Managing employee benefits takes extensive time and resources. Here at Health Insurance Consultants Inc., we take the guesswork out of cumbersome topics like COBRA Administration, health, dental, life, accidental death insurance and more.
Our benefits consulting team works alongside your internal management team to develop a customized and innovative strategy. We utilize our specialized partners and industry experts to meet the needs of your business and employees. Our consultants will provide:
- Employee Surveys
- Market Analysis
- Create a Benefit Strategy to Align with Company Mission and Values
- Assist in Creating a Benefit Committee
- Contract Review
- Develop Mid-term to Long-term Benefit Goals
When it comes to health and dental insurance, there are hundreds of options for employers to choose between. A typical employer policy can cover costs for categories like medical expenses, prescription drugs, doctor’s visits, and much more.
As you can imagine, navigating the benefit world on your own can be complicated. With so many providers and offers, it’s not easy to find the right fit. We’ll work with you to identify criteria for your ideal health insurance plan and then bring together a set of competitively priced policies that match your company’s priorities.
Many employers consider their staff to be family. A great life insurance policy provides your employees with peace of mind knowing their loved ones are going to be taken care of.
At Health Insurance Consultants Inc., we strive to find group term life insurance solutions that cover your highest priorities – from strong death benefits to low premiums, and everything in between. With over two decades of experience and industry relationships, we negotiate with carriers to get the most competitive rates.
Small-group health insurance offers medical coverage for businesses with 50 or fewer full-time employees. It provides employers with the opportunity to buy directly from an insurance company by using either a broker, private exchange, or their state’s network. Small group premiums are set by the insurance company, and once set, premiums are non-negotiable and can’t be discounted. Small group plans are community rated which means everyone in a given area pays the same price for their health coverage regardless of the group’s claims experience.
Large group health plans cover employers with 51 or more full-time employees. What makes them different from small group plans is that premiums are negotiated between the employer and the insurance company, usually through a broker or benefit consultant.
This gives larger businesses a bit more flexibility, and can lead to more comprehensive plans at a lower cost. Large group health insurance is medically underwritten at the time of purchase, with rates based on employee participation and prior claims experience. Medical underwriting refers to the process by which a health insurer uses a group’s medical claims history, typically from the last year and in some cases two years, to determine the rates for the upcoming year. In a large group employment situation, employees are not generally asked to fill out a medical questionnaire prior to obtaining coverage.
Self insured means employers choose this model of funding to pay for health claims from company assets and employee premiums. Self-insurance allows employers to pay only for actual claims, instead of the fixed premiums of fully-insured plans.
There are a lot of different acronyms out there, but basically the below components and options make up a package that allows you to become self funded.
- Third Party Administrator (pays claim / runs plan): Basically you’re breaking apart the pieces and then bundling them back together. A Third Party Administrator (TPA) is going to be the entity that will pay the claims and administer the plan.
- Provider Network (physician, clinic and hospital discounts): You’re still going to need to have a network. When you go see a doctor or have an event at a hospital, you’re not going to want to pay billed charges. You’re going to want to pay discounted charges that come from having a network. The network will also protect you from being balanced billed.
- Pharmacy Benefit Manager (PBM) : You’re also going to want to have a PBM, i.e. a pharmacy benefit manager. PBMs are organizations that secure discounts on prescription drugs.
- Stop Loss Protection:
- Specific Stop Loss (SSL)– 25K to 75K (Employer risk per member): Specific stop loss is basically the maximum risk that an employer takes per covered life under the plan. As an example, a self funded group with 150 lives and a $60,000 risk means the maximum they pay out of their own pocket the first $60,000 of any claim in a calendar year. Then the rest is covered by the insurance carrier. For some groups that are taking that first step into self funding, that may be too big a risk. As a solution you can actually buy down the specific to $25,000. This is simply an example of how you can control your risk on large claims.
- Captive Stop Loss – SSL up to 250K (Captive risk per member): The second layer of stop loss is where the captive comes into play . You have your company’s specific risk up to $25,000, and then the captive takes the risk from $25,000 up to $250,000. As a result if you have a claim that goes to $50,000, you pay the first $25,000 and the captive picks up the next $25,000.
- Reinsurance Over 250K to Separate Insurance Carrier: You want to pass any substantial large claims to an insurance carrier, and the captive as a whole buys protection. Then if you have a large claim, the first $25,000 is your responsibility, and the next $225,000 would be the captive’s responsibility. Anything above $250,000 is ceded to a reinsurance carrier.
A group captive is an insurance company owned and controlled by its shareholders. Typically the shareholders are of similar-sized companies that join together to form a “small insurance company.” The captive, (small insurance company), then buys insurance to protect against large losses and provide policy forms and the “A” rated insurance policy required by most companies. 100% of the underwriting profits and investment income of the captive are distributed to the shareholders/policy owners.
The captive concept is not new. Today, there are over 7,000 captives as more and more business owners exit the traditional insurance marketplace for an alternative to gain ownership and control of their insurance programs.
Who are Captive Candidates?
- 75 – 300+ Employees
- Stable Workforce
- Good Demographics
- Strategic Long Term Buyer: Moving into a captive or a self funded arrangement is not something that you just try out for a year. It is a commitment. It is something you need to go into with an understanding that you’re moving down this path because there are other things than just pure cost savings you are looking for, such as transparency, access to claims data, and more predictive modeling.
- Fully Insured and Frustrated with Lack of Control and Lack of Access to Data
- Historically Good, Stable Claims Experience and Rates
- Focused on Risk Management with Wellness Intent: Lastly the employers that get into the captive are going to be focused on risk management, and they are good performing groups of individuals. Then we add a wellness program on top to make sure we’re controlling the risk on an on-going basis as well.
Health Savings Accounts (HSA) are a type of savings account that lets individuals set aside part of their income in order to pay for qualified 213(d) expenses. All money added to this account is free of taxes, and caps out at $3,600 for self-only plans, and $7,200 for family coverage for the 2021 plan year. These limits are adjusted annually.
A Health Reimbursement Arrangement (HRA) is an employer-funded account that helps employees pay for qualified medical expenses not covered by their health plans. Your employer sets aside a fixed amount of money to your HRA each year for you to use. The money is available to you at the beginning of the year. And, based on your employer’s individual plan, funds may roll over each year. An HRA is funded by employer contributions only.
Flexible Spending Accounts (FSA) are special accounts where employees put money in each month, then use it towards the payment of certain out-of-pocket health care costs. This money is non-taxable, and employers may even make contributions, but aren’t required to.
Voluntary Worksite Benefits
Critical illness insurance provides employees with another source of support if they are diagnosed with one of the specific illnesses on a predetermined list as part of the carrier’s policy. Usually, once diagnosed, the insurer under contract is required to make a single lump sum payment to the insured individual. This money can go a long way, and is great for kickstarting treatment plans right away instead of pushing employees into debt or delaying treatment for falling under the impact of an unexpected illness.
Health Insurance Consultants Inc., provides COBRA expertise paired with an innovative technology platform. Our goal is to ease your administrative burden, fully support your COBRA participants, and reduce employer risk of noncompliance.
Unparalleled COBRA and Regulatory
- Expertise in handling all aspects of COBRA compliance and administration, including day-to-day implementation, regulatory and legislative changes, and Department of Labor rules and regulations
- Total commitment to accurate and timely processing of all notifications to help prevent inadvertent extension of coverage, reducing the overall cost of claims
- Ability to free up your benefits staff to focus on more important issues and avoid the potential. costs associated with noncompliance
Dedicated, Responsive Customer and Client
- Customized support for unique COBRA administrative requirements in regard to severance, leave of absence, and eligibility reporting
- Dedicated, experienced Account Managers
- Dedicated COBRA Call Center for participants