What is the difference between a Fully-Funded Health Plan and a Self-Funded Health Plan?

A fully-funded health plan is one where the insurance carrier assumes all the risk in exchange for a monthly premium.  They will pay all claims on the plan, and service the plan’s administration.  A self-funded plan requires the employer to assume all the risk, paying all claims on the plan, and will often partner with a PPO to provide healthcare services for the plan.  They will also hire a third-party vendor TPA to service the plan’s administration.  In other words, the employer becomes the insurer.

The main advantage of a fully-funded plan is the employer knows exactly what the plan is going to cost them.  With a self-funded plan, employers benefit from a significant savings in the overall cost of their benefit programs.  Additionally, employers have more control over the benefits that the plan offers.

The downside of a fully-funded health plan is when benefits go unused, the employer does not get any money back.  The downside of a self-funded health plan is the employer runs the risk of a large catastrophic claim and must 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.

Boyce & Associates specializes in helping employers set up and maintain self-funded health plans and would be happy to give you a no cost analysis to determine if a self-funded health plan option is right for your company.

Dental and Vision Plans

Individual Dental Plans
Individual and family dental plans or policies are relatively inexpensive but can go a long way in promoting your overall health. Studies have shown that regular dental exams can not only optimize oral health to prevent cavities and bad breath, they also 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, than those who do not have coverage.

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. Similar to individual dental policies, vision plans are inexpensive and save money on routine exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Monitoring your eye health with regular exams also 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.

Accident Plans

Accidents can happen anytime and bring unexpected costs not fully covered by medical insurance.  Accident Insurance is very affordable and complements your major medical policy, in the case of an accidental injury.

Accident insurance helps to protect your employees from suffering through financial hardship due to a great deal of medical and out-of-pocket expenses that follow accidental injuries. Emergency treatment, hospital stays, medical exams, transportation and lodging needs are just a few of the expenses that accident insurance can help cover. Some policies can even pay benefits in as little as one day, based on time of claim submission.

Critical Illness Plans

Surviving cancer, or a heart attack or stroke, or managing other sudden critical illnesses is becoming increasingly common with the advances in modern medical technology.  Critical Illness Insurance can help your employees reduce the personal financial impact of the cost of fighting these illnesses and keeping up with everyday bills through that process.  If you have a health insurance plan and/or disability insurance, Critical Illness Insurance will provide benefits in addition to your other coverage.

Some key features:

• Lump-sum cash benefit paid directly to you.
• You decide how best to spend your payment.
• No network restrictions.
• Benefit level choices to fit your needs and budget.
• Simple plan options for your needs and budget.

The benefits and riders offered are supplemental and are not intended to cover all medical expenses.  Certain terms, exclusions and limitations may apply.

Hospital Indemnity Plans

Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan is a limited benefit plans that pays a lump-sum payment directly to the insured.

When paid directly to the insured, cash payments help your employees with out-of-pocket expenses and covers them when they are off work due to a hospital stay. There are no plan maximums, however the coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.

Types of Group Health Plans

Health Maintenance Organization (HMO)
A Health Maintenance Organization (HMO) is a group health plan that requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Members will designate a primary care physician who treats and directs health care decisions for the member. Additionally, the primary care physician will coordinate any referrals to specialties within the HMO network. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). Most HMOs charge a small co-payment depending upon the type of service provided.

Preferred Provider Organization (PPO)
A Preferred Provider Organization (PPO) does not require group members to designate a particular provider, however, if they use providers within their network, they will save the most money on their healthcare services. If providers outside of the network are used, it is possible that those services may not be covered at all, so it is a good idea to check first with your PPO.  Keep in mind that deductibles must be met on this plan before some services will be covered.  PPOs generally require a co-pay for physician visits.

Point-of-Service (POS)
A Point-of-Service plan (POS) is a group health plans that is a managed care plan with a twist, in that it combines some elements of both an HMO and a PPO plan. Like an HMO, participants designate a primary caregiver within the network. However, with a POS plan, participants may also use providers outside of network for health care services, but will pay a majority of the cost, unless the primary care provider has referred the out-of-network provider. In such a case, the POS plan will pay for the services.

A new kind of self funding for small employers

Partially-Funded Plans (aka Level-Funded) are a variation of a Self-Funding and allows small employers to take advantage of all the cost saving and benefit design features of a fully self-insured plan, however, they share the risk with one of our top national carriers. The premiums for shared funding plans are generally much lower than fully insured plans. An employer may save even more by implementing wellness programs into the benefit strategy.

Group Dental & Vision

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

We offer Preferred Provider Organization (PPO) designs, Pre-paid and Health Maintenance Organization (HMO) designs as well, with a wide range of deductibles, coinsurance, and maximums options.  These plans offer offer a variety of diagnostic, preventative care and corrective services.  We work with multiple national carriers with the largest dental and vision provider networks in the country for your employees’ benefit.

• Dental coverage includes (but not limited to) cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.
• Vision coverage includes (but not limited to) exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK.

Group Life Insurance

Along with Health Insurance, Life Insurance is considered to be a key part of the benefit package for employees. Besides being a valuable tool in attracting top talent, employees are happier and more productive feeling secure that their loved ones will be taken care of in the event of illness or an untimely death.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, mortgage and even their children’s education as well as offering additional added benefits.  Boyce & Associates can help employers protect their employees and their employees’ families with a variety of different life insurance products.   Please read below for some brief information on the various types of life insurance available and then call us today for more information on our life insurance products.

Permanent Life Insurance
Life insurance that ties premiums to various types of investment accounts (stocks, bonds, money market, etc.) in which the savings can be tax deferred and/or borrowed against, if needed. These policies are known as whole life, universal life and variable life insurance.

Term Policy
Life insurance that 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.  Some policies may also make payments upon terminal or critical illness.

Group Disability Plans

When an employee is unable to work due to illness or an accident, the financial impact can be devastating for them.  When this happens, Disability Insurance replaces a portion of your employee’s income, while they are unable to work.  While worst case scenario might seem remote, employees are often surprised to learn statistics show chances of becoming disabled are greater than dying between the ages of 25 & 45.  In fact, more than one in four 20-year-olds will experience a disability for longer than 90 days before the age of 67.

With these statistics, it is no wonder that national surveys continue to show that Disability Insurance remains of high importance for most employees as an affordable strategy to widen their financial safety net. Those who wish to purchase a wrap-around policy to augment their employer provided coverage may do so.  Bottom line, savvy employers attract and retain top talent by offering Short Term and Long Term Disability as part of the employer paid benefit package or as a voluntary (worksite) benefit.

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.

Tax Advantaged, Cost Saving Employee Benefit Strategies

The following innovative benefit arrangements allow for employers and employees to pay for premiums, healthcare services, and other qualifying expenses, with pre-taxed dollars, saving both the employer and the employee money.

Health Savings Account (HSA)
Many group health plans benefit by having a Health Savings Account (HSA) feature that combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute, tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Then, the insurance will begin paying claims, once the deductible is satisfied.

Health Reimbursement Account (HRA)
A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax favored savings account. Employers contribute to the savings account, which can be used for to fund co-pays and other qualified expenses prior to the deductible being met.

Flexible Spending Account (FSA)
A Flexible Spending Account (FSA) is a cafeteria plan under Section 125 of the tax code and allows for benefits to be paid with pre-tax dollars which results in tax savings to both the employee and the employer.  The average working employee in America spends thousands of dollars annually on certain types of medical benefits, daycare expenses and transportation services. By participating in an FSA, the employee funds the plan through regular pre-tax payroll deductions, which reduces his/her taxable income, and increases the percentage of pay they take home. The account allows them to pay for these benefits and services with the pre-taxed dollars, in essence giving them a discount on these services.  The administrator of the FSA account can issue a debit card that is tied to the FSA making it easy to use the account when needed.

Premium Only Plans
A Premium-Only Plan allows employees to purchase their own individual insurance with pre-tax dollars. In other words, employees can potentially save thousands annually in taxes and premiums combined.  Employees elect a set amount of pre-tax dollars to be deducted from each payroll. Then, the employee purchases an individual health insurance policy from a carrier of their choice.  Accordingly, the employee is responsible for paying the monthly premiums directly to the carrier. Then, the employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars.  After a thorough plan analysis, we can help you determine if a POP program would benefit you and your employees.

Defined Contribution Plans
The benefits of selecting a Defined Contribution Plan are many for both the employer and employee.  An employee is more involved in their own healthcare choices and can choose a plan that is tailored around his/her needs, which reduces risk on employers.  Also, both employer and employee save a significant amount of money on premiums and taxes, while retaining health benefits that are just as good, if not better than a traditional group plan.  Different than the “one size fits all” model, the idea of a defined contribution health plan allows employees to choose a health insurance plan of their choice with funds (a fixed dollar amount – a “defined contribution”) given to them (set aside) by the employer.

Gap Coverage

Gap insurance provides your employees with benefits that supplement their low premium, high deductible major medical health plan. It works by paying a significant amount of the deductible.  More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.  You may find you save more money with a low premium high deductible health plan, along with the additional premium for gap insurance, when compared to one low deductible, high premium plan.

Wellness Benefits

Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy, ultimately reducing healthcare costs all the way around. Your group health plan will generally include the following services designed to promote a healthy life style and identify and treat your most at risk employees.

Healthy Living:

• Promote healthy diet through nutritional coaching
• Promote physical fitness through free or discounted gym memberships, and exercise coaching
• Access to newsletters and online resources for healthy living
• Disease management
• Flu Shots

Health Screenings:

• Blood Pressure Screens
• Cardiac Screens
• Cancer Screens
• Vision Screens
• Hearing Screens

Other Wellness:

• Smoking Cessation Wellness
• Substance Abuse Wellness
• Financial Wellness

For those employers serious about taking wellness to a higher level, as they are keenly aware that healthy employees are less likely to have serious health issues that drive up claims and premiums, we work with vendors that will help you get employees in control of their own well-being. These programs provide your employees with tools and services designed to encourage employees to use preventive care to create healthy living habits and to identify and address early potential medical issues.

Buy-Up or Purchase Additional Coverage

In addition to offering Life, Disability, Dental, and Vision as part of the basic benefit offering, some employees may wish to “buy-up” their employer provided coverage, and/or they may also want to purchase an additional separate policy, either for themselves as secondary or wrap-around coverage, for their dependents.

Protect Your High-Earning, Valuable Key Employees and Your Business

Typical Group Life and Disability insurance offered to employees usually only cover a fraction of a key executive’s high income. Providing a customized benefit package to wrap around the group plan for key executives not only protects the executive and his/her family, but also the business in the event of a sudden critical illness or death. Executive benefits can include supplemental life insurance and/or carve out disability, and plans may be structured to avoid taxation of benefits at the time of claim.

Following are some more specific examples of Key-Person Executive Benefits.

A Key Person Life Insurance policy is designed to protect your business should one of the main partners pass away unexpectedly.  This policy will name your business as the beneficiary and premiums are billed under the business name.  Benefits and premiums are tied the value you have established through financial records. Benefit payments are made to the business to help minimize financial loss should your business lose the insured (key personnel) due to death.

Business Overhead Disability prevents businesses from going under from regular overhead expenses while the business owner is unable to work and run the business due to disability.  These types of policies will typically pay for things like employee salaries, rent and utilities, among other expenses.

Buy-Sell Agreements are intended to protect a business after the death of a key employee.  Buy-Sell Agreements (also known as Continuation Agreements) are tied to and funded by life insurance policies.  The agreement sets out the details of the transfer of business interest by the key-person (or his/her estate) upon a certain triggering event–usually death, disability and retirement.  The surviving or continuing business owner or partner can rest assured knowing that they will be able to purchase the key-person share without interference from other survivors of the key person and his/her estate.

Telemedicine

This Health and Wellness Option is very affordable and gives your employees access to a modern, easy-to-use telemedicine solution for non-emergency illnesses and general care. Members and their families have direct access to fully credentialed doctors, via phone or video consultations, to receive treatment (including prescriptions) and advice for common ailments, including colds, the flu, rashes and more.

More about Worksite (Voluntary Benefits) Benefits

Worksite Benefits, also referred to as “voluntary” benefits, are an essential benefit option that helps to enrich your employees’ lives and safeguard their financial security, all at little or no cost to you.  Premiums are paid by employees at discounted group rates and through pre-taxed payroll deductions.

Worksite benefits play a critical role in helping employees offset rising out-of-pocket healthcare costs by augmenting and enhancing the employer sponsored benefit package. Following are all they many advantages of offering voluntary benefits, and what many employees feel are a “necessity” when searching for a new employer.

• -Allows employees to tailor coverage to fit their personal needs.
• -Creates financial wellness by providing benefits that go beyond traditional employer paid benefits.
• -Lower’s payroll taxes for both employer and employee.
• -Increases job satisfaction, loyalty and employer’s ability to attract the very best talent.
• -Provides a financial safety net for your employees, giving them piece of mind and consequently boosts your morale and productivity.

Additionally, our user-friendly benefit management portal makes it easy for employers to add worksite benefits, without adding costs to the bottom line.

Worksite benefits available include highly desired benefits such as Accident, Critical Illness, Disability, and Life Insurance, as well as telemedicine, Dental and Vision and more.  To get details on these benefits,

and click the links provided.

Legal Shield

Legal Shield is a perk membership that provides your employees with financial protection, and piece of mind, should they ever be facing legal matters (generally only covers civil matters).  The membership will afford them unlimited legal assistance from top law firms for any legal needs they may have. Employees can choose to add family/dependents to plan as well.

Pet Insurance

A trip to the pet can be expensive.  Pet insurance is a healthcare plan that covers the unexpected accidents, injuries, and illnesses of your employees’ pets.  Features include premiums that don’t increase due to the aging of a pet, low deductibles and copays, and easy-to-understand (and use) coverage.  Adding Pet Insurance to the voluntary benefit offering is just one more way you can be looking out for the financial well-being of your employees.

Group Medicare

We help employers who provide medical benefits to their retirees tackle the challenges of ever increasing premiums and health care costs.  We offer a guaranteed issue “true group” approach where eligible employees and their spouses will receive all the benefits of Medicare and more with a quality Group Medicare Supplement through one of our top carriers.

What is a Medicare Supplement?

Medicare Supplement Insurance policies complement your retiree’s original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.