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The Great Transition: Healthcare Benefits & Defined Contribution

November 26, 2012 1 comment

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

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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).

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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.

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

November 19, 2012 2 comments

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

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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).

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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

November 12, 2012 6 comments

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

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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.

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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: http://www.policyadvantage.com

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

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

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

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

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

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

November 5, 2012 Leave a comment

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. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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

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

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

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

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

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

Categories: Political Elections