by admin | Feb 20, 2023 | Health Insurance, Hot Topics
The pandemic gave us more reasons, and more options, to see doctors online. More and more, people are seeking out telemedicine services versus the traditional brick and mortar physician’s office. This trend includes telemental health services as well. And much like the necessity of remote work proved its potential to employers, telemedicine took hold as a convenient, safe and effective approach to healthcare.
While telemedicine services perform an important role in filling gaps in care, they do not address chronic care and primary care of people. This shortcoming has led to the creation of an entirely new category: virtual primary care (VPC). Today, many employers are exploring incorporating VPC into their employee benefits offering.
In practice, virtual primary care gives patients face-to-face time with their physicians across electronic devices. VPC combines the convenience of telehealth technology with an emphasis on building and maintaining strong relationships between patients and the primary care providers (PCPs). It can be used for chronic conditions such as asthma and diabetes or screening for issues like anxiety and depression. During these visits, doctors can refer patients to specialists or even write prescriptions for some acute illnesses that do not require an in-person assessment.
The COVID-19 pandemic definitely thrust the use of telemedicine forward, but many healthcare providers have been using this type of service for years. What the pandemic did do is encourage patients’ use of the telehealth services already in place. In fact, in 2020 telehealth visits increased 8,336% over visits in 2019 and telehealth appointments continue to rise.
Patients and medical professionals struggle to stay afloat in the current healthcare space. Long wait times have become the norm at doctor’s offices. As a result, more people are avoiding medical appointments altogether. Alongside outrageous wait times, patients are also plagued by high medical costs.
VPC is a cost-effective way for more people to access healthcare more easily, as it reduces taking time off from work and traveling to see a doctor – especially for those living in remote areas. Not every visit can be a digital visit, but many can be.
The shift to virtual primary care is a solution appealing to younger generations who enjoy the ease of digital appointments. A poll by the Kaiser Family Foundation found one-fourth of all adults and nearly half of adults under 30 don’t have a primary care provider – and don’t want one. Millennials and Gen Z (those born in 1997 or later) are “digital natives” and do not remember a time when the internet and social media didn’t exist. As a result, they communicate, shop and manage all aspects of their lives differently than generations before them. When it comes to healthcare, their expectations are no different. They want to schedule and complete a medical consultation from the same place they order dinner – their couch.
Today, all generations of health consumers are demanding a focus shift from just healthcare to health and well-being. VPC is a healthcare evolution that could open doorways for patients to interact with more doctors, receive a better diagnosis, and reduce the common healthcare concerns that are so prevalent today.
by admin | Feb 6, 2023 | Employee Benefits, Health Insurance
Getting sick can be expensive. Even minor illnesses and injuries can be very costly to diagnose and treat. Health care coverage helps you get the care you need and protects you and your family financially if you get sick or injured.
We’re breaking down the health insurance basics. Because, when you understand it, you’re more likely to get preventive care, make better health decisions and even reduce your costs.
55% of people can’t answer basic health insurance questions and younger generations struggle with understanding the fundamentals of insurance even more. 69% of millennials and 64% of Gen Zers admitted they’ve opted not to seek care due to uncertainty about their health insurance.
Put simply, health insurance is a way to pay for your health care. Your health insurance protects you from paying the full costs of medical services when you’re injured or sick. And it works the same way your car or home insurance works: you or your employer choose a plan and agree to pay a certain rate, or premium, each month. In return, your health insurer agrees to pay a portion of your covered medical costs.
How Health Insurance Payments Work
Your premium, or how much you pay for your health insurance each month, covers some or all the medical care you receive – everything from prescription drugs to doctors’ visits. Most people choose a health insurance plan based on the benefits and medical services the plan covers, as well as on monthly cost. But there are other factors to consider as well, like what you will be required to pay when you see a doctor or a health care facility.
These out-of-pocket payments are important to understand and know the differences between them:
- Deductible – A deductible is the amount you pay out of pocket on healthcare costs before your insurance company starts to contribute to your healthcare costs for the year. Generally, a plan with a lower deductible will have a higher monthly premium than a plan with a higher deductible.
- Co-pay – A co-pay is a set fee you pay for a doctor visit. For example, if your policy lists a co-payment of $20 for a doctor visit, you pay that amount each time you see the doctor. Keep in mind that the co-pay will differ for different services. What you pay for a trip to the emergency room will probably not be the same as a co-pay for a visit to your primary care physician.
- Co-Insurance – Co-insurance is the amount you pay for covered health care after you meet your deductible. This amount is a percentage of the total cost of care – for example, if your co-insurance is 20%, your insurance covers the other 80%. Co-insurance levels vary by plan, as do deductibles.
- Out-of-Pocket Maximum – An out-of-pocket maximum is a limit on the amount of money you have to pay for covered services in a plan year. After you spend this amount on your deductible, co-payments and co-insurance, your health plan pays 100% of the costs of covered benefits.
Knowing how your insurance and healthcare costs are structured is an important part of your personal finances. When you choose a plan, look at your typical healthcare needs and costs so you can make the best decision for your health, and your wallet.
by admin | Oct 5, 2022 | Health Insurance, Open Enrollment
For most employers, employee benefits represent a significant portion of their overall budget and a critical part of their employee recruitment and retention strategy. Benefits vary from employer to employer but can range from medical or dental insurance to flexible spending accounts, life and disability insurance, and more. The annual process of renewing those benefits involves a great deal of work, most of which is unseen by employees.
As you finalize your benefits lineup for the next year and hold your first open enrollment meeting, we’re sharing five tips related to common issues we hear from Mineral customers each year.
There are different ways to handle benefit elections. They range from affirmative or “active” elections that require everyone to select options, to evergreen “rolling” elections that only require employees to take action if they want to make changes. There are also many other options in between. Which option an employer chooses depends on their strategy for participation, the types of benefits they offer, state wage deduction rules, and other factors. Before you get started with benefits elections:
- Double check to confirm that any election rules you are using during open enrollment match what was discussed with your insurance carrier or third-party administrator (TPA), as well as matching what you say to employees in plan materials and open enrollment communications.
- Decide what happens if an employee who is enrolled in coverage takes no action during open enrollment. Will their coverage be dropped? Will some or all of their elections carry over to the next plan year? Clearly communicate the consequences of inaction, if any.
Don’t Forget About COBRA!
Federal COBRA applies to most employers that offer group health coverage and that have 20 or more employees. COBRA allows employees (and certain dependents) who experience qualifying events during the plan year to continue coverage for a period of time, at their own cost. Many states have similar laws for employers with fewer than 20 employees, often called “mini-COBRA” laws. Individuals who have elected federal COBRA have many of the same rights as active participants and must be provided the option to waive or elect coverage or add or remove dependents as well. To notify employees of their COBRA rights:
- Clarify who is responsible for sending open enrollment information to COBRA qualified beneficiaries. If you administer COBRA in-house, ensure the person responsible knows open enrollment communications should include COBRA qualified beneficiaries.
- If you are using a third-party vendor for COBRA administration, make sure they send any required communications or paperwork to eligible employees. If the vendor doesn’t do this, the responsibility generally falls on the plan sponsor (the employer).
Leverage Attention
The open enrollment period happens when employees are paying closer attention to benefit-related topics. Open enrollment meetings and communications can present additional opportunities to gather data and insight into the needs and experiences of participants in your benefit programs. Use this time to:
- Consider including an employee survey or otherwise collecting feedback, even anecdotally, on areas of interest or concern. This might include asking for feedback on the open enrollment process and communications. If you hear grumbling about a specific process or hear people express confusion about a particular option, that can be a great way to identify opportunities for education or change. For example, if several people mention in an open enrollment meeting that drug prices are too high, you might decide to send a follow-up communication to remind employees about bulk mail order prescriptions and the additional value that can provide.
- Consider a dependent audit. Dependent audits ensure only eligible individuals are on the plan, which keeps employers in compliance with their plans as written and reduces any unnecessary costs for ineligible dependents. Timing an audit to occur just before or during open enrollment can reduce compliance complications if a dependent is deemed ineligible.
Carefully Review Salary Deduction Agreements
Benefit costs typically change from year to year and most state wage and hour laws require employees to authorize payroll deductions for benefit contributions. Use this time to review your existing deduction agreements and ensure they cover the most current options. Then gather updated deduction agreements from employees. As you review these agreements, consider the following questions:
- Do they clearly indicate the approved amounts to be deducted from pay and the frequency?
- What rights do employees have to choose whether or not their cost share is taken pre-tax or after-tax? If you have a § 125 cafeteria plan in place, confirm the options available so your deduction agreements accurately reflect the choices available to employees.
- Do they address deductions from final pay (e.g., double deductions)? Caution: Cafeteria plan rules do not allow for double deductions from final pay in most cases, and state wage and hour laws can heavily restrict this as well.
Align Processes
Carefully review your electronic or online benefits enrollment systems to confirm the options and language align with the plan rules, and consider the following:
- If you use a universal enrollment form or electronic system, confirm they contain any insurance carrier or TPA required arbitration or enrollment language, so the election is considered valid.
- Put an audit process in place so that, after open enrollment, you can confirm the elections made by employees are transmitted to the carrier/TPA accurately and payroll entries are aligned.
- Provide employees with a confirmation statement that outlines their final election choices and deduction agreements. Also, consider reminding employees to confirm this statement against their first payroll of the new plan year to make sure it reflects their choices. Both steps can go a long way to catching mistakes early, when they are easiest to compliantly correct.
Planning ahead can result in a more effective, streamlined process for the employer and clarity for employees.
By Eeloria Brown
Originally posted on Mineral
