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Voluntary Benefits in the Post Healthcare Reform Environment

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This blog post is about “voluntary benefits” and how they are poised to see significant growth in the post-healthcare reform environment. If you’ve been following along here at our blog, you’ll know that we’ve discussed the definition of voluntary benefits in the past. We’ve referred to these benefits as “supplemental health insurance.”

As we move forward with this concept, keep in mind that you may see this specific category of benefit worded in three ways:

  1. Voluntary Benefits (the verbiage we’re using in this blog post).
  2. Supplemental Health Insurance (verbiage we’ve used in the past).
  3. Ancillary Benefits (or: benefits that support existing benefits).

The above listed could all be considered “voluntary benefits.” Each are composed of a variety of different important products when designing employer health programs.

The big question: What are voluntary benefits? 

Answer: voluntary benefits are exactly what they say they are. They are products that employees voluntarily participate in at work. In other words, employees typically pay for voluntary plans with their own money. The employer usually does not make a contribution.

The next big question: What types of plans are available voluntarily? 

Answer: there are a number of different plans that are available on a voluntary basis. Listed below are a few of them.

  • Supplemental Health Insurance: Accident Plans, Cancer Plans, Hospital Plans
  • Ancillary Benefits: Vision, Dental, Life Insurance, Disability Insurance
  • Specialty Benefits: Pet Insurance, Legal Counsel, Law/Litigation Insurance

The last big question: Why are these types of plans poised to grow significantly?

Answer: there are two big reasons why voluntary benefits are poised to grow significantly in the post-healthcare reform environment.

  1. It’s expected that there will continue to be increased exposure to “out of pocket expenses” and “cost sharing.” In other words, deductibles, co-payments, and coinsurance will all continue to be common. And most likely, these types of out of pocket expenses will continue to increase over time. Voluntary benefits can help reduce exposure to these kinds of expenses. Read more here.
  2. Government money is now helping to pay for a considerable number of new health insurance plans. This is especially true for small businesses (under 50 employees). With the integration of the new health insurance exchanges into the insurance marketplace, the federal government is now helping millions of new people pay their premiums in the form of tax subsides. What does this do? It frees up money for products like voluntary benefits.

As you can see, voluntary benefits will be a very important component in the post-healthcare reform environment. According to a recent study by Met Life, 51% of employees are willing to bear more of their benefits costs in order to have better choices, and 58% of employers say providing voluntary benefits will be significant to their benefits strategy in the coming years.

Policy Advantage Insurance Services provides a broad range of voluntary and ancillary products. If you have questions, please contact us, and we can evaluate your situation (as a business or individual) to see exactly where these benefits can fit it, and how they can help. Continue to look for additional posts on this topic.

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: https://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

Benefits Chalk Talk: Premium Only Plan (POP)

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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 be talking about “Premium Only Plans” (POP). The big reason we want to talk about this concept, is because there are some significant tax advantages that can be utilized by employers when adopting this strategy.

The concept of the Premium Only Plan (or POP) really is very simple. It’s exactly what it says it is: it’s a program that allows employees of an organization to pay for certain insurance premiums tax-free through payroll. That’s all there is to it. This concept is allowed under Section 125 of the IRS code.

Example: John Doe is an employee at Acme Corp. Acme Corp offers it’s employees an opportunity to purchase individual health insurance policies pre-tax through a Section 125 Premium Only Plan (POP). So, John Doe purchases a $250/month individual plan from Cigna, and submits his claim through Acme Corp’s POP third party administrator. By doing so, John Doe is now paying for his $250 monthly premium on a pre-tax basis (ie: before the government takes their money), and then paying taxes only on his remaining income.

As you can see in the above example, by pre-taxing his individual insurance premiums through a Section 125 POP, John Doe can save a lot of money on taxes over the course of the year. His employer (Acme Corp) can also reduce their FICA/FUTA liability (by ~7.65%).

Here are some of the types of policies that can be purchased w/ a Premium Only Plan (POP):

  • Major medical individual health insurance premiums (health insurance)
  • Limited benefit individual health insurance premiums
  • Dental & Vision
  • Medicare Part A or B, Medicare HMO (however, Long Term Care policy premiums cannot be reimbursed through a POP plan)
  • Employer Sponsored Health Insurance Premiums (group plans)
  • Qualified Ancillary Premiums (Accident Plans, Cancer Plans)
  • Medicare Advantage and Medicare Supplement Premiums
  • COBRA Premiums

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: https://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

Professional Designations: RHU® and REBC®

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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: https://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

Phrases Made Easy: “Full Time Equivalent Employees”

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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.

Here we go: today’s phrase is “Full Time Equivalent Employees.” *Note: this is a SUPER important concept for employers with regard to healthcare reform. That’s the overwhelming reason we picked this phrase today. You’ll want to understand this one in 2013 (ie: BEFORE 2014 gets here). So highlight it, share it, pass it along, circle it in red, underline it, etc. Do what you need to do to make sure that you “get it”… and help others get it too.

Phew… after that, you’re wondering: “WHY is this one so important?” That’s the best question we’ve heard all day. Here’s why:

  • “Full Time Equivalent Employees” is extremely important because it is the sole factor in healthcare reform that determines which employers are mandated to provide health insurance coverage, and which employers are not mandated to provide health insurance coverage. 

As a business owner, this is one that can cost you money if you don’t get it right (ie: tax penalties that can be fairly sizable). We won’t get into details here, but we’re talking thousands of dollars (and in larger cases, even hundreds of thousands of dollars). You want to make sure that you get this one right so that you’re: A) avoiding tax penalties, and B) planning correctly and efficiently. That’s why there’s more of a sense of urgency in this post.

Question: What are “Full Time Equivalent Employees?”

Answer: Full Time Equivalent Employees (FTE) are employees that do not work full-time (defined as 30 or more hours per week) in your business or organization, but do count towards the full-time equivalent employee count. In other words, YES… part-time employees do count towards your overall employee grand total.

Question: Why is this so important when it comes to healthcare reform?

Answer: As mentioned above, the “Full Time Equivalent Employee” count is what matters when deciding which employers are mandated to provide health insurance coverage to their employees. Furthermore, employers with 50 or more “full time equivalent employees” must provide adequate health insurance coverage to their employees.

Question: OK got it. So how do I calculate how my part-time employees count towards this “full time equivalent employee” total? 

Answer: The following is an example of how this is calculated. For sake of simplicity, this example uses part-time employees that work year round (seasonal employees working 120 days per year or less do not count towards the employee count). Here you go:

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ABC Corp has 42 full-time employees (each working +30 hours per week)

ABC Corp also has 18 part-time employees (these 18 employees work 15 hours per week)

To calculate part-time workers’ full-time equivalent status, you add up all of the part time employees’ monthly hours, and divide by 120. So in this example:

  • 18 part-time employees x 15 hours per week = 270 total part-time hours per week in the company.
  • Then, 270 part-time hours x 4 weeks in the month = 1080 part-time hours per month in the company.
  • So, 1080/120 = 9

In this example, this company has 9 additional “full-time equivalent employees” through their part timers. Add 9 to your full-time employees (42+9), and you have 51 FTE employees. So although they only have 42 full time employees, they have 51 “full-time equivalent employees” based on their part-timers’ hours, and would be required to provide coverage.

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The moral of the story: part-time employees DO count towards your employee grand total, when you apply the phrase “Full Time Equivalent Employees.” If you have further questions about this concept please contact us any time. It’s extremely important for businesses that are at (or near) 50 “Full Time Equivalent Employees” status to understand it. Please share this blog post with companies you think would find this information important.

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: https://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

Phrases Made Easy: “Indemnity Insurance Policy”

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Welcome back to another addition of “Phrases Made Easy” at our blog. Our goal with this blog series is to take all of those confusing and complicated insurance words, and make them easier for you to understand. At Policy Advantage Insurance Services, we feel that informed consumers can make a really big difference in our industry.

Today’s phrase is “Indemnity Insurance Policy.” The words “Insurance Policy” are easy to understand, but it’s the word “Indemnity” that has a tendency to hang people up. You’ll see it in many different insurance products; that’s one of the reasons we’ve selected this phrase. And we’ve got good news for you: this phrase is really simple.

NotRocketScience

So here we go. Here’s “Indemnity Insurance Policy” made easy:

An Indemnity Insurance Policy is an insurance policy that pays cash either directly to you (the policyholder), or to the provider (ie: someone like a doctor, dentist, or hospital). That’s all it is. It’s a cash payment from an insurance company.

There are various types of  insurance products that function as “Indemnity Insurance Policies.” We won’t list them all, but here are a few of the more common ones:

  • Dental Insurance: some dental plans will have a value assigned to each procedure. For example, a crown may pay $250. This would be the amount paid to either you, or the dentist.
  • Supplemental Health Insurance: many supplemental health insurance plans are written as “Indemnity Insurance Policies.” For example, a supplemental cancer plan may pay the policyholder $300 per day that they’re confined to a hospital in a cancer situation.
  • “Mini-Med” or Hospital Indemnity Insurance: these are insurance plans that are not comprehensive major medical plans (ie: an HMO or PPO). They are plans designed to reimburse the policyholder (or hospital) in the event of a hospitalization. For example, a “Hospital Indemnity Policy” may pay the policyholder $1000 per day that they are confined to a hospital. This money can help offset some of the expenses associated with a hospital stay.

Here are a few additional important notes about “Indemnity Insurance Policies”:

  • In most cases, the cash benefit needs to be assigned to either the policyholder or the service provider (ie: the dentist, doctor, hospital, etc).
  • The cash benefit may pay for all, or only a portion of the bills. For example, some dental indemnity plans may pay the entire bill from the dentist. However, in many cases, a hospital indemnity plan will not cover the entire cost of a hospital stay.
  • When it comes to indemnity insurance policies, there are typically no networks. This can be especially nice in dental situations, because the policyholder can select any dentist of their choice.

Thanks again 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: https://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

Insurance Alphabet: Letter E

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E is for:

“Exchange”

GreyE

Exchange: When used as a noun, an exchange is a place where goods or services are bought or sold. In this blog post, we’re specifically referring to exchanges that sell major-medical health insurance policies. These are otherwise known as health insurance exchanges.

The reason that we’ve selected this topic is because you’re going to hear a lot about “exchanges” over the next few years (and into the future in general), when it comes to health insurance. There are two types of health insurance exchanges:

  1. Public Health Insurance Exchanges
  2. Private Health Insurance Exchanges

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A Public Health Insurance Exchange is an exchange that is set up, funded, and administered by the government. There are a combination of ways that this takes place:

  • A) State-only administered exchanges.
  • B) Joint state/federally administered exchanges.
  • and C) Exchanges administered by the federal government only.

Public Health Insurance Exchanges were a large part of healthcare reform (ACA/Obamacare). These are the new exchanges that are mandated by the law. The purpose of these exchanges is to help expand affordable coverage to the uninsured. The state exchange in California is called “Covered California.”

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A Private Health Insurance Exchange is an exchange that is set up, funded, and administered by private parties. In other words, the government is not involved (examples of private parties: employers and their employees).

There are a number of different strategies when setting up a Private Health Insurance Exchange. Most of these strategies revolve around the “defined contribution” health planning concept that we’ve discussed in past blog posts. This concept (defined contribution) is gaining importance as we move forward in health benefits planning. Third party administrators (or TPAs) facilitate the administration of Private Health Insurance Exchanges.

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: https://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

Benefits Chalk Talk: Integrated HRAs

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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 talking about “Integrated HRAs.” If you’ve been reading our blog, you’ve heard about HRAs (or Health Reimbursement Arrangements) before. We’re a big proponent of them (HRAs in general) for a number of different reasons. They’re a very “money smart” concept when it comes to health benefits planning. If you want to understand more about the general nature of HRAs before moving on, you can read about them here.

As we’ve mentioned, HRAs are a great way to help employers retain funds that would normally go to insurance companies. There are many different ways to utilize HRAs. There are various strategies and ways to set up an HRA. This blog post is specifically geared towards explaining “Integrated HRAs.”

Question: What is an Integrated HRA? 

Answer: Integrate means to combine parts with another so that they become a whole. In the case of an Integrated HRA, there are two parts that are being combined:

  1. A group health insurance plan.
  2. A health reimbursement arrangement (HRA).

Question: What kind of group health insurance plan works with an HRA?

Answer: Any kind of group health insurance plan works with an HRA, as long it (the group health plan) conforms with PHS 2711 (no lifetime or annual limits, etc). Without getting into details that will confuse you, PHS 2711 is one of the big reasons that HRAs integrate so well with a group health insurance plan.

Question: Why would I want to “integrate” an HRA with a group health insurance plan?

Answer: The integration of an HRA with a group health insurance plan can allow an employer to retain funds that would normally go to insurance companies as premiums. In essence, it is a way for an employer to “partially self-fund” their group health plan. Example:

  • An employer puts in a higher deductible PPO (with the higher deductible, premium dollars are saved). The employer then “integrates” an HRA with the higher deductible group health plan to help cover the raised deductibles, co-payments, and other out of pocket expenses. In this example, premiums are lowered, and the additional out-of-pocket risk (higher deductibles and co-pays) are picked up by the employer, tax-free.

Question: How much money can I give to each of my employees in their HRA?

Answer: There is no limit on this amount, because it is integrated with the group health insurance plan (which cannot have annual or lifetime limits). You can decide the amount that you would like to give to each employee. It’s very budgetable. You can also tier your contributions (ie: managers get $200/month, and drivers get $150/month). There are many different ways that this can be set up. It’s very manageable; you can customize your contributions how you like. Contributions are also distributed tax-free by employees into “qualified medical expenses” through Section 105.

As you can see, when properly designed, an “Integrated HRA” can be a valuable and important employee health benefit. They are a very “money smart” concept to help employers save money, and provide quality health coverage. The Integrated HRA can be also considered another form of defined contribution health planning (because an employer is defining a contribution to an HRA).

If you have further questions about setting up an Integrated HRA, please contact us at any time. They’re very simple to administer. We work with a couple of different HRA third party administrators.

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: https://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

Phrases Made Easy: “Guaranteed Issue”

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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:

Home Page: https://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

Benefits Chalk Talk: Defined Contribution Health Plan Strategies

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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.

handing-over-cash_100177776_s1

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:

Home Page: https://policyadvantage.com

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

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

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Insurance Alphabet: Letter D

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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:

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