Wednesday, December 30, 2009

Should my company have an employee advocacy program to help my employees with their medical benefits?

The majority of the time that you speak with business owners they’ll tell you “I don’t handle the benefits”. It’s usually the CFO, Office Manager, or HR Representative. The challenge they face is benefits are PART OF THEIR JOB, not THEIR ENTIRE JOB.

This causes quite the dilemma because benefit management is an around the clock job. Most of the aforementioned people can handle new employee paperwork or answering a simple question about a Co-Payment.

But what about the tough questions that happen everyday?

What about questions like “Why was my claim rejected?”, “Is this procedure covered?”, or “How do I appeal this bill?”

That’s where they usually refer the employee to the insurance company. Now let me ask you a question, Who’s looking out for your employees best interests? Do you think if your employee calls the insurance company they can actually get someone on the phone, nevertheless get the problem resolved in a timely manner?

We live in a world of answering machines, when a last resort is an actual person.

That’s why a business should have an employee advocacy program. Whenever you’re dealing with insurance companies it can be confusing, frustrating and difficult. An employee advocacy program provides a central administration point to help employees manage problematic claims issues. It serves as the personal benefits advocate for every employee to make sure they receive all of the benefits you've intended to give them. Employees simply make one phone call and an employee advocate helps them solve any issues directly with their provider.

This results in more productive work time and fewer distractions for everyone involved!

Who's advocating for you and your employees?

If you have any questions you can always reach me at 631-338-9917.

Related Posts: Should I hire someone to manage my benefits?

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Monday, December 21, 2009

What’s a Health Saving Account and why should I consider one?

Most business owners that have offered their employees High Deductible Health Insurance Plans also offer their employees “Health Saving Accounts”. Unfortunately, the majority of employees don’t utilize this potion of their health insurance plan. This has to do with a lack of information on what a “Health Savings Account” is and how it works.

A Health Savings Account is an account that allows you to save money to put toward future Medical Expenses. Think of it as saving for a rainy day to cover medical bills, and costly expenses (Braces, Laser Eye Vision etc). An employee or an employer can put aside money into an account which gives the employee a tax deduction and savings to put toward qualified medical expenses. The plan allows for money to be carried over year after year helping employees meet large expenses or cover routine exams etc.

What makes the plan so interesting is it can allow you to take a portion of what you would have normally paid in premium and save the difference. Almost giving yourself a “Bonus” for keeping yourself healthy.

Let me give you an example:

Option 1:
“Traditional” Individual Plan
Monthly Cost-$400.00
Total Cost- $400.00

Option 2:
“High Deductible Plan $2,500 Deductible w/ HSA account” Individual Plan
Monthly Cost-$200.00
Saving the difference $200.00 in an HSA account
Total Cost- $400.00

After a year the person with Option 2 has set aside $2400 (Not counting interest) and can now use that account to meet his medical expenses. If the situation arises that he had a quiet year medically, his account balance would carry over to the next year.

So in both situations, the monthly expense is the same $400.00 but with an HSA account you have the opportunity to have money set aside for future medical expenses.

Any time you can set aside money for your benefit, and get a tax deduction in the process, you should jump at the chance. Force yourself to save for the future and you’ll be better off in the long run.

If you have any questions you can always reach me at 631-338-9917.

Related Posts: Hoosiers and Health Savings Accounts

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Tuesday, December 15, 2009

What do out of network benefits really mean?

I just recently ran into a few situations, where clients were concerned about “Out of Network benefits”. Typically in the health insurance world there are 2 types of coverages, “In Network Only Plans” (HMO’s, and EPO’s) and “In and Out of Network Plans” (PPO’s, and POS).

Now the question I hear the most often is, “How do out of Network benefits work?”

Typically, aside from the deductible you have to meet, there is a UCR %. What UCR means is “Usual, Customary and Reasonable”, this simply means the insurance company calculates the reasonable “cost” of the procedure and picks up that %.

It does NOT mean they will pick up that % of the total cost.

Let me give you an example.

You have a $25,000 procedure done by your doctor, your UCR % is 80%, and the insurance company thinks the reasonable cost of the procedure is $20,000.

This means they WILL PAY 80% of the reasonable $20,000 which is $16,000.

Leaving YOU with a total cost of $25,000-$16,000= $9,000.

It doesn’t mean your doctor overcharged you for a procedure, it’s simply based on how insurance companies calculate reasonable costs.

The other misconception many client have is “What if I have no out of Network benefits and someone gets hurt out of state? (i.e. on vacation).”

The simple answer… YOU’RE COVERED!

All insurance plans have to cover you regardless of whether your In Network or NOT in EMERGENCY SITUATIONS!

So, you may not be able to get a check up Out of Network but you will be covered for hospitalization!

Make sure to ask questions and see if out of network benefits are worth the additional cost!

If you have any questions you can always reach me at 631-338-9917.

Related Posts: Should I hire someone to manage my benefits?

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Tuesday, December 8, 2009

Should I consider a high deductible health plan as an option?

More often that not, employers want to offer “Comprehensive” medical benefits. What that usually means to employers is a “traditional” plan where everything is covered with low deductibles. Unfortunately, a traditional plan might not make sense to both the insured and the employer.

WHY?

Because people want insurance to protect the “WHAT IF” but they rarely go to the doctor. Last time I checked it was something like 92% of all health insurance claims come from 8% of the insureds.

WOW. I mean do the math, that means the reverse must be true. 92% of Insured’s only account for roughly 8% of claims.

Usually large deductible plans scare employees and employers because it’s different, its not what their used to. But overall it can work out better for both parties given how often they see doctors.

Here’s a quick example:

Option 1: A Traditional Plan

Monthly cost $1100/ Doctor Co Pays $30

The cost per year is $13,200 Without Co-Pays


Option 2: A High Deductible Plan

Monthly Cost $900/ Family Deductible $5000

The MAX cost for insurance is $10,800 + the deductible of $5000 for a TOTAL of $15,800.

So with a high deductible plan you would pay less a month but be responsible for the first $5000. It becomes a matter of preference, and how often you go to the doctor.

You can end up paying a higher amount upfront with a high deductible plan when you count the deductible but it could benefit you in the long run if you see the doctor very often. You should always meet with someone before you make a change because considering all options can help make you a better educated consumer.

REMEMBER KNOWLEDGE IS POWER!

If you have any questions you can always reach me at 631-338-9917.

Related Posts: Hoosiers and Health Savings Accounts

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Tuesday, December 1, 2009

Are your employees well?

Have you ever heard the phrase “It’s better to be proactive, then reactive?” I’ve spent a lot of time trying to use this in both my clients and my life. Too often we as people wait till there is a problem before making a concerned effort to fix it. This is the same way our doctors and hospitals treat our patients, they fix the problem once there is one. They say to themselves, “If there’s not a symptom, there’s not a problem”.

Could you imagine if your mechanic told you “Your cars running fine, bring it in to me when it breaks down and I’ll fix it for you”. You would say he’s insane but we do that with our health care everyday. Unfortunately this is how most Medical plans work, “There’s no heart problem till a heart attack”, “No eating problem till there’s diabetes” etc.

This is another place where EMPLOYERS DROP THE BALL.

As a business, you can offer a wellness program to go along with your medical plan to keep your employees healthy and claim free.

Remember the equation: Health claims decrease = Health Insurance Renewals cheaper

You can customize a plan that makes sense for your employees that covers nutrition, smoking, weight loss etc.

Remember, it’s better to be proactive then reactive!

If you have any questions you can always reach me at 631-338-9917.

Related Posts: How to structure a wellness program to keep your employees healthy

Friday, November 20, 2009

Employees see in dollars NOT percentages

When you’re a business owner for the most part fixed costs are good, unfortunately the way healthcare is that part of your business is anything but fixed. As time goes on people get married, divorced, and have children, and your plan becomes more and more costly but your employees don’t always see the value.

Repeat after me, “People see in dollars, NOT percentages”.

I used to work with an investment advisor, who told me a story once. When he was starting out, he was evaluating client’s portfolio and asked the woman (In a down market) if she would be happy with a 10% rate of return on her $300,000 investment. The woman thought for a second and said to him “That’s the best you can do?” The advisor was confused, as no one had ever given him that response before. He then asked the woman “would you be happy if I was able to earn you $30,000 a year in interest?” The woman almost did a double take and said “Are you kidding me? That would be incredible”. The morale of the story is… PEOPLE SEE IN DOLLARS NOT PERCENTAGES.

So, how does this relate to Employee Benefits? If you’re a business owner and your giving your employees a fixed dollar amount toward their benefits employee can quantify that and will appreciate it. Your employee now becomes aware of the TOTAL cost and will be thankful for what you offer them. Instead of them saying “I have to pay $400 toward benefits” like there getting a discount, there actually saying “My employer paid $400 toward my benefits and I have to pay the other $400”.

Sometimes employees are just handed the bill for there benefits, and they have NO IDEA how much you contribute for them. Let them know, they’ll tend to appreciate you more.

Also, when your renewal comes in and its more expensive, you can say to them “I decided to contribute $420 this year” and you look like a hero.

Where this also helps the businesses save money is you can offer multiple plans but keep your benefit cost fixed.

Here’s an example below:

Option 1 Plan Cost: $1200
Option 2 Plan Cost: $1000
Option 3 Plan Cost: $800

If you decide to pick up 50%, you would pay $400 for option 3, $500 for option 2 and $600 for option 1. But if you offer a fixed amount, you allow your employee to pick which plan best fits there needs, WHILE THINKING OF COST.

Some clients will prefer the best option (Option 1) but they will be willing to pay the difference because the improved coverage means something to them, they will be grateful that they have the choice. Where as someone who doesn’t care about benefits or a drug card (Maybe a 25 year old) doesn’t want to pay more and will be thankful they also have a choice.

Remember… “People see in dollars NOT percentages”.

If you have any questions you can always reach me at 631-338-9917.

Tuesday, November 17, 2009

Why pay for one plan, when you can have two or three…

The startling thing that I’ve encountered with businesses is they only offer one medical plan.

Why do you think that’s the case? Because they didn’t no better!

I bet if I took out 20 business owners and offered to buy them ice cream the majority of them would say yes… but what if I offered to buy them ice cream with the catch that they can only order coffee ice cream with no toppings? Nothing against coffee ice cream but I’m sure I would get more no’s then when I gave them options… Do you see what I’m getting at? People tend to have different needs, and they tend to value different things. So why only offer one medical plan, when you can have two or three for the same cost?

Most employees will be thrilled that you gave them choices. Maybe they wanted a better drug card, or an improved network. Maybe the most important thing to them is paying the least amount possible. When you have employees from different walks of life they have different needs. Does a 25 year old go to the doctor as often as a 60 year old? NO, at least not usually but let them choose!

THE BEST PART IS… THIS DOESN’T COST YOU MORE MONEY!!! THIS IS A WAY TO OFFER MORE DIVERSE BENEFITS TO YOUR EMPLOYEES WITHOUT ANY ADDITIONAL COST!

IF YOUR BROKER DIDN’T MENTION THIS TO YOU ALREADY, YOU MIGHT WANT TO ASK HIM WHY!

If you have any questions you can always reach me at 631-338-9917.

Wednesday, November 11, 2009

Benchmarking, and why it’s important for your business

Every Business Owner regardless of profession asks me the same question…

What is everyone else doing?

See that’s the thing, no one wants to be left out, left behind. Business Owners like to use their peers as a gauge to see how well their doing. How long would it take for the Yankees to make a big off-season signing if the Redsox made a big splash the day before? I’m sure it wouldn’t take too long.

Whether it’s sales, promotion, advertising, and especially their benefits, Businesses want to stay with the pack. The problem is too often the information they receive is clouded. Most businesses, believe it or not don’t know how many people are on their Medical Plan, what the coverages are, or what their being charged. They can pay too much for benefits, carry additional coverages their employees don’t need or want, or simple hurt themselves by not asking the right questions.

That's why benchmarking can be so valuable. My company collects data from every business we work with, big and small. Whether or not we get the client, we take down their information so we can help advise future clients on what’s going on in the benefits world.

Here’s just some of the information you could gain.

• Medical Surveys – Would it shock you to know 50% of employers don’t survey their employees? How do you know what your employees need if you never ask them. You may be paying for benefits they don’t need nor use.

• Eligibility Audits – Over 65% of businesses we interviewed said they never get updates on who’s eligible for benefits. Things constantly change, and that applies to your employees. They get married, divorced; they retire, have children, and even pass away. But the majority of businesses don’t take a moment to even see if there have been any changes in their employee’s lives. It could simply be that your employees are actually unaware that they have to inform you of the change.

BECOME EDUCATED, KNOWLEDGE IS POWER, AND IN THIS CASE, MONEY! JUST BECAUSE YOUR COMFORTABLE DOESN'T MEAN YOUR IN THE BEST POSITION POSSIBLE.

If you have any questions you can always reach me at 631-338-9917.

Related Posts: Should I hire someone to manage my benefits?

Related Posts: Should my company have an employee advocacy program?

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Tuesday, November 10, 2009

Why You, the Business Owner are Partially Responsible For Your Increased Healthcare Costs!

In this day an age everyone, including myself will say how Health care costs have skyrocketed for the small business owner. Regardless of how this legislation works out, the system is still inherently broken and the BUSINESS OWNER PAYS in the form of skyrocketing renewal premiums!

The funny part is, the small business owner is partially to blame!

Yes, you read correctly, THE BUSINESS OWNER IS PARTIALLY TO BLAME.

I’m sure your first response is how, I’m a business owner and I do everything I can. I’ll accept that you’re an expert in your field, you probably research everything about the changes in your field, what the trends are, where the opportunities are, BUT are you working ON or FOR your business?

Most business owners spend there life wearing multiple hats for their business. They’re the BEST at Sales, Customer Service, and every aspect of their business. So, where do they usually drop the ball?

BENEFITS

Too often as business owners we’re quick to pass the buck on the things we don’t know about. We’d rather be focusing the majority of our time on what we know, OUR BUSINESS.

As a business owner there’s actually a lot you can do, well a lot you can ask your broker to do, IF HE CAN.

Audit your health insurance plan – Too often there are people covered under a plan that shouldn’t be, and the business pays. Examples include divorced spouses, children covered under another plan, illegally listed dependants ex.

Have a Medical Director review the claims- This is important for groups 100 and up, typically your renewals are based upon your prior year’s claims. So “Joe Employee” that had a Rare Disorder that put in a large amount of claims in the prior year but has since retired, is causing your expensive renewal, why? Because, they have doctors looking at your claims but YOU DON’T.

These are just 2 of the ways you can save drastic amounts of money for your business in benefits, UNFORTUNATELY most brokers either can’t or don’t understand how to do this. They just quote rates.

People always tell me "There happy with the plan they have in place" or "they love their broker". I tell these same people I loved black and white TV, til I found out there was color.

BECOME EDUCATED, KNOWLEDGE IS POWER, AND IN THIS CASE, MONEY! JUST BECAUSE YOUR COMFORTABLE DOESN'T MEAN YOUR IN THE BEST POSITION POSSIBLE.

If you have any questions you can always reach me at 631-338-9917.