Welcome back to another edition of “Benefits Chalk Talk.” In this series at our blog, we provide you with valuable, up-to-date, relevant information about health benefits planning so that you can put the things in place that make the most sense for yourself or your company. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

Today we’re going to talk a little bit more about the Registered Health Underwriter® (or RHU®) designation. If you’ve been following along here at the blog, we’ve talked a little bit about insurance professional designations in the past. Instead of going back through what we covered in that previous blog post, we’re going to tell you more about the specific knowledge that a Registered Health Underwriter® has acquired in order to help clients.

Remember, as we had mentioned in the past blog post, these are robust designations. The holder of these designations has demonstrated a significant and advanced understanding of the concepts which apply. According to NAHU ( the National Association of Health Underwriters):

The Registered Health Underwriter® designation is the undisputed professional credential for persons involved in the sale and service of disability income and health insurance. Individuals earning the RHU designation demonstrate a high level of knowledge about the principles and practices governing the disability income and health insurance business.

Here is some of the specific knowledge that holders of the Registered Health Underwriter® (or RHU®) designation have obtained:

  • Federal Regulation: Assisting clients with things like COBRA, HIPAA, and ERISA.
  • Individual Health Insurance: Providing health insurance consultation outside of the workplace (ie: individual and family plans).
  • Employer Self-Funding: Advanced knowledge about administration, the TPA environment, and stop-loss coverage.
  • Group Health Benefits: Planning and design of group health insurance programs, benefits structure, tax incentives, Section 125 cafeteria plan administration, etc.
  • Consumer Directed Healthcare: Explaining how Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), and High Deductible Health Plans (HDHPs) work together to help consumers retain funds.
  • Federal and Social Programs: A knowledge of things like OASDI (Social Security), Medicare, Medicaid, FEHBP (Federal Employees Health Benefits Program), TRICARE, etc.
  • Ancillary Benefits: Vision, dental, and hearing.
  • Voluntary Benefits: Hospital indemnity, accident indemnity, specified health event (critical illness), cancer indemnity, small face value term life (final expenses protection). Supplemental health insurance fits into this category.
  • Managed Care Organizations (MCO’s): PPO’s, HMO’s, POS plans, EPO plans, physician contracting, hospital contracting, accreditation, case management, disease management, managed behavioral health, performance based incentives, integrated health care delivery systems (IDS’s), hospital networks, physician networks, basic compensation of physicians, medical/surgical utilization, quality management.
  • Disability Income InsuranceShort term & long term disability.

As you can see, a Registered Health Underwriter® (RHU®) can be a valuable resource. These individuals have a wide variety of knowledge they can make available to you, to help you make good decisions when it comes to health benefits planning.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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Hi, and welcome back to another blog post here at Policy Advantage Insurance Services. Today we’re explaining the concept of the insurance broker, and how a broker can benefit you as an individual or business.

As explained in one of our past blog posts: “5 Reasons to Give Yourself the Advantage,” we described the different ways that our clients can really benefit from the services of a health benefits broker. Your broker can be a very valuable asset.

So, instead of repeating what we went over in that blog post, we’re going to conceptualize the broker concept in this one. When we say conceptualize, we mean we’ll put it into everyday terms for you.

The first important thing to understand is the actual definition of “broker.” Here it is:

A broker is one that negotiates insurance contracts on behalf of the insured, therefore representing the client’s interest, not the insurer’s.

With that definition on-hand, you now understand that brokers are working in the interest of the client, and not the insurance companies. Two of the biggest goals of an insurance broker:

  1. Help the client save money.
  2. Help the client improve coverage.

If we can achieve both in a single case (whether at the individual or group level), we’ve hit a home run. It’s what we try to do for our clients every single time.

Now, we’ll move on to the conceptualization of the term “broker.” Our goal is to make it familiar to you, by comparing it to everyday things.

So, let’s keep it simple: a broker is really an “insurance store.” It’s just like any other store where you purchase goods or services.

For example, a sporting goods store will carry items from Nike, Adidas, Under Armour, Louisville Slugger, Rawlings, and others for their customers to choose from. Or, a grocery store will carry items from Quaker Oats, Chiquita Bananas, Kellogg’s, Frito-Lay, and many other food brands. A customer goes to these stores, and shops for the items that they want.

An insurance broker is no different. Effectively, a brokerage is a place where customers can shop the different insurance brands like: Anthem Blue Cross, Kaiser Permanente, Cigna, Aflac, HealthNet, and many others. There can also be accessibility to the new state health insurance exchanges (ie: Covered California) through brokers.

A brokerage is a place where selections can be made based on preferences like:

  1. Type of coverage.
  2. Cost of coverage.
  3. Network access.
  4. Coverage and costs that fit your business’ (or family’s) specific needs.

You’re able to “one-stop-shop” for the coverage that fits you best. An insurance brokerage customer also gets the added value of licensed professionals that can assist with specific questions when selecting coverage (persons with the RHU® or REBC® designations can also be very valuable to you).

Thanks for stopping by today, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

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Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Our biggest goal is to help you tune in, understand, and put this knowledge to work for yourself or your company. We’re firm believers that informed consumers can make a really, really big difference in our industry.

The phrase that we’re talking about today is minimum essential coverage. This one sounds difficult, but it’s really not too bad. We’ve selected this phrase for one primary reason:

  1. Under the healthcare reform law (Obamacare, ACA)… minimum essential coverage is: the type of health insurance coverage that is required to be held by most Americans (per the individual mandate), in order to avoid individual tax penalties

In other words… you need to find a place where you can find minimum essential coverage (or pay a tax penalty). It doesn’t matter how rich you are or poor you are, where you live, or what kind of job you have… the law states that nearly every single American citizen will need to find minimum essential coverage by January 1st, 2014. It’s just that simple.

There are a number of different places where you can find minimum essential coverage. Here are the majority of options available for most people:

  • Coverage under an “eligible employer-sponsored plan,” which the proposed Treasury rule defines generally to mean coverage under a group health plan, whether insured or self-insured, including coverage under a federal or non-federal governmental plan (keeping it simple: coverage through your employer).
  • Coverage under an employer-sponsored retiree health plan.
  • Coverage under certain government programs, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and TRICARE.
  • Coverage in the individual insurance market, including a plan offered by an Exchange** (if you’re in California, you’ll want to look at Covered California).
  • Other coverage recognized by HHS, including self-funded student health coverage and coverage under Medicare Advantage plans.

**Very important new concept to understand

Please note that coverage listed as “excepted benefits” (as defined by HIPAA) will not qualify as minimum essential coverage. IE: dental benefits, vision benefits, and FSAs will not qualify on their own.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

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Facebook: http://www.facebook.com/PolicyAdvantage

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This blog post is about helping people understand insurance professional designations. Sometimes you’ll see a group (or grouping) of letters after a person’s name who works in the insurance industry. In most cases, these are advanced licenses and continuing education. The professional you’ve chosen has decided to further their education in the line of business that he or she works in (“lines of business” = life insurance, health insurance, property insurance, etc).

Today we’re going to take a closer look at the source of two of them:

  1. Registered Health Underwriter® (RHU®):
  2. Registered Employee Benefits Consultant® (REBC®):

The reason we’ve chosen these two is because they deal specifically in the areas of health insurance and employee benefits. If you’ve kept up with our content here at Policy Advantage Insurance Services, you’ll know that these are the primary areas where we work.

Professionals with these designations can be an extremely valuable resource for you. These designations are robust. These are individuals that have:

  • Passed rigorous examinations (this isn’t just a Saturday conference at the Holiday Inn… we’re talking about hundreds of hours of study, days of proctored testing, where the material needs to be known cover-to-cover, and all finals are final).
  • Have met experience requirements.
  • Adhere to strict ethical standards (ie: providing advise in the interest of the client).

According to NAHU ( the National Association of Health Underwriters):

The Registered Health Underwriter® designation is the undisputed professional credential for persons involved in the sale and service of disability income and health insurance. Individuals earning the RHU designation demonstrate a high level of knowledge about the principles and practices governing the disability income and health insurance business.

Here are some additional facts and information about these professional designations:

  • The RHU® and REBC® designations are issued by the Solomon S. Huebner School at The American College in Bryn Mawr, Pennsylvania.
  • The American College is a regionally accredited institution (the highest level of accreditation in the United States).
  • The college offers several professional designations, two types of master’s degrees, and a PhD program.
  • It is a non-profit private school that was established in 1927.
  • Solomon S. Huebner (who founded The American College) was a professor at the University of Pennsylvania in the early 1900’s, and was a pioneer in the insurance industry. For more/additional information about Huebner, click here.
  • Although the University of Pennsylvania and The American College are completely separate institutions, the University of Pennsylvania maintains the prestigious S.S. Huebner Foundation and Geneva Association.

As illustrated, these professional designations can be an extremely valuable asset for someone seeking advice and consultation in the areas of health insurance and employee benefits. You can count on the information that you receive to be valuable, up-to-date, relevant, and ethical. In future blog posts, we’ll describe the specific skill sets and detailed knowledge that holders of the RHU® and REBC® designations have.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

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There are a lot of great reasons to put a health benefits broker to work for yourself or your company these days. As health insurance planning (and the health benefits industry in general) continues to grow more complex… having an informed, knowledgeable, and up-to-date adviser on your team can be a really big advantage.

Here are 5 great reasons to “give yourself the advantage” today:

  1. Healthcare Reform is Fast Approaching: The major portions of healthcare reform (ObamaCare, ACA, the Affordable Care Act, or whatever you want to call it) are quickly approaching. We can’t emphasize this enough. Although it will take years to implement (and there will no-doubt be changes), you’ll want to make sure that you have a good understanding about what is coming up in 2014 (and beyond). Whether you’re an individual or business, if you “miss the boat,” it could end up costing you a lot of money. Contact us with questions today. **Update 1/1/2014: Healthcare reform is here.
  2. Health Insurance and Health Benefits are Complex: As the health insurance and health benefits “system” continues to grow larger, navigating this landscape can become an increasingly burdensome chore for the typical consumer. We’ve got great news for you: we know this industry well, and can help you navigate it. There’s not a better feeling than having an informed friend on your side, helping you with the ins-and-outs. Just check our growing list of customer testimonials.
  3. Save Money and Improve Coverage: Yes, you heard that right. Individuals and business owners take note: with just a few simple adjustments to your current program, you may be able to improve your coverage, and save money at the same time. How’s that for a home run? Having someone in your corner (who knows the industry well) can help you accomplish this. Consider it a “tune-up” for your health insurance program, free of charge. Example: a minor adjustment with a tax incentive here, then a simple adjustment to a physician network there… and boom. You’ve got better coverage at a cheaper price. Granted, improvement doesn’t happen every single time, but in many cases, it’s possible. Contact us to help you look it over.
  4. Valuable, Up-to-Date, Relevant Information: This is one of our big areas of emphasis at Policy Advantage Insurance Services. We know this industry changes. Sometimes quickly. We stay up-to-date with the information that we provide using a number of different strategies. The two big ones: A) Professional Designations (ie: the RHU®/Registered Health Underwriter® and REBC®/Registered Employee Benefits Consultant are the undisputed professional credentials in our industry). B) Information from our partnerships and affiliations (ie: insurance companies, third party administrators, and educational institutions). Companies like Kaiser Permanente, Cigna, United Healthcare, and others are constantly providing us with fresh information that we get out to our client base and readers. We take great pride in providing you with up-to-date info.
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  1. Insurance Company Choices and Options: With a broker, you don’t just choose from one insurance company, you get to choose from many. A broker is like an “insurance store.” This can be very important for a number of different reasons. Physician and hospital networks vary from insurance company to insurance company. Insurance premiums may also vary. The structure and the way that managed care organizations (or MCOs) operate  can also vary considerably. These are all good reasons why it’s a good idea to give yourself some choices when it comes to health insurance companies.

As you can see above, you can “give yourself the advantage” today. Our number one priority are our clients and customers, and helping you navigate the complex world of health insurance and health benefits.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

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Welcome back to another edition of our blog series “Phrases Made Easy.” Generally speaking… insurance phrases, words, and concepts can sometimes be difficult to understand. Our goal is to make all of those long, drawn-out phrases easier to understand. We feel that informed consumers can make a really big difference in our industry.

Today we picked the phrase “Guaranteed Issue.” The reason that we picked this phrase is because starting on January 1st, 2014 all health insurance policies must be written as “guaranteed issue” policies. When we refer to health insurance, we’re talking about major medical (ie: HMO/PPO) policies. Products like supplemental health insurance, dental, vision, long term care, etc are not required to be “guaranteed issue.”

Easy

The first thing we’ll do is give you the longer definition of “guaranteed issue.” That way, the shorter and easier version will be really simple. Here’s the long definition of “guaranteed issue”:

Guaranteed issue is a term used in health insurance to describe a situation where a policy is offered to any eligible applicant without regard to health status. Often this is the result of guaranteed issue statutes regarding how health insurance may be sold, typically to provide a means for people with pre-existing conditions the ability to obtain health insurance of some kind.

Now that you know the longer definition of “guaranteed issue,” here is the simple version: if you apply for health insurance coverage, you must be accepted. It’s very simple, that’s all it is.

Here are some additional notes on guaranteed issue coverage:

  • All plans from all carriers must be “guaranteed issue” nationwide starting on January 1st, 2014
  • The “guaranteed issue” mandate applies to plans both inside and outside of state health insurance exchanges

“Guaranteed Issue” will take some “getting-use-to” by the public. When this concept is mentioned to our clients and potential clients, they still have a difficult time comprehending it. However, this is correct: regardless of your health status (any pre-existing conditions), you must be accepted for health insurance coverage if you apply for coverage starting on January 1st, 2014.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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Welcome back to another edition of “Benefits Chalk Talk.” Our biggest goal in this blog series is to help you understand all of the different tools (and planning strategies) that fund healthcare. By providing you with valuable, up-to-date, and relevant information… we’ll give you the power to put things in place that make the most sense for yourself or your business. Knowledge is power; you’ll be able to put a comprehensive program in place for yourself or your company, while saving money.

Today we’re going to be talking about “defined contribution” health plans again. In case you’ve missed past blog posts, we’ve talked about these concepts a little bit already. If you’d like to read up about the concept a little bit more before moving on with this post, you can find further information about it here.

One of the biggest buzz phrases in health benefits planning today is “defined contribution.” It’s a red hot concept. There are a number of different reasons as to why it’s becoming so popular. Here are a few of them:

  1. Smart Benefits: In most situations, it is a “smarter” way for businesses and individuals to fund healthcare (especially financially). It just makes better sense.
  2. Healthcare Reform: Depending on your defined contribution planning strategy, healthcare reform (ACA/Obamacare) has made current conditions more favorable towards defined contribution benefits planning. 
  3. Technology: New computer programs and software are allowing businesses and companies to administer defined contribution health plans with ease. In most cases, these are what are called TPAs (or Third Party Administrators).
  4. Innovation & Creative Benefits Planning: Businesses and companies have been dealing with rising healthcare costs for quite some time (especially with standard group health insurance plans). It has been tiresome and burdensome to find the right coverage, and contain costs. Defined contribution planning can address both of these issues.

The above listed are a few of the reasons why defined contribution health planning is becoming more popular. Now that you have a better understanding, the remainder of this blog post will concentrate on the different strategies using defined contribution concepts and components.

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First off, we’re going to take a second to briefly define the concept. Here it is, in simple layman’s terms:

Defined contribution health plans are an allowance given to employees by an employer. An employer decides each month (or year) how much money they’d like to give to each employee to spend on healthcare benefits.

That’s all it is. As you can see, it’s very simple and budgetable. Once an employer gives each employee an allowance, the employee then decides how they would like to spend their money. It really is that simple.

There are a number of different strategies that can be utilized when setting up a defined contribution health plan. In this blog post, we’re going to describe those defined contribution strategies in their most basic form. We’ll get into further details about each strategy in later blog posts.

Here are currently some of the more popular defined contribution health plan strategies:

  1. Group Health Insurance Plans with an HRA: This is what is called an “integrated” HRA (it is integrated with a group health insurance plan). A group health insurance plan (typically a high deductible plan) is offered to employees. The employer then decides on a monthly allowance (the defined contribution) to give to each employee through the HRA. The employee utilizes the HRA funds towards qualified medical expenses (ie: the deductible, etc). Essentially an employer is partially self-funding with the HRA, and retaining funds that would normally go to insurance companies. 
  2. Group Health Insurance Plans with HSAs: Certain TPAs or Third Party Administrators (who are usually also technology companies), partner with insurance carriers to set up a pre-determined arrangement of group health insurance plans. Then, a TPA (like www.liazon.com) allows clients to select which products fit them best. The employer still decides the amount of money they would like to give to each employee each month, and employees chose the plan they want (still the defined contribution concept). In this strategy, HSAs are usually used instead of HRAs.
  3. After Tax Stipends: You “define a contribution” (ie: $300) per month, and employees then purchase their own individual health insurance plans. Employees can pick from insurance policies that are both on or off the public health insurance marketplaces (where they may receive substantial subsidies, based on income). This strategy is budgetable, and gets business owners out of the business of making insurance decisions. Employees make their own decisions and purchase their own plan. Effectively, all it is is an after-tax stipend. A raise.

As described above, there are a number of different strategies where an employer can utilize the “defined contribution” planning model. Those listed are only a few of them, and there are further details regarding all three. If you have questions, we encourage you to contact us. We work with the TPAs (Third Party Administrators) that can make defined contribution health benefits planning work for your company.

Defined contribution health benefits planning strategies will also continue to evolve and change, as further guidance is rolled out from the Department of Labor, and HHS. We stay on the front end of all of that, and will continue to keep you up-to-date.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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D is for:

“Deductible”

Letter-D-blue-icon

Deductible: is the initial amount of medical expenses an individual must pay before he or she will receive benefits under a medical expense plan.

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Example:

Plan Type: PPO

Co-Payment: $30 primary care, $50 specialist

Deductible: $3000

Coinsurance: 70%/30%

Annual out of Pocket Maximum: $5000

In the PPO listed above, the deductible is $3000. The $3000 deductible must be met before any other benefits are payable.

However, sometimes primary and specialty care office visits are excluded from having to meet the deductible. Other additional services may also sometimes be excluded (ie: things like lab work and x-rays, etc). It’s important to understand what is covered before the deductible has to be met. In addition, it’s also important to understand whether or not the deducible counts towards the plan’s annual out of pocket maximum.  

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Important note about deductibles: The deductible is one of the major components in a health plan that regulates premium prices. The higher your deductible is (ie: the more you pay out of pocket), the lower your premium is. The lower your deductible is (ie: the less you pay out of pocket), the higher your premium is. The reason this is important to note, is because Consumer Directed Healthcare typically uses higher deductible plans in order to lower premiums. With these higher deductibles, you’ll want to look into additional security with money-smart concepts with things like HRAs, HSAs, etc. They can help you retain premium dollars. For additional information about Consumer Directed Healthcare click here.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

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