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Benefits Chalk Talk: 10 Essential Health Benefits

November 4, 2013 2 comments

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.

The topic today is about the “10 essential health benefits” that must be included in all insurance plans starting on January 1st, 2014. The Affordable Care Act (or ACA/Obamacare), required that certain new “essential benefits” be included in all health insurance plans.

Additionally, you may have heard recently in the news that many people across the country are going to be unable to continue their current health insurance plans. The “10 Essential Health Benefits” provision is one of the reasons why. Many of today’s plans on the individual market do not conform to these minimum standards set forth in the law.

As such, any plans that were not “grandfathered in” (ie: in place before March 23rd, 2010, with certain exceptions) can no longer be offered. As a result, people in these plans will need to find a new one starting on January 1st. In many cases, because of the additional added benefits, premiums will also be more expensive.

Here is an overview of the “10 Essential Health Benefits (source: http://www.healthcare.gov):

  1. Ambulatory Patient Services: “Outpatient care” – the kind you get without being admitted to a hospital
  2. Emergency Care: Trips to the emergency room
  3. Hospitalization: Treatment in the hospital for inpatient care
  4. Maternity & Newborn Care: Care before and after your baby is born
  5. Mental Health Services: Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6. Prescription Drugs: Your prescription drugs
  7. Rehabilitative & Habilitative Services: Services and devices to help you recover if you are injured or have a disability or chronic condition. This includes physical and occupational therapy, speech language pathology, psychiatric rehabilitation, and more
  8. Laboratory Services: Your lab tests
  9. Preventive & Wellness Services: Preventive services including counseling, screening, and vaccines to keep you healthy and care for managing a chronic disease
  10. Pediatric Care: Pediatric services – this includes dental care and vision care for kids

The above listed are the “10 Essential Health Benefits” that must be included in all insurance plans starting on January 1st, 2014. Keep in mind that there may be minor benefits differences between states, but for the most part, all of the above must be included in new insurance policies.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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

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

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

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

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

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

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Benefits Chalk Talk: Metallic Levels of Coverage

October 16, 2013 1 comment

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 tell you a little bit more about the new “Metallic Levels of Coverage” and how they work with regard to healthcare reform and individual health insurance policies. You’re going to want to familiarize yourself with these distinctive types of coverage, because you’ll begin to see them quite often.

These “Metallic Levels of Coverage” will be used both inside and outside of the new state health insurance exchanges. Their primary purpose is to explain (in simple terms) the amount of coverage that health insurance plans provide. The amount of coverage is based on actuarial value. Actuarial value is the percentage of health costs that would be covered by the health plan for an average population. Here are the four standardized “metallic levels of coverage”:

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  • Bronze = 60% Insurance Company Pays, 40% Policyholder Pays
  • Silver = 70% Insurance Company Pays, 30% Policyholder Pays
  • Gold = 80% Insurance Company Pays, 20% Policyholder Pays
  • Platinum = 90% Insurance Company Pays, 10% Policyholder Pays

Insurance companies must offer the minimum “Bronze Level” plan as their lowest level of coverage starting on January 1st, 2014. This will be consistent with plans both inside and outside of the exchange. A couple of important additional items to understand:

  1. There is also a plan level called “Catastrophic Coverage.” This catastrophic plan is available only to people under 30 years of age. This plan is a high deductible health plan intended for those who are not utilizing services (younger people), in order to keep premiums lower.
  2. The “Platinum Level” (90%/10%) plan is not available in certain state health insurance exchanges. Be sure to check to see if you’ll be able to participate in a Platinum Level plan in the state where you reside.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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

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

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

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

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

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

Benefits Chalk Talk: Registered Health Underwriter® (RHU®)

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 talk a little bit more about the Registered Health Underwriter® (or RHU®) designation. If you’ve been following along here at the blog, we’ve talked a little bit about insurance professional designations in the past. Instead of going back through what we covered in that previous blog post, we’re going to tell you more about the specific knowledge that a Registered Health Underwriter® has acquired in order to help clients.

Remember, as we had mentioned in the past blog post, these are robust designations. The holder of these designations has demonstrated a significant and advanced understanding of the concepts which apply. 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 is some of the specific knowledge that holders of the Registered Health Underwriter® (or RHU®) designation have obtained:

  • Federal Regulation: Assisting clients with things like COBRA, HIPAA, and ERISA.
  • Individual Health Insurance: Providing health insurance consultation outside of the workplace (ie: individual and family plans).
  • Employer Self-Funding: Advanced knowledge about administration, the TPA environment, and stop-loss coverage.
  • Group Health Benefits: Planning and design of group health insurance programs, benefits structure, tax incentives, Section 125 cafeteria plan administration, etc.
  • Consumer Directed Healthcare: Explaining how Health Savings Accounts (HSAs), Health Reimbursement Arrangements (HRAs), and High Deductible Health Plans (HDHPs) work together to help consumers retain funds.
  • Federal and Social Programs: A knowledge of things like OASDI (Social Security), Medicare, Medicaid, FEHBP (Federal Employees Health Benefits Program), TRICARE, etc.
  • Ancillary Benefits: Vision, dental, and hearing.
  • Voluntary Benefits: Hospital indemnity, accident indemnity, specified health event (critical illness), cancer indemnity, small face value term life (final expenses protection). Supplemental health insurance fits into this category.
  • Managed Care Organizations (MCO’s): PPO’s, HMO’s, POS plans, EPO plans, physician contracting, hospital contracting, accreditation, case management, disease management, managed behavioral health, performance based incentives, integrated health care delivery systems (IDS’s), hospital networks, physician networks, basic compensation of physicians, medical/surgical utilization, quality management.
  • Disability Income InsuranceShort term & long term disability.

As you can see, a Registered Health Underwriter® (RHU®) can be a valuable resource. These individuals have a wide variety of knowledge they can make available to you, to help you make good decisions when it comes to health benefits planning.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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

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

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

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

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

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

Benefits Chalk Talk: Premium Only Plan (POP)

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: 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

Benefits Chalk Talk: Integrated HRAs

April 29, 2013 1 comment

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: 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

Benefits Chalk Talk: Defined Contribution Health Plan Strategies

April 8, 2013 3 comments

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.

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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: 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

Benefits Chalk Talk: Short Term Disability Insurance

Welcome back to another edition of “Benefits Chalk Talk.” This series at our blog is aimed at providing valuable, up-to-date, relevant information about all of the different concepts that go into funding healthcare. One of our biggest goals is to help our clients and potential clients put the things in place that make the most sense.

The topic of this blog post is Short Term Disability Insurance. Think of it 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 anticipating 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.

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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. Many 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: 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