by admin | Aug 15, 2023 | Health Insurance
Health insurance may not be the most exciting thing to shop for but it’s one of the most important things that you can buy for yourself and for your family. Having health insurance has many benefits. It protects you and your family from financial loss in the same way that home or car insurance does. Even if you are in good health, you never know when you might have an accident or get sick.
Here are some key advantages of having health insurance:
- Access to Medical Care: Health insurance provides you with access to a network of healthcare providers, hospitals, and specialists. It ensures that you can receive timely medical attention when needed, promoting early diagnosis and treatment.
- Financial Protection: One of the most significant benefits of health insurance is the financial protection it provides. Medical expenses can be substantial, especially in the case of major illnesses, surgeries, or emergencies. Health insurance helps mitigate these costs, preventing individuals from facing overwhelming medical bills and potential debt.
- Preventive Care: Health insurance plans cover preventive services at no cost if you use an in-network provider. This includes routine check-ups, vaccinations, screenings, and counseling services.
- Coverage for Essential Health Services: Health insurance plans typically cover essential health services, such as hospitalization, emergency care, prescription drugs, maternity care, mental health services, and rehabilitation.
- Health and Wellness Programs: Some health insurance plans offer additional benefits such as wellness programs, gym memberships, and access to health management tools. These initiatives encourage you to adopt a healthier lifestyle, manage chronic conditions, and take proactive steps towards improving your overall well-being.
- Specialist Care and Treatment: Health insurance often covers specialized medical care, including consultations with specialists, diagnostic tests, and treatments. Having access to specialists can be crucial for managing complex or chronic conditions effectively.
- Family Coverage: Health insurance plans often provide coverage for family members, including spouses and dependent children.
- Peace of Mind: Knowing that you have health insurance can bring peace of mind, reducing stress and anxiety about potential medical expenses. It allows you to focus on your health and recovery without the added burden of worrying about the financial implications.
Your health is your most valued asset. With a good health insurance plan, you help protect the health and financial future of yourself and your family for a lifetime. It’s important to note that the specific benefits and coverage may vary depending on the health insurance plan, provider, and local regulations. Make sure to review and understand the terms and conditions of a health insurance policy before enrolling.
by admin | May 16, 2023 | Health Insurance, Hot Topics
Healthcare costs, and consequently employee health benefit costs, have been growing at an alarming rate in recent years. The U.S. as a nation spends more on health care than any other developed country but has worse health outcomes. How is this possible?
Four Key Factors Driving U.S. Healthcare Costs:
Healthcare gets more expensive when the population expands, as people get older and live longer. The Baby Boomers, one of America’s largest adult generations, is approaching retirement age. Because of this, the 65+ population is growing at an unprecedented rate. According to the U.S. Census Bureau, 21% of the entire population will be age 65 or older by 2030. Older Americans will make up almost one-quarter of the population by 2060.
This growth is likely to contribute to rising healthcare costs in two important ways:
- Growth in Medicare enrollment
- More complex, chronic conditions
- U.S. Population Is Growing More Unhealthy
According to the Center for Disease Control and Prevention (CDC), 6 out of every 10 adults in the U.S. have at least one chronic disease, such as asthma, heart disease, high blood pressure, or diabetes, which all drive up health insurance costs. In 2020, the health care costs of people with at least one chronic condition were responsible for 86% of health care spending.
Additionally, recent data finds that nearly 20% of children and 40% of adults over 20 in the U.S. are either overweight or obese, which can lead to chronic diseases and inflated healthcare spending.
On average, Americans shell out almost twice as much for pharmaceutical drugs as citizens of other industrialized countries pay. Moreover, prescription drug spending in the U.S. will grow by 6.1% each year through 2027, according to the Centers for Medicare and Medicaid Services (CMS) estimates.
Drug pricing strategies also contribute to rising healthcare costs. Drug manufacturers establish a list price based on their product’s estimated value, and manufacturers can raise this list price as they see fit. In the United States, there are few regulations to prevent manufacturers from inflating drug prices in this way.
Simply put, multiple systems create waste. “Administrative” costs are frequently cited as a cause for excess medical spending. The U.S. spends about 8% of its health care dollar on administrative costs, compared to 1% to 3% in the 10 other countries the JAMA study looked at.
Why is administrative spending so high in the United States? The U.S. operates within a complex, multi-payor system, in which healthcare costs are financed by many different payors. With so many stakeholders involved, healthcare administration becomes a complicated, inefficient process.
These inefficiencies contribute to excess administrative spending. The main component of excess administrative spending is billing and insurance-related (BIR) costs. These are overhead costs related to medical billing, and include services like claims submission, claims reconciliation and payment processing.
Administrative costs, an aging population, rising prescription drug costs, and lifestyle choices all play a factor in ballooning healthcare expenses. While some of these factors are not in your control, others are. Find out where you can make a difference, not only in health insurance costs, but also to your overall health!
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
