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?
Related Posts: What do out of network benefits really mean
Related Posts: Benchmarking and why its important for your business
Wednesday, December 30, 2009
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
Related Posts: What's a H.R.A & How is it different then an H.S.A?
Related Posts: What's the difference between an H.S.A & a F.S.A?
Related Posts: Should I consider a High Deductible Plan?
Related Posts: Using a Health Savings Account to pay for Cobra
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
Related Posts: What's a H.R.A & How is it different then an H.S.A?
Related Posts: What's the difference between an H.S.A & a F.S.A?
Related Posts: Should I consider a High Deductible Plan?
Related Posts: Using a Health Savings Account to pay for Cobra
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?
Related Posts: Should my company have an employee advocacy program?
Related Posts: Benchmarking and why its important for your business
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?
Related Posts: Should my company have an employee advocacy program?
Related Posts: Benchmarking and why its important for your business
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
Related Posts: What's a H.R.A & How is it different then an H.S.A?
Related Posts: What's the difference between an H.S.A & a F.S.A?
Related Posts: What's a Health Savings Account (H.S.A) and why I should consider one
Related Posts: Using a Health Savings Account to pay for Cobra
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
Related Posts: What's a H.R.A & How is it different then an H.S.A?
Related Posts: What's the difference between an H.S.A & a F.S.A?
Related Posts: What's a Health Savings Account (H.S.A) and why I should consider one
Related Posts: Using a Health Savings Account to pay for Cobra
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
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
Subscribe to:
Posts (Atom)
