Posts Tagged ‘Plans’
Many employers in California do not realize that paying for employee’s individual health insurance policies presents many problems. There can be liability for the employer in doing so. Let’s look at the implications and understand why providing Small Group health insurance to your California employees is important.
First, we need to understand the differences between Small Group health or employer sponsored health insurance and individual/family or private insurance. Small Group is quite different in a few key ways. First, it is governed by California law AB 1672. Among many provisions set forth in AB 1672, Small Group coverage is guaranteed issue to qualified small companies with 2-50 employees. This means that a person with a legitimate employer-employee relationship (can be full or part-time depending on group preference) cannot be declined due to health.
Individual/Family health insurance is quite different in this respect. Individuals must qualify based on health in a process called medical underwriting. They can be declined coverage have rates increased based on their health history or status. This difference in medical qualification is a big issue for small groups that pay for individual health insurance plans for their employees if the group is eligible or capable of providing group health. If an employee is declined coverage and/or suffers a major medical bill, he/she can go after the employer saying that the employer should have sponsored a qualified (guaranteed issue) group health plan. This assumes that the employer met the requirements under AB 1672 to offer such a plan. As an employer, you also do not want to know too much about an employee’s health status. If you need to let the employee go, there can be issues in knowing that they were declined individual health insurance. Keep a good separation from this knowledge to avoid issues in hiring/firing.
Employers usually offer individual plans based on cost but the difference hardly justifies this exposure to liability. In California, the employer can pay as little as 50% of the employees health insurance premium and with options such as Employee Elect through Anthem Blue Cross, an employer can now offer a full range of plans to each employee with a fixed contribution (dollar amount or a percentage of a given plan).
The other main issue deals with the tax treatment of employers paying for employee’s individual health plans. Officially, only a qualified group plan premium for employees can be deducted as a business expense. Paying for individual health plans generally cannot be deducted. Make sure to run your company’s situation by a tax professional but this is a major drawback for paying for individual health plans.
In summary, with all the options, both from a plan and cost perspective, on the market, small group health insurance makes the most sense. Run your instant quote and please let us know how we can help investigate your Small Group health insurance options. It is important to avoid the liability of employees not qualifying for individual health plans due to health history and to make sure you take advantage of the tax benefits associated with paying for qualify Group health plans.
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With open enrollment season upon us, consumers have a chance to evaluate these consumer-driven plans and decide if these new options might be right for them. Past editions of this study have accurately predicted other health care changes, so these findings carry a great deal of weight among industry leaders.
Consumer-driven health plans, which include health reimbursement accounts and health savings accounts, are high-deductible medical plans that are coupled with a savings account. Employees can use those funds to pay their health care costs.
With lower premiums than traditional health insurance plans, consumer-driven health plans enable consumers to choose what kind of health care services they would like to receive, making them more active participants in the decision-making process.
Nearly 30 percent of employers are planning to offer these consumer-driven health plans, and employees will need to determine if they are ready to switch to this new way of approaching health care.
The study also revealed that there is not much hope for those awaiting nationalized health care. Only 3 percent of respondents felt that there was a likelihood of adopting a single-payer system and only 7 percent saw U.S. government mandates in America’s future.
While the future of health care is still unknown, the study predicts that America is headed toward private market initiatives to help solve this crisis.
Health insurance concerns almost everybody in the US these days. You may get a health plan from an employer, but probably have some options to choose from, and that choice can be confusing. Millions of Americans do not get health insurance at work, and they need to find coverage on the individual health plan market. Finding an affordable and quality medical plan is even more complex than choosing a group benefit from work!
The best choice for you, and your family, will depend upon many things. For one thing, available policies vary by local area or zip code. Your age, health status, budget and expectations will also affect your choice.
Younger families, without any severe health problems, will probably have an easy time finding affordable coverage. Older Americans, who are not quite old enough for Medicare, will have a harder time. And of course, those who already have a serious health issue will have a harder time finding a low cost medical policy, if they can find a private plan that accepts them at all!
If you do get declined for individual health insurance, know that every state has a high risk plan to cover people like you! You should find a qualified insurance agent or your state insurance commission in order to find out what the next step is in your state.
If you get accepted, but a health condition causes a rate increase that really strains your budget, consider raising the deductible. The premium difference between a $500 deductible and a $2500 deductible can be hundreds of dollars every month. When faced with high costs of medical coverage, people need to purchase a policy to save them financial collapse, and not to cover every small expense.
PPO plans are popular because they use a network to contain costs, but still allow some flexibility. In general, a covered person may leave the network if they accept less coverage. Of course, emergencies and some other limited situations will still provide full coverage. Make sure you check with your insurance company if you seek non-emergency coverage outside the network.
HSA plans work with a health savings account, and they allow a participant to make tax deductible contributions to an interest earning account. This account can be used to pay a higher deductible on health claims, and also for some other medical services. This is a good choice for good savers. The HSA money rolls over, so you never lose your contributions if you do not use them. Then, at Medicare age, you can withdraw the money without a penalty.
HMO plans use a nework, much like a PPO. The difference is that under most situations, they will not provide any coverage for non-network medical services. Of course, emergencies are generally covered. Certain medical services that are not provided by the HMO network may also be approved for coverage, but that needs to be authorized before seeking care.
In order to find the best health coverage for you, and your family, compare the available plans, and make sure you understand your policy. In my experience, people tend to be satisfied with their coverage when they understand it before they have to make a claim!