Category Archive

Benefit Spotlight

Wellness Programs

Employer-sponsored medical benefits are provided to help you stay healthy. But some employers go a step further by implementing wellness programs.

Wellness programs provide various tools and incentives for you to keep an eye on your overall health. These incentives often take the form of discounts off your medical premiums (or even a surcharge), fitness trackers, or gym memberships. If your spouse is on your insurance, they may also be eligible.

Often times these programs will require an annual biometric screening that checks certain standard health factors, such as blood pressure, cholesterol levels, height, weight, and glucose levels. These are helpful in the short-term because they may reveal health issues that you can address with your doctor. These screenings are helpful long-term because they will provide your doctor a consistent medical history — if some of your benchmarks change suddenly from one year to the next, it may indicate a health problem. You can usually get these biometric screenings done at your doctor’s office, though some employers will offer onsite screening opportunities as well.

Many wellness programs also include health education modules and mental and financial wellbeing resources. Overall, wellness programs help you become better informed about your own health, which keeps you healthier and could save you money in the long run. Check your benefits information to see whether your employer has a wellness program and what its benefits are.

Extended Leave

Life happens, and sometimes you need to take an extended period of time away from work outside of what your standard PTO and sick time off cover.

This is where the Family and Medical Leave Act (FMLA) steps in. It provides employees up to 12 weeks of unpaid leave in a 12-month period to handle the birth, adoption, or foster placement of a child, care for oneself or an immediate family member due to severe health conditions, or qualifying emergency due to a spouse, child, or parent being a covered member of the armed services on active duty. The FMLA ensures your job is protected while you are away (i.e., you cannot legally be let go due to your absence) and you keep your health insurance during the leave.

Some states, such as California and Colorado, also require employers to provide certain forms of paid sick leave or paid family and medical leave. In some instances, this paid leave also applies to employees affected by domestic violence or assault. These provisions vary widely by state, and not all states require employees to put paid sick leave provisions in place. Click HERE and HERE to find your state and any provisions it has made. If your state has both FMLA and paid sick/family leave, your employer must follow the law that benefits employees most.

Extra, Extra! Understanding Supplemental Insurance

Maybe this is a familiar scenario.

You’re reviewing your annual enrollment materials to figure out what coverage is best for you and your dependents. Medical, dental, and vision coverage are pretty straightforward. Now you’re looking at the extra kinds of coverage, and they all sound similar. Accident coverage, hospital indemnity coverage, and critical illness – what’s the difference? While exact coverage varies per provider and employer, these are the general differences between plans.

  • Accident coverage provides benefits for you and your covered family member for expenses related to an accidental injury that occurs outside of work. This coverage can help pay deductibles, copays, and even typical day-to-day expenses such as a mortgage or car payment.
  • Critical Illness coverage pays a lump-sum benefit if you are diagnosed with a covered disease or condition (the exact diseases and conditions will be specified in plan documentation). You can use this money however you like. You might pay expenses not covered by your medical plan, lost wages, childcare, travel, home healthcare costs, or any of your regular household expenses.
  • Hospital Indemnity coverage pays you cash benefits directly if you are admitted to the hospital or an Intensive Care Unit (ICU) for a covered stay. This can help pay for your medical expenses such as deductibles and copays, travel cost, food and lodging, or everyday expenses such as groceries and utilities.

While these coverages may overlap at points, they are definitely not all the same. Before your next benefits enrollment, consider whether you might want to enroll in any of these coverages for a little extra peace of mind.

Doc On Retainer: Concierge Medicine

2023 May, Benefit Spotlight April 27, 2023

If you’ve moved recently or had to find a new primary care physician (PCP) for any reason, it might have taken you much longer to get an appointment than expected.

Even getting a regular appointment could take weeks longer than it used to. You’re not imagining it – due to a growing shortage of PCPs, Americans are having to wait significantly longer to see doctors than we used to.

An alternative to long waits at traditional doctors’ offices is concierge medicine, or its cousin, direct primary care (DPC). To access this kind of care, you’ll pay an annual or monthly fee that gets you direct physician access. Each practice will vary, but generally you can expect to receive the following benefits:

  • Guaranteed access to care 24/7
  • Same-day or next-day appointments
  • Coverage of standard care like blood work, preventive screenings, and physicals
  • No copays or deductibles for office visits
  • More personalized care
  • On average, twice as much time with your doctor per visit

It’s crucial to note that there are drawbacks as well. DPC practices typically do not accept insurance and are entirely fee-based, while some concierge systems do accept insurance. You’ll still need regular health insurance to cover hospitalization and specialty referrals. If cash is tight, concierge medicine may not be a good choice – annual fees can run from $1,200 to $10,000. However, if your finances are in a good place, and you want guaranteed access to care, there is a growing number of concierge and DPC providers you can investigate today.

What Is Concierge Medicine? A Complete Guide – Forbes Health
Advantages and Disadvantages of Concierge Medical Care (
Many Doctors are Switching to Concierge Medicine, Exacerbating Physician Shortages – Scientific American

Broadening Benefits for Your Health: Lifestyle Spending Accounts

While your medical insurance covers much of your bodily health, and many companies have Employee Assistance Programs to help you out with mental health, there’s more to your overall wellbeing.

Employers realize this, which is why more and more companies are adding a new acronym to the fold – the LSA, or the Lifestyle Spending Account.

Health Savings Accounts and Flexible Spending Accounts help cover specific IRS-approved expenses such as copays, glasses, or dental care, Lifestyle Spending Accounts have fewer restrictions. They can be used to pay for a broad variety of services and products that promote your own physical, mental, or financial wellness. Below are just a few examples:

  • Exercise equipment and nutritional supplements
  • Personal trainer
  • Entry fees for races or sports leagues; sports lessons
  • Spiritual retreats
  • State or national park passes
  • Camping equipment
  • Spa treatments
  • Estate planning costs
  • Financial planning services

The crucial difference between LSAs and other health-related spending accounts is that expenses submitted for reimbursement through a Lifestyle Spending Account are taxable to you. The reimbursed amount is considered income and is subject to the same taxes as your normal wages. If you’re looking to further your health and wellness, see whether your employer offers an LSA. It can be a helpful tool in taking care of yourself.

Qualifying Life Events

2023 March, Benefit Spotlight February 24, 2023

Signing up for benefits usually only occurs during your company’s open enrollment period, or when starting a new job at a new company. But did you know that these are not necessarily the only times you can elect or change your benefits?

Sometimes there are changes in your life, planned or unplanned, called Qualifying Life Events (QLEs), that allow you to add or change benefits. These QLEs are determined by the IRS, and when they occur, QLEs can allow you to enroll in health insurance or make changes to your benefits outside of the regular windows

When a qualifying life event occurs, you typically have 30 to 31 days to request changes to your coverage. Common QLEs include:

  • A change in the number of dependents (through birth or adoption or if a child is no longer an eligible dependent)
  • A change in a spouse’s employment status (resulting in a loss or gain of coverage)
  • A change in your legal marital status (marriage, divorce, or legal separation)
  • A change in employment status from full time to part time, or part time to full time, resulting in a gain or loss of eligibility
  • Eligibility for coverage through the Marketplace
  • Changes in address or location that may affect coverage
  • Entitlement to Medicare or Medicaid

Some lesser-known QLEs are:

  • Turning 26 and losing coverage through a parent’s plan
  • Death in the family (leading to change in dependents or loss of coverage)
  • Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)

If you have recently experienced a QLE or expect to in the near future, reach out to your company’s Human Resources for questions regarding specific life events and your ability to request changes.

Legal Assistance

For most of us non-experts, legal matters can be confusing, whether it’s dealing with paperwork for adoptions, ensuring that estate-related documents are in place in the event of your passing, or even dealing with traffic tickets. The idea of hiring a lawyer for help with these matters is also daunting given the potential cost.

The good news is that many employers provide access to affordable legal help for your personal needs, often paid for with per-pay-period deductions directly from your payroll, just like your medical coverage. It’s like having your own lawyer on retainer for a very reasonable cost. These attorneys are licensed and experienced, able to help you (and usually your dependents) with:

  • Estate planning, wills, and trusts
  • Real-estate matters
  • Identity-theft defense
  • Financial matters, such as debt-collection defense
  • Traffic offenses
  • Document review
  • Family law, including adoption and name change
  • Advice and consultation on personal legal matters
  • Divorce

This is not a comprehensive list, as plans differ slightly between employers and vendors. Check your benefits guide or with your HR department to see whether this is an optional benefit your employer offers. While most of us don’t plan on needing legal help, it may be worth the peace of mind knowing you have immediate, affordable access to it should the occasion arise.

Copays, Coinsurance, and Deductibles

2023 January, Benefit Spotlight December 27, 2022

If you’re new to having your own medical insurance plan (or maybe even if you’ve had one for a while), the terminology surrounding how much you have to pay for a given service can be confusing. Let’s look at some of the most important terms that will help you better understand your benefits:

Deductible: A deductible is a fixed amount of money that you have to pay before your insurance starts paying benefits. For example, if your deductible is $2,000, you’ll pay out-of-pocket until you reach that amount, and then your coinsurance will kick in. This amount varies by plan, but typically plans with higher monthly costs have lower deductibles and plans with lower monthly costs have higher deductibles. (Side note: some plans have separate deductibles for prescription benefits, so make sure to check your plan details for this.)

Coinsurance: Coinsurance kicks in once you’ve reached your deductible. Now whenever you have a covered medical expense, you’ll pay coinsurance, which is a set percentage of the total cost, and your insurance will pay the rest.

Copay: This is a set amount you’ll pay for a covered service and varies per service. You may pay copays before you hit your deductible and after; this varies by plan.

Out-of-pocket maximum: This one is a little more self-explanatory. Once you’ve paid this set amount out-of-pocket, your plan will pay 100% for covered services for the rest of the year. Depending on your plan, your deductible may or may not include to your out-of-pocket maximum.

Each plan has different deductibles, coinsurance, copays, and out-of-pocket maximums. It’s important to review your benefits carefully to make sure you know what you’re on the hook for when you receive medical care. Consult your summary plan description for more information.

How do deductibles, coinsurance and copays work? |
Your total costs for health care: Premium, deductible, and out-of-pocket costs |

Tobacco Surcharges Burn

2022 November, Benefit Spotlight September 26, 2022

It’s that time of year for benefits enrollment, and many people have gotten materials outlining the next year’s benefits. Some of you may notice a line item in your medical benefits page that reads “Tobacco Surcharge.”

By the terms of the Affordable Care Act, group health plans and self-insured employers can upcharge tobacco users up to 50% for their health insurance premiums. (Tobacco use in this case includes smoking, vaping, and chewing tobacco.) Why do some plans include this surcharge? It hasn’t been a mystery for decades that tobacco use is bad for the human body. It is responsible for nearly half a million deaths in the US each year and is the leading preventable cause of disease and death.

Not only is tobacco use harmful and potentially fatal, it is expensive. The CDC estimates that smoking-related illness costs more than $300 billion dollars annually in the U.S., including both medical care and for lost productivity. Group health plans and employers include this surcharge both to help cover tobacco-related medical expenses and to encourage people to quit using tobacco products.

However, if an employer plan implements a tobacco surcharge, it must also provide a tobacco cessation program. If you are a tobacco user and want to quit and to avoid the surcharge, you can sign up for a tobacco cessation program, or, in some cases, submit confirmation of being under a physician’s care for tobacco or nicotine use to HR. To find out exactly what you need to do to avoid the surcharge, talk to your Human Resources Department.

What is a Tobacco Surcharge and How Does My Company Offer One? (
What You Need to Know About Smoking and Health Insurance | HealthMarkets
Economic Trends in Tobacco | Smoking & Tobacco Use | CDC

Resolving Insurance Issues

2022 October, Benefit Spotlight September 25, 2022

It’s never fun to get bills in the mail. It can be additionally frustrating when they’re medical bills for a procedure you thought was covered.

Health benefits can be confusing to sort through, and alarmingly, insurance billing errors are not uncommon. Depending on the source, it’s estimated that between 7% and 80% of medical bills contain errors.

If you receive a bill that you think is incorrect, start by asking the provider to explain the exact charges submitted to your insurance carrier. For example, if you went to your primary care provider (PCP) for what you thought was a routine preventive visit but see additional charges, call your PCP’s office and ask what those charges were for. You can also check the bill against the Explanation of Benefits (EOB) that your insurer is required to send you after your medical provider has filed a claim. An EOB will detail exactly what your medical insurance covers and what it has paid toward this claim.

If you see discrepancies between your bill and your EOB, talk to your doctor’s office, explain the discrepancies, and ask them to review and fix the charges. If your insurance provider has not covered something they are supposed to, you should also contact them to review your case. You may need to file an appeal – make sure to do this as soon as possible to avoid your bill going to collections. See HERE for a more detailed, step-by-step outline.

You may not have to do this on your own. Check to see whether your employer provides access to third-party vendors like Health Advocate or Alight. These companies will help you review your benefits and dispute charges you think were made in error.

What to Do if Your Medical Bill Has Mistakes (
This simple form can keep you from overpaying for medical care (