Growth Exchange
THE FUTURE OF FUNDRAISING EVENTS
Health
HSA
FSA
Dental
Vision
Basic Life
Disability
Vol Life
Accident Critical Illness Medical Gap
History of Health Insurance
Civil War era / popular 1916‐1920 ‐ sickness funds ‐‐ Precursor to Private Health Insurance
Early 1930s – Hospital Service Plans – beginning of Blue Cross as sociations
1939 – Medical Service Plans – Blue Shield – paid patient similar to AFLAC plans (indemnity)
1940s ‐ 1950s – expansion of private health insurance Later came HMOs, Medicare/Medicaid
Health
Health Plan Categories
- Employers (<50 employees)
- Grandfathered
- ACA (age rated)
- Level Funded (composite rated)
- Employers (>50 employees)
- Fully Insured
- Self Funded
- Captive
Health Benefits
| Employer with fewer than 50 EEs | |||
|---|---|---|---|
| Grandfathered Plans | Written prior to the ACA | Renewal Pricing is based on health of the employees (according to claims) | Can be negotiated |
| ACA Compliant | Written after the ACA | Pricing is based on age of employee/dependent Determined by the insurance carrier and the state DOI | Not negotiable |
| Level Funded / MEWA* | Popularized after the ACA began | Pricing is determined by the health of the employees. (Based on expected claims)Generally be negotiated | |
Health Benefits
| Employer with 50 EEs or more | |||
|---|---|---|---|
| Fully Insured | Pricing is determined by the health of the employees. (Based on expected claims) | Generally No Claims Data | |
| Self Insured | Set up Stop Loss to avoid large claim impacts | Pricing is determined by the health of the employees. (Based on expected claims) | Claims Data Provided |
| Level Funded / Captive | Provides for claims surplus refund | Pricing is determined by the health of the employees. (Based on expected claims)Claims Data Provided | |
Health Benefits
Considerations for Medical Plans
‐ Types of plans and pricing available are based number of employees (enrolling) and overall health of those employees
‐ Plan Designs
‐ Deductible and Copay Combinations
‐ HSA‐compatible versus Traditional Copay Health Plans
‐ Multiple Plan Options
‐ Doctor / Hospital / Pharmacy Networks
Health Benefits
| Medical Plan Designs | |
|---|---|
| Traditional Copay | HSA Compatible |
| Lowest Deductible $0 | Lowest Deductible $1,250 plus coins |
| Highest Maximum Out of Pocket $9,450 (individual) $18,900 (family) | Highest Maximum Out of Pocket $9,450 (individual) $18,900 (family) |
Health Savings & Flexible Spending Accounts
- Can be entirely employee contribution or include employer contribution
- Annual maximum contribution: $4,150 for employee only or $8,30 0 for family
- Individuals 55 or older can contr ibute an additional $1,000 (ca tch up contribution
- Can be entirely employee contribution or include employer contribution
- Annual maximum contribution: $3,050
- Can also include Dependent Care FSA with contribution maximum of $5,000
- Special considerations regarding FSAs and company liability to discuss
Dental, Vision, Basic Life
- Can be bundled with Medical plan
- Employer Paid vs Contributory or Voluntary
Dental & Vision Insurance
Considerations for Dental and Vision Plans
‐ Plan Designs
‐Percentage of coinsurance / copays
‐ Include orthodontics for children and/or adults (dental)
‐ Include implants (dental)
‐ Dual option (in some cases for dental)
‐ Include a better frames frequency (vision)
‐ Pricing is lower when Employer Paid
Basic Life Insurance
Considerations for Basic Life
‐ Plan Designs
‐ Flat Benefit Amount
‐ Percent of Salary
‐ Plans can offer dependent life options
‐ Generally Basic Life is paid by the employer
Disability & Voluntary Life
- Short Term Disability
- Employer Sponsored, Contributory or Voluntary
- Long Term Disability
- Employer Sponsored, Contributory or Voluntary
- Voluntary Life
Disability Insurance
Considerations for Short Term Disability / Long Term Disability
‐Elimination Periods / Benefit Periods
‐ Short Term Disability can be used for leave after pregnancy
‐ Pricing is lower (on average) when it is Employer Paid
‐ Voluntary disability plans most often have participation requirements and pricing will be based on age and salary of employee
Voluntary Life Insurance
Considerations for Voluntary Life
‐Maximum Life Insurance benefit is set by the insurance carrier
($100,000 or $200,000 benefit for example)
‐ Sometimes offered as Guaranteed Issue (no medical questions) Sometimes they will require medical questions over a certain limit
‐ Voluntary Life Insurance is portable – employees can continue to pay for it at home if they leave your company
Supplemental Plans
Accident, Critical Illness, Medical Gap
- Help fill the gap left with health insurance
- Helps to cover out off pocket expenses
- Generally 100% voluntary, but can create a “benefit bank” to have some employer contribution
Added Services
Other Considerations
‐Benefits Administration System (Ben Admin)
‐ Enrollment Support‐ Analytics
‐ COBRA Administration (20 or more employees)
‐ 1095 Reporting (if applicable)
‐ Employee Communication and Education Pieces
‐ Wellness Solutions‐ Compliance Solutions
Chris Porter (816) 434‐3620 Chris.Porter@Assuredpartners.com
Change Your Mind
What would you like to learn about next?
Is there anything you’d like us to cover in an upcoming Growth Exchange? Be as general or descriptive as you’d like. Your feedback helps us find experts that address your concerns. It also helps our presenters with ideas on what to add to their presentations.
Subscribe to the Growth Exchange
Sign-up to get our Growth Exchange newsletter. Find out what topics we’ll be covering. Get updates on any changes. Get calendar invitations to each of our presentations. And get value recaps after each session.