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


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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.


Michael Braun

Leading Times Insurance





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Top 10 Health Services Commonly Excluded from Plans

The new Affordable Care Act law does not mean everything will change. Experts say many services that were excluded prior to the law remain unchanged. They examined over 3,000 health plans in 2014 to see which services were the most commonly excluded. Their data showed that about 80 percent of exclusions were unchanged prior to and immediately after the new law taking effect. The following were the top 10 services most commonly excluded.
1. Weight Loss Surgery
Nearly 60 percent of plans exclude this type of surgery following the new health care law taking effect. Prior to that, 90 percent of plans excluded weight loss surgery. Experts said they were surprised that 40 percent of programs still excluded the surgery and similar programs as well due to the high rate of obesity in the United States. However, counseling and screening for obesity is provided as preventative care without the need to pay upfront.

2. Eye Exams For Adults
Slightly more than 60 percent of plans exclude this benefit, which experts say is disappointing due to the many benefits of eye exams. They point out that optometrists can detect diabetes and other health problems early on with this simple type of exam. Not many providers offer standalone vision plans. While 50 percent of large employers offered standalone dental plans, less than 20 percent offered standalone vision plans.

3. Private Nursing Care
More than 65 percent of plans now exclude this benefit. However, that number improved within the span of one year. In the past, more than 90 percent of plans excluded private nursing care.

4. Infertility Treatments
Experts said more than 65 percent of plans exclude fertility treatments. This number was down from before. The amount of plans excluding these treatments before the new law took effect was nearly 95 percent. Since the average cost of each cycle is over $12,000 and most people need multiple cycles, the procedure was widely inaccessible for most people before the new law’s introduction.

5. Regular Foot Care
More than 70 percent of plans now exclude routine foot care, but the number was higher before the new law started. Researchers say that the law has a large influence on the individual market for health insurance, but they said the effect on most of the excluded services was less extensive.

6. Acupuncture
Nearly 85 percent of plans exclude acupuncture, but more than 90 percent of plans excluded it prior to the Affordable Care Act. Researchers said that acupuncture is a good solution for chronic pain. They think doctors should recommend it more often for arthritis or other ailments that are ongoing.

7. Weight Loss Programs
Less than 90 percent of plans cover weight loss programs, but nearly 95 percent excluded them before the new law’s beginning. Experts find this disappointing due to the many serious health problems that are related to obesity.

8. Dental Services For Adults
Slightly less than 90 percent of plans exclude adult dental care. This number is actually an increase from prior years. In 2013, barely more than 80 percent of plans excluded dental care for adults. However, the new law provides for pediatric dental and vision care.

9. Cosmetic Surgery
More than 90 percent of plans exclude cosmetic procedures. In the past, over 95 percent excluded it, so this is a slight improvement for people who may need cosmetic surgery.

10. Long-Term Care
Barely less than 100 percent of plans exclude long-term care. It was rarely included in health plans in the past, and it is still the most commonly excluded health care service. This type of coverage includes services for people who need to live in skilled nursing facilities for long periods of time due to disabilities or chronic conditions. While some younger individuals require this form of care, it is most common among the elderly.

Many people visit sites online to try to shop for insurance.  Please call us for a wide range of options.


Michael Braun



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Can you Really Keep your Doctor with a Narrow Network?

One of the key selling points of the Affordable Care Act was the promise that “you can keep your doctor, period.”

Not so fast.

In fact, millions of Americans who have or will be signing up for medical coverage via the online exchanges established by the ACA are due for a nasty surprise: Most of the plans available via the exchanges come with significant network restrictions, and in many case will not provide in-network coverage to the most sought-after hospitals, clinics and physicians in their markets.

The issue: In order to control costs, the Affordable Care Act relies a great deal on the managed care model employed by health maintenance organizations (HMOs) preferred provider organizations (PPOs). Here’s how it works:

Managed care organizations try to get as many subscribers as possible within a certain market, such as a city, state or zip code. They then approach the medical care providers in the community and use their large subscriber base as a bargaining chip. They offer the medical care provider or institution the prospect of a significant flow of referrals. In exchange, they ask hospitals and clinicians to take a much lower reimbursement rate.

The arrangement is known in health care circles as the “narrow network” concept. The smaller the network, the more value the stream of referrals has to those providers included in the network. Expanding the network to too many care providers also dilutes the value of the stream of providers.

The result: the system is skewed in favor of the lowest cost providers. Those with higher fees – the best specialists and hospitals in the greatest demand, and who have made the most investments in technology and training, for example – get locked out of the process. They cannot underbid the low-cost providers.

Exclusions Abound

Across the country, individuals purchasing or shopping for coverage via the networks are discovering that many or most plans don’t cover the best local hospitals. For example, the venerated Cleveland Clinic accepts dozens of private health plans offered via independent health insurance brokers and through carriers outside of the ACA exchanges. But if you buy your plan through the exchange in Ohio, only one exchange plan out of the twelve offered provides in-network coverage to the Cleveland Clinic.

As another example, Southern California Health Net has announced that individual plans sold via exchanges in that market will have access to less than a third of the number of doctors available via employer plans. Furthermore, while all the exchange plans include the Los Angeles County hospital system, most of them will not provide in-network coverage to the most respected private hospitals like Cedars-Sinai, or the top research hospitals like UCLA.

Additionally, Seattle Children’s Hospital – a popular and respected institution in Seattle, Washington, has filed a lawsuit against the state because it has been excluded from the exchanges. Of the seven plans available in King County, only two of them provide in-network coverage for Seattle Children’s Hospital.

“The notion that a major insurance plan is going to exclude us from their network is truly precedent-setting,” said Sandy Meltzer, a physician and the hospital’s senior vice president, in an interview with the Seattle Times. “[It] represents a new level of degradation in children’s access to care.”

 The Bottom Line

When it comes to health insurance, the monthly premium cost is only a small part of the big picture. The proper way to evaluate any health insurance policy isn’t just premium. Instead, you should consider how likely you are going to be to be satisfied with your care options in the event you have a claim. That’s why you should look carefully not just at your premium and deductible, but also read the fine print and find out whether you will have access to the best providers in your area.

It may well be that your independent insurance advisor has options for you that you would never find on the exchanges. Indeed, many carriers have opted out of the exchange system for a variety of reasons.

Please call us for a consultation to review networks and plans.

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Working with an Agent Instead of a Navigator has Multiple Benefits

Millions of people will be purchasing health insurance through marketplaces, which are part of the Affordable Care Act provision. In doing this, some consumers face problems with program access due to site failures on the Internet. One option most people forget about or are not told is available is the opportunity to purchase coverage through an agent or broker. These professionals can provide enrollment assistance and valuable advice, and they are able to answer most questions.

There are also navigators, which are not the same as professional brokers and agents. Navigators are paid by the government, and they are not able to provide as much assistance as a broker or agent could. These navigators are prohibited by law to make recommendations or give advice about policies. In the majority of states, navigators do not have to be licensed, and they do not have to comply with the same continuing educations requirements that professional agents are required by law to meet. In addition to this, navigators are not required to keep the professional liability coverage that agents must purchase.

Most independent brokers and agents have been trained to provide assistance to people who are trying to enroll in health plans. They are also able to make consumers aware of options that are not offered through exchanges. Experts point out that choosing a health plan is a serious step that should involve research. It should not be the same as going online and purchasing commodities. Buying inadequate coverage could cost a person his or her life or life savings if something goes wrong.

In addition to the problems consumers could face if they use navigators, experts point out that navigators cannot provide prompt assistance. With the many site issues online associated with the enrollment page, there is a backlog of people waiting for help. About $67 million was put into funding the enrollment efforts, but navigators still have to wait for issues to be fixed despite this investment. As they continue to sort through the piles of paper applications, they will slowly be able to provide limited help to consumers. People who are concerned about obtaining coverage in the time allowed will have better luck talking to a professional broker or agent. Since there is not a great deal of time left to purchase coverage, it is important to contact an agent or my firm as quickly as possible to discuss concerns and ask questions.

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Who’s Paying for it?

Who is going to pay the bills when they come due for insurance.    People that buy coverage through the and receive a subsidy will be allowed a 90 day grace period to pay premiums.    Typically, the insurance carrier will allow a 15 day grace period for unpaid insurance premiums.    

This new policy of 90 day grace periods will begin January 1 2014 with the Affordable Care Act.    When patients visit Dr’s offices they will be asked for their insurance cards and the Dr’s office will confirm eligibility with the various systems in place.   Since there is a 90 day grace period to pay insurance premiums, members in the plan will show active or eligible.   

What happens if they do not pay their premiums?  Who is paying for it?

Well under the Affordable Care Act, the insurance carrier will pick up the 1st months claims cost and the Drs and Hospitals will pick up the other two months.    Anyone who has been in the business knows that once one month goes by the likelihood of someone paying back premiums is very small.    This problem will compound the already heavy administrative burden on insurance carriers and medical administrators.    This problem will lead to the death spiral in rates.    Those who need care will pay premiums and those who do not need care will opt out.  This leaves a carrier with bad risk and rates will spiral out of control and will consume the whole market.   

Who’s paying for it?   This is an easy answer.   It is you.   

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Employer Mandate Delayed

As some of you may be aware the Employer Mandate is being delayed from 2014 till 2015.    This does not effect the individual mandate.  Individuals that do not have insurance will still be required to buy insurance for a start date of January 1, 2014.   If you do not purchase health insurance through your employer you will be required to buy insurance through a federal or state based exchange or broker.    Here are some other key pieces of information:

  • Enrollment will begin  October 1  for a January 1, 2014 start date. (we feel that this could delayed, we are less than three months away and there has been no training or testing be done with the marketplace.)
  • If you fail to purchase insurance, you will pay a tax of $96 the first couple years and then it indexes up in 2016.   Most people get a refund so it will be take out of your refund.
  • You may be eligible for a subsidy based on your household size and household income.    You can see if you are eligible for the subsidy by going to this link. http://kff.org/interactive/subsidy-calculator/

We think there is more information to come about federal based exchanges in the next couple of weeks.   There is a lot of work and there is a lot of to be done.

Mike Braun

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« The Worst Study Ever? Commentary Magazine

Great article.   Is equal distribution better or better outcomes?

Take a read and find out some real information.

« The Worst Study Ever? Commentary Magazine.

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Pay or Play

The IRS has issued long awaited regulations proving additional guidance for employers on the employer shared responsibility mandate (“Pay or Play”) of the Affordable Care Act (“ACA” or “Health Care Reform”). By way of background, the Pay or Play mandate requires that large employers, those with more than 50 employees, provide coverage to all full time employees (those working more than 30 hours per week) and their dependents beginning on the first day of the first plan year after January 1, 2014. Such coverage must also pass certain tests to ensure that such coverage is adequate and affordable in regard to the full time employee.
Please note that this new guidance provides some changes to previous assumptions regarding the Pay or Play Mandate that were widely accepted within the benefits community. It is also important to note that these are proposed regulations that could be subject to further change. Unless, or until, a change is issued, employers may rely on the proposed regulations.

Transitional Rule for Non-Calendar Year Plans
The IRS has delayed Pay or Play penalties for some employers with non-calendar year plans. This is a welcome relief since earlier guidance suggested that all plans would be subject to the Pay or Play mandate immediately on January 1, 2014. Rather, an employer will not incur a Pay or Play penalty for any month prior to the first day of its 2014 plan year if:
• The non-calendar year plan was in existence as of December 27, 2012;

• At least ¼ of the employees are enrolled in the mid-year plan or at least 1/3 of the employees were offered coverage under the mid-year plan during open enrollment; and
• The full-time employees, or full time equivalent employees (“FTE”) are offered affordable and adequate coverage no later than the first day of the 2014 plan year.

This communication is provided for informational purposes only and does not constitute legal advice. It contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation, or requirement.
Common Ownership Issues
• Companies under common control, or under common ownership, should be counted together for purposes of determining whether the employer is a “large employer” (over 50 employees) and thus subject to the mandate.

• Although employers need to count affiliated entities together to determine if it is a “large employer”, any penalties would be calculated separately for each entity.

Substantial Compliance / The De Minimus Rule / The 95% Rule
• An applicable large employer can avoid a penalty for not offering coverage so long as it offers coverage to 95% of its full-time employees (and the employees’ children)

• The failure to offer coverage to the other 5% will not trigger a penalty, regardless of whether the failure is inadvertent or by design.

• If a large employer has fewer than 100 full time employees, the employer can avoid penalty by offering coverage to all by five (5) of its full time employees, even if the offer of coverage would be less than 95% of the member’s full-time employees.

Requirement to Cover Dependents

• Large employers will have to offer coverage to the children (those 26 and under) of full time employees in order to avoid a non-coverage penalty

• Spouses are not considered dependents under this provision

• The children that will have to be covered include:
o Children by birth, adoption and placement for adoption;
o Stepchildren;
o Foster children
• If a plan currently does not offer to coverage to all such children listed (ex. Foster Children), a large employer will have until 2015 to change its definition of eligible children. This will also require an amendment to existing plan documents.

• A large employer will not be subject to a no-offer penalty for failing to offer coverage to a full-time employee’s children (as defined) until 2015 so long as efforts are undertaken in 2014 to cover those children.
• While an employer must offer coverage to these children, the employer is not under an obligation to offer unsubsidized family coverage. In other words, the coverage of the children need not meet the “affordable and adequate” standards required for single coverage.
Clarification of Measurement Periods, Stability Periods, Administrative Periods
• As set forth in detail, in prior guidance, employers will have to determine the status of variable hour and seasonal employees.

Safe Harbors to Determine If Health Coverage is Affordable
• The Pay or Play Mandate requires not only that large employers offer coverage to their full-time employees, but also that such coverage is “adequate and affordable” in order to avoid a penalty.

• “Affordable” is defined as the employee’s share for single coverage not exceeding 9.5% of the employee’s household income. Since it is nearly impossible to accurately determine an employee’s “household” income, the IRS has developed three safe harbor options to ascertain “affordable”:

o Form W-2 Safe Harbor. The employer can rely on Box 1 income for the months during which the employee was eligible for coverage.

o Rate of Pay Safe Harbor. A salaried employee’s monthly salary or an hourly employee’s rate of pay multiplied by 130 hours for the months during which the employee was eligible for coverage.

o Federal Poverty Line (“FPL”) Safe Harbor. The federal poverty line for a single individual. In 2012, the federal poverty line for a single individual was $11,170.

• While these safe harbors are used for determining whether a penalty will apply, these safe harbors will not be used to determine subsidies. Subsidies will be based solely on employee’s household income. Such amounts will be determined through the exchange.

Determining Full-Time Employees
• A “full-time” employee is a person who is employed an average of 30 hours per week.

• An employee’s hours of service include:
o Each hour for which an employee is paid, or entitled to payment for the performance of duties for the employer; and

o Each hour for which an employee is paid, or entitled to payment by the employer on account of a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence).

• Proposed guidance sets for specific hours of service requirements for teachers, commissioned employees, adjunct faculty, transportation employees, temporary staff members, and other special employment situations.

Grace Period for Payment of Employee Contributions
• If an employee’s pay is not sufficient to withhold the employee’s contribution for health care coverage (e.g., tipped employees, reduced work schedules, leave of absence). An employer may bill the employee for missed contributions and will not be treated as failing to offer health coverage if the employer ends health coverage because the employee fails to pay the required contribution within a 30 day grace period. This rule is comparable to the grace period for COBRA premiums.

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Obamacare Tax

One of the many taxes this bill brings forth will be a tax on HMO plans of 3.5%. Starting on the February renewal cycle, there will be a 3.5% excise tax on carriers. Insurance carriers will bear the cost of the tax which will ultimately be paid by employers and consumers. This is on top of trend (year over year cost from the carrier) and any other increase employers will bear in this renewal season. The other taxes that are going to be into effect will be the 3.8% tax on unearned income for people earning $250,000 joint or $200,000 single.
The other tax is tax rate on wages for Medicare Part A from 1.45% to 2.35%. It is a .9% increase in this tax.
There will be other taxes felt in the marketplace for medical device manufacturers. This will be felt by insurance companies and paid for by employer groups and consumers. This tax will be 2.3% on devices sold.

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