What Taxpayers Need to Know about Reporting Health Coverage on Tax Forms

What Taxpayers Need to Know about Reporting Health Coverage on Tax Forms

While many people know there is a fee incurred by people who do not have health insurance, they do not understand how the Internal Revenue Service knows if they have insurance. When a person enrolls in an insurance policy, information is sent to the IRS by the insurer. Any coverage purchased must meet the minimum essential coverage requirements. If a policy does not meet these standards or if a person goes uninsured, the fee is assessed based on income and every month a person was uninsured or did not have sufficient coverage.

Tax Information
The 2014 tax year was the first year where people had to submit information about their health insurance coverage. This was reported on line 61 of IRS Form 1040. People who had coverage should check the box. For those who did not have coverage, the box should not be checked. For the 2015 tax year and beyond, look for the Form 1095-B from your insurance company. It will be sent out for all policyholders to help them file their tax returns.

What Is A 1095-B?
This form shows what type of coverage a person has, the period of coverage and the person or people who are covered. This includes the policyholder and any spouses or dependents. If there are any adult dependents under the plan, they will not receive their own Form 1095-B. It is not necessary to have the same health insurance plan for spouses and children. However, every person must have health insurance or qualify for an exemption.

Some examples of exemptions include losing a job where the employer provided insurance, moving out of state, incarceration and similar events. When in doubt, discuss these exemption rules with an agent. People who do not have insurance and do not qualify for an exemption will be fined on tax forms for the months they were uninsured based on their total household income. If a person has insurance from one provider for part of the year and insurance from another provider for the other part of the year, that individual should receive two separate Form 1095-B statements.

Expect to see these forms arrive in the mail every year around the time when W-2s, 1099s and other tax forms arrive in the mail. To learn more about exemptions and how to use a Form 1095-B to report insurance coverage, discuss concerns with your agent.

Michael Braun

 

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Filing a Medicare Complaint

Filing a Medicare Complaint

If you believe you have not been treated fairly as a Medicare beneficiary, or if you have not received the benefits you believe you are entitled to, you may file a complaint with the Department of Medicare and Medicaid Services.

To complain about a specific doctor, nurse or other care provider

The best way to complain about a medical care provider is to contact your state medical board directly. This is the appropriate route for complaints about unprofessional or unethical care, incompetent practice, practicing without a license, etc.

To complain about a hospital or clinic

If you want to file a complaint about a hospital, clinic or other facility, contact your state health department. This is the appropriate avenue to take for facilities that are unsafe, have poor access for the handicapped, have air conditioning or heating issues that impact care, have poor food, poor housekeeping or unsanitary conditions.

To complain about quality of care

To complain about the quality of care you received at the hands of a Medicare provider, contact your Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO).

Examples of quality of care complaints include:

  • Drug errors
  • Unnecessary treatments
  • Unnecessary surgery
  • Premature discharges from hospitals
  • Not getting adequate treatment when your condition changes.
  • Poor or incomplete discharge instructions

To complain about your prescription drug plan

If you have a problem with your prescription drug plan and you want the Department of Medicare and Medicaid Services to address it, you mist file the complaint within 60 days of the event or events leading to your complaint.

To do so, contact the plan directly, either in writing or over the phone. Generally, you must be notified of the action or decision regarding your complaint within 30 days of the day your plan receives your complaint.

If your complaint arises because the plan has not made a fast coverage determination and you have not received the drug, the plan must respond with a decision within 24 hours of the time it receives your complaint.

Other plan complaints

For more general plan complaints about such things as customer service, access to specialists, problems with the processing of an appeal, or complaints about information you receive or don’t receive from your plan, you should consult the contact information on your plan membership card.

Complaints about durable medical equipment

To file a complaint about durable medical equipment (DME), contact your supplier first. Your supplier must acknowledge your complaint within 5 calendar days, and send you the result of their investigation within 14 calendar days, per Medicare rules.

If this is not sufficient, call 1-800-Medicare and request your complaint be forwarded to the Medicare Competitive Acquisition Ombudsman (CAO)

Complaints about kidney care

If you are receiving treatment for end-stage renal disease (ESRD) and you have a complaint about your facility, you can contact your ESRD network and file a complaint with them. You may do this if you cannot resolve your complaint at the facility level or if you wish to remain anonymous. This route may be appropriate for complaints about your dialysis or kidney transplant center.

You may file a complaint, for example, if your dialysis shift conflicts with your job and you cannot get your center to change your shift so you can work.

You may also contact your state survey agency if you believe you cannot resolve the situation with the clinic, or if you wish to remain anonymous.

You can find a directory of ESRD Network Organizations here.

Need Assistance?

You can contact your State Health Insurance Assistance Program (SHIP). Assistance is free.

You can contact us as well.

Mike Braun

mikebraun@franklinbenefitsgroup.com

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Special Enrollment Period for Individuals

The Centers for Medicare and Medicaid Services (CMS) announced a new Individual Health Insurance Marketplace Special Enrollment Opportunity beginning on March 15 through April 30. This Special Enrollment Opportunity is for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in a Federally Facilitated Marketplace (FFM) states.

Who is Eligible
Your clients who live in a FFM state are eligible for this Special Enrollment Opportunity if they:

  • Are not currently enrolled in health coverage through the FFM for 2015,
  • Attest that they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the penalty or shared responsibility payment after Feb. 15, 2015, when Open Enrollment ended, in connection with preparing their 2014 taxes.

State-based Exchanges (SBE) have the flexibility to determine whether they will establish a similar special enrollment period. Check specific SBE websites for additional information.

What This Means
Your eligible clients will have the opportunity to purchase an On-Exchange Individual Health Plan from March 15 through April 30.

  • Enrollments made by the 15th of the month will have coverage effective on the 1st day of the following month.
  • Enrollments made after the 15th of the month will have coverage effective on the 1st day of the second month.

Please contact us at 610-427-8122 for a consultation.   If you would like to see a quote you can also go to

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When Urgent Care is a Better Option than the Emergency Room

 

When it comes to emergency care and emergency rooms in hospitals, what exactly is a true emergency? It is not uncommon to walk into an emergency room and see an overly-concerned parent bringing in a child with a small scrape, an uninsured person visiting the ER for an ear infection because lack of insurance prohibits doctor visits, and a person with severe chest pain. Of those three, the person with chest pain is experiencing a true emergency. That pain could be an indicator of an impending heart attack.

A real emergency is an event that could result in loss of a limb or loss of life. Chest pain and injuries due to serious accidents or gunshots are priorities in hospital emergency rooms. Loss of consciousness, abdominal pain that could indicate appendicitis and broken limbs are also examples. Many people in emergency room waiting areas complain about long waits, but they are also usually the ones who come in with issues such as a sprained ankle or back pain. Health experts emphasize that emergency rooms never have been and never will be based on the concept of first come, first served.

They also point out the topic of urgent care. This is several steps down from emergency care, and it includes issues that need to be addressed quickly. Cuts that may need stitches, possible infections, sprained ankles, dog bites and severe muscular pains are all examples of incidents that require prompt attention but are not considered threatening enough to send a person to the emergency room. Urgent care clinics are usually open past regular business hours. This means a person who has an issue such as a cold or sore throat that needs attention but not immediate attention could also be seen if it is not possible to come in during day hours to a physician’s office. At urgent care clinics, people are usually seen in the order the show up.

Health experts recommend urgent care clinics for issues that are not true emergencies, because people who need urgent but not emergency care will almost always be seen faster at an urgent care clinic. Emergency rooms are crowded, busy and very expensive. It is much more affordable to visit an urgent care clinic. Insurance companies assign higher copay amounts to emergency room visits than they do to urgent care visits. For example, an insurer who may charge a $20 copay for a regular doctor visit may also charge $100 for an emergency room visit. However, the copay for urgent care on that scale would likely be about $40 or $50.

People who visit emergency rooms for all health issues instead of obtaining insurance these days are only hurting themselves. Affordable plans can cost a person much less than even half of one emergency room visit for a sore throat today. Emergency room care includes high fees for the use of emergency services as well as lab fees, testing fees and many other increased charges. For those who have free medical care, it is important to take advantage of urgent care services when an issue must be addressed immediately. Always remember that if the issue may not result in loss of a limb or life, visit the urgent care clinic to avoid waiting and overcrowding the emergency room. It is also a courtesy to people who are suffering true emergencies and the staff who need to treat them. To learn more about what insurance covers or what affordable options are newly available, discuss concerns with an agent.

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Buy Your Own Health Insurance – Get a Tax Break

 

The government wants you to have health insurance. So much so that it will actually penalize you if you go without health insurance – by as much as 2 percent of your household income in 2015, or $325 per person for the year ($162.50 per child under 18), up to $975 per family, whichever is higher.

But Uncle Sam has a carrot to go along with the stick – it actually encourages the ownership of health insurance by providing tax incentives to help make the decision to buy coverage easier.

Self-Employed Individuals

Self-employed individuals may be able to deduct the cost of their health insurance premiums for themselves and their families – up to the amount of earned income claimed for the year.

Health insurance premiums are considered an adjustment to income, and hence are “above the line” deductions. That’s good news, because it means you don’t have to itemize your expenses in order to take the deduction. You can take the tax benefit while still opting for the standard deduction. It’s also not subject to the 10 percent of adjusted gross income threshold that generally applies to medical expenses if claimed as miscellaneous itemized expenses on a Schedule A.

You do need to file using a Form 1040, however. You cannot use a Form EZ.

You must have paid the premiums yourself, however. If someone else can take a tax deduction for your premiums, then you cannot subtract your health insurance premiums from your income.

You can only claim this deduction if you are not eligible for an employer sponsored plan, and eligibility is determined month-by-month. So if you were laid off or left a job for six months out of the year and paid your own health insurance premiums (including COLA premiums) then you can deduct the cost of premiums paid those six months.

Lower-income Families

Lower-income Individuals and families can take advantage of a new premium tax credit to help them afford health insurance coverage purchased through an Affordable Insurance Exchange. You don’t have to have a high income to take advantage of this provision; the credit is refundable, so it still works for people with little or no income tax liability. The credit also can be paid in advance to a taxpayer’s insurance company to help cover the cost of premiums.

If you make over 400 percent of the federal poverty level, however, you will likely not qualify for this credit.

If Your Employer Pays Your Premiums

You are not taxed on premiums your employer pays on your behalf for group coverage. You cannot claim a deduction on any premiums your employer paid on your behalf – your employer is already claiming that deduction (However, if you are the owner/employee of your own corporation, you can have your corporation pay the health insurance premiums. This may help you if your corporate tax rate is higher than your personal income tax rate – but don’t forget to account for Social Security Taxes in this scenario!

Long Term Care Insurance

You may be able to deduct premiums paid for qualified long term care insurance, depending on your age. These premiums are also ‘above the line’ deduction, noted on Page 1 of your Form 1040, so you do not have to itemize your expenses in order to take advantage of the deduction. It is also not subject to a 10 percent of AGI threshold.

Your allowable deduction is based on your age (or your spouse’s age, if your spouse is the insured), and increases as you get older. For 2015, allowable deductions are as follows:

  • 40 or younger:                                                          $380
  • More than than 40 but not more than 50:                     $710
  • More than 50 but not more than 60:                          $1,430
  • More than 60 but not more than 70:                          $3,800
  • More than 70:                                                         $4,750
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Between Jobs? What To Do About Health Insurance

These days it happens more and more. You’ve been downsized, underemployed, divorced from someone with access to group health insurance, or your employer has simply decided to discontinue a workplace plan. What now?

Many times, the choice comes down to purchasing insurance in the private market via a broker, or to continue enrollment in the employer’s old plan via COBRA – a special program that entitles certain individuals to continue coverage under the employer’s old plan for up to 18 months.

COBRA doesn’t apply in every situation. If you were fired for cause or voluntarily left your employer for example, or if your employer did not have enough employees, you may not be eligible. To be covered under COBRA, an employer must have at least 20 employees, either full- or part- time, on 50 percent of its typical business days or more during the previous calendar year.

Also, there has to have been a ‘qualifying event’ to trigger COBRA eligibility. These include:

 

  • Terminations for reasons besides “gross misconduct.”
  • Reduction in hours worked

For dependents – that is, for spouses and children of workers in COBRA eligible plans, a qualifying event could involve a divorce or legal separation from the worker, the death of the worker, or the worker qualifying for Medicare and therefore losing eligibility for the workplace plan.

If you do lose access to your health care plan, and you are, indeed, covered under COBRA, how can you choose between continuing via COBRA or going out on the open market?

 

  • Compare COBRA premiums with broker-sold quotes. Because of the way insurance companies price large groups, COBRA may make sense for older workers. Younger workers, on the other hand, may be better off going through an insurance broker because they can frequently offer better pricing for younger ages.
  • Check open enrollment. By statute, you can only enroll in an ACA plan via the exchanges through March 31st.

In the Affordable Care Act Marketplace, you generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. If you don’t have a special enrollment period, you can’t buy insurance through the Marketplace until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 30 days.

 

  • Calculate your income. If it’s below 400 percent of the poverty level for a family of your size, you may be eligible for a subsidy under the Affordable Care Act – provided you go through the online exchanges to purchase a policy. As of 2014, the cutoff for subsidy eligibility for individuals was an annual income of $45,960. The cutoff for couples is $62,040, and the cutoff for a family of five is $110,280. Amounts in some areas like Alaska and Hawaii are higher because of the comparatively high costs of living in those states.

 

  • Examine provider networks. HMOs and PPOs tend to offer lower premiums than comparable indemnity plans, but restrict your options when it comes to providers, doctors, clinics and hospitals.

 

Many insurance policies available on the exchanges have severely restricted networks of authorized care providers. Keep that in mind as you shop for insurance coverage. If you are COBRA eligible, however, ask you HR department about some help paying COBRA premiums. Many times, severance packages also include some additional amounts to offset COBRA premiums for laid-off employees.

 

  • Consider how much you have already paid toward this years’ deductible. Have you already had medical expenses this year? If so, that could be a vote in favor of COBRA, since your expenditures would count against any deductibles for this year. If you switch to another plan you may well have to meet a whole new deductible before benefits kick in.

 

Many times, a knowledgeable agent is able to bring a great deal of value to the table. Because an agent has a wider variety of plans to choose from, and he or she knows your personal situation, an agent can reduce the amount of time spent searching for the ideal plan and refer you to the insurance policy that is best tailored to your individual circumstances.

Click here to get a quote.

You can also consider Short term medical insurance as well.

 

Mike Braun

Leading Times Insurance, LLC

610-427-8122

 

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Insurance Agents vs. Payroll Providers – Who Do You Want to Call When Your Business is On The Line?

For many years, insurance agents and brokers have worked side-by-side with payroll service providers, cooperating and combining their separate skill sets for the benefit of their small business clients.

In recent years, as competition tightened across the board, we have seen an increasing movement on the part of payroll service providers to offer services and products and solutions that have traditionally fallen under the purview of the insurance agent.

Payroll service providers in many cases bring the advantages of economies of scale and a seamless integration with payroll software currently in place. After all, it’s their program!

And so we are seeing payroll providers call on business owners to offer things like workers compensation quotes, business and umbrella coverage, and other basic programs.

But insurance is much more than a matter of providing a quote. The most suitable plan for small business owners is rarely the cheapest. Insurance planning is a matter of using multiple insurance products and solutions in combination to protect the unique risk profile of the client – whether that client is a business, the business owner, or an employee and his or her family.

It’s a matter of core competencies. Payroll service providers are experts at efficiently moving dollars between accounts via sophisticated computer programs. But very few payroll providers understand your people like an experienced insurance agent.

By the time a typical insurance agent becomes a multi-line benefits broker with a sizeable small business clientele, he or she has generally done hundreds, if not thousands, of detailed fact finders not just with business owners, but with workers just like your employees and families just like those of your employees – at the individual level.

He or she has asked them what happens if the breadwinner dies tomorrow? What happens if the breadwinner or a stay at home spouse becomes disabled tomorrow? How will college be funded? How will the healthy spouse, or a surviving parent, continue to work and manage child care and home duties at the same time?

Asking these difficult questions at the individual family level, and sensitively designing insurance solutions for your workers families as well as for your own needs as a business owner or principal.

There is nothing in any payroll company’s list of core competencies that is a substitute for what insurance agents do best – protect people.

Another core competency is in the area of specialty lines – some of which few people outside of veteran property and casualty agents have even heard of.

Is your business in an antique building? Do you need specialized errors and omissions coverage?  Do you have unique concerns about wildfires, flooding and contents coverage? Directors and Officers liability? Do your employees ever drive their own cars on company business? If the answer to any of these three questions is “yes,” you may need some special underwriting attention from a veteran agent who has shepherded cases through underwriting and managed claims many times before, at multiple insurance carriers.

That’s when your relationship with your insurance provider matters the most – when the chips are down and everything is in crisis and when all seems lost. When you pick up the phone, do you want to call the agent who lives, eats and breathes insurance? Or do you want to talk to someone for whom insurance is merely a sideline to their payroll processing business.

The difference is clear – when the claim is on the line, you want an insurance professional handling it. Not a payroll vendor.

by Mike Braun, Leading Times Insurance, LLC 610-427-8122

www.ltiins.com

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What to Know Before Enrolling in Medicare

 

Medicare is the government-sponsored health coverage for people who are 65 years of age or older or those who are under 65 but are disabled. People whose spouses have worked at least 10 years in the United States or people who have received SSDI benefits for two years may be eligible for both Part A and Part B coverage. There are four parts of Medicare.

Part A
This is also known as hospital coverage, and it compensates for inpatient hospital visits, some extended home health care and skilled nursing care.

Part B
This is the medical insurance part of Medicare, which covers doctor visits and most outpatient treatments. It also covers some home health care, physical therapy and medical equipment.

Part C
This is the Medicare Advantage Plan, and private insurers with Medicare contracts offer it. Part C coverage may be offered as POS, PPO, HMO or MSA plans. It may also be offered in a plan featuring fees for services. There are more benefits than found in original Medicare in Part C coverage, and there are low premiums or no premiums depending on circumstances and insurers. Copay amounts and out-of-pocket maximums vary.

Part D
This form of Medicare coverage applies to prescription drugs. It may be combined with Part C coverage or purchased as a standalone policy. The types of drugs covered and the percentages vary from one insurer to another, and the premiums also vary depending on several factors.

How To Enroll In Original Medicare
During the three months before a person turns 65, he or she can apply for Medicare. The best way to do this is to discuss the details with an agent. Every person’s circumstances vary, and agents can recommend options that will fit each person’s needs best. In addition to Advantage plans, there are also supplemental plans and retiree plans. After being approved for Medicare, coverage will begin on the first day of the following month. People who do not enroll in Part A, Part B and Part D when eligible may be subject to a penalty for late enrollment, which is added to the premium amount. It is important to note that Part C and Part D plans have regulated enrollment, so there are open enrollment periods. These usually occur during the fall each year. In most states, enrollment can occur during any time of the year for Part A and Part B. Failing to apply on time will result in medical questions being asked for these parts. However, Part C and Part D plan sponsors cannot ask medical questions aside from whether a person has been diagnosed with end-stage renal disease.

How Much Does Each Part Cover?
Coverage amounts are subject to change from one year to the next, so it is best to discuss the current copay amounts, coverage limits and out-of-pocket limits for each plan with an agent. Premiums will vary depending on circumstances and plan details. Some people may also be eligible for extra help. People who have low income may qualify for special plans that pay the Part B premiums or offer reduced fees for prescription drugs through Part D. To learn more about these options, discuss concerns with an agent.

Not all people may need full Medicare coverage. Those who have employer-sponsored health plans may not need coverage from multiple Medicare parts. In some situations, people who are working may be able to delay their Medicare enrollment. Individuals who receive Railroad benefits or Social Security will automatically receive their cards, but a person does not have to be receiving Social Security to sign up for Medicare.

If you would like more information on Medicare, please contact me at the information below.

Mike Braun

Leading Times Insurance, LLC

mikebraun@ltiins.com

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Voluntary Benefits Menu Is Bigger and Better Than Ever

It turns out that there is life beyond major medical. This is important for employers to take to heart because some of the other forms of employer benefits will soon take on increased importance in the medical insurance landscape in workers eyes. The reason: Once the employer mandates for the Affordable Care Act become effective, almost every good-sized employer will have to offer a major medical plan. Even where they don’t, workers with health concerns will be able to buy them off of federal or state exchanges (assuming they will be fully functional by then!)

At that point, your voluntary benefits package will take on much greater importance in the eyes of your work force. To recruit and retain the very best, most profitable employees, you should consider offering one of the very best, most robust menus of employee benefits – including employee-paid voluntary benefits, which you can provide at no cost to you, the employer.

Why offer voluntary benefits?

According to the 2013 MetLife Survey of Trends in Employee Benefits, 65 percent of employees report that their group life, dental and disability insurance plans (short-term and long-term) were important reasons to stay with the company. Furthermore, over six in ten – 62 percent – report that these benefit packages were important reasons they chose to join those firms in the first place.

Non-Traditional Benefits.

Carriers and brokers offer online calculators and decision-making tools – designed to help minimize the need for day-to-day handholding on the part of your human resources staff.

What’s Available?

Almost everyone knows to ask about health insurance now. But there is a wide array of less well-known benefits that have proven to be enormously popular, where offered, and are proven contributors to employee recruiting and retention. You can offer many of these benefits with little or no incremental costs simply by tacking them onto your existing benefits administrative systems.

 

  • College savings plans
  • Identity theft protection
  • Fitness club memberships
  • Ticket discount programs
  • Legal services insurance
  • Critical illness insurance
  • Supplemental medical insurance, such as accident, hospital indemnity and cancer insurance
  • Limited medical plans
  • Tuition assistance plans
  • Disability insurance
  • Smoking cessation and weight loss programs
  • Dental
  • Vision
  • Voluntary term life insurance
  • Voluntary whole life insurance or universal life insurance (with cash values)
  • Computer purchase and financing programs
  • Auto financing programs
  • Pet insurance

And much more.

Carriers are adding innovative solutions all the time. In the end, you can be confident that each of your employees will find a close match with their own interests and desires. For example, more and more employers are learning that lenders are willing to extend credit on better terms to employed individuals paying by payroll deduction rather than via more traditional means. This is beginning to make itself felt in increasingly common computer purchase programs and programs for auto and home insurance.

The right mix for you depends on your employee demographic, income and education levels. If it’s been a while since you’ve explored the voluntary benefits and cafeteria/Section 125 options available to you, chances are you will find there has been a lot of innovation and development since then.

If you are looking for new ideas to enhance employee loyalty and help retain the best talent possible, voluntary benefit programs, available at little or no cost to the employer, are better and more powerful than ever.

Mike Braun

Leading Times Insurance, LLC

mikebraun@ltiins.com

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Controlling Health Benefit Costs: What We Can Learn from The Best

 

For all the difficulties with the rollout of the Affordable Care Act, there has been some good news: The rate of increase in health care spending has slowed to about 5.1 percent between 2012 and 2013 – which is more than inflation, but actually the slowest rate of growth posted in 15 years. Nevertheless, average employer is now shelling out over $9,000 per year in employee medical insurance costs.

Towers Watson, a global human resources consulting company, surveyed over 500 large employers about their health insurance and employee benefits offerings and strategies, and how they fit into what they call their EVP – their employee value proposition.

Towers Watson analysts then identified those companies who were most successful at controlling their employee benefit cost increases. Specifically, they took a closer look at those companies whose increases were half of the mean increase for other large employers or less – and identified the key measures these companies were taking to rein in costs.

Many of these companies had pools large enough they chose to self-insure. This isn’t an option for small employers, however. Of the cost-saving measures these successful companies were making, here are the ones most relevant to the small business owner who contracts with a health insurance carrier to provide medical insurance.

 

  • The most successful companies at controlling costs also frequently consolidated health and productivity programs under a single vendor.
  • They adopted “account-based” health plans such as health savings accounts that give employees additional flexibility and responsibility for their own health care costs.
  • They contributed to HSAs on behalf of employees.
  • They emphasized the tax and other benefits of HSAs in communications to their employees.
  • They provided meaningful incentives to employees to lose weight or quit smoking – and involved spouses in the effort.
  • They emphasized the transparency of health care costs by providing actual costs per service to employees.
  • They invested in communication and educational resources for employees, to include leveraging social media such as blogs to bring information to workers.
  • They expected employees to take more responsibility.
  • They extended incentives for maintaining good health to spouses of employees as well.
  • They leveraged corporate communication resources to create a “culture of health.”
  • They offered telemedicine for some professional consultations.
  • They retained a pharmacy benefit management (PBM) vendor, or took other steps to reign in increasing exposure to soaring pharmaceutical costs. A PBM vendor is a company that oversees pharmacy benefits within the organization. The PBM can arrange pharmacy networks, leverage volume for discounts, take advantage of cost savings by using mailed prescriptions and e-prescribing, and negotiate volume discounts with drug manufacturers. These can be separate companies or they can be operations set up within larger health insurance and health care organizations.

The keys to success in controlling your costs are going to be in understanding what your EVP to employees is, how your medical benefits fit in to your overall compensation package, and overall employee health profile.

That said, some companies are taking concrete steps to improve their employee health profile. For example, some companies no longer hire smokers at all, and some impose a cap on body mass index on new hires. The military has been actively releasing overweight servicemembers for generations with the express purpose of limiting later health care costs, particularly with regard to retirees.

The full 40-page Towers Watson report, the 2013 18th Annual Towers Watson/National Business Group on Health, Employer Survey on Purchasing Value in Health Care, is available here.

For a consultation please contact us at the number below.

By

Michael Braun

Leading Times Insurance

610-427-8122

mikebraun@ltiins.com

 

 

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