on & off exchange, with or without subsidy
for times of transition, limited benefits
when traveling abroad, don’t go without coverage
Dental & Vision Plans, Hospital/Doctor Indemnity Plans, Accident, Critical Illness, Telehealth, RX Discount Plans – pays benefits in addition to your regular health insurance
First passed in 2010, and constantly changing, the rules of the Affordable Care Act is healthcare reform that impacts how employers provide benefits for employees. As group insurance experts, the consultants of Healthfirm Benefits strive to stay knowledgeable in all state and federal laws concerning employee benefits, and we are mindful of new rules and regulations as they are established, including those of the Affordable Care Act.
We provide the following services to ensure employers avoid penalties and remain compliant with the ACA.
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We assure clients keep up with the requirements of the ever-changing Affordable Care Act |
Individuals and Small Businesses may be eligible for a tax credit under ACA healthcare reform laws. Thus, the credit is applied as a discount on your monthly insurance premium. Accordingly, to see if you are eligible for a tax credit, please use the Subsidy Calculator provided by the Health Insurance Marketplace. Or, if you are a business, use the Small Business Tax Credit Calculator provided by the Health Insurance Marketplace. In any case, both businesses and individuals must purchase benefits through the Health Insurance Marketplace to secure their tax credit.
EMPLOYERS: Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. Accordingly, if you are in non-compliance, you will incur a penalty of $2,140 per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).
INDIVIDUALS: Following is information on the Individual Mandate of the ACA. However, note the tax penalty for individuals has been recently repealed. The penalty, prior to 2019, affects individuals who fail to obtain qualifying health insurance. Individuals can have coverage through their employer, or through an individual policy to satisfy the requirement. Accordingly, if you do not have qualifying health insurance, the tax penalty will be $695 for adults. Additionally, the penalty is $347.50 for each child. However, the maximum family penalty is the greater of 2.5% of income, or three times the adult penalty, which is $2,085. Consequently, your penalty will be applied on your annual tax return.
Your employer paid benefits must comply with the “Essential Benefits” of ACA. Specifically, to be in full compliance with the law, your insurance policy must cover at least 60% of the costs of the following essential benefits. If you purchase an individual policy from the marketplace, it’s likely that your policy will also contain these benefits.
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A critical illness can prove disastrous to the financial future of both you and your family. Fortunately, surviving cancer, heart disease, stroke or other chronic illness is becoming increasingly common with medical advancement. Critical Illness and Critical Care Plans can help reduce the personal financial impact of these illnesses. The cost of fighting or recovering from these illnesses and keeping up with everyday bills can quickly add up. This supplemental policy will provide a lump-sum cash payment when all policy terms and conditions are met. See plan summary for more information. If you have a health insurance plan and/or disability insurance, this policy will provide benefits in addition to your other coverage.
Key Features Of Critical Illness Insurance:
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Employers receive a customized benefit portal with benefit descriptions, HR forms, and other tools to handle onboarding and benefit enrollment, create reports to send data to their payroll, compliance, administrators or any other vendor.
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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.
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. Dental, vision and hearing wellness benefits may be included.
Group Long-Term Care plans are becoming an increasingly common voluntary benefit offered by employers today. The prospect of long-term care is one of the most important issues your employees may have to face. The cost of long-term care is expensive and generally not covered by other employee benefits, disability or even Medicare.
If someone requires long-term care, it is not just an emotional strain but a financial one as well, impacting retirement savings and overall financial position. Savvy employers know that access to additional resources can increase employee productivity when confronted with managing long-term care situations. Long-Term Care plans demonstrate to your current and prospective employees that your company cares about them–increasing the ability to attract and retain the very best talent.
Most LTC plans are designed to provide benefits for care through nursing homes, assisted living centers, home health care and adult day care.
Employers can provide a base benefit while giving the employees the opportunity to “buy up” and obtain the level of coverage that they need for their families.
National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Thus, savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit.
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.
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.
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 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.
A Flexible Spending Account is a cafeteria plan under Section 125 of the tax code. In other words, it is a tax favored savings account and is funded solely by the employee through regular pre-tax payroll deductions. Accordingly, the funds (account) can be withdrawn tax-free to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Additionally, employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. For example, the average working employee in America spends more than $1,000 annually on these types of benefits. By participating in a FSA, an employee’s taxable income is reduced, which increases the percentage of pay they take home.
Employees always appreciate dental & vision coverage as part of their Employee Benefits Package. We offer individual, group or voluntary Dental & Vision through many of our major insurance carriers.
Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.
Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.
Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.
Employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. Thus, you should consider life insurance a key part of the benefit package for your employees. And, also a valuable tool in attracting top talent.
Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, and mortgage. Additionally, it may even pay for their children’s education.
This type of life insurance builds cash value which is sometimes used as collateral for loans, if needed. However, most employers only offer basic term life insurance (see below), but also offer permanent life insurance on a voluntary basis. Even so, employees appreciate the opportunity to widen their safety net.
This type of life insurance 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. Additionally, some policies may also make payments upon terminal or critical illness.
When employers self-fund their own group health plan, they will benefit from a significant savings in the overall cost of their benefit programs. For example, savings may be in premiums, increased cash flow and certain tax advantages. Additionally, employers have more control over the benefits that the plan offers. Typically, self-funding was not available to small employers in the past. However, today self-insured group health plans are considered to be good options for both small and large employers.
The experienced benefit consultants at Healthfirm Benefits specialize in helping employers set up and maintain self-funded health plans. Accordingly, we would be happy to give you a no cost analysis to determine if a self-funded health plan option is right for your company.
A self-funded group health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. Then, a third party administrator (a TPA) is engaged to handle claims and processing. Self-insured employers run the risk of large catastrophic claims. As a result, they will purchase stop-loss insurance to protect them in such an event. Even with the additional expense of stop-loss insurance, employers can enjoy saving thousands in premiums and other advantages.
Shared Funding Plans allow small employers to take advantages of all the cost saving and benefit design features of a self-insured plan. Typically, these plans have been designed for larger groups. However, in today’s market, any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan.
An employer will select any of the fully insured plans that the carrier offers. Then rates will be determined by the group’s claim history. Next, stop-loss insurance is added to protect against catastrophic claims. Additionally, just like an insured plan, the carrier will handle the administration of the plan. This includes processing claims, in addition to offering members online access to their benefits.
The premiums for shared funding plans are generally much lower than fully insured plans. That is because the employer shares some of the risk. Additionally, an employer may save even more by implementing wellness programs into the benefit programs. Our thorough plan analysis will help you determine if shared-funding is right for your company.
An HMO group health plan requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Thus, members are required to designate a primary care physician within the HMO. Then, the primary care physician treats and directs health care decisions. In addition, the primary care physician coordinates referrals to specialties within the HMO network. Accordingly, HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). However, most HMOs charge a small co-payment depending upon the type of service provided.
If you belong to a PPO group health plan, you will save the most money on healthcare if you use providers within the PPO network. Thus, if providers outside of the network are used, it is possible that those services may be covered only partially or not at all. Also, deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits and some other healthcare services. However, the great thing about a PPO is it’s rich network of quality doctors and healthcare facilities, and the ability to utilize healthcare services outside of your deductible. For example, doctors visits.
An HSA combines a high deductible, lower premium group health insurance plan (PPO) with a savings account. Accordingly, both employer and employee can contribute, tax-free, to the savings account. Then, the account is used to help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.
An HRA combines high deductible, low premium health insurance plan with a tax favored savings account. Consequently, this plan requires that the employer contribute to the savings account. Then, the account can be used to fund co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.
Single, Dual or Triple Option Plans offer eligible employees a choice between several different types of plans as described above.
Through our thorough analysis and plan design process, we can help you determine which traditional health plan is right for your company.
A Long Term Care Plan augments your health insurance or Medicare and pays for services associated with performing tasks required for daily living such as dressing, bathing, eating, getting in/out of bed, toileting, walking or other basic activities. These services fall under skilled care or personal care and are the types of services that regular health insurance, Medicare or Disability generally does not cover.
As stated, long-term care is usually not medical care and most often does not require a doctor or a nurse. In addition, the need for LTC is not always age related. In fact, statistics tell us that more than half of all individuals age 65 & over will need LTC at some point. Even so, it is important to note that roughly 40% of those receiving LTC today are between the ages of 18 and 64.
Why LTC Insurance?
Regular health insurance, Medicare or Medicaid typically will not pay for Long-Term Care services. The cost of LTC can quickly add up and burden those closest to you, both financially and emotionally. Purchasing a LTC plan can help you avoid those difficult situations, as well as give you the power you need to maintain control of your care, choosing the facilities that best suit your needs. Thus, instead of allowing welfare or the government to make your LTC decisions for you, you are in charge. Additionally, you should be aware that Disability Income Insurance is not designed to cover LTC expenses, but simply replaces part or all of your income during your working years should you become disabled. You need specific coverage to pay for long-term care needs.
Here are examples of what LTC policies may cover:
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Disability Insurance protects your ability to earn a living during your working years. In other words, it protects one of your most valuable assets. And, this is pretty important considering that statistics show our chances are greater of becoming disabled than dying between the ages of 25 & 45. During the time you are unable to work due to a qualifying disability (illness or injury), the replacement of your regular income through a monthly benefit provided by disability insurance helps to maintain your pre-disability lifestyle.
Employers often provide standard short-term disability (STD) and long-term disability (LTD) insurance to meet federal guidelines. Individual disability income insurance can be customized to meet your needs and considers your occupation, age, income and other factors in determining your cost and monthly benefit payment amount.
What type of coverage is available?
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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 pays a lump-sum payment directly to the insured. The cash payment helps with out-of-pocket expenses and covers you when you are off work due to a hospital stay. The coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.
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Accidents can happen anytime. As a supplemental health insurance, Accident Insurance is very affordable and provides benefits in addition to your regular health insurance and/or disability insurance, in the case of a accidental injury. Thus, Accident Insurance can go a long way to protect you from financial hardship due to a great deal of medical, recovery and out-of-pocket expenses that follow accidental injuries.
In the event of a covered accident, Accidental Injury insurance pays benefits directly to you* or anyone you assign. How you use the money is up to you. Cover deductibles and copays for primary care visits and physical therapy, emergency treatment, hospital stays, medical exams, transportation and lodging needs, along with other expenses that regular health insurance doesn’t cover when you have an accident. Some policies can even pay benefits in as little as one day, based on time of claim submission*
Advantages:
*Benefits are only payable when all policy terms and conditions are met – see plan summary for more information.
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Individual dental plans are inexpensive and can contribute greatly in promoting overall good health. Studies have shown that regular dental exams can optimize oral health to prevent cavities and bad breath. In addition, they help to 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.
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.
Take care of your eyes with an individual vision plan that can be purchased separately or combined with your major medical insurance. Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on routine eye care, such as exams, eyeglass frames and lenses, contacts, and even offer big discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams 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.
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