by admin | Oct 7, 2025 | Custom Content, Employee Benefits
Health Insurance today is significantly more complex for young workers than it was just a decade ago. This complexity is driven in large part by healthcare costs that have outpaced inflation, pushing premiums, copays, and other out-of-pocket expenses to comprise substantial portions of their budgets. For many younger employees, navigating this landscape is confusing – more than 50% of Gen Z and Millennial workers admit to randomly selecting a health insurance plan, and nearly half say they don’t know where to turn for help during open enrollment. This lack of guidance makes it difficult for them to anticipate costs and make informed decisions about their care.
They also don’t truly grasp basic health insurance terms like “premium” or “deductible.” This knowledge gap doesn’t just confuse employees; it costs businesses an estimated $106 billion to $238 billion annually due to poor health literacy. (do we need to say where this number comes from?)
The good news? We can turn the tide. Empowering employees to become smarter benefits consumers pays off for everyone, leading to better health outcomes and lower costs. The earlier this education begins, the greater the impact. Here are five practical strategies for helping young employees get up to speed on their benefits:
- Begin with the Basics – Assume nothing. Most employees, particularly those just starting out, aren’t familiar with insurance jargon. Start with “Benefits 101” initiatives that cover the absolute basics: common terms, the ins and outs of group health coverage, vesting schedules, and enrollment period restrictions. Laying this groundwork early helps ensure young employees can make the most of their benefits from day one.
- Highlight the Personal Value – Young employees want to know, “What’s in it for me?” Beyond basic definitions, highlight how a deeper understanding can translate into real-world savings. Explain provider networks and demonstrate how a little research can save thousands on medical procedures.
- Mix Up the Messaging – Traditional handouts are helpful, but young employees often engage more with dynamic content. Use a variety of formats—emails, videos, infographics, flyers, posters, and interactive presentations—to make benefits education more appealing and memorable. A diverse approach ensures the message reaches everyone.
- Make Education Ongoing – Benefits education shouldn’t be a one-time event. Start as soon as employees are hired and keep the conversation going year-round. Regularly discuss relevant topics, such as how to handle life events, use telemedicine, fill prescriptions, or choose between urgent care and the ER. Consider implementing a consistent communication schedule, tackling different benefits topics each month to keep knowledge fresh, especially as open enrollment approaches.
- Offer Personalized Support – Even with great resources, some employees will still have questions. Designate an HR team member as the go-to benefits expert, available for email, virtual, or in-person support. Encourage all employees to meet with HR at least once before open enrollment and consider one-on-one sessions to address individual concerns.
It’s up to employers to help their teams understand and use their benefits wisely—especially young employees who can’t be expected to make informed decisions without a solid grasp of the basics. The real-life reasons people give for delaying or avoiding care—or choosing an ER visit over a primary care doctor—are a powerful testament to why this education is so critical. By investing in benefits education, employers set everyone up for better health, financial security, and peace of mind.
by admin | Sep 30, 2025 | Custom Content, Employee Benefits
Open enrollment doesn’t have to be a stressful administrative task. When planned well in advance, it becomes a valuable opportunity to review and enhance your benefits offerings, demonstrating your commitment to your team’s physical, mental, and financial well-being. A well-executed open enrollment can boost employee morale, improve retention, and ensure your workforce is supported.
Use this checklist to guide your organization through a successful open enrollment period, from the initial planning stages to the final follow-up.
Phase 1: Plan and Prepare Early (8-12 Weeks Before)
- Leverage technology: Consider a benefits portal where employees can easily access health plan documents such as benefit summaries, plan flyers, and contributions charts.
- Gather Employee Feedback: Solicit and record employee questions, concerns, and suggestions from the previous year. Consider conducting a survey to understand what benefits or improvements your workforce desires for the upcoming year.
- Evaluate and Enhance Offerings: Identify new or updated enrollment options.
- Develop Core Resources: Begin preparing your benefits guide and consider implementing or updating online enrollment tools and software.
- Create Educational Content: Produce digital educational materials like FAQs and videos.
Phase 2: Communication Kick-Off (4 Weeks Before)
- Launch Communication Campaign: Start sharing enrollment information across all selected online platforms (e.g., intranet, company newsletter, email).
- Equip Management: Develop a resource kit for your management team, including talking points and FAQs, to ensure they can confidently discuss open enrollment with their teams.
- Integrate Reminders: Add open enrollment reminders and key dates to the email signatures of your management team.
Phase 3: The Final Countdown (1-2 Weeks Before)
- Host Informational Sessions: Schedule and host virtual benefits meetings, webinars, and one-on-one sessions as needed to answer specific questions.
- Distribute Physical Materials: Provide informational pamphlets and mailers to employees.
- Prepare for Questions: Have answers ready for FAQs to ensure a smooth process.
Phase 4: During Open Enrollment
- Ensure Full Distribution: Make sure every employee receives the following information:
- The open enrollment timeline and deadlines
- A statement of their current coverage
- Information on plan-specific changes and rates
- Summaries of available plans
- The open enrollment booklet and any necessary forms
- Contact details for all plan carriers
- Promote Discussion: Remind managers to actively discuss benefit options with their teams.
- Provide Support: Offer ample time for enrollment and send frequent reminders throughout the period.
- Last-Minute Reminder: Schedule a company-wide reminder for the day before the enrollment deadline to prevent employees from missing the window.
Phase 5: Post-Enrollment Actions (1-2 Weeks After)
- Audit and Submit: Review all enrollment forms for missing or incorrect information.
- Ensure Compliance: Confirm that all relevant health care reform requirements have been met.
- Follow Up: Collect feedback from employees on their open enrollment experience.
Bonus Tip for Success
Consider holding a separate, off-cycle enrollment period to highlight voluntary benefits that might be overlooked during the busy primary open enrollment. This provides employees with a dedicated opportunity to explore additional benefits, potentially increasing your overall benefits utilization and employee satisfaction.
We are here to help; reach out to us with any open enrollment questions or needs you may have!
by admin | Sep 8, 2025 | Custom Content, Employee Benefits, Health Insurance
When navigating the world of health insurance, you will likely encounter the term PPO (Preferred Provider Organization). A PPO plan – whether medical or dental – is about balancing the cost and convenience of care. With a PPO plan, you get the flexibility to see a wide range of doctors. You’ll save money by staying within the plan’s network of preferred providers, but you can still choose to go out of network and receive partial coverage. Unlike some other plans, a PPO allows you to see specialists without a referral.
How a PPO Works
A PPO plan functions much like other health insurance plans, but with a key difference in how it handles providers. The plan pays its contracted providers a set, pre-negotiated rate for services. Because of this arrangement, you pay less in cost-sharing—such as copays or coinsurance—when you receive care from an in-network provider.
While PPO plans offer the flexibility to see out-of-network providers, your costs will be significantly higher. You will likely pay more and may need to submit an insurance claim yourself. It’s also important to note that most PPO plans have a separate out-of-network deductible that you must meet before your plan benefits will begin to cover those costs.
Key Advantages of a PPO Plan
PPO plans are often chosen for their flexibility and convenience. Key benefits include:
- No Referrals Needed: You do not need a referral from a primary care provider to see a specialist. You have the freedom to schedule an appointment with any in-network specialist at any time.’
- Out-of-Network Coverage: You can choose to see providers outside of the plan’s network, which is particularly beneficial for those who travel frequently or live in different states.
- Large Provider Networks: Many PPO plans have a broad, nationwide provider network, offering a wide range of choices for care.
- No PCP Requirement: Unlike some other plan types, you are not required to choose a primary care provider(PCP).
PPO vs. HMO: The Main Differences
The primary difference between a PPO and an HMO (Health Maintenance Organization) plan lies in their approach to networks and referrals.
An HMO plan typically provides coverage only for services received from providers within its network, except in emergency situations. You are also required to choose a primary care provider and obtain a referral to see a specialist. HMO plans often come with lower premiums, but they offer less flexibility.
A PPO plan, on the other hand, gives you greater freedom. You can see specialists without a referral and have coverage for out-of-network care (albeit at a higher cost). While premiums are generally higher for a PPO, the added flexibility can be a major advantage for those who prioritize choice in their healthcare.
Ultimately, choosing the right health and dental plan depends on your individual needs and priorities. By understanding the core principles of a Preferred Provider Organization, you can make a more informed decision that aligns with your lifestyle and ensure you get the most value from your benefits.
by admin | Aug 26, 2025 | Custom Content, Employee Benefits, Health Insurance
Ever found a confusing document in your mailbox after a doctor’s visit, wondering if it’s a bill, especially with an “amount you owe” at the bottom? You’re not alone! That document is most likely an Explanation of Benefits (EOB) from your health insurance company. It’s crucial to remember: an EOB is NOT a bill.
Think of your EOB as a detailed receipt or a comprehensive financial statement from your insurance provider. It breaks down the services you received, how much your healthcare provider charged, how much your health plan covered, and any portion you’re responsible for paying. It’s an essential tool for transparency and helps ensure accuracy in your medical billing.
How EOBs Work
The process generally follows these steps:
- Provider Bills Your Insurer: After your medical service, your healthcare provider submits a claim to your insurance company.
- Insurer Processes and Sends EOB: Your insurance company processes the claim, determines coverage based on your plan, and then sends the EOB to you.
- Bill Arrives Separately: You will receive a separate bill from your healthcare provider for the amount you owe after you’ve received and reviewed your EOB. It’s a good practice to wait for your EOB before paying any medical bill to compare the two documents.
What Information Will You Find on an EOB?
While the exact format can vary, most EOBs include similar key sections:
- Account Summary: This lists basic details like the patient’s name, the date(s) of service, and a unique claim number.
- Claim Details: This section provides a breakdown of the specific services you received, including procedure codes, the dates services were provided, and the healthcare provider’s name.
- Amounts Billed & Covered: This crucial part details:
- The total amount your provider charged for each service.
- The amount your health plan paid or approved.
- Any discounts or adjustments negotiated by your insurance company.
- The reason if any portion of the service was not covered (e.g., “not a covered service,” “deductible not met”).
- Your estimated patient responsibility, which is the “amount you owe.”
Remember, insurance rarely covers 100% of costs. Your out-of-pocket expenses will depend on your specific plan’s structure, including:
- Deductible: The amount you must pay for covered healthcare services before your insurance plan begins to pay.
- Copay: A fixed amount you pay for a covered healthcare service, like a doctor’s visit or prescription, usually paid at the time of service.
- Coinsurance: Your share of the costs of a healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service after you’ve met your deductible.
Why Your EOB is So Important
Regularly reviewing your EOB offers several critical benefits:
- Catching Errors: Medical billing errors can occur. Your EOB acts as a window into your medical billing history, allowing you to cross-reference the services listed against what you actually received. You can verify that procedures and diagnoses are coded correctly, potentially saving you money.
- Understanding Your Plan: EOBs provide transparency in the often-complicated world of healthcare finances. By understanding what your plan covers and why certain amounts are or aren’t paid, you gain a clearer picture of how your health insurance truly works.
- Financial Control: Knowing what an EOB is and understanding its contents empowers you to stay in control of your healthcare expenses, ensuring you maximize your benefits and only pay what you genuinely owe.
While an EOB might seem intimidating at first glance, taking the time to understand this document is a vital step in becoming a more informed and empowered healthcare consumer. It’s your financial roadmap to navigating your health plan effectively!
by admin | Aug 4, 2025 | Custom Content, Employee Benefits
Employers will see several changes to their health and welfare benefits due to comprehensive new tax and spending legislation. This includes notable improvements to Health Savings Accounts (HSAs), Dependent Care Flexible Spending Arrangements (DCFSAs), and employer-provided student loan payments, as well as the introduction of some new fringe benefit choices.
These updates introduce significant changes to employee benefits. These changes are part of a comprehensive legislative package enacted on July 4, 2025 and will require employers and employees to adjust their understanding and utilization of benefit programs. Some of the most notable provisions are:
- Health Savings Accounts (HSAs) can now cover Direct Primary Care (DPC) fees, up to $150/month for individuals and $300/month for families.
- The telehealth exception for high-deductible health plans (HDHPs) is now permanent, ensuring continued access to virtual care. Employees with HDHPs will have first-dollar coverage of most telehealth services, before meeting their HDHP deductible.
- The dependent care FSA limit has increased from $5,000 to $7,500 ($3,750 for married filing separately), a boost for working parents.
- Bronze and catastrophic ACA exchange plans are now HSA-qualified.
- The tax exclusion for employer-sponsored health insurance remains intact, a win for traditional group benefits.
- Permanent exclusion for student loan assistance allows for a tax exclusion of up to $5,250 per year for employer payments of student loans and offers long-term support for employees managing student debt.
- New tax-advantaged accounts for children (a.k.a. “Trump Accounts”) are individual retirement accounts (IRAs) for children under 18 with an annual contribution cap of $5,000. These accounts allow for employers to contribute up to $2,500 per employee. Additionally, children born between January 1, 2025, and December 31, 2028, are eligible to receive a one-time $1,000 government contribution.
These changes are important as they significantly impact the employee benefits landscape. They also enhance access to care, reduce wait times, and provide greater flexibility, cost savings, and options for both employers and employees. By leveraging these updates, organizations can elevate employee well-being while remaining tax-compliant and strategically competitive.
by admin | Jul 15, 2025 | Custom Content, Employee Benefits
Want to attract and keep top talent? Your benefits package is crucial! Think beyond just health and retirement. Fringe benefits like Dependent Care Assistance Programs (DCAPs) offer real, meaningful support, especially for employees caring for kids or dependent adults.
What is A DCAP?
A DCAP – also known as a dependent care flexible spending account (DCFSA) (since it functions similarly to a health flexible spending account (FSA)) – helps to ease the financial burden. This program allows employees to set aside pre-tax dollars specifically for eligible dependent care expenses, providing a substantial financial advantage. Through convenient payroll deductions, employees contribute pre-tax funds to this account. These funds can then be used to reimburse them for qualifying expenses such as daycare, babysitting services, or after-school programs.
DCAPs can be standalone benefits or part of a larger “cafeteria plan.” Regardless, they operate under strict IRS rules to ensure proper use of the funds.
What Expenses Qualify for Reimbursement?
To qualify for reimbursement, the expense must be directly related to care that enables the employee (and their spouse, if applicable) to work or look for work. Reimbursement is provided after the care has been rendered.
Eligible Expenses Include:
- Preschool, nursery school, or similar programs (below kindergarten level).
- Before- and after-school care for children.
- Day camps, including specialized camps (e.g., sports, computer).
- Transportation to and from the place of care, if provided by the care provider.
- Employment taxes paid to a caregiver.
- Room and board for a caregiver (in specific cases).
- Application or agency fees related to finding care.
Ineligible Expenses Include:
- Kindergarten tuition or higher education costs.
- Overnight camps.
- Payments made to an employee’s spouse or the child’s other parent (if not their spouse).
Who Qualifies as a Dependent?
Employees can utilize DCAP funds for:
- A dependent child under the age of 13.
- A spouse or dependent who lives with the employee and is physically or mentally unable to care for themselves.
It is important for employees to note that eligibility is calculated on a daily basis. For example, reimbursement cannot be sought for expenses incurred after a dependent’s 13th birthday.
Contribution Limits
Internal Revenue Code Section 129 sets annual contribution limits for DCAPs, ensuring tax compliance:
- Up to $5,000 per year for employees who are single or married filing jointly.
- Up to $2,500 per year for employees who are married filing separately.
These pre-tax contributions are a significant advantage, reducing an employee’s taxable income and thereby increasing their take-home pay. It’s also important for employees to understand that the same expenses cannot be claimed for both a DCAP and the federal dependent care tax credit.
DCAP contributions must be used for eligible care expenses within the coverage period, or they are forfeited. This is often referred to as the “use it or lose it rule.” While a 2.5-month grace period for incurring and submitting claims is permitted, DCAPs do not allow carryovers of unused funds to the next plan year. Additionally, a DCAP is not portable – meaning that if an employee leaves, the funds are forfeited.
Maximizing Benefits for Employees
Offering a DCAP provides meaningful support to employees, whether they are new parents, caring for a loved one with special needs, or simply seeking ways to manage household budgets more effectively. It is a valuable tool that helps team members save money while managing essential care costs.
