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This is another post in our series called “Phrases Made Easy.” The purpose of this series is to help our clients and potential clients understand insurance jargon that has a tendency to be complicated.

Consumer directed healthcare is an important concept that sounds difficult… but it really is very simple! We’ve selected this phrase for a few reasons:

  1. It’s a concept that gives the consumer power to make their own health benefits decisions.
  2. It is an important concept in the post-healthcare reform environment.
  3. It is a phrase you will see a lot in our content at Policy Advantage Insurance Services (in fact, it was already in another one of our series’ called Benefits Chalk Talk: Consumer Directed Healthcare).

Easy

Here it is… this is the Policy Advantage Insurance Services definition of consumer directed healthcare:

Consumer directed healthcare is the idea that patients will behave as medical consumers. Patients will be the ones deciding how their healthcare dollars will be spent. Not doctors, employers, insurance companies, or the government.

That’s it… that’s all it is. You (the consumer) make your own decisions about your own health benefits.

As a consumer, you’ll need to know about all of the different “tools” that are available to you. You’ll also need to know whether-or-not you’re getting help from an employer, the government… or if you’re doing it on your own (there are also combinations of the three).

That’s where Policy Advantage Insurance Services comes in. We share valuable, up-to-date, relevant information that helps businesses and individuals finance (pay for) healthcare. In other words, we help you put all the pieces together. These are the kinds of questions we can help you with:

  1. What kind of health insurance plan should I be looking at?
  2. What do I need to know about healthcare reform, and what kinds of new options are available?
  3. How can my employer or the government help me?
  4. Are there any tax incentives when it comes to health insurance/benefits?
  5. Where does dental insurance and supplemental health insurance fit in?
  6. What is a health savings account, and a health reimbursement arrangement?
  7. …plus others.

There you have it… consumer directed healthcare, made easy. 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: www.PolicyAdvantage.com

Twitter: www.twitter.com/PolicyAdvantage

Facebook: www.facebook.com/PolicyAdvantage

YouTube: www.youtube.com/PolicyAdvantage

Pinterest: www.pinterest.com/PolicyAdvantage

Word Press: www.policyadvantage.wordpress.com

C is for:

“COINSURANCE”

LetterCGrey

Coinsurance (or co-insurance): is the percentage of covered expenses under a major medical plan that will be paid once the deductible is satisfied.

Said another way, it’s the portion of the bill that the policyholder is responsible for, once the deductible has been met. 

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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

Based on the example above, once the $3000 deductible has been paid, the policyholder is then responsible for 30% of covered expenses (the coinsurance) up to $5000 (the out of pocket maximum)The insurance company pays the remaining covered expenses.

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In many cases, the use of coinsurance is most common with a hospital stay. However, in some cases (depending on the structure of the insurance contract you have in place), there may be coinsurance for outpatient surgeries, basic physician services, primary care, etc.

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

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

Welcome back to another edition of Phrases Made Easy.  This series at our blog takes all of those long, drawn-out insurance phrases and turns them into concepts that are easy for people to understand.

Today we’re going to be talking about the “FPL” or “Federal Poverty Level.” The reason that we want to discuss this phrase, is because it’s an important component in the new state health insurance exchanges which are set to get going by 2014. As you know, these exchanges are a large part of healthcare reform.

As mentioned in the previous blog article “Benefits Chalk Talk: State Health Insurance Exchanges,” a business or individual may or may not utilize these exchanges (depending on preference and planning strategy). However it’s a good idea to have an understanding of them. So here we go… this phrase is easy: Federal Poverty Level or FPL.

It'sEasy

Here’s the first simple question:

Q: What exactly is the Federal Poverty Level or FPL?

A: In the United States, the Federal Poverty Level (FPL) is a measure used by the federal government to define who is poor.

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With that question answered about as simply as possible, here are some important notes about the Federal Poverty Level (FPL):

  • It’s origin was from Lyndon B. Johnson’s “War on Poverty” 
  • From this “War on Poverty” came many of today’s programs such as food stamps, Medicare, and Medicaid
  • The Federal Poverty Level (FPL) is calculated based on current “federal poverty guidelines”
  • These guidelines are issued and updated yearly by the Department of Health and Human Services (HHS)
  • The Federal Poverty Level (FPL) is used to determine who is eligible for federal subsides or aid
  • In 2012, 100% percent of the Federal Poverty Level was $23,050 for a family of four (4 people), and $11,170 for an individual (1 person)

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Which brings us back to a few more important questions:

Q: Who is eligible for federal subsides (or aid) in a state health insurance exchange?

A: State health insurance exchanges will provide subsidies for individuals and families who fall within 100% to 400% of the Federal Poverty Level (most Americans).

Q: What is 100% of the Federal Poverty Level (FPL), and how is it calculated? 

A: In 2012, 100% of the federal poverty level was yearly income of $23,050 for a family of four. Add (+) $3,960 per person for families that are larger than four, and subtract (-) $3,960 per person for families with less than four.

Q: What is 400% of the Federal Poverty Level (FPL), and how is it calculated?

A: Sometimes the Federal Poverty Level is used to determine subsidies for those who earn more than the poverty level (up to 400% of FPL in this case). State health insurance exchanges will provide subsidies for individuals and families earning up to 400% of the FPL. 400% of the Federal Poverty Level for a family of four in 2012 is $92,200 ($23,050 x 4). 

Q: What are the ranges of income that are eligible for subsidies in a state health insurance exchange?

A: Families of four (4 persons) with yearly incomes between $23,050 (100%) and $92,200 (400%) may be eligible for subsidies.

A2: An individual (1 person) with a yearly income between $11,170 (100%) and $44,680 (400%) may be eligible for subsidies. 

We hope this blog post helped you understand the Federal Poverty Level (FPL) better. It’s an important concept when determining eligibility for subsides in the new state health insurance exchanges. Contact us for further information if you may be interested in enrolling in a state health insurance exchange. 

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

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

An insurance plan that pays you cash when you get sick or hurt, right? You got it. That’s the exact concept behind supplemental health insurance. In this blog article… we’re going to describe supplemental health insurance, talk about the different policies that are available, and explain exactly where it fits in.

Here are some examples of the plans that fit into the category of supplemental health insurance:

  • Personal Accident Indemnity Plan
  • Personal Cancer Indemnity Plan
  • Hospital Protection Plan (cash benefits for hospitalizations)
  • Specified Health Event/Critical Illness Plan (things like heart attacks & strokes)
  • Vision, Dental, Short Term Disability, and Life Insurance

As mentioned above, unlike major medical insurance (which pays physicians, surgeons, and hospitals)… supplemental health insurance pays the policyholder a cash benefit to use where they need it the most. Yep, you manage the cash benefit yourself. It’s important to understand that it’s different than health insurance. Here are some examples of the places where people use their cash benefits:

  1. Out of pocket medical expenses: cash benefits from supplemental health insurance can be used to pay for things like deductibles, co-payments, and other out-of-pocket medical expenses. 
  2. Rent & mortgage payments: in certain situations where someone is sick or hurt, they may need some additional help w/ maintaining their standard of living. You can use cash benefits to make mortgage and rent payments.
  3. Car/Kids/Gas/Utilities/Groceries: if you’re sick or hurt, these types of things continue to go on. Cash benefits from a supplemental health insurance plan can help assist with these kinds of expenses.
  4. Additional Treatment Options & Travel: in certain situations (ie: cancer situations, severe accidents, etc), a patient may want to travel and/or seek treatment outside of the network. They may want to see a specific surgeon, visit a renowned institution for specialized care, have a specific procedure performed, etc. Cash benefits can help with these kinds of expenses.

Depending on the major medical plan that you have in place, and the standard of living you maintain… as listed above, you can see exactly where supplemental health insurance fits in. It can be a very important component of your overall benefits planning strategy (individual & business). 

That covers the basics on the concept of supplemental health insurance. Keep in mind that supplemental health insurance is also typically much more affordable than health insurance. It’s a good idea to educate yourself on it, and understand it. It also fits in with any health insurance plan (some more than others).

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

Pinterest: http://www.pinterest.com/PolicyAdvantage

Word Press: http://www.policyadvantage.wordpress.com

There are lots of questions about state health insurance exchanges, and where/how they will fit in. In this “Benefits Chalk Talk” post, we’re going to give you some 101 (simple) insight into these exchanges, what they’re about, and how they’ll work.

A state health insurance exchange may or may not be the right option for your personal (or business) situation, but it’s a good idea to understand them. Consider them another “tool in your belt” to fund healthcare.

HealthBenefitsChalkTalk1

First off, here are some basic facts and information about these new exchanges:

  • State-based health insurance exchanges (or marketplaces) are a key component of the Affordable Care Act (ACA)
  • States have the option of running their own exchange, or partnering w/ the federal government to run an exchange (or choosing neither, and a federally facilitated exchange will be set up)
  • All exchanges must be ready to enroll customers by 10/1/2013, and be fully operational by 1/1/2014

State health insurance exchanges may be an important part of an individual or business benefits planning strategy. Although some businesses and individuals may make the decision to completely steer clear of the exchanges, others who are open to the idea of utilizing government options will want to learn more.

When it comes to healthcare reform (love it or hate it), it’s important to understand that Policy Advantage Insurance Services takes an unbiased (non-political) approach to these concepts. Our goal is to deliver fact-based information to our clients, so they can put the things in place that make the most sense.  

Health Insurance Exchange

Here is some additional information about the exchanges:

  • Plans offered within the exchange must be the same (contain the same benefits), as those offered outside of the exchange
  • Enrollment in plans will take place predominantly online
  • Plans in the exchange will be “guaranteed issue,” meaning you must be accepted for coverage if you apply
  • An “exchange certified” agent or broker can assist you with enrolling in a state health insurance exchange plan (for more details, ask your current agent/broker, or find an agent/broker)
  • There are provisions to lower premiums (through massive subsides), for Americans with household incomes under 400% of the Federal Poverty Level (that’s most Americans)

Here are the early 2012 Federal Poverty Level guidelines. If your yearly earnings fall within 100% to 400% of the FPL, you may be eligible for a tiered subsidy through the exchange:

  • 100% of the Federal Poverty Level (FPL) was $11,170 for an individual and $23,050 for a family of four through early 2012
  • 400% of the Federal Poverty Level was ~$44,680 for an individual and ~$92,200 for a family of four through early 2012

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: www.policyadvantage.com

Twitter: www.twitter.com/policyadvantage

Facebook: www.facebook.com/policyadvantage

YouTube: www.youtube.com/policyadvantage

Pinterest: www.pinterest.com/policyadvantage

Word Press (you are here): www.policyadvantage.wordpress.com

This is the Policy Advantage Insurance Services comprehensive content guide. We are giving you insight into our various information outlets (much like TV channels), so that you can effectively utilize these resources as valuable tools. You can find us at all of the top social media sites on the web. (username: policyadvantage)

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In this blog post you will discover all of the platforms and services where we distribute our information (ie: Facebook, Twitter, YouTube, etc). Although each location is a little bit different, we try to stay as consistent as possible with the information we share. Our biggest goal is to help empower our clients, when it comes to making decisions about funding their healthcare.

You can click on the icons below to visit each location. There’s a goldmine of information… here you go:

Policy Advantage Insurance Services’ Homepage: 

home

Page URL: www.policyadvantage.com

Purpose: Like any home page, this is where our business resides online. Here you will find standard company information (addresses, phone numbers, email addresses, etc). You will also find things like customer testimonials, links to our social media, online application tools, and other information that is useful for both clients and colleagues.

Our homepage’s goal is to be a very important resource to our clients and policyholders. We are currently in the early stages of our homepage development, with a goal to make it a very interactive and user-friendly location that provides many tools (ie: applying online, user profiles, easy accessibility to information, and many others). We’ll continue to improve our homepage, so make sure to check back.

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Policy Advantage Insurance Services’ Twitter Page:

Twitter

Page URL: www.twitter.com/policyadvantage

Purpose: The purpose of our Twitter page is to distribute short, valuable, up-to-date pieces of information to our Twitter followers. We like to call it a “micro-blog.” At our Twitter page, we will tweet links to articles of interest, important webpages, important blog posts, etc. Our Twitter posts are also sometimes social (ie: non-insurance content that may include current events, pictures, “inside” company info, sports, local events, etc).

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Policy Advantage Insurance Services’ Facebook Page:

facebook f

Page URL: www.facebook.com/policyadvantage

Purpose: The purpose of our Facebook page is to distribute valuable information to the people who “Like” our Facebook page and also to the general public. Everything (all posts) at our Facebook page are public. We encourage our friends, clients, and followers to “like and share” the information that we post in our news feed. There are graphics, links, etc that can come in handy. We share a lot of info at our Facebook page.

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Policy Advantage Insurance Services’ Word Press Page:

word press

Page URL: www.policyadvantage.wordpress.com

Purpose: This is Policy Advantage Insurance Services’ primary blog. This is where you’ll find the most in-depth written information that we share. Our intended audience here is both employers and individuals. You will find valuable information across all subjects when it comes to financing (paying for) healthcare. Many of our posts are categorized, and we try to keep things as simple as possible. Whatever you are looking for, you will find it here… spend some time at this blog. It’s like a health benefits newspaper.

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Policy Advantage Insurance Services’ YouTube Page: 

youtube-logo

Page URL: www.youtube.com/policyadvantage

Purpose: Some people would rather watch/listen than read. For those that would rather watch, our YouTube page is for you. If you are interested in hearing presentations on the various topics and subjects, this is where you want to be. We add Power Point presentations on a periodic basis. Some of our most important information is shared through our YouTube channel.

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Policy Advantage Insurance Services’ Pinterest Page:

Pinterest

Page URL: www.pinterest.com/policyadvantage

Purpose: Pinterest is kind of a newbie in the social media world. It is a great website. This is a place where you can learn more about us at a personal level (outside of just insurance/health benefits talk). We have various creative pin boards here, where we pin the things that inspire us. We even have one dedicated to our clients and colleagues: “Heart of a Lion.” Definitely look us up and follow us at Pinterest, we have fun here. Our webpage was also just recently “Pinterest verified.” We now have the official red check mark next to our URL.

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Policy Advantage Insurance Services’ Blogspot Blog:

Blogger

Page URL: www.policyadvantage.blogspot.com

Purpose: Our Blogspot blog is currently our secondary blog (we always recommend our Word Press blog first). We have future plans to develop this blog further. Currently, it is pretty much a “mirror” to the rest of our content.  Check back periodically.

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Policy Advantage Insurance Services’ About.me Page:

about.me

Page URL: www.about.me/policyadvantage

Purpose: Our newest addition to the content family, our About.me page is currently under construction. Check back periodically as we prepare it to distribute more Policy Advantage Insurance Services information in the future.

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This concludes our comprehensive review of our internet content guide. Check any of the various outlets, and you fill find valuable, up-to-date, relevant information about financing (paying for) healthcare. There is some great information at these different Policy Advantage Insurance Services social media locations.

We also stay on top of current trends, and will add additional “channels” when they become popular. Our username at each one is typically “slash policyadvantage.” (www.example.com/policyadvantage)

As always, thanks for stopping by. We hope that you found our information to be valuable. Please share it with friends, clients, colleagues, and family.

B is for:

“BROKER”

b_blue

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

Brokers already have established relationships with the companies that they contract with. Because of this, they are able to navigate for the insurance consumer more easily. Areas of advantage:

  • Customer Service (changes, enrollment, administration, etc)
  • Ability to Expedite Processes (saving the consumer time, and making things more convenient)
  • Brokers are “Fluent in Insurance Language” (able to communicate w/ companies efficiently)
  • Product Knowledge (knowing the insurance company’s products inside-and-out)

Give yourself the advantage, and put a medical benefits broker to work for yourself or your company today.

PAIS Twitter: www.twitter.com/policyadvantage

PAIS Facebook: www.facebook.com/policyadvantage

This is our first post in our series called “Benefits Chalk Talk.” Much like an after-practice or halftime chalk session in athletics, our goal is to help empower our clients to put all the many different benefits tools in play.  And, much like you face different opponents in a sports contest (and strategies change over time)… our chalk sessions will provide relevant, up-to-date information that will help give you the advantage.

Today’s topic is “Consumer Directed Healthcare.” We selected this as our first concept for a number of different reasons:

  1. Consumer Directed Healthcare’s foundation rests upon individual choices, planning strategies, and knowledge.
  2. Consumer Directed Healthcare will be a concept of emphasis in the post-healthcare reform (Obamacare) environment.
  3. Consumer Directed Healthcare emphasizes the direct involvement of the consumer, encouraging people (and employers) to make sound, informed purchasing decisions (the idea is to make the whole system more efficient).

HealthBenefitsChalkTalk1So this leads us to our question: What exactly is consumer directed healthcare?

Well… consumer directed healthcare has many different definitions. Sometimes it’s even referred to as consumer driven healthcare.

This is the definition we use at Policy Advantage Insurance Services:

Consumer directed healthcare is the idea that patients will behave as medical consumers. Patients will be the ones deciding how their healthcare dollars will be spent. Not doctors, employers, insurance companies, or the government.

Some definitions claim that consumer directed healthcare must be utilized with a high deductible health insurance plan (HDHP). We reject this definition, because we think that all tools and programs must be considered when someone is directing their own program (whether-or-not their strategy includes the use of a high deductible health insurance plan).

There are many things that go into consumer directing:

  • Am I an individual or employer?
  • What is my personal situation (family, hobbies, lifestyle, etc)?
  • Should I utilize private or public options (or a combination of the two)?
  • What type of heath insurance plan should I put in place?
  • What are HSAs and HRAs?
  • What do I need to know about dental, vision, and ancillary programs?
  • What kinds of tax incentives are available to me?
  • Plus others…

We’ll answer these kinds of questions in future blog posts. “Benefits Chalk Talk” will identify the different areas of healthcare benefits planning, and then inform the consumer on how to put them into play.

Thanks for stopping by, we hope you found our information valuable. Please feel free to follow us at our other outlets:

Twitter: www.twitter.com/policyadvantage

Facebook: PAIS Facebook Page

Google+: PAIS Google+ Page

Blog: www.policyadvantage.wordpress.com

Blog2: www.policyadvantage.blogspot.com

Note: **this is the fourth (4) of a series of four (4) blog posts that require some knowledge of previous posts to be understood. We recommend that you read them in order. Here is the suggested order of reading:

  1. Healthcare Reform: The Major Players
  2. Phrases Made Easy: “Defined Benefit” and “Defined Contribution”
  3. The Great Transition: Healthcare Benefits & Defined Contribution
  4. Health Reimbursement Arrangements (HRAs): The Employee Benefits Home Run

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When we talk about an employee benefits “home run,” we’re talking about a concept that is really “clutch” in many different aspects. HRAs are that clutch concept… especially in the post-healthcare reform environment. Here’s why:

  • Flexibility, Freedom of Choice, and Quality of Coverage: HRAs are flexible in the sense that they can help in just about any employee benefits setting. They’re really a “universal key.” It doesn’t matter what you currently have in place, they can be very beneficial in your planning strategy. In many cases, HRAs also allow an employee to choose the plan that fits them best, and “consumer direct” their program.
  • Budgetability and Ease of Administration:  We have talked about the “defined contribution” concept w/ respect to employee benefits in past posts. This is that concept: the HRA allows an employer to make decisions based on how much money he/she would like to contribute to each employee’s HRA (it’s much like a monthly allowance, tax free). Employees then make their own purchasing decisions. That’s the defined contribution… and it’s budgetable. With the help of a third party administrator (TPA), administration is easy. 5 minutes a month. 
  • Tax Incentives: “Qualified Medical Expenses” can be reimbursed tax-free through payroll with the help of Section 105 HRAs (this includes individual insurance premiums).

Home Run

As you can see, Health Reimbursement arrangements hit every base. That’s why we refer to them as an employee benefits “home run.”

Employers can utilize the tax incentives, flexibility, budgetability, and simple administration to tailor a program that fits the exact needs of each business. Employees also have freedom of choice (to pick any plan); they will become involved in their own decision-making.

We will get into further detail about how an HRA goes in to place, step-by-step, in future posts. Keep in mind that these are an important concept w/ regard to healthcare reform. They’re a valuable employee benefit, regardless of your future strategy when it comes to navigating the new legislation (ie: whether you decide to utilize private or public options).

Important Editor’s Note 11/22/2013: Since these original blog posts, federal guidance regarding “Stand-Alone HRAs” (which are addressed in-depth throughout these articles) has undergone significant changes. In order to stay in full compliance, please be advised that there are now many additional considerations when adopting this type of benefits planning strategy. Consult with a proper broker or insurance professional before utilizing employer dollars to purchase individual health insurance policies. 

Thanks for stopping by. We hope you found this information to be useful and valuable to yourself or your organization. Please check back weekly, as we add posts that help empower our clients to make sound health benefits decisions. Also, feel free to follow along at our other outlets:

Twitter: www.twitter.com/policyadvantage

Facebook: PAIS Facebook Page

Google+: PAIS Google+ Page

Blog: www.policyadvantage.wordpress.com

Blog2: www.policyadvantage.blogspot.com