist with the reporting process and necessary tax forms
-Handle employee notices
Individuals and Small Businesses may be eligible for a tax credit under ACA healthcare reform laws. The credit is applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit, use the Small Business Tax Credit Calculator provided by the Health Insurance Marketplace. Benefits must be purchased through the Health Insurance Marketplace to secure a tax credit.
Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the essential benefits (see below). If you are in non-compliance, you will incur a penalty of 2,970 (2024) and $2,880 (2023) annually multiplied by the number of full-time employees (excluding the first 30 employees). Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).
-Insurance companies can not increase rates or deny coverage because of a pre-existing condition.
-Dependents can remain on a policy until age 26.
-Insurance companies can not consider gender when setting rates.
-Employer renewals must be based on the same rates as new business.
-The waiting period for employer benefits should not exceed 90 days.
Your employer paid benefits must comply with the “Essential Benefits” of ACA. Specifically, to be in full compliance with the law, your insurance policy must cover at least 60% of the costs of the following essential benefits.
-Ambulatory patient services
-Emergency services
-Hospitalization
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management
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.
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Wellness benefits, which have become very popular, help to attract good employees while increasing productivity, moral and your bottom line. Our carriers have invested heavily in 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.
Following are a few of the wellness resources available through these wellness benefits:
-Biometric screening, education and preventative programs.
-Onsite or virtual physical fitness & nutritional classes.
-Discounts to gym memberships.
-Access to additional resources such as fitness trackers, blogs, subscriptions and more.
-Employees also have access to telehealth solutions, as well as a nurse hotline 24/7 for general medical advice.
-Employees have access to programs such as smoking cessation, substance abuse help, financial wellness seminars and more.
-Employees have access to preventative medicine such as flu shots, mammograms, colonoscopy, heart and cancer screenings and more.
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.
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.
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.
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.
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.
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.
National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Thus, 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.
During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.
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. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.
Employees always appreciate dental & vision coverage as part of the benefits package. We offer both dental and vision as part of the employer sponsored package or on a voluntary basis.
Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.
Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.
Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.
When employers self-fund their own group health plan, they will benefit from a significant savings in the overall cost of their benefit programs. For example, savings may be in premiums, increased cash flow and certain tax advantages. Additionally, employers have more control over the benefits that the plan offers. Typically, self-funding was not available to small employers in the past. However, today self-insured group health plans are considered to be good options for both small and large employers.
A self-funded group health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. Then, a third party administrator (a TPA) is engaged to handle claims and processing. Self-insured employers run the risk of large catastrophic claims. As a result, they need to purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers save a significant amount of money on premiums and other advantages.
Level-funding is “shared” funding that allows small employers to take advantages of all the cost saving and benefit design features of a self-insured plan. Typically, self-funded plans have been designed for larger groups. However, in today’s market, any small or large group could benefit greatly by the cost saving opportunities of a level-funded (shared) funding plan.
An employer will select any of the fully insured plans that the carrier offers. Then rates will be determined by the group’s claim history. Next, stop-loss insurance is added to protect against catastrophic claims. Since the carrier will handle the administration of the plan, there is no need to hire a separate vendor to handle claims and processing.
The premiums for shared funding plans are generally much lower than fully insured plans. That is because the employer shares some of the risk. Additionally, an employer may save even more by implementing wellness programs into the benefit programs. Our thorough plan analysis will help you determine if shared-funding is right for your company.
An HMO group health plan requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Thus, members are required to designate a primary care physician within the HMO. Then, the primary care physician treats and directs health care decisions. In addition, the primary care physician coordinates referrals to specialties within the HMO network. Accordingly, HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). However, most HMOs charge a small co-payment depending upon the type of service provided.
If you belong to a PPO group health plan, you will save the most money on healthcare if you use providers within the PPO network. Thus, if providers outside of the network are used, it is possible that those services may be covered only partially or not at all. Also, deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits and some other healthcare services. However, the great thing about a PPO is it’s rich network of quality doctors and healthcare facilities, and the ability to utilize healthcare services outside of your deductible. For example, doctors visits.
An HSA combines a high deductible, lower premium group health insurance plan (PPO) with a savings account. Accordingly, both employer and employee can contribute, tax-free, to the savings account. Then, the account is used to help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.
An HRA combines high deductible, low premium health insurance plan with a tax favored savings account. Consequently, this plan requires that the employer contribute to the savings account. Then, the account can be used to fund co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.
Single, Dual or Triple Option Plans offer eligible employees a choice between several different types of plans as described above.
Through our thorough analysis and plan design process, we can help you determine which traditional health plan is right for your company.
The public health insurance Marketplace (also referred to as an “Exchange”) was created as a result of The Affordable Care Act and is where you can utilize your premium subsidy, if eligible, to purchase health insurance (also known as Obama Care) for you and your family. Plans from the marketplace contain comprehensive major medical coverage with varying premiums and deductibles.
Following are new rules and regulations governing health insurance, whether sold on the Exchange or off the Exchange.
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.
A Gap plan provides benefits that supplement a major medical and comprehensive benefit package. It works by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.
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.
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.
Accidents can happen anytime. Accident insurance helps to protect employees from financial hardship due to a great deal of medical and out-of-pocket expenses that follow accidental injuries. For example, emergency treatment, hospital stays, medical exams, transportation and lodging needs are just a few of the expenses that accident insurance can help cover. In fact, some policies can even pay benefits in as little as one day, based on time of claim submission.
This special type of coverage can reduce the personal financial impact of the cost of fighting critical illnesses or recovering from injuries, helping to keep up with everyday bills through that process. Some key features include cash benefits paid directly to the employee and plans to fit different levels of coverage/budgets.
Key Person Life Insurance protects your business if one of the main partners passes away unexpectedly, and helps to minimize financial loss. Your business is typically responsible for the premiums, as it is also the beneficiary. The value of your business (as established through financial records) will help to determine the benefit level and premium amounts.
Buy-Sell Agreements protect a business after the death of a key employee. Also, known as Continuation Agreements, they are tied to and funded by life insurance policies. The agreement sets out the details of the transfer of business interest by the key-person (or his/her estate) upon a certain triggering event–usually death, disability and retirement. The surviving or continuing business owner or partner can rest assured knowing that they will be able to purchase the key-person share without interference from other survivors of the key person and his/her estate.
A Business Overhead Disability policy prevents businesses from going under from regular overhead expenses while the business owner is unable to work and run the business due to disability. These types of policies will typically pay for things like employee salaries, rent and utilities, among other expenses.
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If your current broker isn’t offering value added services and tools to help you succeed, then maybe it’s time to rethink your benefit strategy.
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Once enrolled in Medicare, if you wish to change or purchase Medicare plans you must act during the open enrollment period.
When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:
-You are turning 65
-You move to a new area that is not in your current plan’s service area
-Recently moved back to the US
-You lose your current coverage (either Group or Medicaid)
-You now need a SNP (Special Needs Plan) or you no longer need a SNP
To sign up for Medicare Parts A, B, or Medicare Advantage, or for Prescription Drug coverage), most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Once your Initial Enrollment Period is over, if you wish to change your Medicare coverage, you must act during the annual open enrollment period.
Note that Medicare Supplement Plans can be purchased any time of the year, but you will be able to skip the underwriting process if you sign up during the annual open enrollment period.
Also note that you should sign up for Part D (even if you do not have prescriptions) when you first turn 65, as waiting may result in a costly monthly penalty added to your premium.
Medicare open enrollment begins each year on October 15th and runs through December 7th.
Medicare is the federal health insurance program for people who are 65 or older. The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Most people will pay a standard Part B premium which varies depending on income.
Medicare Part C (Medicare Advantage)
Part C rolls Part A and B into one plan, which you may purchase each year during open enrollment from an approved carrier, for one low or ZERO premium.
Medicare Part D (Prescription Drug Coverage)
Part D adds prescription drug coverage to your Medicare benefits.
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.
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.
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.
Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan pays a lump-sum payment directly to the insured. The cash payment helps with out-of-pocket expenses and covers you when you are off work due to a hospital stay. The coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.
Critical Illness insurance is considered a type of supplemental health insurance that provides benefits in addition to your regular health insurance and/or disability insurance.
This special type of insurance coverage pays cash directly to you to help reduce the personal financial impact of the cost of fighting common types of critical illnesses, such as cancer, heart attack, stroke and more. With the advancements in modern medical technology, Critical Illness insurance is an increasing popular supplemental health insurance policy that allows you to focus more on recovery and less on the financial burden of a critical illness event or diagnosis.
Costs are based on your age and selected benefit amount. There is typically a 30 to 90 day waiting period.
While traveling, your regular health plan only covers a fraction of medical costs, if the need should arise to seek medical attention. Don’t go without coverage. Medical travel insurance is typically very affordable and provides valuable medical coverage when traveling in the US or abroad, much like a regular health insurance policy. Most often these types of policies will cover care and services that are not typically covered by your regular health policy or Medicare.
Temporary or Short Term Medical Plans are health plans designed for times of transition and help to bridge gaps in coverage for individuals and families. In the past, short term plans have been available for up to three months, but new federal guidelines allow for plans up to one year, and are renewable for up to three years. The great thing about short term plans are they are generally less expensive than traditional health insurance, however, they do not provide full coverage and they typically do not cover pre-existing conditions.
If you do not qualify for a premium subsidy for health insurance on the Marketplace (Exchange), or, you do not plan on using a lot of health services, then Short-Term Health Insurance plans could be a good option for you and your family.
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.
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.
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.
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.
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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.
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
A subsidy is financial assistance provided by the government to help you pay for your health plan purchased from the federal or state-based marketplace. The amount of assistance you are provided is based on your family size and income. Use the calculator provided by the Marketplace to determine your eligibility for a tax credit. If you qualify for a subsidy, it may be a good idea to purchase your health insurance through the Marketplace.
This type of life insurance policy helps you save for the future by building a cash value that has many benefits to the insured, such as borrowing against the policy or building a tax deferred investment income, in addition to paying a death benefit. Whole life, variable life and universal life are all types of cash value life insurance. Cash value insurance is also known as permanent life insurance because it provides coverage for the policyholder’s entire life.
This life insurance policy does not build a cash value, but pays a death benefit upon your death. It covers you for a set period of time provided you pay the monthly premium, or in some instances, a lump sum in advance. The policy will pay to the named beneficiary the face amount of the policy (set benefit and/or lump sum) upon death of the insured within the stated term. Depending on the policy, it may also make payments upon terminal or critical illness. Premiums are typically very affordable depending on age and health status.
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.
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.
