Posts

Your Health Benefits Toolbox

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

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

Phrases Made Easy: “Federal Poverty Level”

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.

———————————————————————————————————————————–

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)

———————————————————————————————————————————–

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: State Health Insurance Exchanges

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

The Great Transition: Healthcare Benefits & Defined Contribution

Note: **this is the third (3) 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

——————————————————————————————————————————

Until now, the “defined contribution” (HRA) concept as a health benefits solution has been used most frequently within smaller businesses. However, healthcare reform is paving the way for a massive transition from group health insurance plans (defined benefit), to Health Reimbursement Arrangements (defined contribution). The reason: starting on January 1st, 2014… anyone who applies for health insurance coverage (including individual applicants), must be accepted. In insurance lingo, this is known as “Guaranteed Issue.”

Much like we did in the last post, we are going to explain “defined benefit” and “defined contribution.” This time, we’re specifically referring to employer health benefits. Here we go.

Phrase #1 – “Defined Benefit”

  • Example of “Defined Benefit” in Employee Health Benefits: You’re an employee at a plastics manufacturing company. The company extends health insurance coverage to all eligible employees through a group health insurance plan! That’s a “defined benefit.” 
  • Simpler Terms: The benefit (health insurance), has been defined (the type of coverage the company allows you to select, typically a PPO or HMO).

Phrase #2 – “Defined Contribution”

  • Example of “Defined Contribution” in Employee Health Benefits: You’re an employee at an occupational medical center. The medical center gives employees a monthly $300 HRA (health reimbursement arrangement) allowance. That’s a “defined contribution.” 
  • Simpler Terms: The contribution (funds to the HRA), have been defined ($300 per month).

——————————————————————————————————————————————–

Starting post-2014, employer health benefits (especially in groups of under 50 employees), will begin to make the change from the defined benefit (group health insurance plan) model, to the defined contribution (HRA) model.

Gone will be the days of “minimum participation requirements” and “minimum contribution requirements” (as were seen in group health insurance plans). Instead, employers will begin to decide how much money they would like to contribute to each employee’s HRA (the defined contribution), and then let employees make their own purchasing decisions.

We’ll get into further detail in a later blog post, but HRAs will be the “vehicle” that facilitates this transition. Policy Advantage Insurance Services partners with HRA third party administrators that make this a simple transition. A few things that we’ll talk about in future blog posts:

  1. How HRAs will work on their own (referred to as: private health exchanges)
  2. How HRAs will integrate with state health benefits exchanges (there is much to be announced)
  3. How (regardless of either above scenario), HRAs will be a valuable employee benefit for attraction and retention of employees

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 informative and valuable.

Twitter: www.twitter.com/policyadvantage

Facebook: PAIS Facebook Page

Google+: PAIS Google+ Page

Blog: www.policyadvantage.wordpress.com

Blog2: www.policyadvantage.blogspot.com

Phrases Made Easy: “Defined Benefit” and “Defined Contribution”

Note: **this is the second (2) 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

——————————————————————————————————————————

Defined benefit and defined contribution are long, “scary” phrases. We’ve got news for you though: at Policy Advantage Insurance Services, we work hard to explain all this jargon in simpler terms. And even better news: these two are really easy.

That’s right, they’re actually quite simple to understand. Once you “get” them… you’ve got them (there are only two of them, and they won’t change). Understanding their concept will be a valuable tool for you… especially in the post healthcare reform environment.

In the past, these two phrases were most commonly associated with retirement planning. Now (as a result of healthcare reform), you’ll also want to understand them when it comes to health benefits planning. Here we go.

Phrase #1 — “Defined Benefit” made easy:

  • “Defined Benefit” Example in Retirement Planning: You’re a teacher, you retire, and the school district sends you a monthly retirement check! Simple. That’s a “defined benefit.”
  • Simpler Terms: The benefit (cash/check), has been defined (the dollar amount paid to you each month)
  • Examples of “Defined Benefits” in Retirement and Healthcare Planning: a) pension plans (our example), b) cash-balance pension plans, and c) any group health insurance plan (large or small).

Phrase #2 — “Defined Contribution” made easy:

  • “Defined Contribution” Example in Retirement Planning: You work at a software company. That software company matches your contribution to your 401k each month. That is a “defined contribution.”
  • Simpler Terms: The contribution (match to your 401k account), has been defined (usually as a percentage).
  • Examples of “Defined Contributions” in Retirement and Healthcare Planning: a) 401k’s (our example), b) ESOPs, c) stock bonus plans, d) profit-sharing plans, e) target-benefit pension plans, f) money-purchase plans, and g) health reimbursement arrangements (or HRAs).

——————————————————————————————————————————

As mentioned, health benefits planning will begin to transition from “defined benefit” plans (ie: group insurance plans) to “defined contribution” plans (ie: HRAs). The reason: healthcare reform has created planning conditions that are suitable for this transition. Retirement plans evolved in similar fashion from pensions (defined benefit) to 401k’s (defined contribution).

If you followed along last week (“Healthcare Reform: The Major Players”), you would have read that HRAs were one of the “major players” we described. This is why: health reimbursement arrangements (or HRAs) will be the “vehicle” that will facilitate this change to defined contribution healthcare plans. We’ll begin to explain in our next blog post… so come back and read up!

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. 

That’s all for now. We hope this information was beneficial, as these can be important concepts for anyone.  Thanks for stopping by, and 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

Healthcare Reform: The Major Players

Note: **this is the first (1) of a series of four (4) blog posts that are related to healthcare reform. 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

——————————————————————————————————————————

Now that healthcare reform has made it through Congress, been signed by the President, was upheld by the Supreme Court, and survived an additional presidential election… we’re assuming the law is here to stay.

So with that… we need to introduce to our clients, potential clients, and colleagues the “cast of characters” that are important as this legislation sets in. ie: some of the major players. Here’s the scouting report:

#1) State Health Insurance Exchanges: In California, the exchange is called “Covered California” (www.coveredca.com). There is still much to be announced (because these exchanges have not yet completely taken shape). As information becomes available, we’ll roll it out. Begin to understand State Health Insurance Exchanges: they’re set to start January 1st, 2014.

#2) “Guaranteed Issue” Mandate: The phrase “Guaranteed Issue” is an insurance term. It means a policy must be offered to any eligible applicant without regard to health status. In other words, if you apply for coverage, you must be accepted. Starting on January 1st, 2014… all health insurance policies must be guaranteed issue.

#3) Health Insurance Mandate: The law imposes a health insurance mandate (for nearly all Americans) to take effect starting in 2014, based on the Congressional power to regulate tax. Know where (and how) you can obtain affordable coverage.

#4) Individual & Family Plans (IFP): Currently there are only two segments of health insurance: A) Individual and Family Plans and B) Group Health Insurance.

The Individual and Family Plan (or IFP) segment is set to expand considerably starting in 2014. The reason: preexisting conditions must be covered at that time.

#5) Large Employer Mandate (+50 employees): Starting in 2014, the Act requires employers with 50 or more equivalent full-time employees to offer health insurance that is “affordable, minimum essential coverage” (and if not, face tax penalties). Specific questions about tax penalties should be directed to your tax advisor.

 #6) Account-Based & Defined Contribution Health Planning: Health Savings Accounts (or HSAs), and Health Reimbursement Arrangements (or HRAs) will be an important tool for employers in the post healthcare reform environment. Look for health benefits planning strategies to continue to move in this direction. “Equity-based” health planning involves pairing-up health insurance policies with tax-advantaged reimbursement accounts.

#7) Medicare & Medicaid: There were significant portions of the law that were relevant to Medicare and Medicaid. You’ll want to stay up-to-date on those topics. If you have questions, we’re currently referring them to our Medicare and Medicaid affiliates.

#8) Changes: This was large and far-reaching legislation… over time, legislation of this magnitude has a tendency to go through changes. Know and understand this may occur (most likely if/when things don’t go as planned). Some of these changes may be as important as the above mentioned topics. In the years to come, there may be additions and subtractions to portions of the law. Simply: you’ll want to stay up-to-date with changes.

———————————————————————————————————————————-

That concludes our introduction of healthcare reform’s major players. The above “cast of characters” will give our clients, potential clients, and colleagues a good place to start when trying to understand this large (and sometimes complicated) piece of legislation.

Over the coming weeks and months, we’ll continue to roll out information that is pertinent to these subjects. We invite you to follow along as we continue to move forward. We like sharing great information. We’ll be your resource in one place.

Thanks for stopping by, we hope our information was valuable to you. 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

Important Editor’s Note 11/22/2013: Since posting these original blog posts, federal guidance regarding “Stand-Alone HRAs” (which are addressed in some places throughout these articles) has undergone significant changes. In order to stay in full IRS/ERISA 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. 

Information After Election Day

At Policy Advantage Insurance Services… we’re all set to keep-up with the political climate.

Begin to check our various outlets over the next few weeks after tomorrow’s election. We’ll share some great information that’s relevant to the results.

Thanks for stopping by, we hope our information was valuable to you. Check back at our blog to get further information about funding healthcare suivez ce lien. 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

Election Day IF/THEN Advice:

There’s an election coming up soon, and regardless of results… we’ll have some valuable information to share with you.

So for now… we have some simple IF/THEN election advice:

IF: Obama wins the election, THEN: Start to understand state health insurance exchanges and the Affordable Care Act.

IF: Romney wins the election, THEN: Stay tuned for possible Affordable Care Act changes/repeal.

That’s all for now… pretty simple.

Thanks for stopping by, we hope our information was valuable to you. 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