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Your Guide: Short Term Disability Insurance

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DisabilityIconThe topic of this blog post is Short Term Disability Insurance. Think of this type of insurance policy as a “paycheck protector.” It literally insures a portion of your paycheck in the event that you find yourself disabled and unable to work.

You insure your house, you insure your car… but do you insure your paycheck and income? That’s a very important question to ask yourself, because in the event of a disability, you’ll want to maintain your standard of living as best you can.

There are two types of disability plans:

  1. Short Term Disability Insurance
  2. Long Term Disability Insurance

There are specific differences between the two. Short Term Disability Insurance is our area of concentration in this blog post. Short Term Disability Insurance means just that: it insures your income/paycheck for the short term.

Typically a short term plan will have a benefit period of between 3 and 18 months. The benefit period is the period of time that your insurance plan will pay you in the event that you become disabled and are unable to work. If you’re more concerned about a situation where you’ll be off of work for a year or more, you may want to look into a long term disability plan.

The benefit amount (the amount of money you receive from your plan) is dependent upon income. The benefit typically replaces a percentage (or portion) of your wages. In most cases, that amount is between 50%-70% of what you would normally earn. You will not typically find a plan that will cover 100% or more of your income, because there needs to be incentive to go back to work.

Disability plans also have what is called an elimination period. The elimination period is the amount of time that you must wait in order to begin receiving your benefit. For example, if you have a 0/7 (accident/sickness) elimination period, your plan will begin paying you right away (0 days) for an accident, and on the 7th day for a sickness. Typical elimination periods in a short term plan are: 0/7, 0/14, 7/7, 7/14, 14/14 and so on. The elimination period will adjust your premium payment (up or down), based on the amount of time you are willing to wait to receive your benefit.

Another important thing to consider is if you have off-the-job coverage only, or if you are also covered on the job. Most plans are off-the-job coverage only (because worker’s compensation typically pays for on the job disabilities). Make sure that you understand where you are covered under your short term disability plan.

A final thing to consider are state disability programs. If your state has a disability program, in most cases, you’ll need to factor in the amount of benefit you’d be eligible for from the state if you were to file a disability claim. In California, it’s up to ~56% of income. Beyond that, a person is on their own. If a person wants more income protection than what the state is providing, he/she can find a private plan that will help bridge that gap up to ~70% of income. The following states and territories have state disability income programs:

  • California
  • Rhode Island
  • New York
  • Hawaii
  • New Jersey
  • Puerto Rico

That’s all for now on Short Term Disability Insurance. This can be a very important concept for many people because it insures your income and your livelihood (paying for rent, mortgages, car payments, child care, groceries, utilities, etc). Make sure to contact us if you have questions.

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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Benefits Chalk Talk: Individual Tax Penalties Starting in 2014

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By now you’ve heard all about the “individual tax penalties” that apply to most Americans if they’re not carrying health insurance by January 1st, 2014. Back in June of 2012, the Supreme Court of the United States upheld the “individual mandate” based on the congressional power to regulate tax.

What does this mean? It means that nearly every American will need to be insured by 2014, or face a yearly tax penalty.

In this blog post, we’re going to briefly explain the basic structure of this individual tax penalty, and how it will be “phased in.” Keep in mind that we’re emphasizing individual tax penalties only in this blog post. There are different mandates for employers with +50 employees, but we’re not discussing those tax penalties here.

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As mentioned above, we used the phrase “phased in.” The bulk of the tax penalties will not hit right away in 2014; this will allow people to familiarize themselves with the new system. Here is how it will work, starting in 2014 if you decide not to purchase health insurance:

Uninsured Individual Tax Penalty in 2014:

  • 1% of yearly income or $95/year (whichever is higher)

Uninsured Individual Tax Penalty in 2015:

  • 2% of yearly income or $325/year (whichever is higher)

Uninsured Individual Tax Penalty in 2016:

  • 2.5% of yearly income or $695/year (whichever is higher)

Uninsured Individual Tax Penalties after 2016:

  • Increased annually by the Cost of Living Adjustment (COLA)

The penalty amounts are capped at the family level. The most that a family can pay in tax penalties is 3x the yearly individual amount listed above. In other words, if a family has five uninsured family members, only three of them will be subject to the yearly penalty.

You’ll want to discuss with your broker/insurance professional where you can find affordable health insurance by 2014, or face a new tax penalty. Again, as mentioned in this article, the tax penalties will increase over time. Our advice is to be proactive about it, and have a plan that makes the most sense for you and your personal situation. Your decisions will be most likely based on the Federal Poverty Level (or FPL). Contact us any time with questions. You can find an infographic on our Pinterest page here: PAIS Individual Tax Penalty Info

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

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Your Health Benefits Toolbox

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WrenchToday’s blog post is a general overview about all of the “tools” that are available to people to fund their healthcare. We’re also going to talk about the sources of these tools.

One of our biggest goals is to help you understand the programs that are available, and where the access and funding of these programs comes from.

Keeping it simple, there are three major sources that fund benefits programs:

  1. Your employer.
  2. Your contributions (You).
  3. The government.

Below are summaries of the programs that are available to people through the above listed benefits sources. Keep in mind that only healthcare, disability, and life benefits are discussed (retirement benefits are not included):

Government Programs:

  • OASDI (Social Security): Old Age, Survivors, and Disability Insurance. This is a government program that provides benefits for the elderly, survivors/dependents of deceased family members, and the disabled. 
  • Medicare: This is a government program that provides health benefits for the elderly.
  • Medicaid: This is a government program that provides health benefits for the poor.
  • State Disability Income: Five states have state disability programs (California, New York, New Jersey, Hawaii, Rhode Island). Puerto Rico also has a disability program. These programs help the citizens of these states with income protection in the event of disability.
  • State Health Insurance Exchanges (set to begin January 1st, 2014): The new “Health Insurance Marketplaces” of healthcare reform (ACA 2010) will provide a place where people with incomes between 100% and 400% of the Federal Poverty Level (FPL) may receive subsides to purchase individual health insurance policies.
  • Guaranteed Issue Mandate: A provision of ACA 2010 (healthcare reform) that will require insurance companies to accept all applicants who apply for health insurance.

Employer Programs: 

  • Group Health Insurance Plan: Some employers may offer their employees an opportunity to enroll in a group health insurance plan. The employer may pay all (or a portion) of premiums. 
  • Group Dental Insurance Plan: Some employers may offer a group dental plan that is similar in concept to a group health insurance plan.
  • Employer-Paid Vision, Supplemental Health Insurance, and Life: Employers may decide to add additional benefits that are paid for.
  • Health Reimbursement Arrangements (HRAs): These are arrangements that are set up by an employer to reimburse employees tax-free for “qualified medical expenses.”
  • Employer Self Funding: This is an arrangement where an employer pays for the medical expenses of their employees through the general revenue of the company. Typically there is a third party administrator and stop-loss coverage involved.

Individual Programs (programs you pay for individually):

  • Individual Health Insurance Plans: These are insurance plans that people participate in outside of an employer. Starting on January 1st, 2014 all applicants who apply for individual health insurance must be accepted.
  • Voluntary Benefits: These are benefits that are typically offered to the employees of a group at a “group rate” that is usually discounted. Employees typically pay for these benefits through payroll deduction, and premiums can also be paid for tax-free through section 125. Examples of voluntary benefits include supplemental health insurance, vision & dental plans, disability insurance, life insurance, etc.
  • Individual Life, Dental, Vision: There are many individual life insurance, dental, and vision programs available outside of group plans.
  • Health Savings Accounts (HSAs): Health Savings Accounts allow people to save money for medical expenses, and then pay for them tax free.
  • Union, Association, MEWA, etc: Individuals may have accessibility to benefits through these types of organizations. Benefits may be paid for out of pocket, and could be offered at a reduced rate.

The above listed gives you the general overview of the benefits that are available through the government, employers, and individual purchases. This does not include all benefits (as it is a general overview)… but it should give you a broad-based idea about the tools that are available, and where they come from.

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

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Phrases Made Easy: “Consumer Directed Healthcare”

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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

Insurance Alphabet: Letter C

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C is for:

“COINSURANCE”

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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: 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

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Phrases Made Easy: “Federal Poverty Level”

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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.

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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: 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: Your Guide to Supplemental Health Insurance

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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: 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: State Health Insurance Exchanges

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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