Transitioning to Medicare

Self-Funded Health Plans

When employers self-fund their own group health plan, they will benefit from a significant savings in the overall cost of their benefit programs.  For example, savings may be in premiums, increased cash flow and certain tax advantages.  Additionally, employers have more control over the benefits that the plan offers. Typically, self-funding was not available to small employers in the past.  However, today self-insured group health plans are considered to be good options for both small and large employers.

How self-funding works.

A self-funded group health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. Then, a third party administrator (a TPA) is engaged to handle claims and processing.  Self-insured employers run the risk of large catastrophic claims. As a result, they need to purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers save a significant amount of money on premiums and other advantages.

Partially- Funded Health Plans

Shared Funding Plans allow small employers to take advantages of all the cost saving and benefit design features of a self-insured plan.  Typically, these plans have been designed for larger groups. However, in today’s market, any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan.

How partial-funding works.

An employer will select any of the fully insured plans that the carrier offers.  Then rates will be determined by the group’s claim history.  Next, stop-loss insurance is added to protect against catastrophic claims.  Since the carrier will handle the administration of the plan, there is no need to hire a separate vendor to handle claims and processing.

Advantages of Shared Funding

The premiums for shared funding plans are generally much lower than fully insured plans.  That is because the employer shares some of the risk. Additionally, an employer may save even more by implementing wellness programs into the benefit programs.  Our thorough plan analysis will help you determine if shared-funding is right for your company.

Group Disability Insurance

National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Thus, savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit.

Here’s how Disability plans work.

Short Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Group Dental and Vision

Employees always appreciate dental & vision coverage as part of the benefits package. We offer both dental and vision as part of the employer sponsored package or on a voluntary basis.

Dental Plans

Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Vision Plans

Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.

Group Life Insurance

Employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. Thus, you should consider life insurance a key part of the benefit package for your employees. And, also a valuable tool in attracting top talent.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, and mortgage. Additionally, it may even pay for their children’s education.

Permanent Life Insurance

This type of life insurance builds cash value which is sometimes used as collateral for loans, if needed. However, most employers only offer basic term life insurance (see below), but also offer permanent life insurance on a voluntary basis. Even so, employees appreciate the opportunity to widen their safety net.

Term Policy

This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

Traditional Health Plans

A Health Maintenance Organization (HMO)

An HMO group health plan requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Thus, members are required to designate a primary care physician within the HMO.  Then, the primary care physician treats and directs health care decisions.  In addition, the primary care physician coordinates referrals to specialties within the HMO network.  Accordingly, HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”).  However, most HMOs charge a small co-payment depending upon the type of service provided.

Preferred Provider Organization (PPO)

If you belong to a PPO group health plan, you will save the most money on healthcare if you use providers within the PPO network. Thus, if providers outside of the network are used, it is possible that those services may be covered only partially or not at all.  Also, deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits and some other healthcare services.  However, the great thing about a PPO is it’s rich network of quality doctors and healthcare facilities, and the ability to utilize healthcare services outside of your deductible.  For example, doctors visits.

Health Savings Account (HSA)

An HSA combines a high deductible, lower premium group health insurance plan (PPO) with a savings account.  Accordingly, both employer and employee can contribute, tax-free, to the savings account. Then, the account is used to help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.

Health Reimbursement Account (HRA)

An HRA combines high deductible, low premium health insurance plan with a tax favored savings account.  Consequently, this plan requires that the employer contribute to the savings account.  Then, the account can be used to fund co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.

Single, Dual or Triple Option Plans offer eligible employees a choice between several different types of plans as described above.

Through our thorough analysis and plan design process, we can help you determine which traditional health plan is right for your company.

Flexible Spending Accounts (FSA’s)

A Flexible Spending Account is a cafeteria plan under Section 125 of the tax code. It is a tax-favored savings account and is funded solely by the employee through regular pre-tax payroll deductions.  The funds from the account can be withdrawn tax-free to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Additionally, employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. For example, the average working employee in America spends more than $1,000 annually on these types of benefits. By participating in a FSA, an employee always has cash to pay for these expenses, and as an added benefit, their taxable income is reduced which also increases the percentage of pay they take home.

Health Reimbursement Accounts (HRA’s)

An Health Reimbursement Account pairs a high deductible, low premium health insurance plan with a tax-favored savings account to cover the high deductible.  The plan requires that the employer contribute to the savings account.  The account can be used to reimburse employees for co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.

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Dental Plans

Individual dental plans are inexpensive and can contribute greatly in promoting overall good health. Studies have shown that regular dental exams can optimize oral health to prevent cavities and bad breath. In addition, they help to detect serious medical conditions such as heart disease and diabetes. Some studies have even shown that people who have dental insurance suffer less from depression.

Dental plans can range from a PPO or HMO to Pre-Paid, Fee-for-Service, and Discount on a variety of diagnostic and preventative care services including cleanings, exams, x-rays, fillings, orthodontia for children, and emergency care while traveling.

Individual Vision Plans

Take care of your eyes with an individual vision plan that can be purchased separately or combined with your major medical insurance. Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on routine eye care, such as exams, eyeglass frames and lenses, contacts, and even offer big discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts, and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol.

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