Employee Benefits

As you make choices about the benefits you will make available to your staff, be prepared for the questions and comments your employees may have about how this important coverage will protect them and their families, such as:

• Why do you offer several different plans?
• Do the comparison charts tell me the most important details I need to know?
• Can I change plans later if I don’t like the one I choose now?
• Do you offer a conversion tool so I can compare my current plan to the coverage you’re offering?
• Do you have a plan that offers low deductibles, flexibility, and least amount of money out of pocket?
• Is it better to choose a flexible comprehensive plan?
• What am I losing out on if I choose the least expensive option?

Insurance can be confusing, to say the least. Our goal is to simplify and streamline your decision-making process and serve as trusted advisors as you make decisions about the benefits you will offer your employees.

When plans overlap in the coverage that they offer, when your employees want the best coverage possible without feeling like they’re losing out, when you just need to understand every option available, The Benefits Group is your source for information, support, and group health insurance.

The Benefits Group assists companies every day in the self-funded, partially funded and fully insured markets. The customized services we offer are even more important amid ever-changing government regulations and healthcare options. If you feel forced to reduce employee benefits, shift more costs to employees, or drop coverage entirely, it’s time to seek alternative options to decrease company spending without losing employee coverage completely.

By taking preventive measures and working with The Benefits Group to develop a creative plan design, including wellness programs and HDHP plans, you can design employee benefits that are not lacking in any way. Plus, as an employer you will not only maintain the quality of coverage for your employees, you can lower your costs by as much as 25 percent.

One of the advantages The Benefits Group offers to our clients is the privilege of working with experts in group health care insurance. Our long-tenured employees have seen the many changes that have made this specialized industry shift, prosper, and fail. They are aware of the signs that indicate upheaval or security in the future. And they are well-versed in the many different types of employee benefits options that are appropriate for your employees and their needs.

Our highly educated team works with large companies, small businesses, and everything in between to find the best creative solution for group health insurance. Your engagement with The Benefits Group will begin with the completion of a simple questionnaire that asks for details regarding your employees and benefit wishes. Our team of small group health insurance experts will analyze your needs and shop the market for the best combination of small group coverage and costs.

By aligning with several insurance carriers, we have created a competitive environment that gives the most significant benefits to you – the client. It is our goal to find the best insurance solution for your employees and your bottom line, no matter the size of your organization.

For our benefits consultants to serve you best, and for you to best serve your employees and their varied needs, the following information highlights the services we can make available to you.

All types of health insurance programs have their positives and negatives. The goal should be to elect the healthcare plan with the most beneficial medical benefits for employees and your company budget.

There is also a great deal of blurred lines between certain plans that can make choosing the right plan a challenging decision.

Employees enrolled in an HMO must use a defined set of medical providers and hospitals that are included in the HMO network. The primary care doctor that a patient chooses is their main point of contact for all health issues. Any care needed beyond the primary care doctor’s expertise requires a referral to a specialty doctor who is also within the HMO.

HMOs are low-cost, and they are low-maintenance when it comes to reimbursement claims or pre-existing conditions, which makes them a desirable option. However, being limited to certain doctors and hospitals can be frustrating. The cost of out-of-network services is not covered, though sometimes exceptions are made in emergencies.

A PPO contracts with doctors and hospitals to create a large health network of participating providers accompanied by low-cost office visits and prescription drugs. Those enrolled in the plan will have smaller bills if they use providers who are in network, but coverage for out-of-network providers is also an option; there will simply be additional (but usually reasonable) out-of-pocket costs to cover. A primary care physician and specialists can all be chosen freely and referrals are not necessary. Hospital deductibles are non-existent or very limited.

You may associate POS with retail centers, but this term also applies to certain health care plans. In short, enrollees will pay less for health care if they use providers who are in the plan’s network. Subscribers choose a primary care doctor, and that medical provider can be out of network. However, the subscriber will be subject to increased out-of-pocket costs. Referrals to specialists from a primary care physician are required.

An exclusive plan is limited. When you belong to an EPO, you can only use the in-network medical providers. Enrollees cannot go out of network for medical care; there are no out-of-network benefits. EPO plans have much lower negotiated rates than an HMO or PPO.

Consumer-driven healthcare plans (CDHP) allow the covered party to have greater control over their healthcare dollars. Plans like this typically come with a higher deductible but lower monthly premiums.

High-deductible health plans (HDHP) are a type of CDHP that is growing in popularity. An HDHP comes with a higher deductible and a lower premium. Enrollees pay for routine or minor health care expenses until they meet the deductible, at which point co-insurance kicks in and your medical plan pays a percentage of each charge incurred. The enrollee pays the rest.

CDHPs may be offered in conjunction with tax-free or tax-deductible spending accounts that are eligible to cover qualified medical expenses. These accounts give enrollees more control over healthcare spending and include:

• Health Savings Account (HSA): This tax-advantaged medical savings account is eligible to enrollees in a high-deductible health plan and can be used to purchase qualified medical expenses. Funds contributed to an HSA are not subject to federal income tax at the time they’re deposited. If HSA funds are not used, they rollover and accumulate from year to year.
• Flexible Spending Account (FSA): Populated with tax-free money, an FSA is used to pay for certain out-of-pocket healthcare costs, like copayments, some prescription drugs, certain medical and dental expenses, medical equipment, and deductibles. Employers can make FSA contributions, but this is not a requirement of the account. The FSA contribution amount cannot exceed $2,600 annually. Typically, the funds in an FSA must be used within the plan year or the money is lost, but an employer may offer a grace period to use up the money, or may permit a carryover amount into the following year.
• Health Reimbursement Arrangement (HRA): A tax-advantaged benefit that allows employees and employers to save on healthcare costs, an HRA is an employer-funded medical reimbursement plan. Pre-tax dollars are set aside annually by an employer to pay for an employee’s healthcare expenses. An HRA is very flexible in cost and parameters, which makes it attractive to employers who get to establish what the funds can be used for and the design of the HRA. Plus, the fact that an HRA is used in conjunction with an HDHP means premium costs are reduced and these savings can be used to fund employee HRAs. Employer contributions are tax deductible to the employer and tax-free to the employer.

Employers have the option to offer employees a prescription drug plan as a component of their health insurance offerings. A network of nationwide retail pharmacies is typically included in the plan to supply outpatient medication needs. Some plans offer a convenient mail order service. Depending on the plan’s design, there will be different copays for brand name, generic, or specialty drugs, with the goal always being to offer the most effective medications at the most appealing prices.

Not every employee will opt for dental insurance or discount dental plans, but those who realize the significance of such coverage will be thrilled to know their employer makes it available for a reasonable cost. In-network dental offices provide a range of procedures for an employee and their dependents, such as preventive care in the form of two annual dental exams, two teeth cleanings, and one annual set of x-rays. There may also be significant discounts offered for a range of restorative procedures, such as fillings, root canals, and bridges.

Not everyone wears glasses or contact lenses, so employers or employees may consider vision coverage incidental. However, employees and their dependents who do rely on quality vision care will appreciate the option to participate in a cost-effective vision plan. Benefits may include offerings such as covering one annual exam and providing an allowance toward the purchase of glasses or contact lenses.

If you choose to offer life insurance benefits to your employees, there are many decisions to be made, including what type of benefits to offer, who the coverage applies to, and the optimal amount of life insurance to offer. For example, full-time employees may have the opportunity to say yes to group term life insurance benefits as well as group accidental death and dismemberment, split-dollar, or business travel accident insurance.

While life insurance is an optional benefit, insuring a group means your company and employees can potentially benefit from lower rates. There are many life insurance vendors, and choosing the right provider for your employees and administering benefits is a heavy decision.

Many employers are not willing to leave disability to chance and therefore offer disability plans to their employees. These income insurance plans typically cover a portion of an employee’s income in case of an accident or illness that limits a person’s ability to work. Short-term disability and long-term disability are both options that employers can pursue, and they can cover everything from the birth of a child to cancer, a disabling injury to a mental disorder, heart attack to lengthy illness.

Some employers may want to limit their monetary contribution to employee benefits but still offer various types of coverage to their employees. Voluntary benefits are paid completely by employees through the deferment of their pay and can include accident insurance, life insurance, disability, vision, dental, and cancer and critical illness insurance.

Employers want their employees to thrive and do their best possible work every day. Life does happen, though, and challenges will arise that could negatively affect job performance or health and wellness. Employee assistance programs are voluntary, work-based programs that offer free, confidential assessments, short-term counseling, and follow-up services to employees with personal or work-related problems, from mental instability to substance abuse, grief to family problems.

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) has made it possible for an employee to temporarily keep their health care coverage after employment ends. COBRA requires the employer to offer continuing group health coverage at group rates for employees who are losing coverage because of retirement, termination, or reduction of employment hours.