business man explain the basics of group health insurance in an office

Group Health Coverage Basics for Small Businesses

Offering health insurance to your employees may sound like an overwhelming process — but it doesn’t need to be. Once you’ve identified your business’s needs and know the basics of group health insurance, the rest is easy. So, what do you need to know first?

What’s the difference between group and individual health plans?

According to the U.S. Department of Labor, “A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.”

In other words, a group health plan is designed to cover a group of employees, but each enrollee has their own plan with benefits – and the plan’s monthly premium is calculated differently than if it were purchased as an individual health plan.

The monthly premium for all health plans is determined by the perceived risk of the carrier in offering coverage. With a group health plan, the group seeking coverage has their risk pooled together as one, which in some cases, may lower the monthly cost.

Unlike individual plans, group health plans are also available in different types designed to help your business save the most money and make the best coverage decisions. To learn more about these different plan types and ways that your business can save money on group health coverage, feel free to check out our latest group health webinar.

As a business owner, do I have to offer group health insurance to my employees?

Depending on the size of your business, the answer could be no. The Affordable Care Act (ACA) stated that businesses with fewer than 50 full-time employees are not legally obligated to provide health insurance to their employees — but many choose to regardless.

Looking for a better benefits package is one of the most common reasons people change jobs. And if your business doesn’t offer a health insurance benefit, it may give current and prospective employees reason to look somewhere else for employment.

If you are federally mandated to offer health insurance to your employees, you will need to ensure you are following the rest of the ACA’s rules and regulations for small businesses.

Making The Right Group Health Decisions For Your Business

Ready to take a look at your options? Our team of licensed benefits counselors is on hand to help you find the best group health solutions for your business. Visit osteopathic.memberbenefits.com/employer-group-solutions/ or schedule an appointment with us today.

man diagnosed with long term disability contemplating future

5 Most Common Attorney Long-Term Disability Claims

According to the Council for Disability Awareness, it is estimated that one out of every four Americans will find themselves diagnosed with a disability prior to retiring at the age of 65. Additional studies show that less than half of individuals and families have enough money saved to sustain their living expenses for even one month before feeling the financial strain— illustrating that a long-term disability diagnosis can not just be devastating for the individual but also financially devastating for their entire family.

In short, no one plans to become disabled. And yet, it can happen to anyone at any time and the chances of it happening only increase with age, lifestyle choices, and even the type of work we do on a daily basis.

Popular Long-Term Disability Claims

But while the majority of people may imagine someone who struggles with a long-term disability as wheelchair-bound, the fact of the matter is that long-term disabilities can manifest in a host of different ways— some visible, some not.

Below are the top five long-term disability diagnosis types by category according to our own research and the CDA’s 2013 Long-Term Disability Claims Review:

  1. Musculoskeletal/Connective Tissue Disorders and Conditions

According to the CDA’s 2013 Long-Term Disability Claims Review, nearly one-third of all long-term disability claims are due to musculoskeletal and connective tissue disorders. These are best described as issues related to neck and joint pain as well as back and neck issues; muscle and tendon problems; foot, ankle and hand disorders as well.

More specifically, the following are among the most commonly diagnosed musculoskeletal and connective tissue disorders and conditions:

  • back pain
  • degenerated disk
  • arthritis
  • osteoporosis
  • rheumatism
  1. Nervous System-Related Disorders and Conditions

Most nervous system disorders are common and can be helped or managed with treatments such as physical therapy and/or medication. Nevertheless, with some being generative, working full-time or even part-time can prove extremely difficult.

Below are a few common nervous system related disorders:

  • Multiple Sclerosis (MS)
  • Alzheimer’s Disease
  • Parkinson’s Disease
  • Epilepsy and Seizures
  • Shingles
  1. Cardiovascular/Circulatory Disorders and Conditions

According to the American College of Cardiology (ACC), it is estimated that an average of one person dies every 40 seconds in America due to cardiovascular disease. But for those individuals who experience cardiovascular issues and require surgeries and rehabilitation services, the time spent recovering can have a serious impact on their livelihood— limiting them from earning a paycheck as well as increased difficulties managing day-to-day activities.

  1. Cancer and Tumors

Studies estimate that 41% of men and 38% of women will develop some form of cancer within their lifetime. And while hereditary factors and lifestyle choices can play a part in determining one’s risk factor, there is no fool-proof way of determining if or when you will be diagnosed with cancer.

If a cancer diagnosis or tumor does occur treatments such as chemotherapy, radiation, and surgeries can leave your body sick, exhausted, and bedridden among other things. During this time, it may be difficult or impossible for you to keep up with your job duties.

  1. Mental Disorders

Depression and anxiety, are among the most common mental disorders that can affect one’s ability to work. Though the systems may not appear physical (though they can), mental disorders are nothing to be brushed off. If you experience lingering or worsening symptoms of depression or other mental disorders for a period of two weeks or more, talking to your doctor may prove helpful.

Most disorders can improve over time with the proper medical attention but leaving them untreated can lead to worsening symptoms that can have an effect on every facet of your life and limit you from living your best life.

Planning For The Future

Just because no one can predict the future, doesn’t mean you shouldn’t still plan for it.

If you wish to receive more information about how you can safeguard your financial future in the event of being diagnosed with a long-term disability, please visit osteopathic.memberbenefits.com/long-term-disability/ to view the complete Long-Term Disability brochure or to download an application.

adult couple reviewing bills and open enrollment materials

4 Myths About the Individual Health Insurance Open Enrollment Period

We’ve heard a lot of Open Enrollment myths over the years and want to set the record straight.

Myth #1 “There are fewer insurers to choose from.”

Many carriers who initially fled the federal exchange have returned and now offer plans alongside others who have entered the marketplace. This increase in the number of plans being offered has allowed many individuals and families to re-examine their needs and adjust their coverage amounts accordingly.

In addition to having access to the same carriers and plans listed on the federal exchange, the AOA Insurance Marketplace can offer members even more options. To view the full range of available ACA-compliant health plans, please visit https://osteopathic.memberbenefits.com/.

Myth #2 “The premiums are too expensive.”

Now that the federal exchange marketplace has stabilized, there may be lower-cost options for ACA-compliant health plans than past Open Enrollment periods. For example, Blue Cross Blue Shield has filed for a 2.03% decrease in premiums in Texas.

Even if your coverage needs remain the same, you may be able to find a lower premium being offered by a different insurer. We recommend always reviewing the health insurance options available to you during the annual Open Enrollment period.

Myth #3 “You’ll be penalized at tax time for not having insurance.”

In previous years, if an individual did not have health insurance for more than 2 months of the year and did not qualify for an exemption they would face a tax penalty of $695 or 2.5% of their taxable income (whichever amount was greater). As of January 1, 2019, the tax penalty known as the individual mandate has been repealed, though some states may still enforce penalties on individuals who don’t have health insurance.

Myth #4 “Applications are processed instantly.”

On average, our team will process an enrollment application within 24 business hours and submit it to the carrier. Once the application is with the carrier, their team will take over and require an additional 10-15 business days to process the application.

The carriers often get overwhelmed with applications during the Open Enrollment period, so we recommend enrollees submit their health insurance applications as early as possible.

Securing ACA-Complaint Coverage for 2020

This year, Open Enrollment runs from November 1 through December 15 with a coverage effective date of January 1, 2020. This is the one time of year where individuals and families can enroll in ACA-compliant health insurance plans.

Ready to start shopping? Visit https://osteopathic.memberbenefits.com/ to shop ACA-compliant health plans today.

Not sure where to start? Schedule an appointment with one of our licensed benefits counselors and let us walk you through finding the best health insurance fit for your needs.

happy family on couch browsing health insurance options on tablet

Getting the Most out of Open Enrollment

With 2020 Open Enrollment period in full swing, families across the country are reviewing their current insurance coverages and seeing what other options may be available to them. Below are a few tips to help you navigate the process.

  1. Learn the Language

Insurance jargon may be enough to make some people’s heads spin but learning just a few key terms could help you pick the best health coverage for you and your family. To make it easy, here are a few words we feel you should know:

  • ACA-compliant” refers to plans that follow all the guidelines and regulations in the Affordable Care Act. These plans are only available during the annual Open Enrollment period or through a Special enrollment period, if you have a qualifying event.
  • Non-ACA plans” also known as short term health plans do not adhere to all of the Affordable Care Act’s guidelines and regulations.
  • Deductible” the amount of money you must pay out of pocket before your insurance kicks in
  • Premium” the amount you pay to your insurance company every month
  • In-network” refers to a provider that has a contract with your insurance provider
  • Out-of-network” refers to a provider that does not have a contract with your insurance provider
  1. Think of the Future

No one can predict the future, but you may be able to take an educated guess as to what the next 12 months could hold. Thinking about the coming year could help you determine how much coverage is right for you and your family. Have you had any health issues in the past year? Are you taking any medications? By examining your current health status and concerns you may be able to narrow down your health insurance plan options.

  1. Utilize Your Resources

Did you know as a benefit of your AOA membership, you have access to our team of licensed Benefits Counselors? Our Benefits Counselors are experts in their field and are standing by to help you navigate the Open Enrollment process and find the best health insurance for you and your family’s needs.

We’ve been providing health insurance answers and guidance for over 30 years. Be sure to visit the AOA Insurance Marketplace for access to appointment scheduling services, webinar replays, and other informational resources designed to help make the Open Enrollment process as quick and easy as possible.

  1. Know Your Deadlines

Like last year, the annual individual health insurance Open Enrollment period began on November 1 and will run until December 15. For those who enroll in one of these ACA-compliant plans, you can expect an effective date of January 1.

Non-ACA plans typically do not follow the ACA open enrollment period dates and are available in most states year-round.

Ready to make your decision? Visit https://osteopathic.memberbenefits.com/health-insurance/ today to secure ACA-compliant coverage for you and your family in 2020.

2020 Open Enrollment Webinar invite

Upcoming 2020 Individual Health Insurance Open Enrollment Webinar

Join us for a free webinar on Tuesday, October 29 from 12:00pm-12:30pm EDT, where we’ll review the upcoming 2020 Individual Health Insurance Open Enrollment period and cover topics such as important dates, preparation tips, industry updates, and more! Reserve your spot by registering today. Can’t make it to the webinar? Register anyway and we’ll send you a link to the video replay later that day.

professional woman on phone outside smiling

Knowing Your Options Outside of Open Enrollment

While the annual Open Enrollment period focuses on ACA-compliant individual major medical insurance, there are still other forms of insurance available for potential enrollees.

Knowing Your Options

According to healthinsurance.org, “ACA-compliant coverage refers to a major medical health insurance policy that conforms to the regulations set forth in the Affordable Care Act (Obamacare)…This means they must include coverage for the ten essential benefits with no lifetime or annual benefit maximums, and must adhere to the consumer protections built into the law.”

Unless you qualify for a special enrollment period, you cannot receive ACA-compliant individual health insurance coverage outside of the annual Open Enrollment Period, which typically runs from November 1st until December 15th of each year.

If you missed out on Open Enrollment but still need individual health insurance, you still have a few options available:

  1. COBRA

According to the U.S. Department of Labor, “The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.”

  1. Qualifying Life Event (QLE)

There are certain life circumstances called Qualifying Life Events (QLEs) that can qualify you for a special enrollment period. Special enrollment periods allow you to obtain ACA-compliant health coverage outside of the annual Open Enrollment period for you and your eligible dependents. The most common QLEs pertain to:

  • Loss of health coverage
  • Changes in household
  • Changes in residence

If you find yourself matching any of the above circumstances or feel your unique circumstance should qualify you for a special enrollment period, please contact us and our team will help guide you in the right direction based on your individual needs.

  1. Non-ACA Compliant plans

Non-ACA compliant plans, also referred to as short-term medical plans, have recently become more appealing to a growing number of people due to their lower rates. According to the Henry J Kaiser Family Foundation, “Late last year (2017), President Trump issued an executive order directing the Secretary of Health and Human Services to take steps to expand the availability of short-term health insurance policies, and a proposed regulation to increase the maximum coverage term under such policies was published in February.”

So, what separates the ACA-compliant health plans from the ones that are not? One of the biggest factors being the ACA’s ten essential health benefits. Non-ACA compliant plans do not need to adhere to the numerous rules and regulations laid out in the Affordable Care Act.

employee benefits book on a wooden desk with glasses succulent coffee and notebooks

Trending Employee Benefits That Companies Should Be Aware Of

The U.S. unemployment rate is now at its lowest levels since 1969. This strengthening of the American job market has given many workers the confidence to reassess their employment situations in a way that they may not have felt comfortable doing ten years ago.

Employers are realizing that it is becoming harder to attract top talent and keep them. Previous benefits packages such as PTO and 401(k) offerings don’t seem to be enough anymore. So many businesses are now tasked with developing new ways to find and retain good staff.

While a comfortable salary is nice, a growing number of workers are placing a higher value on voluntary benefits. According to the Organization for Economic Co-operation and Development (OECD), the United States ranks 7th in the world for Countries With the Worst Work-Life Balance. So the more companies do to make their employees’ lives easier outside of the workplace, the more appealing and valuable those jobs become.

These are some of the most sought-after benefits right now:

Identity Theft Protection

According to Javelin’s 2019 Identity Fraud Study, over 14.4 million people fell victim to identity fraud in 2018 and over 23 percent of victims were not reimbursed for personal expenses. As technology continues to evolve, protecting your identity has never been more important. With new reports of data hacks every month, it’s at the forefront of many minds. Offering identity-theft protection could give employees an invaluable benefit: peace of mind.

Student Loan Refinancing

At the start of 2019, over 44 million U.S. citizens owed more than $1.56 trillion in student loan debt – signaling the highest amount ever recorded. According to Forbes, “Student loan debt is now the second highest consumer debt category – behind only mortgage debt – and higher than both credit cards and auto loans.” For the majority, this level of debt will continue to weigh them down for decades making this a crisis that impacts more than just recent college graduates.

This has led many businesses to begin offering student loan benefits to their employees in the form of refinancing options – or even help to pay down some of their debt (usually a set amount over a period of years). Some businesses who have implemented this approach have seen increased employee retention rates.

Wellness

Providing your employees with the tools they need to maintain their overall physical health can benefit not only them but your business as well. As a result, many employers are choosing to invest in everything from gym memberships to telemedicine options for their employees.

While exercise is a great way to relieve stress and improve overall cognitive abilities such as learning and concentration, sometimes that isn’t enough to fight off common depression and anxiety symptoms.

Roughly 1 million workers are absent from their jobs every day because of stress. According to The American Institute of Stress, “Unanticipated absenteeism is estimated to cost American companies $602.00/worker/year and the price tag for large employers could approach $3.5 million annually.”

Improving the access and affordability of mental health services is something that could greatly benefit businesses and employees alike. Many telemedicine services, such as Teladoc, have ventured into the realm of mental health counseling. This gives employees an additional benefit while allowing them to access crucial mental and physical health services wherever and whenever they need.

Moving Forward

Looking to refresh your voluntary benefits offerings to new and existing employees? Visit https://osteopathic.memberbenefits.com/ to learn about the voluntary ancillary products available to you as a valued member. Our licensed Benefits Counselors are standing by to help guide you to the best benefits for your business and budget. Contact us today!

young business man explaining group health insurance options to business group at a table in an office

New Strategies to Save Money on Group Health Costs in 2019

As group health insurance costs continue to increase, many employers are looking for new, creative ways to save money while still providing their employees with coverage.

Reference Based Pricing

Reference Based Pricing is a rapidly growing strategy that a number of employers are using to save money on group health insurance costs. This technique gives the employee the ability to choose any provider without the limitations and higher costs of a traditional provider network. By choosing to take advantage of this method, employers have the potential to save between 15 and 20 percent on group health insurance costs.

Association Health Plans

According to the U.S. Department of Labor (DOL), Association Health Plans are defined as “group health plans that employer groups and associations offer to provide health coverage for employees.”

In April of this year, the federal government will begin to allow small employer groups to form new associations based on industry and finally receive access to group health insurance plans typically only reserved for larger companies. While many association health plans already exist, the new legislation eliminates the geographic barriers previously in place.

According to the Congressional Budget Office, “four million Americans, including 400,000 who otherwise would lack insurance, will join an AHP by 2023.”

Direct Primary Care

Direct Primary Care (DPC) is an alternative payment model to third-party billing. With DPC, there is a flat monthly membership fee and nothing else. Employees have access to a physician of their choice and the physician remains accountable to only their patients. This option can also exist alongside a comprehensive major medical plan.

Level Funding

For groups of five or more, level-funded plans are becoming increasingly popular. These plans boast a nationwide network of hospitals and physicians and are offered by a number of reputable insurance carriers. Designed to offer more flexibility to employers, level-funded plans are ERISA complaint and partially self-insured with a savings potential of 10 to 15 percent. Many also offer return-of-premium potential.

Learn More

Want to learn more about these strategies? Tune in to our free webinar on March 7th at 1 pm EST. Jason Cleary, a licensed Benefits Counselor with over 18 years of experience, will be sharing information on how to utilize these tactics and save on group health costs in 2019.

Click to register today.

 

mother with breast cancer smiling and hugging her young daughter

What You Should Know: Home Breast Cancer DNA Tests

In March of this year, ancestry DNA testing giant, 23andMe, announced that they would begin testing user DNA for Breast Cancer genes, more specifically identified as the BRCA1 and BRCA2 genes. While technically able to test for these genes for years, it wasn’t until this past March that the FDA officially signed off on it, therefore, making the 23andMe at-home DNA test, the first FDA-approved direct-to-consumer test to evaluate one’s potential risk for cancer.

What Can Your DNA Reveal

The test is offered as an add-on to 23andMe’s standard ancestry report for a total of $199 and is delivered alongside a variety of other reports designed to tell you if you possess certain genetic markers which may suggest a predisposition to things such as:

  • Macular Degeneration
  • Lung and/or Liver Disease
  • Celiac Disease
  • Hemochromatosis
  • Hereditary Thrombophilia
  • Alzheimer’s Disease
  • Parkinson’s, and many more
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