Insurance World

1. Health Savings Accounts (HSA)

This is a strategy where the employer buys a health plan with a large deductible. Typically, these are groups that are coming from a plan with a very low deductible. Since the higher deductible plans are usually much less money, the money saved is used to put into the employee’s “Health Savings Account.” The money in this account is used by the employee to pay qualified medical expenses. If it’s not used, the money rolls over to the next year. The money belongs to the employee, even if they leave the company.

2. Health Reimbursement Arrangements (HRA)

This is very similar to the HSA above but a portion of the qualified medical expenses not covered by the insurance is “pledged” by the employer, that is, the employer only spends the money, if there is a portion of the bill not paid by the insurance. This would be more favorable to the employer since on an HSA the money goes to the employee, whether there are claims or not. The problem with HRAs is that there are very few carriers that offer them right now.

3. Medical Reimbursement Accounts

This is very similar to HRAs above and extremely flexible. It’s otherwise known as partial self-funding. Employer buys a larger deductible and if the employee uses up that deductible, the employer pays all or a portion of it, depending on how a pre-arranged agreement is written. This goes for other expenses not paid by the insurance. The idea is that the employer self insures the typically smaller expenses with their own cash, (presumably, the savings in premium dollars from going to a higher deductible.) The downside to this is that many carriers prohibit the use of this strategy with their plans. It can be very effective but make sure you use an experienced third party administrator as there may be some legal and tax documentation required. Otherwise known as Section 105.

4. Kaiser.

More and more groups are moving to Kaiser. It is typically, benefit for benefit, less money than just about every other plan. Kaiser is spending billions on the future and their quality control is promising.

5. Offering Blue Cross and Kaiser side by side. Blue Cross has a new program where only five employees need to enroll with Blue Cross. The rest can be with Kaiser. This is a ground breaking opportunity in flexibility.

6. Blue Cross Elect. Blue Cross has a portfolio called Elect with 16 plans in it comprised of HMOs, PPOs, and an EPO plan. Each of these plans is priced from low premiums up to a much higher premium.

The beauty of this program is that Blue Cross allows the employer to “define” how much premium they are willing to pay towards an employee’s cost. For example, Blue Cross offers a $10, $20, $25, $30, $35, and a $40 copay PPO plan. The $10 plan is the most expensive of this group.

After viewing all of the premiums for the various plans, the employer can establish, arbitrarily, which plan they are willing to pay, say the employee only premium for. In this case, let’s say it’s the $25 copay plan. The employee can buy the $25 copay plan and it doesn’t cost them anything. However, if they want the more expensive $10 copay plan, the employer would payroll deduct the difference in premium costs.

Let’s say they have dependents they want to cover but the employer only wants to pay for the employee only. The employee could take the lesser expensive $40 copay plan, and use a little bit of the savings to help them with the costs of adding their dependents.

This has been a highly successful program because it gives the employees a greater number of choices, helping the employees be more definitive in their costs and needs, and at the same time, allows the employer to more efficiently define their costs.

This information is time sensitive and can change at anytime. If you have a question or need more information, please contact me at mail@thestrategyguide.com. –Todd Rich

Todd Rich is an expert on California Small Group Health Insurance Plans and has written four books on the subject. To learn more about Todd and his books, please visit www.TheStrategyGuide.com/ezines

You may view dental insurance as a way for ravenous companies to take yet more money out of your pockets for something you do not really need with you being able to insure just about anything now. Good dental health is not only important for our appearance, it is important for our overall health too as problems in the mouth can often be a sign that something else needs looking at health-wise. A good dental insurance policy can help envelop the costs of dental treatment whether it is an emergency or a routine check up, in the sense that you never have to worry about the cost of keeping your mouth, teeth and gums healthy.

Many healthcare cash plan providers offer cover for dentistry fees up to a set limit within their policies. Now there are also a select number of companies who offer standalone dental insurance. The cover offered by the insurers vary, but depending who take you take a policy out with and whether it is part of a cash plan or a standalone dental insurance policy, you can get cover that will pay for routine treatment, dental emergencies and accidental dental injuries. Currently one insurer provides cover for serious dental problems such as reconstructive surgery including plastic surgery following a dental injury or oral cancer.

General types of coverage:

PPO Plans proffer patients with a group of dentists who’ve agreed to provide care to patients within the group at a discounted fee. In essence the dentist is keen to accomplish less for the view of additional patients. Self Insurance is a pretty option for businesses due to the fact that there is a strong potential for cost savings if services aren’t utilized in any given year. The intricacy with this plan is the administrative headache that often accompanies it.

Direct Reimbursement is analogous to self-insurance. Employees are welcome to choose their own dentist. The patient pays the dentist and is reimbursed by their employer. This approach is attractive to the employer because research shows that over 40% of employees may not require dental work in a given year providing a potential savings to the employer. Closed Panel plans are one of the most restrictive in that they confine the number of available providers. The patient doesn’t get to choose his or her own dentist.

Indemnity Programs are much like many health insurance plans that permit a choice in dentist. They also provide a limit on total coverage and co-pay options. Capitulation provides a contract for service arrangement that pays a specific provider a specified amount each month to cover all treatment. That fee is paid even if no services are rendered. Dental insurance can be affordable and a perk that will be appreciated by employees, but private coverage can also be obtained through a local broker or online.