Category Archive

Benefit Spotlight

Picking a Plan

Lynn White 2024 September, Benefit Spotlight July 1, 2024

Choosing a Plan that is right for you and your family can seem like a daunting task.

You should consider any medical needs you foresee for the upcoming year, your overall health, and any medications you currently take. The following scenarios may also help you make an informed decision.

If you are single or married with no children and in good health with no medical needs outside of preventive care…

A Consumer Driven Health Plan (CDHP) or similarly, and High Deductible Health Plan (HDHP) may be a good fit. These plans offer lower premiums and most preventive care is covered at 100% if using an in-network provider. You may also be able to use a Health Savings Account (HSA) with these types of plans, a tax-advantaged account that provides a safety net for unexpected medical costs.

If you are single or married with children and/or have major medical concerns or anticipate a pregnancy or surgery…

A Preferred Provider Organization (PPO) may be the right answer for you. These plans come with higher premiums, but less costs at the time of service and a smaller deductible, meaning your out-of-pocket maximum may be reached earlier in the year. These plans allow you to choose from a network of providers, typically without the need for a referral or use of a Primary Care Physician (PCP).

What about an HMO?

A Health Maintenance Organization (HMO) may be your best option if lower costs are most important, and you don’t mind the restriction of seeing a PCP first for any referrals to specialists that you might need. HMOs will generally not cover any out-of-network expenses unless it is an emergency.

In-Office Maternal Benefits

Lynn White 2024 October, Benefit Spotlight June 13, 2024

It’s no secret that being a working mom has challenges, and that’s especially true for women who are returning to work after giving birth.

On top of the emotional and logistical obstacles they face, many post-partum women have the added challenge of needing to express breastmilk throughout the day.

The PUMP Act— which stands for Providing Urgent Maternal Protections — is a law that requires employers across the nation to provide reasonable break time and a private, non-bathroom space for an employee to pump breast milk.

The location must be shielded from the view of others and free of intrusion from the public or coworkers, and the employee must have access to these accommodations for one year after childbirth.

It was signed into law at the end of 2022 and helped close gaps in the Break Time for Nursing Mothers law that left 1 in 4 women without pumping protection during the workday and expanded the legal right to teachers, registered nurses, farmworkers, and more. The PUMP Act also clarifies that these breaks count as working time and allows an employee to take legal action against the employer if the law is violated. On April 28, 2023, The PUMP Act expanded its enforcement provision to allow employees to file a lawsuit for monetary remedies.

A lawsuit can be filed under the following circumstances:

  • Violations of the break time requirement
  • The employer indicates no intention of providing private space for pumping
  • If an employee is terminated for requesting break time or space

Complaints can be filed with the U.S. Department of Labor Wage and Hour Division (WHD) at the toll-free number 1-800-487-9243 or by visiting www.dol.gov/whd. Employees may also contact the free helplines from the Center for WorkLife Law and/or A Better Balance to understand their legal rights and options.

Source:

COBRA Benefits

Lynn White 2024 June, Benefit Spotlight May 15, 2024

With COBRA, you can avoid a lapse in coverage for up to 18 months (coverage can be extended to 29 months if you are considered disabled by the Social Security Administration).

According to the U.S. Bureau of Labor Statistics, more than half of Americans have healthcare coverage through their employer. Should you leave your employer, one option for continuing healthcare coverage is COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act.

While COBRA is a convenient continuation of your job-based coverage that would otherwise be terminated, it isn’t a permanent solution, and it comes with certain considerations around eligibility and costs.

 

Eligibility

Not everyone is eligible for COBRA. According to the Department of Labor, you are entitled to elect COBRA continuation coverage if the following apply:

  • You experience a qualifying event, such as:
    • Job loss (for anything other than gross misconduct)
    • Reduction in employment hours
    • Divorce or legal separation from a covered employee
    • Covered employee passes away
    • Covered employee becomes eligible for Medicare
    • You lose your status as a dependent child
  • Your health plan is covered by COBRA (organizations with fewer than 20 employees are not required to offer COBRA), and you were covered by the plan the day before the qualifying event.

 

The Cost of COBRA

Oftentimes when you have coverage through your employer, they share the monthly premium costs. However, a COBRA coverage premium will be more expensive than what it was under your group health plan because you pay both your portion of the premium and what the employer paid. For example, if you only paid 20% of the premium and your previous employer paid 80%, under COBRA you will be financially responsible for 100% of the premium.

It’s important to be aware of what you will be responsible for paying each month if you elect COBRA coverage because you risk losing your COBRA coverage immediately if you are late making a payment. If you have an HSA, you can use those funds to pay COBRA premiums.

 

Enrolling in COBRA

You have a 60-day window from when you are given notice whether you want to enroll in COBRA. Even if you initially waive your coverage, you can still enroll later if it’s still within the 60-day window (for example, on day 57), however, the coverage is retroactive, meaning you would have to backpay those first 57 days.

 

Alternatives to COBRA

  • Enroll in a spouse’s plan — If your spouse has health coverage offered through their job, you (and your dependents who were covered by your coverage) can enroll in their employer’s plan since your coverage loss is a qualifying life event.
  • Enroll in a parent’s plan — You can enroll in a parent’s employer’s coverage (due to your qualifying event) if you are under 26 years of age and lose your coverage.
  • Purchase a federal or state marketplace policy — After losing your coverage, you have 60 days to purchase new coverage through the federal government’s marketplace (healthcare.gov) or your state’s marketplace (if your state offers one).
  • Purchase private insurance — If you want to explore more plan options than what the public marketplace offers, you can work with insurance companies, a local health plan agent or broker, or health insurance seller to find plans from multiple carriers.

Health coverage is necessary for most Americans, and it’s important to weigh all your options and find the solution that fits your and your dependents’ needs.

 

Sources:

https://www.dol.gov/general/topic/health-plans/cobra
https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-consumer.pdf
https://www.usa.gov/cobra-health-insurance
https://www.forbes.com/advisor/health-insurance/what-is-cobra-insurance/

Education Benefits

Kaylon Walton 2024 March, Benefit Spotlight February 12, 2024
Man on laptop

Education benefits are employee perks that help you enrich or learn new skills.

They may also help you go back to school to earn your degree, GED, or in rare cases, assist you with paying back your student loans. The goal of any education benefits program is to improve the organization’s overall skill set, which boosts productivity and autonomy. It can also help attract top talent for open positions.

Education benefits aren’t uncommon, especially for larger organizations. According to the International Foundation of Employee Benefit Plans, more than 92% of the organizations that responded to their survey offered an educational benefit.

Check with your Human Resources department to see if any of these common types of education benefits are offered at your company:

  • Tuition assistance/reimbursement
  • In-house training seminars
  • Attendance at educational conferences
  • Continuing education courses
  • Coverage for licensing courses and exams
  • Personal development courses
  • 529 college savings plans

In-Network vs. Out-of-Network

Lynn White 2024 February, Benefit Spotlight January 23, 2024
In-Network vs Out-of-Network

The distinction between in-network and out-of-network for medical plans lies in the coverage of healthcare services. In-network refers to healthcare providers and facilities that have established agreements with the insurance company, offering services at discounted rates. Choosing in-network options typically results in lower out-of-pocket costs for the insured individual. On the other hand, out-of-network providers have no agreements, potentially leading to higher costs for the insured, as the insurance plan may cover a smaller percentage of the expenses. Understanding and selecting the right network is crucial for optimizing healthcare coverage and managing financial responsibilities.

401(k) Retirement Plan

2024 January, Benefit Spotlight December 27, 2023

Contributing to a 401(k) plan is a way to help you build savings for your future self and financial security later on in life. One of its benefits is its automation (often deducted straight from your paycheck), and it can make investing easier. It also comes with different tax benefits, depending on the type of plan you elect.

Types of 401(k) Plans

  • Traditional 401(k): These contributions are made with pre-tax dollars, which lowers your annual taxable income and grows on a tax-deferred basis. You won’t pay taxes on this money until you begin withdrawing during retirement.
  • Roth 401(k): Contributions to this option are deducted after taxes. You pay the tax now, but you won’t be taxed down the line when making withdrawals during retirement.

A good rule of thumb is to opt for the traditional plan if you expect to be in a lower marginal tax bracket during retirement. That way you can take advantage of the immediate tax break. Another consideration is if your budget is extremely tight, the traditional 401(k) doesn’t reduce your immediate spending as much as a Roth will.

If you think you may be in a higher bracket come retirement, the Roth option can help you maximize your savings and avoid higher taxes later on (especially since the Roth can grow over the years and that earned money will be tax-free).

There’s also the option to contribute to both plan types and hedge your bets — just don’t exceed the contribution limits!

2024 Limits

The contribution limits for a 401(k) periodically rise year-over-year due to rising inflation. For 2024, individuals can contribute up to $23,000 to their 401(k) plans, which is a $500 increase from the 2023 limit.

The catch-up contribution limit for employees (aged 50+ years) remains at $7,500, for a total of $30,500. The catch-up contribution helps accelerate the progress for those closer to retirement.

Contributing to a 401(k)

Industry standards suggest saving 12-15% of your income, but it’s important to look at your own financial situation and needs. You don’t want to reduce your take-home pay so much that you end up in a bind and need to withdraw early (before age 59 ½) from your 401(k) — something that comes with a penalty from the IRS.

If your employer offers a company match, make sure you contribute up to the match amount so you’re not leaving free money behind. For example, if your company offers a 3% match, be sure to contribute 3% of your income (which will result in a 6% contribution total).

Another important consideration if you’re participating in your company-sponsored 401(k) is vesting. It’s necessary to understand your company’s vesting schedule so you know what money is yours to keep should you leave your employer. The money you contribute will be 100% yours to keep (or rollover into another employer’s plan), but the contributions made from the employer may take some years before they’re your dollars to keep.

https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k

Cost Comparison Shopping

Kaylon Walton 2023 December, Benefit Spotlight November 22, 2023
Man in suit talking to woman

There are so many different providers and varying costs for healthcare services — how do you choose?

Online services called healthcare cost transparency tools can help. Available through most health insurance carriers, these tools allow you to compare costs for services, from prescriptions to major surgeries, to make your choices simpler. Ask your Human Resources team for more information.

What Is Balance Billing?

Keesha Maybank 2023 November, Benefit Spotlight October 30, 2023

Balance billing is not a well-known term, but if you may have experienced it, especially if you’ve had a medical emergency and received emergency services.

Simply put, balance billing is when a medical provider sends you a bill for the remainder of an invoice that your insurance provider did not cover. This happens commonly with out-of-network providers – medical providers who are not under any contracts with your insurance provider and who will cost more to see.

For example, say you have an emergency appendectomy. Depending on the situation, you probably don’t have time to research a provider or find out whether everyone involved in your appendectomy is in-network – you’re concerned with getting to the emergency room as fast as you can. If the anesthesiologist, the hospital, or someone else involved with the procedure is out of network, you may receive an unexpected bill in the mail after the procedure.

The good news is that as of 2022, you have some protection against these kinds of bills if you receive emergency care, non-emergency care from out-of-network providers in an in-network facility (e.g., if your theoretical anesthesiologist was out of network even though the hospital itself is in network), or air ambulance services from an out-of-network provider. Click HERE to learn more about what rights you have under the No Surprises Act and HERE to ask questions or get help regarding surprise medical bills.

What is a “surprise medical bill” and what should I know about the No Surprises Act? | Consumer Financial Protection Bureau (consumerfinance.gov)
Balance billing – Glossary | HealthCare.gov

¿Qué es la facturación de saldo?

2023 November, Benefit Spotlight October 30, 2023

La facturación de saldo no es un término bien conocido, pero puede que la haya experimentado, especialmente si ha tenido una emergencia médica y recibido servicios de emergencia

En pocas palabras, la facturación de saldo es cuando un proveedor médico le envía una factura por el resto de una cuenta que su proveedor de seguro no cubrió. Esto suele ocurrir con los proveedores fuera de la red, es decir, proveedores médicos que no tienen ningún contrato con su proveedor de seguro y con quienes será más costoso atenderse.

Por ejemplo, digamos que tiene una apendicectomía de emergencia. Dependiendo de la situación, probablemente no tenga tiempo de investigar a un proveedor o averiguar si todas las personas involucradas en su apendicectomía están dentro de la red, está preocupado por llegar a la sala de emergencia lo más rápido posible. Si el anestesiólogo, el hospital u otra persona involucrada en el procedimiento está fuera de la red, puede recibir una factura inesperada en el correo después del procedimiento.

La buena noticia es que, desde 2022, tiene cierta protección contra estos tipos de facturas si recibe atención de emergencia, atención no de emergencia de proveedores fuera de la red en un centro dentro de la red (p. ej., si en teoría su anestesiólogo está fuera de la red, incluso si el hospital esté dentro de la red) o los servicios de ambulancia de un proveedor fuera de la red. Haga clic AQUÍ para averiguar más sobre los derechos que tiene en conformidad con la Ley Sin Sorpresas y AQUÍ para hacer preguntas o recibir ayuda sobre las facturas médicas sorpresa.

What is a “surprise medical bill” and what should I know about the No Surprises Act? | Consumer Financial Protection Bureau (consumerfinance.gov)
Balance billing – Glossary | HealthCare.gov

Cutting Rx Costs

2023 October, Benefit Spotlight September 21, 2023

Sometimes the prescriptions we need are flat-out expensive. The good news is there are prescription discount programs and coupons available for some medications.

How do prescription discount programs work? These discounts can’t be combined with your benefit plan’s coverage, so make sure to check the price against the cost of using your insurance’s prescription drug benefit. Something else to consider: If you choose to use a discount card and are therefore not tapping into your insurance’s prescription drug benefit, the cash amount you pay for the prescription may not count toward your deductible or out-of-pocket maximum under the benefit plan.

GoodRX is a web- and app-based platform that allows you to search for prescription drug coupons and compare pharmacy prices. The company claims a savings of up to 80% on generics. Optum Perks also provides coupons for medications and a searchable database for drug cost comparison at participating pharmacies near you. The Optum Perks member card, which can be used at more than 64,000 pharmacies, is free to use and requires no personal data.

Another discount option is the Amazon Prime RX Savings discount card, which is included with an Amazon Prime membership and is administered by InsideRX. It provides discounts of up to 80% for generics and up to 40% for brand-name medication at participating pharmacies.

Cost Plus Drug Company is a web-based pharmacy that claims to keep costs low by buying directly from the manufacturer. It currently only offers a certain selection of medications and accepts a handful of prescription insurance providers, but it may be worth checking the price difference between Cost Plus and your regular pharmacy.

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