Healthcare Consultants News

Employee Health Benefits

How to Construct the Perfect Employee Health Benefits Plan

One could argue that building an employee health benefits plan is like constructing a house. It requires a design, vision, and appropriate budget.

Since some 60% of employees report that benefits are a major factor when deciding whether or not to accept a job offer, it’s good practice to build a stellar employee benefits package. A competitive job market makes benefits all the more important.

If you think about employee health benefits like you would building a home, you can piece together a plan of action that puts you in the line of sight for well-qualified employees. And that’s precisely what we did.

Here’s How to Think About Your Employee Health Benefits Plan for Better Results

Planning the Design & Blueprints (Financial Planning)

Designers work with property owners to develop a strategic blueprint for the building. This design process starts with one discussion—the budget.

Your financial situation can change from year to year, so opting for high-end employee health packages can come back to bite you if there is a downturn in your market.

The best route to go is to analyze what your business can comfortably handle in terms of benefits. Meet with your HR department to ensure your numbers match what you’d like to do.

Determine an estimate of how many employees the package will be applicable to. Analyze the cost to benefit ratio of your benefits package as well. Who will benefit from your package? What value do they offer your company?

Just like when building a home you have to plan your budget far into the future and with unexpected challenges in mind, you must do the same with your employee’s health benefits package.

Laying the Foundation (Doing Research)

Before you can frame a home you must first lay down a solid foundation. The same is true of an employee benefits package. To lay that foundation you have to do research.

For example, when asked what benefits they valued the most, 88% of job seekers remarked that better health, vision, and dental insurance were of greater importance than vacation time and work-from-home opportunities.

Another important factor is to consider the cost to value ratio of offering said benefits. The cost of health insurance premiums rise every year, with some outpacing others. Having a defined contribution plan goes a long way towards keeping costs manageable, however.

Of course, demographics play an important role in laying the right foundation as well.

In our home-building analogy, an expert builder would be fully aware of the ground on which she builds. Slopped landscapes aren’t a good place to build a mansion, for example.

A lack of understanding of your target demographic is equally unstable footing from which to build an employee health benefit plan.

Get inside the minds of your employees. For example, millennials are looking for health benefits and wellness packages more than previous generations. Understanding the details of what they want gives you an opportunity to build your employee health benefit plans according to the market.

Some current trends in employee health benefit plans include:

  • Customized health insurance plans. Employees aren’t fond of the “one size fits all” insurance benefits plans. Communication between you and your employees makes a big difference in determining the right benefits to offer.
  • Digital Health Care. Access to health information on the go is important for many Americans and becoming increasingly so. This benefits your business as employees get well sooner, increasing productivity in the process.
  • Consumer-based health care. Preventive care, prescription drugs, and wellness coverage are all critical to 21st-century

Zoning (Padding Your Plan)

Now that you know what the expectations are for your demographic employees, the next step is to start to fill in your frame and foundation.

This process starts with deciding how you’ll offer the benefits you have now secured. Another component is figuring out how to align your new employee benefits package with what is legal.

Most employers are fully aware of the 10 minimum essential benefits they have to offer but less aware of some of the other health care reforms that have been made to the system. These include:

How do the health care exchanges dictate the availability of plans through employers? First, small businesses will be able to shop for group health insurance plans on the exchange network. In so doing they’ll receive a subsidiary to compensate them. Alternatively, they can be reimbursed for the nonsubsidized part of the plan through their defined contribution allowance.

What are the requirements if I have more than 50 employees? The requirements are simple, you have to offer the minimum essential coverage we mentioned in addition to making sure that coverage is affordable for all employees. Failure to do so results in a penalty. However, by providing your employees with quality health insurance benefits you can not only win them over but also reduce penalties associated with the ACA.

Adhering to these regulations is non-negotiable. Understanding how to do so isn’t that easy, which leads us to our next point.

Put On the Finishing Touches (Meeting with a Health Care Consultant)

No builder does it all alone. They need assistance and support from individuals who have years of experience in the construction business to make the most of their benefits packages.

Similarly, when it comes to designing your own employee health benefits plan, it’s critical you consult with a professional. The finer details of employee health plans can come back to bite you if you’re unaware of their costs.

Factors that can greatly impact the outcome of your plan include:

  • An uncertain future for your company.
  • Frustration for employees who may not enjoy the same perks because you’re changing your plan for newcomers.
  • A lack of competence in administering new benefits.
  • Failure to realize how many employees will actually use the new benefits package.
  • A lack of available funding for many of the benefits of the plan.

You don’t want to face these issues alone. Having a Healthcare consultant on your side can minimize the risks of signing up for a new employee health benefits plan.

Another important consideration you can make before securing a new plan is to simply speak with your employees. Conduct a survey to see what it is they want to see from their new benefits plan. What are some benefits they want? What are some benefits they could do without?

A simple in-house survey can work wonders towards saving you money on unnecessary benefits.

You can also take a look at what your competitors are offering their employees, after all, they’re the ones who could steal your employees if you’re not careful.

Summing It Up

Building an employee health benefits plan is a challenge, just like building a home. It requires forethought, proper planning, the right tools and the right support.

Our team at Healthcare Consultants Inc. wants to help you. We’ve helped thousands of businesses in Houston, Texas secure high-quality employee benefits plans and save them money. Contact our team today for the help you need.

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A Complete Guide to Qualifying Life Events

The Affordable Health Care Act requires Americans to carry an insurance plan that adheres to the 10 minimum essential benefits. Employers are also required to adhere to the ACA. However, qualifying life events can muddy the waters for open enrollment. Understanding what qualifying life events are applicable for a special enrollment period can help you ensure your employees always have health insurance in Houston.

For a better understanding of this process, and the qualifications it requires, please continue reading.

COBRA Compliance

All employers with more than 20 employees are typically required to provide COBRA coverage and to let their employees know they offer such coverage. Most private-sector employers are required to offer it, including those in Texas.

When group plans are subject to COBRA compliance, there is one small exception to this rule. If an employer has employed over 20 employees during the previous year there is no requirement for compliance. The purpose of COBRA is to offer continued group health care coverage even when that plan has been eliminated.

COBRA was enacted by Congress in 1986 to protect individuals under group health plans. The provision it offers extend to retirees, previous employees, dependent children, and former spouses of recipients. However, COBRA coverage is only applicable when plan members suffer a qualifying life event. These qualifying life events dictate whether or not a person associated with the plan can receive benefits.

In most cases, COBRA compliant plans are more expensive for non-employees and more affordable under a group employer plan for individuals. The greatest advantage to this law is the guarantee of health care coverage during unforeseen life changes. Let’s take a look at what these qualifying life events are and what you need to know about them.

Qualifying Life Events

Qualifying events require employers to continue their health insurance coverage when a group health plan ends because of them. COBRA compliance outlines seven specific life events that qualify for this emergency coverage. They are the following.

  1. Reduced working hours for employees. If an employee has had their hours reduced they qualify for a change to their plan.
  2. Termination of employment. Employees that are covered by a COBRA compliant group health care plan qualify for COBRA coverage if and when they are fired. The only exception to this rule is gross misconduct.
  3. Divorce or legal separation from a covered employee. When a spouse is covered by one of these plans they qualify for changes and a special enrollment period if they are legally separated or divorced.
  4. An employee passes away. The death of an employee covered by this plan is considered a qualifying life event.
  5. A dependent child ceases to qualify as one under the plan terms. Typically, children can stay on their parent’s plan until age 26.
  6. The employee’s entitlement to Medicare begins.
  7. Employer files for bankruptcy.

Should an employee lose access to their group health plan for any reason that is not considered a COBRA qualifying event the employer is not required to provide them COBRA coverage. Understanding these qualifying events is crucial for employers to avoid offering coverage unnecessarily. Additionally, if a life event doesn’t result in the loss of coverage, employers don’t have to provide coverage.

Alternative qualifying life events include:

  • Having or adopting a child.
  • Getting married
  • Moving to the USA within 28 days of employment

How it Works for Beneficiaries

Once a plan member hits a qualifying event it triggers a process that requires employers to adhere to COBRA requirements. This includes offering coverage to beneficiaries of the employee. Qualified beneficiaries have a right to elect COBRA if they so choose.

Who are Qualified Beneficiaries?

  • Individuals who are covered under a plan at least 1 day prior to a qualifying life event
  • Employee
  • Spouse of an employee
  • Child or dependent of an employee
  • Any child who is born or placed for adoption with an employee during COBRA continuation coverage.

A good example of this would be if an employee and her spouse were covered by a health plan before a qualifying life event. The spouse could potentially elect COBRA regardless if the employee denied coverage. This means they choose to use COBRA as an emergency safety net for their health care coverage. The time that a beneficiary or employee opts to have COBRA coverage is also known as the “maximum coverage period.”

The maximum time allotted for COBRA coverage varies from plan to plan, but in general, for group health plans it stays at 30 to 60 days total. Depending on the qualifying life event, it can be extended for up to 36 months, but that’s only under certain stipulations.

Of course, not all loss of health care coverage is due to a qualifying life event. This means that beneficiaries and employees might not be eligible for coverage.

What It Means to Lose Coverage

There are a couple of instances that may result in a loss health insurance in Houston but don’t necessarily qualify individuals for COBRA coverage.

The first is a failure to pay premiums. If employees are failing to pay their side of health care premiums they are not eligible for emergency coverage. Employers are not required to enact COBRA for employees in this situation.

The second is cancellation of coverage. If an employee was accidentally enrolled in a health plan but the plan is canceled that doesn’t count as a qualifying life event for COBRA.

Even partial loss of coverage can actually trigger COBRA rights for employees. An uptick in employee premiums or contributions because of a qualifying event. We’ve covered the basis of what these events are, but it’s important to pay attention to even minor changes in lifestyle as it could result in COBRA enactment without employer knowledge.

Additional Qualifying Life Events

Besides COBRA requirements, health care plans can be changed by other qualifying life events under HIPPA special enrollments events, FMLA Leaves of Absence, Medicare or Medicaid entitlement, significant changes to the employer’s plan. Improvement to your benefits package or a serious change in coverage can also be enough to qualify employees to alter their group health plan.

Ultimately, it is the responsibility of the employer to inform employees that they qualify for the special enrollment period, but it’s important to note any changes to their coverage can be complicated and change the costs of the overall plan.

It’s best to consult with experts before making any changes to your plan or advising your employees to do so.

At Healthcare Consultants Inc., that’s what we do best. For more information about your plan, how to handle qualifying life events, or manage your health insurance in Houston, we’d love to be of assistance. Please reach out to us with any questions you may have about this or other health insurance related requirements.

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Claims data and Healthcare Costs

How To Use HB2015 Claims Data to Reduce Healthcare Costs


Growing concern over rising employer healthcare costs has caused many to turn their attention to claims data. Claims data provides greater transparency for employers selecting plans. Texas is one of the only states in the nation that has a law on the books that requires transparency of health plan claims data by insurance carriers. Known as HB2015, the bill was enacted in 2007 before the ACA and was designed to reduce healthcare costs.

The question is, how can you as an employer use this law to reduce healthcare costs and ensure that you’re getting the best coverage for the best rate. Before we do that, let’s explore what HB2015 is and how it works.

What is HB2015?

House Bill 2015 (HB2015) changes the Insurance Code to demand that health insurance issuers who receive a written request for a report from a group health plan must provide a claims report.

Inside this report, claims data must be included. However, certain restrictions apply. The requester must prove they have a right to access the information contained. Once the requestor receives the report, they can follow up for additional information if needed. Once a request is submitted, issuers must respond within 30 days.

Issuers who refuse to release this information to approved of individuals can be subject to administrative penalties. They cannot, however, be held liable for civil damages.

There are many laws that protect individuals from having their health history used against them. HB2015 is focused on gaining accurate information to make a health plan decision without violating individual privacy.

The claims data that the plan’s sponsor has requested must include this information:

  • Total dollar amount of pendent claims
  • Total monthly premiums
  • Paid claims data per month
  • Census data for employees

These reports are captured in either Tier 1 or Tier 2. Tier 1 includes large claims and tier 2 is large claims exceeding $15,000. If an individual claims report has paid claims worth more than $15,000 within 12 months, they must provide a separate sheet and description of those claims. Each claim over $15,000 must have a unique identifying number for the person who received them, the date of service, the amount paid, and procedure and diagnosis codes.

Armed with this information, employers can take steps to reduce healthcare costs and ensure their employees are well taken care of. Of course, it’s a bit more complicated than that. Here’s how claims data makes a huge difference in your costs.

Claims Data Makes a Difference

When health insurance broker’s like our team are looking to lower costs for employers, we try to avoid community rating proposals. One way we’re able to do this is through claims data. We maximize the data to help underwriters determine the appropriate risk for the group and pricing. Pricing that’s based on accurate claims information is a powerful way to keep costs under control.

Large claims data is equally important. Some groups may run over 100% in their previous year because of a one-off cost like a high-cost surgery. We call this a “shock claim.” These “shock claims” do not require follow up treatment and therefore shouldn’t be included in the underwriting process. By having cold hard data that shows how the group used their insurance in the previous year is the easiest way to determine what future costs will be. However, if you don’t have access to claims data you can’t argue to lower costs based on this alone.

The good news is, a carrier typically has 12-24 months of continuous claims data available to rate a group. You simply need to know to access it or work with someone who does. Failing to request a report could cost you big.

Claims data with additional information from other sources can provide a solid basis for developing lower-cost group plans. Another component is the cost and use of prescription medications. The first part of the process is using the drug utilization report.

What About the Drug Utilization Report?

Each year, states are required to record their state’s prescribing habits and cost savings generated from the Drug Utilization Review (DUR) programs. Employers and health plan providers use DUR programs and reports to increase the efficiency of health care resources.

Drug utilization reports enable the managed care pharmacist to identify group prescription trends for patients with conditions like high blood pressure, asthma, and diabetes. This, in turn, provides better care for the individuals in the group and reduces unnecessary costs for the employer.

The ultimate purpose of DURs is to improve patient care. And the better care individuals receive, the less likely they are to file claims, and the less likely they are to have high pharmaceutical expenditures.  Reduced claims lead to lower costs for the holder.

Auditing claims data can seem inconsequential but the reality is it can greatly bring back your investment and then some. By improving the healthcare of the individuals on a group plan, you can increase their benefits by default.

The Healthcare Consultants Inc. team is determined to use tools like the drug utilization report to maintain affordable prices and higher quality care for sponsors and their beneficiaries.

How Your Business Can Benefit

For every service you receive as a business you know exactly what you’re getting. You sign contracts that clearly outline the services you’re getting or giving. It is not a guessing game. You know precisely what to expect—especially if you’re paying thousands of dollars. Why should healthcare be any different?

As a business, you likely pay out thousands, if not hundreds of thousands of dollars, in health insurance. It’s only logical that you’d want to know what the insurance company is paying out, for what, and to whom. Saving money on your plan and turning the cost curve downwards begins and ends with educating yourself about insurance payouts.

A simple critique of your company’s insurance costs can go a long way towards improving your health insurance costs. And thanks to state laws, companies in Houston, Texas can use HB2015 to request insurance records and claims data to make smarter decisions.

Once you have this information the next step is to use it for underwriting your proposal. That’s where we can help. The Healthcare Consultants Inc., team knows how to use often overlooked tools like claims data to reduce your healthcare costs.

For more information about claims data or HB2015 and how it might affect your business, please reach out to us. We can walk you through the process of gathering this information and can let you know how it translates into greater costs savings.

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Health insurance Broker

Do All Health Insurance Brokers Really Have the Same Price?

Searching for a health insurance broker in Houston, Texas? The complexities of employer-based health insurance require the assistance of a professional, but did you know that no two brokers offer the same service?

Brokers vary in the services they offer, the experience they have, and the negotiation power they can wield. Reducing costs and keeping employees satisfied with benefits packages is a tough balance to strike. The right broker, however, does this and so much more.

But should pricing differ that much? What is it you really get with the plan your broker is offering?

Understanding Health Insurance Broker Compensation

Health insurance brokers are trained to understand the health insurance market and how to negotiate with carriers to get the best possible rates for their clients. Clients may be experienced employers with hundreds of employees or individuals who simply want a better rate and coverage for their needs.

The Patient Protection and Affordable Care Act (PPACA) has had a dramatic impact on the health insurance landscape. Brokers are now a critical part of helping individuals and businesses navigate this complex world. Broker compensation, however, has largely remained the same.

Most broker compensation is based on several factors including:

  • Experience
  • Services offered
  • Market Knowledge
  • Strategic Plan Design
  • Market Power
  • Negotiating Ability

The more adept the broker is at these abilities or services, the greater their value to the person using them. Just as with any other position, compensation should be based on value and skill. Unfortunately, many consumers find it difficult to distinguish between brokers. While some may claim to offer the lowest rates, what does that really mean for you?

First, brokers are not paid by the client. They are paid by commission based on the plans they secure for the folks that use them. For example, if a company with a group size of 50 employees comes to a broker looking for guidance, the broker will not receive compensation from that group if he secures a plan for them. Instead, the broker receives compensation from the insurer.

Broker’s compensation fees are built into every plan, so consumers pay for them whether or not they use a broker. However, by using brokers, employers and individuals can benefit from a wide range of services they may not know they needed. What are not included are broker’s fees.

Broker’s Fees

Broker’s fees are another area to consider. While broker compensation is typically in the commission or in the core price paid for your coverage many brokers attempt to incur fees via added services. These services might include:

  • COBRA Assistance
  • Compliance
  • Online Enrollment
  • HR Support
  • Claims Support
  • Consultation
  • Employee Handbooks

Fees are most often billed separately, but this where most brokers differ. Some opt to charge their clients high fees for the services they need, while others choose to include those in the premium costs. So while you may be paying the same rate, what you aren’t getting is the same level of service.

Clients often realize this when their broker doesn’t seem overly concerned with negotiating their rates. This can also come out when a client needs assistance with claims or could use the added help of a qualified lawyer. Many brokers only provide those services for an additional fee even though they are already getting a percentage of the total premium.

A health insurance broker who is only concerned with broker compensation won’t focus on making your rates more affordable or your coverage better.

Brokers Role in Health Insurance Coverage

Brokers are responsible for representing buyers. Their job is to seek out agreements that are in your best interest. They do this by first gathering information about you or your company, what requirements you may have, and your budget. A broker can always find a better plan than standard offers because of their ability to understand the market place. The right broker will not only understand the market place but also consider your personal needs. What they charge, however, can vary greatly.

Many brokers charge up to 8% or 9% for the services they provide. Commissions based services come with a down side—they incentivize the broker to offer higher priced plans. The higher the premium you pay, the more they earn in commission.

The trouble is, many of these brokers aren’t providing the valuable services needed to justify the ROI. For example, your broker should aggressively negotiate better rates on your company’s behalf or shop the market to find a competitive rate. They should also handle adds or terms and hold enrollment meetings for employers. All of that is factored into the ongoing commission they make on each plan they negotiate.

Another area to be aware of is partially self-funded, level-funded, self-insured plans. These plan rates are often set by brokers. Brokers negotiate on behalf of the buyer with the TPA or reinsurance carrier. In many cases, the fee schedule (the rate paid to doctors or providers) is far from transparent. Unfortunately, some brokers take advantage of this and add in the aggregate or specific premium they want to increase their commission. The result? A higher premium for the buyer.

To get the most out of your insurance coverage, you need a broker in your corner who is always transparent. You need a team that is on the lookout for the best rate possible without sacrificing on the quality of the coverage you deserve.

Healthcare Consultants Inc. Brokers You Can Trust

At Healthcare Consultants Inc., our first priority is actively negotiating better rates for our clients. At the end of the day, we are only as valuable as the services we offer and the premiums we can negotiate. That’s why with every commission we earn we offer assistance with COBRA, HR, Compliance, Claims assistance, Enrollment Meetings, and even provide Employee handbooks at no extra fee. We also provide a transparent rate structure so you know exactly what you’re paying for.

Our goal is to make our percentage rating as low as possible and offer the greatest level of service. Our 20 plus years of industry experience, market knowledge, and negotiating ability has earned us countless loyal long-term clients.

We fully appreciate that your company or family deserves the best in health insurance coverage. That’s why we deliver the best possible broker services at the best possible rates. We take a hands-on approach to the negotiation process, and as a small business ourselves, we try to find the best coverage options. While other brokers are charging 8% because they can, we believe you should get a significant ROI, which is why we always offer the services mentioned above in our broker’s fees.

If you’re looking for a health insurance broker in Houston, Texas, or the surrounding areas, we’d love to help. For fast, friendly, and efficient service please reach out to us today.


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HMO's and Employer-Sponsored Health Plans

Why do HMO’s Cost Less?—Is It Worth it For My Company?

HMOs are increasingly becoming a popular option for employers and employees. The Kaiser Family Foundation reports that employers pay as much as 82% for their employer-sponsored plans. While most companies offer at least two plan options for employees, determining which one is best for their team can be difficult. Add to that high costs for PPO plans and other benefits, and health insurance can quickly turn into a budget crunch.

But what about HMO’s? Most employees and employers are familiar with their basic functioning, but much of what is reported spins them in a poor light.

How might HMO’s prove beneficial for small and large companies? How might employees benefit from having them? What are the downsides of offering an HMO?

HMOs What Are They and How Do They Work?

HMO stands for Health Maintenance Organization. They require you to select a Primary Care Physician (PCP) in the network. That doctor is responsible for referring you to in-network specialist and hospitals as needed. Each time you require medical assistance you must see your PCP first.

After that initial visit, they determine where to send you next if your medical issue requires further treatment. HMO’s also do not cover out-of-network medical care except for extreme emergencies. You are also required to contact your PCP as soon as possible to inform them of your emergency.

Patients who already have a PCP whom they trust and prefer, might not like HMO plans simply because they are no longer allowed to use that physician without paying out of pocket. There is also typically no limit to how much your health-care costs are per year under the plan. Depending on the plan, specialized treatment may or may not be covered.

Additionally, instead of deductibles, HMO plans frequently charge a minimum amount or copayment for each doctor’s visit. That copayment may be as little as $5 or as much as $50 for visits. This amount is also applied to prescription medications, making more serious illnesses more expensive as the cost can be dictated by the percentage.

Now that you know the basics of what an HMO is, let’s talk about the benefits it offers to both employees and employers.

Benefits for Employees

The greatest benefits of an HMO is cost-savings. HMO’s dictate what providers can and cannot charge. This eliminates unnecessary spending and doctor’s visits along with outrageous costs for standard services. Employee’s benefit in the form of lowered copayments for the services they receive. Healthy families and single folks benefit most from HMO plans.

Preventive health care is another huge bonus for using HMO’s. HMO’s cover virtually all preventive health care services. The end goal is to keep patients happy and healthy so they avoid higher and unnecessary medical costs down the road. HMO’s also attempt to avoid high costs by rewarding doctors for providing only the necessary medical coverage required to keep patients healthy.

HMO’s, despite what some might say, have a healthy network that allows employees to select the best PCP for them and their families. Additionally, low prescription costs and all basic preventive care allow employees to take their health into their own hands.

Dental, vision and other wellness benefits can be offered separately, which further lowers costs since most employees will opt to keep costs low rather than tack on unnecessary coverage.

HMO Costs for Employers

HMO’s cut costs by as much as 20% of the final premium. Additionally, employers aren’t limiting their employees to certain doctors or providers, as there are usually thousands of capable and qualified physicians. Lower monthly premiums require lower employer contributions, which overall lowers the costs for employers.

Another factor many don’t consider is claims data. If employer groups are hoping to explore their options for level-funded or self-funded plans in the future they need solid claims data to get a better rate. HMOs provide some of the best claims data because they are cost-containment focused. Physicians focus on the quality of the treatment instead of offering unnecessary services thereby reducing claims.

PPO’s, on the other hand, often result in higher claims data simply because of the vetting process for each claim. HMO’s make it more difficult for employees to be subject to fraud in any way as well. Fewer claims also equal a better claims experience, which in turn leads to better rates for level funded or self-funded plans.

In terms of costs for employers, while they may have to pay upwards of 90% for the costs, HMOs are considerably less costly on premiums. Also, if employees would like to add out-of-network care and opt not to use the PCP in-network, they can still do so but will be paying out-of-pocket. Employers are not responsible for paying the difference or paying for service, neither is the HMO.

The downside to offering an HMO plan is that many employees are looking to work for companies that provide comprehensive insurance benefits. HMO’s don’t include vision and dental, and the copayments can increase for specialized services. Additionally, there are fewer drugs on their formulary and the process of seeing a specialist can be frustrating at times. In terms of keeping employees happy, an HMO doesn’t always do the best of jobs.

Should Your Company Offer an HMO?

The answer to that question should be based on several factors. These include:

  • Analysis of your group. Do they have specialized requirements that make an HMO more frustration than it is worth?
  • Claims Data. Do you hope to offer level-funded or self-funded plans in the future? If so, an HMO is a good option.
  • How important are benefits to your company and employees?
  • What are other plan options you might want to provide to your employees?

While a PPO always seems like the best route to take, simply because employees have greater options, it can cost far more than it is worth. PPO’s can climb in expenses because there is no cost-containment. However, HMO’s via employer-sponsored plans can also leave employees dissatisfied with a lack of control over their own health. Premiums are more affordable, but they leave something to be desired in the realm of specialized services.

Does all this have your head scratching yet? If so, we want to help.

As Healthcare Consultants, we strive to provide high-quality advice your company can count on. HMO’s and PPO’s are complicated. We’ll work with you to demystify the selection process and give you a greater overview of what you and your employees can expect from each plan.

Visit us in person or give us a phone call for a quick chat about your employer-sponsored plan in Houston, Texas and we’ll walk you through the process of selecting the right one for your team.

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Long-term care insurance

Why Long-Term Care is More Important Than Life Insurance

Long-term care insurance is considered by many to be a luxury. Others opt for life insurance policies to protect their loved ones after they pass.  As health insurance consultants in Houston, Texas, we understand that long-term care insurance is by far more important than the alternative.

Today we’re exploring why this type of coverage is important and what type of benefits you can expect when you choose it over life insurance.

What is Long-Term Care Insurance?

Long-term care insurance (LTC) covers long-term care services required by individuals in their home, community, or in a private facility. It can cover personal and custodial care as well. These policies are built on a daily reimbursement amount that is pre-selected by the insurance choice of the individual.

For example, if you require an in-home nurse to care for your daily needs like bathing, eating, and dressing, your long-term care insurance policy may state they will reimburse you for up to $50 a day. If the amount exceeds that price, you could pay out of pocket to cover the costs. The good news is, this greatly reduces your overall financial burden, allowing for a significant nest egg for funeral expenses and inheritance.

There are limits on many LTC policies, specifically on how much or how long they will pay. Some pay for long-term care costs for up to five years, while others pay for these costs throughout your life regardless of costs. Only a hand full have zero limits on pay out or policy length.

You can work with our health insurance consultants team to identify a wide variety of care options that you may potentially need on your plan.

Coverage Offered

As mentioned, there are a wide variety of plans available for long-term care insurance. Coverage is dependent on the policy selected. Some important areas of distinction include:

  • Ability to hire whomever you like. Some policies require you hire a certified home care agency or licensed professional, while others allow non-licensed providers to receive a payout.
  • Facility limitations. You may be required to use a certified facility for your care under certain plans. Others may allow you to enjoy care at home.
  • Specifications on nursing home coverage. Some will provide full coverage for rehabilitation and 24/7 personal care coverage. Others will only cover the cost of room and board.
  • Assisted Living care. This is covered under most policies.
  • Home modifications. Requirements for installation of ramps or other handicap-friendly equipment is typically covered under a long-term care insurance policy.
  • Additional coverage options. Many policies provide flexibility for future services that could become a part of your policy.

Each of these services may sound excessive to a younger healthy individual, but they are necessities for many elderly adults in Houston, Texas. Planning ahead by signing up for these plans while still healthy can provide relief from hefty financial burdens that come with long-term care needs. They also provide real benefit for those investing in the policies, in contrast with life insurance which doesn’t pay out until after a death.

Benefits of Long-Term Care

In addition to the covered services listed above, there are countless benefits of long-term care insurance. Unfortunately, few people realize the importance of this type of policy. Life insurance may seem to be all that’s needed to provide for your family, but what happens before you pass can be financially devasting. Preparing for the worst by opting for this coverage can prove to be a well-thought out decision for any family.

Analyzing the difference between life and care insurance reveals that the benefits heavily favor care insurance policies.

For example, long-term care provides massive cost savings. With the right health care consultants, you can look for deductibles that lower your premiums, “health” discounts where applicable or share your policy with a partner to reduce costs.

Overall, however, long-term care provides a safety net if and when you require it. Paying out of pocket for these expenses can add up quickly. In-home health care starts at around $700 and climbs as high as $3,000 per week. A policy that covers those costs provides peace of mind.

Another difference is LTC plans provide immediate payouts. There’s typically very little, if any, waiting period for benefits. Pay attention to your plan, however, as exclusions apply.

While life insurance is typically more expensive for older individuals, long term care insurance is much more affordable. It is ideal for people aged 55 and older. This is especially true since 70% of people who reach age 65 will need long term care.

Inflation protection is another benefit of an LTC. Life insurance plans don’t increase with inflation. The amount you sign up for is the amount you get at payout. An LTC provides a defense against inflation by adjusting their payout according to market rates.

LTC plans also provide coverage for many health care services that aren’t covered under health insurance like assisted living or adult day care. A boarder range of coverage is appreciated by those who need immediate care.

Long-term Care Vs. Life Insurance—Which is Right for You?

Selecting a new insurance plan isn’t easy. It requires forethought and may feel like you have to see into the future to get it right. However, with long-term care insurance, you don’t have to get it exactly right.  Unlike with life insurance, LTC plans are more likely to pay off. Many life insurance plans end up forfeited, while LTC’s are used.

Compared: Life insurance & Long-term Care Insurance

Life insurance pays out the amount of the plan you buy into and does not increase with inflation. Long-term care insurance does the opposite.

Long-term care insurance provides for your family and takes care of financial care obligations. Life insurance only pays out when you die.

Illnesses such as Alzheimer’s require hundreds of thousands of dollars in care expenses. There’s a good chance you and your family will deplete your savings before a life insurance policy would ever pay out. Long-term care insurance provides the coverage you need throughout your illness, thereby protecting your family.

Life insurance may not be necessary if you don’t have dependents or enough money to cover burial costs. Long-term care is much more necessary for coverage.

Life insurance is extremely expensive in comparison with the benefits it offers. It often takes months or even years for claims to be accepted, unlike the higher rate of acceptance for long-term care insurance plans.

For more information about why long-term care insurance is more important than life insurance, please contact us. As health insurance consultants in Houston, Texas, we will happily answer your questions so you can make an informed decision.

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Health Care Reform

Why Health Care Reform Has Failed

On March 23, 2010, President Barack Obama signed the Affordable Care Act into law. Two years later the law was upheld by the Supreme Court. Five years later, and we are in the middle of a Congressional healthcare ‘war’ where health care reform is taking a completely different turn. In the meantime, the health care coverage of millions of Americans is being threatened.

The question on many minds is, why has health care reform failed? With countless health care carriers pulling out local exchange markets, hundreds of thousands now find themselves without coverage. Features of health care that the ACA deliberately set out to transform are now seemingly going back to pre-ACA days. But how did all this happen? What has caused the ACA to fail, and if it hasn’t failed what might total implosion look like?

Healthcare Reform: The Origins

According to, the ACA was designed to “give more Americans access to affordable, quality health insurance and to reduce the growth of U.S. health care spending.” The purpose is also to increase these same features under private and public health insurance via exchanges, subsidies, taxes, and regulations.

Ultimately, those who previously couldn’t afford health insurance were promised low-cost, high coverage options that would benefit their families. Claims from the Obama administration that some 47.5 million Americans couldn’t afford insurance before the ACA are largely inaccurate. A more accurate snapshot of the uninsured pre-ACA is closer to 8 million to 18 million—those were the ones that actually could not afford insurance.

Another factor was to mandate the coverage of pre-existing conditions. The 10 minimum essential benefits included maternity and newborn care, hospitalization, prescription drugs, preventative and wellness services and devices among a few others such as ambulatory services. This list of benefits directly increases costs for insurers, who gradually increased their premiums to keep up with costs.

A healthier healthcare market was another goal of the ACA. Ideally, insurers would develop countless plans around the minimum essential benefits to provide options for every age group. Younger people would have plans that fit their needs while older individuals could still rely on Medicare to balance their health insurance costs.

Healthcare reform has not worked that way, however. It is far from affordable and plans are greatly limited by the exchange. But what caused it all to go south?

Why Healthcare is Not Affordable under Obamacare

Dissecting the unaffordability of Obamacare is a complex undertaking. Countless factors contributed to the downfall of healthcare reform. Today we are seeing major carriers pull out of the exchanges. Additionally, these major carriers are also now offering level funded products that require medical underwriting. Medical underwriting is what insurance companies use to determine the health status of the insured to decide if the individual should be offered coverage, what price it should be set at, and what limits or exclusions should be included. It is also a practice that Obamacare was attempting to eliminate from the market. Prior to 2014, insurers regularly used medical underwriting to manage costs. Major carriers have gotten around this requirement rather easily. Instead of outright declining coverage to individuals, as is prohibited by the ACA, carriers are increasing rates to such high levels that no one can afford them.

Level-Funding Plans

Interestingly, level-funded plans give individuals far more flexibility in affordability and coverage. Despite underwriting being one of the key debates during the ACA enactment, it is still effectively legal, as long as coverage is not declined. Healthy people are turning towards these plans more frequently, as are small businesses who wish to pay less for employer coverage.

Level-funded plans enable employers to set aside a set amount to cover claims for their employees. If at the end of the year their employee’s claims are less than the amount they budgeted they can receive a refund of up to 42 percent of the total. This benefits both employers and employees, as it offers the same coverage as a full insurance plan would.

Another piece of the puzzle is the mandate. Healthy young people are critical for the robustness of the health care pool. If they opt out, all that is left is the sick. This increases premiums and health insurers lose money.

The maximum amount an individual can be charged under the mandate is $2,085, however, single adults can be charged only up to $695. Compared to the cost of the average health insurance plan, that’s serious cost savings. So, we see the ‘invincible’ (those aged 18-29) dropping out of the health insurance market altogether and opting to pay the penalty instead. The obvious conclusion is the mandate doesn’t work.

Has Healthcare Reform Failed?

In Houston, Texas, the average cost of health insurance per month on the individual market is $218.41. Coupled with the type of coverage provided many are choosing not to be part of the market. Employers are especially hard-hit by healthcare reform, as their costs continue to skyrocket.

If higher premiums, fewer individuals insured, and lower incentive to sign up for health care are not a sign of health care reform failure than what would be? The entire bill was built on affordability and greater rates of coverage, but the opposite has largely been what we’re left with.

Major carriers are not blind to the failures of Obamacare, which is why they continue to drop out of the exchanges. Atena, BlueCross and BlueShield, and Humana are just a few of the major carriers to remove themselves from the exchange citing losses.

The primary reason the ACA was signed into law was to allow people with pre-existing conditions to still get a cost-efficient health care plan. Now, these carriers are offering their own alternative to the ACA. Underwriting gives them more plan options to offer while finding balance in their pricing.

All of this has left the largest portion of Americans without health care coverage. The burden has also largely fallen on the middle class, another thing that Obamacare was said to help ease. The poorest individuals benefit from the ACA’s basic coverage, but the middle class has to foot the bill. As mentioned above, those individuals are choosing to pay the penalty instead of play a part in the market. The ones who suffer the most aren’t just the carriers, but those who make up the greatest portion of the healthcare market—the middle class.

Where We Stand

Despite Republicans efforts to repeal and replace Obamacare, they have largely failed to change the tides. It isn’t likely we will see a full replacement of the law anytime soon, which leaves many Americans turning to alternative options like underwritten plans. Employers too will be turning to alternative plan options. Healthcare reform is anything but a success, but there is time for real reform to take place.

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Health insurance broker, health insurance agent

The Difference Between a Health Insurance Broker and Agent

A health insurance broker is a professional who can help you secure the best policy for your needs. But how are they different from a health insurance agent? What should you know before using either of their services? Do you get a better deal using one over the other?

When it comes time to search for a new insurance company or employee policy it pays to understand the difference between an agent and a broker. Before you sign on the dotted line for your next policy review what each has to offer and some finer points you may be unaware of.

What a Health Insurance Broker Does

A health insurance broker’s primary job involves working one-on-one with clients to locate a health insurance policy that’s right for them. These brokers are authorized to guide clients through the various policies available to them. They explain the nuances of each plan so clients can make a well-informed decision. They also assist clients in enrolling in a Qualified Health Plan (QHP) via the marketplace.

Brokers are licensed and must have passed a series of examinations and courses to attain that license. After they’ve received their legal license, brokers may be required to take additional classes by the state. Once they’ve passed these examinations, they are required to stay up to date with the latest policy and law changes. Currently, health care reform has required brokers continuously educate themselves to ensure they can provide their clients with relevant information. Additionally, states constantly change their health care policy, making it an even greater challenge to be a broker.

In addition to securing and negotiating health care coverage for clients, brokers are also involved in day-to-day insurance activities. They resolve claim disputes, assist with enrollments, manage the status of family and child care policies, and resolve billing problems. They are more than just a middleman between the individual and the insurance company.

Most brokers are independent of insurance companies. They work as “free” brokers and are given the authorization to offer clients a host of insurance plans. A health insurance broker earns more by finding clients affordable plans with high benefits, which works in the favor of his clients.

Brokers may also be paid a fee by companies to isolate the best plan in the local marketplace for their business.

The Affordable Care Act (ACA) has increased demand for brokers as the complexities of the bill are difficult to follow. Individuals and small businesses are in particular need of brokers to identify the best plans available.

To recap, health insurance brokers do the following for clients:

  • Shop local healthcare markets to find the best plan options
  • Help clients with claims
  • Negotiate rates
  • Assist with billing issues
  • Outline plan designs and options

What a Health Insurance Agent Does

A health insurance agent is a bit different. While their primary job description is the same as a health insurance broker (identifying the right plan for clients), who they answer to is different. Most brokers are able to offer a wide variety of health insurance policies to their clients because they don’t work for just one. Instead, they receive a commission on the sale of policies, but this does not increase the costs for their clients.

Agents, on the other hand, may represent a single insurance company, instead of several. They are paid by that company in a more generalized sense. The number of plans they can offer is limited to that company. Obviously, this can cause their clients to pay more for the same or similar policies that a broker might suggest.

Interestingly, however, a health insurance agent may be employed by a health insurance broker. These agents work with brokers to isolate the best plan from a specific company. The word “agent” and “broker” may also be used interchangeably, but most brokers will advertise that they are a broker since most in the market associate that title with greater options and lower priced plans.

Health insurance agents, like brokers, can also help their clients understand the benefits offered by non-government exchange plan options. The marketplace is designed to bring about lower priced premiums, but recently that hasn’t been the case. To get a more affordable plan, most individuals and employers need a qualified and highly educated agent in their corner working to explain their plan options. However, with most agents, you won’t be able to purchase the plan through them since they are restricted by the company they work for. Nonetheless, the information they provide is invaluable.

Another offshoot of health insurance agent is a “captive” health insurance agent.

What Are Captive Insurance Agents?

Captive agents, also known as “direct” agents, sell policies exclusively for a single insurance company. You can easily spot these captive agents via their marketing. Notice a specific insurance logo in their emails or invoices? If so, they are likely a captive agent.

An independent agent is usually called a “broker” as they shop the marketplace for the best policy and then once they identify a plan that works for you, they become your ‘agent’. Because they aren’t bound by the insurance company’s options, they won’t sell you a policy that might not be right for you. Captive agents, however, are bound by the company and will do their best to sell you plans that may or may not be right for your needs.

How You’re Affected

Whether you’re hiring a health insurance broker to find a good group employee plan or an individual family health care plan, a broker is a crucial tool in lowering insurance costs. Additionally, the right broker can secure a plan that has all the benefits you need and more. They save you time and money along the way.

A health insurance agent can also save you money, but if they are a captive agent they might corner you into a plan you don’t want because they don’t have the freedom to search the entire marketplace. If you’re looking for the best plan option, then the best route to take is to hire a health insurance broker who can then become an independent agent once they find the right plan.

Also, working with multiple agents won’t save you money. An independent broker can provide the cost savings you’re looking for without the headache of working with multiple agents.

Companies are particularly in need of a broker. Negotiating employer-sponsored plans is difficult and outsourcing this task to a professional saves time and money.

Either route you go, remember that entering the market without a broker or agent can cost you big time. The savings you can secure with a professional on your side is incomparable.

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Individual Market Houston

Individual Market Losing Carriers—What Does it Mean for Group Plans?

In 2016, insurance carriers lost some $7.5 billion. While that rate has improved slightly since the Affordable Care Act was first signed into law, losses are still extremely high. In Texas, where the number of the uninsured is highest, the individual insurance market is seeing carriers drop out of the market at an alarming rate. As Houston healthcare consultants, we’ve watched the steady decline of carriers in Houston since the ACA took effect. The question is, how will this ultimately affect group insurance plans and what does it mean for the individual market?

Fewer Insurance Carriers—Why It Matters

On the surface, it might seem as though it doesn’t really matter that more insurance carriers are dropping out of the individual market. However, this development has the potential to undermine some of the ACA’s strongest features.

Fewer Options

Customers, in general, prefer more options to compare and select from. A dwindling number of carriers means fewer choices for customers leading to less satisfaction and a sense of being “forced” into purchasing insurance. As Houston healthcare consultants, we’ve witnessed as this has caused confusion among customers who want to know what their options are. With fewer exchange options available, more people are being pushed off and into the hands of non-exchange insurance carriers.

Increased Costs

The ACA was built on the premise of a strong network of insurance carriers. Without a strong marketplace, competition wouldn’t keep costs affordable—which was the entire point of the bill. As more and more insurers leave the individual insurance market, the costs have seen a significant rise.

The number of carriers on the exchange continues to decrease while premiums have grown more unaffordable. Not only are consumers left with fewer choices, those choices continue to grow more expensive as premium hikes are imposed each year (some jumping up as much as 18% from the previous year).

How Houston Has Been Affected

Texas has long been the face of ACA opposition. Former Gov. Rick Perry refused to expand Medicaid under the ACA, despite the federal government pledging to pay some $100 billion of the costs over the next decade.

When it comes to the exchange, the climate hasn’t changed much. Insurance carriers continue to leave Houston’s exchange networks. Currently, there are only three insurance carriers on the individual market in Houston. They include BlueCross and Blue Shield of Texas, Community Health Choice, and Molina Healthcare.

That number has dropped from seven individual market insurance carriers in 2016. Some of the major players who are dropping out of the market include Atena (who has been pulling out of exchanges around the country), Humana, and Cigna.

As these insurers are leaving the market, they take their coverage options with them leaving thousands in the Houston area without affordable health care options.

Plan options have also changed. Carriers are required to maintain the minimum essential health benefits, but the rates of those plans continue to increase due to two or three carriers carrying the brunt of the burden. That burden, of course, is passed on to participating consumers.

Insurance Carrier Price Hikes

On the heels of this news, the remaining three insurance carriers in Houston have announced significant price hikes.

Community Health Choice has announced a 16 percent hike in premiums and has warned more may be needed. Blue Cross and Blue Shield of Texas hasn’t yet announced their premium hike, although some reports say they are seeking up to a 60 percent hike throughout the country.

Coupled with premium rate hikes we will also see a reduced number of plans overall. Insurance carriers are looking for ways to cut costs while staying on the exchange, and limiting plan options is one way to do it.

As companies struggle to stay on the exchange and scramble to deal with Congress’ overhaul of the ACA, consumers are caught in the crosshairs. Even those in Houston. Using Houston healthcare consultants to select the ideal plan is a route most companies are now taking.

What Does This Mean For Group Plans?

Group plans are directly affected by any decision insurance carriers make. Just as rates increase on the individual market, so do they for group plans.

Ultimately, this will result in increased premiums for both employees and employers. Employers typically pay about 1 percent more (a bit over half) for employee insurance plans. As these rates rise, this will cost employers in a major way while employees continue to have support from their employer.

It could also change the way group plans are structured, particularly if a reversal of the ACA actually happens. Additionally, uninsured rates are likely to rise and costs for the federal government will increase.

What The Future of The Individual Market Carriers Looks Like

The future of the individual market carriers in Houston and around the nation is uncertain. Most of the carriers pulling out of the market are citing losses and chaos as the main culprits. Reversing this trend will not be easy.

Uncertainty isn’t good for any product, but especially so for insurance providers. However, if Congress can pass a new bill that transforms the market the results could be positive. Insurers may have greater flexibility to offer their products and plans, and consumers will have more options to choose from. This could produce a healthier marketplace in the long run.

In the short-term, uncertainty is likely to cause more insurance providers to drop out of the Houston exchange. For example, the Memorial Hermann Health System has opted to quit the individual insurance business in Houston.

The company has spent 3 years trying to master the exchange with nothing but losses to show for it. The company will continue to offer Medicare Advantage coverage options for businesses, but they are permanently leaving the individual marketplace. Some 66,000 plus people currently have those plans but will be unable to resign for them in 2018.

Additionally, consumers aren’t likely to get the affordable plans they were promised from Obamacare. Fewer options reduce competition leaving companies who stick with the exchange an opportunity to increase their premiums.

With no way to estimate who they’ll be covering, how sick policyholders will be, or what will come in the future insurers are left with little other option but to pull out of the individual market. Uncertainty is on the rise, and until the federal government can come to an agreement on what they’ll be offering consumers, it will continue.

How We Can Help

As Houston healthcare consultants, we help both individuals and employers navigate the complex and confusing individual insurance market. We understand it’s nearly impossible to understand your options. And we want to help.

If you need assistance selecting the right employer sponsored or individual health insurance plan in Houston, please contact our team. We are ready to give you the guidance you need to opt for the right plan.


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healthcare costs, healthcare management

10 Healthcare Management Mistakes Costing Your Business Money

Each year, some 20% of health care costs are wasted in the United States. Most of this waste is caused by a poor understanding of coverage. Proper healthcare management for businesses is, therefore, a crucial component to reduce costs. However, business health insurance and group plans can be a source of reprieve for employees and businesses, if they’re used correctly.

Unfortunately, many CTO’s simply don’t know what they can and can’t do with employee health plans. Additionally, employees are often overwhelmed by their benefit options. Complex healthcare lingo only complicates things further.

The result of all this confusion? Increased health care costs. But it doesn’t have to be that way. The first step is to figure out where your company is going wrong.

Let’s look at some of the most common healthcare management mistakes that are costing your business money right now.

1. Lack of Healthcare Cost Awareness

Ignorance is not always bliss. Companies hemorrhage money when they don’t understand the true cost of healthcare. Seemingly minor details like what a PPO charges for hospitalized visits can end up costing your business big. Additionally, if you aren’t fully aware of how much your plan pays for XYZ, how do you expect your employees to?

Time spent scrutinizing your company’s business health insurance plan is time well spent. Health care costs rise each year. Don’t be on the wrong end of those costs just because you don’t understand them.

2. Not Realizing You Can Lower Healthcare Costs

Do you assume that what you have now is the best you can get? You might be wrong. There are countless business health insurance plans in Houston, and you might have overlooked one that can save you thousands.

Some studies have shown that health and wellness programs can slow the growth of healthcare costs by up to 15%. That number can increase as your employees take greater advantage of in-house gyms, meditation centers, and other wellness benefits.

You can also save money with discount drug programs. Brokering deals with pharmacies can slash the cost of pharmaceuticals for you and your employees as well.

Simply understanding your options can save you thousands every year.

3. Not Communicating with Your HR Department Regarding Healthcare Costs

Most HR departments are under little to no direction from their manager to reduce health care costs. Healthcare management is often left to the higher ups. When those higher ups aren’t aware of this, costs increase.

Communicating with your HR department and incentivizing them to perform better reduces costs. Offer bonuses if health care spending dips. Many would gladly pursue better deals for your company if they had a reason to. With an average spending of $12,000-14,000 per employee on healthcare, there’s no better time to demand more of your HR team.

4. Not Understanding ACA Compliance

Despite recent headlines, we are still under the Affordable Care Act (ACA). That law requires employees offer compliant health insurance plans. Leaving compliance in the hands of a third party could be a costly mistake—especially if you choose the wrong provider.

Failure to adhere to ACA compliance too can result in stiff fines and wasted time spent sorting things out. Make sure you understand the benefits required by the ACA and how best to handle them in your business. We’ve also outlined these requirements in our Health Insurance Plans Buyer’s Guide.

5. Shying Away from High-Deductible Group Medical Plans

High-deductible group medical plans are typically far more inexpensive than low-deductible plans. They are also surprisingly beneficial. For example, when combined with a Health Savings Account (HSA) or a Flexible Spending Account (FSA), healthcare management is easier and costs are reduced.

That’s precisely what former CEO of Whole Foods, John Mackey did for his employees. His company saved about $1,689 per individual and $782 per family than they would with the average PPO. Imagine what savings like that could do for your company. Additionally, employee’s save money on taxes thanks to tax-free savings accounts.  Employees get comprehensive coverage and affordable rates and your business saves money when you choose an HSA.

6. Offering Employees “Free” Health Benefits

The saying is true. Nothing is truly ‘free’. Offering employees free health benefits severely hurts your costs. Instead, asking employees to contribute even a small portion to their benefits goes a long way to improving costs. When employees are cognizant of the costs you keep rates more affordable. Needless ER or doctor visits are greatly reduced along with costs.

7. Buying Inflexible Group Plans for Employees

If you own a small business, your business health insurance should focus on a few core benefits:

  • Vision care
  • Disability
  • Medical
  • Dental

Additional coverage options like life insurance, accidental death, pet insurance etc. should be up to your employees to add to the plan. For those extremely budget conscious, you can even leave off dental and vision allowing employees to add that instead.

You don’t have to take away your employees’ options. Simply let them choose the care they want and enjoy greater healthcare cost savings.

8. Outdated Health Reimbursement Arrangements (HRAs)

Insurance is complicated. Healthcare management is even more complicated. The rules for HRAs constantly change, and not staying on top of these changes could be costing you big time. The ACA changed how they are used and in 2017, a new Small Business HRA was released. Not taking advantage of this offer could result in penalties from the IRS.

9. Overlooking Total Healthcare Costs

Many companies look at monthly premiums instead of the total cost of healthcare for their employees. While monthly premiums typically make up the greatest amount you’ll pay, other factors contribute to your costs. These include:

  • Co-pays
  • Out-of-network costs
  • Deductibles for In and Out of Network Providers
  • Drug coverage costs
  • Quality of Coverage
  • Gated and Non-Gated Coverage Options

Each of these factors can increase your health care costs if overlooked. Paying attention to how each affects your overall premiums and what the benefits are long-term of each add-on benefit, plays an important role in healthcare management.

10. Not Getting Help from HCI to Reduce Costs

At Healthcare Consultants Inc., we help businesses get their business health insurance in Houston under control.

We pinpoint precisely where you could be saving money, what options are available for you company’s size, and how to take the next steps. We also work with employees to help them understand their coverage and how to lower their costs over the long term.

Whether you need to design a better plan for your business or want to encourage your employees to improve their own healthcare management, HCI is a trusted source for countless companies in the Houston area.

Let us help you get back on track or improve your healthcare costs as they stand. Please contact our team today.


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