Phrases Made Easy: “Advanced Premium Tax Credits” (APTCs)

Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here.

Today we’re going to talk about “Advanced Premium Tax Credits” (or APTCs). And we’ve got great news for you: this one is really easy.

If you’ve enrolled in a health insurance plan at the new health insurance exchanges, there’s a pretty good chance that you’ve already put “Advanced Premium Tax Credits” to work. We’re going to give you the long version of the definition first. This one comes directly from http://www.healthcare.gov (*note: skip below the “Easy St” sign if you want to make this easier):

The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Also called premium tax credit.

OK. That was pretty wordy. Now let’s make this easy. Here’s what you need to know about “Advanced Premium Tax Credits” (or APTCs):

• APTCs are the health insurance “subsidies” that you hear so much about.
• They are credits that make your premiums more affordable if you purchase insurance through the new exchange.
• The APTCs that you may qualify for are based on FPL or “Federal Poverty Level” (we made that phrase easy one time before, go check it out).
• The more money that you make, the less of a monthly APTC you will get.
• The less money that you make, the more of a monthly APTC you will get.
• If you get too much credit for the year (because you under-stated your income), you’ll have to pay it back at tax time.
• And (you guessed it), if you don’t get enough credit for the year (because you over-stated your income), you’ll get a credit at tax time.

The moral of the story: APTCs are really what makes individual health insurance “affordable” in the Affordable Care Act. They’re government tax credits that are designed to make health insurance premiums less expensive.

In certain exchanges (like Covered California), when you shop and compare plans (using their “Shop & Compare Tool“), they will apply the APTCs you may eligible for, and give you your total monthly premium estimate. This estimate is based on four factors:

1. Number of People in the Household
2. Ages of People in the Household
3. Yearly Household Income
4. and Zip Code

Once again, if you want to see an example, look at Covered California’s “Shop & Compare Tool.” Once you input the factors listed above, you’ll be able to see what kind of APTC you may qualify for.

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

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Phrases Made Easy: “Cost Sharing Reductions”

Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Today we’ve selected the phrase “Cost Sharing Reductions.” The primary reason we’ve selected this phrase, is because it can be a very important concept for certain people in the new Covered California state health insurance exchange. Like many other phrases in our “Phrases Made Easy” series, this one sounds difficult, but it’s really not that bad at all.

If you are shopping in the health insurance exchange, you may start to see the phrase Cost Sharing Reduction (or CSR). Here is what a Cost Sharing Reduction is:

Cost sharing reduction plans are offered through Covered California for consumers whose income is between 133% to 250% of the federal poverty level (FPL). These plans offer lower cost-sharing to reduce your clients’ out-of-pocket costs when accessing medical care. These plans are available only through Covered California.

Quite simply: Cost Sharing Reductions reduce your out-of-pocket expenses. If you purchase what is called an “Enhanced Silver Level Plan” through Covered California, and are eligible for Cost Sharing Reductions, you will get help with your co-payments, deductibles, and other out-of-pocket medical expenses.

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Question: What is the criteria for Cost Sharing Reduction eligibility?

Answer: There are two criteria:

1. You need to purchase an “Enhanced Silver Level Plan” on the Covered California state health insurance exchange.
2. Your yearly income must be between 100% and 250% of FPL (or approximately $11,490 per year & $28,725 per year for individuals).

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Here are the three tiers of Silver Level Plans that include Cost Sharing Reductions (or CSRs) in the new state health insurance exchange in California. A standard Silver Level Plan without Cost Sharing Reductions has 70% actuarial value:

• Enhanced Silver 94: 100% FPL to 150% FPL (94% enhanced actuarial value)
• Enhanced Silver 87: 150% FPL to 200% FPL (87% enhanced actuarial value)
• Enhanced Silver 73: 200% FPL to 250% FPL (73% enhanced actuarial value)

Essentially, these are additional benefits that help people who make less, reduce their out of pocket costs. If you have additional questions about “Cost Sharing Reductions” (or CSRs), and how they may apply to you, please contact Policy Advantage Insurance Services. We are “Covered California Certified” and can help you with your questions when navigating the 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: http://www.policyadvantage.com

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Phrases Made Easy: “Minimum Essential Coverage”

Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Our biggest goal is to help you tune in, understand, and put this knowledge to work for yourself or your company. We’re firm believers that informed consumers can make a really, really big difference in our industry.

The phrase that we’re talking about today is minimum essential coverage. This one sounds difficult, but it’s really not too bad. We’ve selected this phrase for one primary reason:

1. Under the healthcare reform law (Obamacare, ACA)… minimum essential coverage is: the type of health insurance coverage that is required to be held by most Americans (per the individual mandate), in order to avoid individual tax penalties. 

In other words… you need to find a place where you can find minimum essential coverage (or pay a tax penalty). It doesn’t matter how rich you are or poor you are, where you live, or what kind of job you have… the law states that nearly every single American citizen will need to find minimum essential coverage by January 1st, 2014. It’s just that simple.

There are a number of different places where you can find minimum essential coverage. Here are the majority of options available for most people:

• Coverage under an “eligible employer-sponsored plan,” which the proposed Treasury rule defines generally to mean coverage under a group health plan, whether insured or self-insured, including coverage under a federal or non-federal governmental plan (keeping it simple: coverage through your employer).
• Coverage under an employer-sponsored retiree health plan.
• Coverage under certain government programs, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and TRICARE.
• Coverage in the individual insurance market, including a plan offered by an Exchange** (if you’re in California, you’ll want to look at Covered California).
• Other coverage recognized by HHS, including self-funded student health coverage and coverage under Medicare Advantage plans.

**Very important new concept to understand

Please note that coverage listed as “excepted benefits” (as defined by HIPAA) will not qualify as minimum essential coverage. IE: dental benefits, vision benefits, and FSAs will not qualify on their own.

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

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Phrases Made Easy: “Full Time Equivalent Employees”

Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here! Our biggest goal is to help you tune in, understand, and put this knowledge to work for yourself or your company. We’re firm believers that informed consumers can make a really-really big difference in our industry.

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

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

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

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

Question: What are “Full Time Equivalent Employees?”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Phrases Made Easy: “Indemnity Insurance Policy”

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

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

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

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

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

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

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

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

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

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

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

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Phrases Made Easy: “Guaranteed Issue”

Welcome back to another edition of our blog series “Phrases Made Easy.” Generally speaking… insurance phrases, words, and concepts can sometimes be difficult to understand. Our goal is to make all of those long, drawn-out phrases easier to understand. We feel that informed consumers can make a really big difference in our industry.

Today we picked the phrase “Guaranteed Issue.” The reason that we picked this phrase is because starting on January 1st, 2014 all health insurance policies must be written as “guaranteed issue” policies. When we refer to health insurance, we’re talking about major medical (ie: HMO/PPO) policies. Products like supplemental health insurance, dental, vision, long term care, etc are not required to be “guaranteed issue.”

The first thing we’ll do is give you the longer definition of “guaranteed issue.” That way, the shorter and easier version will be really simple. Here’s the long definition of “guaranteed issue”:

Guaranteed issue is a term used in health insurance to describe a situation where a policy is offered to any eligible applicant without regard to health status. Often this is the result of guaranteed issue statutes regarding how health insurance may be sold, typically to provide a means for people with pre-existing conditions the ability to obtain health insurance of some kind.

Now that you know the longer definition of “guaranteed issue,” here is the simple version: if you apply for health insurance coverage, you must be accepted. It’s very simple, that’s all it is.

Here are some additional notes on guaranteed issue coverage:

• All plans from all carriers must be “guaranteed issue” nationwide starting on January 1st, 2014
• The “guaranteed issue” mandate applies to plans both inside and outside of state health insurance exchanges

“Guaranteed Issue” will take some “getting-use-to” by the public. When this concept is mentioned to our clients and potential clients, they still have a difficult time comprehending it. However, this is correct: regardless of your health status (any pre-existing conditions), you must be accepted for health insurance coverage if you apply for coverage starting on January 1st, 2014.

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

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

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Phrases Made Easy: “High Deductible Health Plan” (HDHP)

Welcome back to another edition of “Phrases Made Easy.” Our intention with this series is to help make all of those long, drawn-out insurance phrases easier for people to understand. One of our biggest goals is to give our clients and potential clients the power to put the things in place that make the most sense. Well-informed consumers can make a big difference.

This post is about High Deductible Health Plans (or HDHPs). We selected this phrase for a few different reasons:

• In many cases (but not all), High Deductible Health Plans (HDHPs) are the cornerstone of Consumer Directed Healthcare.
• High Deductible Health Plans are usually used in coordination with HSAs and HRAs.
• Consumer Directed Healthcare & High Deductible Health Plans are currently very popular within our industry.

To put the concept in perspective starting off, a High Deductible Health Plan (HDHP) usually works with other products in a system. Much like systems in a house: you have to have plumbing first to run your sink; you have to have electricity first before you can turn on your TV; and you need to have the walls and windows completed, before you turn on the heater or air conditioner.

The visualization mentioned above is similar to the components that work with a High Deductible Health Plan (HDHP). There are four things that usually work in the system:

1. A High Deductible Health Plan (HDHP)
2. A Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA)
3. Supplemental Health Insurance
4. Tax Incentives (Section 105/106 & 125)

The management and coordination of the above concepts all make up a system that can help people manage their own health services more affordably and efficiently. In most cases, the system we just described is commonly referred to as Consumer Directed Healthcare.

Here are some additional facts about High Deductible Health Plans (HDHPs):

• Insurance premiums can be most easily controlled by raising or lowering the deductible.
• A High Deductible Health Plan can be referred to as a “catastrophic plan” that covers the lion’s share of the bills in the event of a hospitalization. HDHPs also usually have at least one yearly wellness visit.
• Cash payments for other services (ie: deductibles, co-insurance, co-pays, physician visits, cash payments for lab work, cash payments for primary care, etc) can be funded w/ tax-advantaged (or sometimes tax-free) arrangements such as HSAs and HRAs. In most cases, unused cash is retained by individuals or employers.
• Cash payments through an HSA or HRA encourage providers (doctors, hospitals, and dentists) to be more transparent with their pricing.
• Additional concerns (accident, cancer, etc) can be “shored up” with supplemental health insurance plans.
• High Deductible Health Plans work very well with the evolving Defined Contribution Healthcare model.

A High Deductible Health Plan was defined in 2013 (for HSA qualification) as a plan with a minimum individual deductible of $1,250/year, and minimum family deductible of $2,500/year. Should you have further questions about how a High Deducible Health Plan might work for you, we encourage you to contact us any time.

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

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Phrases Made Easy: “Consumer Directed Healthcare”

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).

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: http://www.policyadvantage.com

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

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

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

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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.

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: http://www.policyadvantage.com

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

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

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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

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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:

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