Enrolling in Benefits

How Running a High-Performing Health Plan is Like Driving a Toyota Prius--and that's a good thing!

I finally got myself a Prius which I’ve been wanting for a long time.  Watching the technology “do it’s thing” in the background while I drive really got my "wheels turning” (pardon the pun) about how health plans with great design and technology behind the scenes are similar.

I finally got myself a Prius which I’ve been wanting for a long time. Watching the technology “do it’s thing” in the background while I drive really got my "wheels turning” (pardon the pun) about how health plans with great design and technology behind the scenes are similar.

For about a decade my Mom had a Toyota Prius.  She absolutely loved it and I got to drive it from time to time.  Sometimes I’d meet up with her midway between my NC home and her SC home and I’d swap my GMC Yukon loaded down with my kids and our clothes for the weekend.  Then I’d get to drive the Prius around visiting a few clients on the way to reunite with them in SC.  I loved scooting around in that little thing and set my sights on owning one someday.

Well, it finally happened.  This week I became the proud owner of a cute pearl white Prius and I couldn’t be happier.  There were 9 miles on it when I drove it off the lot and today (2 days later) there are 400 miles on it.  Funny thing is, half of the “free” tank of gas the dealership put in still remains.  I’m in love.

I’m sure I know what you’re thinking…”but you’re supposed to be a successful benefits broker.  Can’t you afford anything better than a Prius?”  Trust me, with the abuse I put my work car through, I can’t be trusted with a car worth any more than this.  It’s just not a good idea.  After all, I’m not Contorno with his big, fancy car and his personal driver.

Yesterday, as I was driving, I began to pay close attention to the monitors and displays that light up with every touch of the gas pedal.  It shows me when the battery is providing all the power, when the power is coming from a mix of battery and gas and when the car is using 100% gas.  This really got my “wheels turning” (pardon the pun).

I was reminded of how a transparent, high performing health plan works and how a successfully run plan only spends about half as much as a traditionally funded plan that has no view into the actual unit cost of healthcare.  What I’ve told clients and prospects is that because of the technology operating behind a transparent, high-performing plan, it allows the plan to save money even when you’re using the high cost sources of funding like hospitals and facilities.  On the other end of the spectrum, you completely level out your exposure to claims costs (why don’t we call this renewable energy) by embedding Direct Primary Care into your plan design.  That’s just like when your Prius is only using the battery to get you from point A to point B.  Everything in between is a mix of great technology and a smarter use of your plan’s resources.  Just like the gas in your car.

Why is this so important?  Well, we all know that the Kaiser Family Foundation just reported that American families and employers are spending around 67% more on healthcare than they were 10 years ago.  Healthcare has exponentially outpaced inflation and it’s killing our economy, causing wage stagnation and keeping workers from being able to retire on time.

Why do we tolerate this?  Because big insurers are marketing geniuses.  And we bought it hook, line and sinker.  Even though the net promoter score of the major insurers is in the single digits, many American employers are too afraid to design a plan that isn’t run by one of them.  Until now.

At a very grassroots level, employers of all sizes and makeups are seeing the Direct Primary Care practices build a presence in their communities.  Many seek out that care and then decide they want to try it out for themselves.  They’re hooked instantly.  They want to provide it as an option to the rest of their workforce.  They ask their current broker to help them implement it and that’s where the difficulties start.  They hear things like, “this is just an added expense” or “your employees already have all of the doctors in the network” or “this won’t work with your health savings account”. 

As a Health Rosetta Advisor that’s music to my ears.  My most recent client acquisition told me just before I was hired that it was refreshing to hear someone say “yes you can” when cost containment solutions like DPC, transparent pharmacy benefits and bundled surgical agreements were inserted into the conversation.  They told me all they heard from their incumbent broker was how the status quo was the best they could do. 

But not all employers are so bold.  Many are too afraid that their employees are going to revolt at the mere mention of a different insurer.  Well, I’ll just describe the open enrollment meeting at this new client.  The changes were explained, the booklets were passed out, heads knodded, frowns turned to smiles and several employees were giving high fives to the CFO as they walked out of the conference room.  I’d say those employees were pretty happy with those changes.  Here’s the difference.  Instead of employees being given bad news, they were told the following:  “your primary care visits are free” and “your generic prescriptions can likely be dispensed right in your DPC provider’s office, no need for a separate trip to the pharmacy” and “if you follow the surgical advocate’s recommendation of the high-quality provider for your procedure, it’ll be no cost to you.”  I’m no genius, but that sounds a whole lot better than “copays, deductibles, co-insurance and premiums are going up again.”

What’s my point?  As an employer you have options.  More importantly, so do your employees.  Someday you may have to come to the sad reality that your outdated benefits package just cost you the great new hire you were recruiting.  When that day comes you know where to reach me.  I’ll show up in my cute, pearl white Toyota Prius that got me there at a rate of about 60 miles per gallon.

Look Backward to Plan Forward | North Carolina Employee Benefits

We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.

Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.

Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offer

Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”

As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.

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Ask the Experts: FSA Limits | North Carolina Employee Benefits

Question: Our company offers flexible spending accounts (FSAs) for health care and dependent daycare. Our plan limits are the maximum amounts allowed by federal law. Will the IRS increase the limits for 2019? We hold open enrollment in November for employees to make their FSA elections for the following year.

Answer: The maximum annual limits for Dependent Care FSAs and Health Care FSAs are set forth under § 129 and § 125, respectively, of the Internal Revenue Code.

The § 129 (Dependent Care) limits do not change from year to year. They are currently $5,000, or $2,500 if married and filing separately, and they apply on a calendar-year basis. To change them would require a change in law, which is unlikely in the current Congress.

On the other hand, the maximum limit for elective contributions to a Health Care FSA (HFSA) may change from year to year depending on inflation. The limit applies on a plan-year basis and the HFSA limit for a 12-month plan year beginning in 2018 is $2,650. The limit is one of over 50 different tax provisions that is subject to annual cost-of-living or inflation adjustments. Each fall, the IRS announces any changes for the following year. The announcement usually is released in mid-October, which should give employers time to prepare 2019 enrollment materials.

Based on estimated inflation, it appears the HFSA limit will increase from $2,650 for plan years beginning in 2018 to $2,700 for plan years beginning in 2019. The increase will not be official, however, until the IRS announcement is released.

Originally published by www.thinkhr.com

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Custom Benefits Solutions Expands Services

Custom Benefits Solutions Expands Services

With the desperate need to control healthcare costs, employers are eager to have a solution that allows them the advantage of large numbers but the autonomy to create their own destiny.  The current constraints and opaque pricing models of the provider-payer relationship as well as “secret” PPO contracts have yielded a healthcare system that is confusing, hard to navigate and, in some situations, bankrupting to healthcare consumers. These days it takes an employee benefits consultant who understands how to think around problems before they ever really become problems.

Employees get "a free expert" with every open enrollment

Employees get "a free expert" with every open enrollment

Technology makes it easier to do just about everything. It simplifies and speeds banking and paying bills. It allows people to stay connected with colleagues, friends and family in numerous ways. It enables collaboration, creativity and research. But relying on technology alone to solve connectivity challenges can be problematic. Connectivity takes a human touch and that goes the same for employee benefits.

Accolades...

Cristy Gupton has been honored by the National Association of Health Underwriters with the Leading Producer's Round Table Soaring Eagle Award.  The Leading Producer's Round Table sets apart leaders in the benefits industry as experts in their trade and professionals who have a very respectable level of success.