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Top Tips for Spring Cleaning Your Health

Spring is in the air. This means it’s time to spring clean not only your home but also your healthy habits. By focusing on simple ways to improve your health, you are setting yourself up to take advantage of lifelong health benefits. Implementing healthy habits is simpler than you’d think. 

Use Your Health Plan to Your Advantage 

Your health plan is a resource to be used to your advantage. Using your plan helps you stay healthy, and find any potential chronic illnesses before they become dangerous. 

Basic health insurance plans, like Minimum Essential Coverage plans, include ACA-compliant services that cover wellness, preventative services, prescription discounts, and telehealth services.  

How can you use your health insurance to spring clean your health? 

First, visit your primary care provider. Plans offer coverage for an annual checkup with your primary care physician. This annual checkup helps keep you and your healthcare team ahead of potential chronic illnesses by catching a diagnosis early. This visit allows your provider to consistently monitor your health year after year. Anything found during this visit can be addressed and monitored before it becomes more serious. 

Next, use your plan to cover routine vaccinations. They protect your body and keep you strong against viral and bacterial illnesses. It helps you reduce the risk of contracting disease or spreading disease. 

Your health plan may offer prescription discounts that make medication more affordable. If your healthcare provider prescribes a medication, stay healthy by taking your medication as directed, and save money in the process.  

Lab work and screenings act similarly to your annual physical. If the lab work or screenings flag your doctor of potential illness, catching it early can help you stay healthy, longer. 

Use Telemedicine Services

Telemedicine supports your health by providing you with cost-effective access to your medical resources. Oftentimes, telehealth copays are less expensive than an office co-pay. 

Use telehealth as an opportunity to speak with your health care team regarding:

  • Medical test results 
  • Lifestyle coaching 
  • Health coaching 
  • Consultation visits 
  • Medication management 
  • Chronic disease management 

 

Patients receive the same quality of care with telehealth visits as they do in a provider’s office. Taking advantage of telemedicine services supports your health, reduces time spent at the doctor’s office, and saves money. Learn more about the top reasons why you should use telehealth here. 

Eat Fruits and Vegetables

A well-balanced diet including fruits and vegetables, especially those in season, help promote your health. A few of the positive effects they have on your body include: 

  • Lowering blood pressure 
  • Reducing the risk of stroke 
  • Cancer prevention 
  • Reduce digestive issues 
  • Support your vision 
  • Promote weight loss
  • And more 

 

Easy ways to add fruits and vegetables into your daily diet are by keeping them where you can see them, and by incorporating them into a meal itself (i.e. soups, salads, and stir-fries). 

Instead of turning towards a sugary treat after a meal, try an in-season fruit. It’ll satisfy your sweet tooth and support your body’s overall health simultaneously. 

Curious if the foods you think are actually healthy for you, are? Take our quiz here to find out if the foods marketed as “healthy” are actually good for you. 

Drink Water 

Oftentimes, the answer seems to be “drink more water.”  This may be one of the best ways to spring clean your health this season because of how much it can positively impact your wellbeing. 

At a basic level, water helps your body function by: 

  • Eliminating waste through urination, and perspiration
  • Temperature regulation 
  • Lubricating and cushioning joints 
  • Protecting sensitive tissues 

Dehydration can lead to fatigue and a reduction in your body’s ability to perform the way it needs to. 

Other ways water supports your health is through:

  • Supporting brain functions 
  • Supporting your kidneys 
  • Aiding with digestion 
  • Promoting clearer skin and skin elasticity 

How much water should you drink a day? According to The U.S. National Academies of Sciences, Engineering, and Medicine men should drink at least 15.5 cups a day and women should drink at least 11.5 cups a day. One way you can increase your liquid intake is by swapping out sugary drinks for water. Your body will thank you for it.  

Walk 11 Minutes A Day 

Ideally, physicians recommend at least 30 minutes of moderate physical activity each day.  Unfortunately, the increase in more sedentary lifestyles hinders the amount of physical activity people take daily. Forbes found that the average stay-at-home employee sits for about 15 hours a day. 

Sitting for the majority of the day has detrimental effects on the body. In fact, the Mayo Clinic analyzed 13 studies and found that all found, “sitting time and activity levels found in those who sat for more than 8 hours a day with no physical activity had a risk of dying similar to the risks of dying posed by obesity and smoking.” 

A way to combat the negative effects sitting has on your health is by taking at least an 11-minute walk a day. The positive impact it has on your health is lifelong according to a study by the British Journal of Sports Medicine. They found that walking for at least 11 minutes a day actually combats the negative effects of sitting for long periods of time. 

 

Take Standing Breaks

As previously mentioned, sitting for long periods of time has detrimental effects on your body. Its impact is so great that it is now coined “the new smoking.” 

A few ways it hurts your body is through:

  • Leading to weight gain 
  • Muscle loss 
  • Links to lung, uterine, and colon cancer 

Learn more about the long and short-term effects here. 

A way to combat the negative effects of sitting is to support your health is by taking standing breaks. Ways you can do this is through:

  • Standing while working 
  • Walking during meetings 
  • Taking movement breaks
  • Stretch during the day
  • Take walks 
  • Set timers to move around 

A Final Word

Spring clean your healthy habits by implementing these habits. Together, they have a lifelong impact on supporting your overall wellbeing. For more healthy habit tips, read our article giving tips on using your health insurance to meet your health goals. 

use the resources you have, like your health plan, to spring clean your health

Article originally published on SBMA Benefits.

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Top 5 Reasons to Use Telehealth

Telehealth, a once overlooked method of healthcare services, has significantly grown as a result of the COVID-19 pandemic. Virtual visits are now part of everyday medical services. Its booming growth in the medical industry helps grant easier access to patient care for those in remote areas, or those seeking services that don’t necessitate in-person visits. But that’s not all. Let’s discuss the top five reasons you should use telehealth services. 

1. Save Time on your Appointments 

Telehealth visits cut down the time you spend before, during, and after your appointments. Participating in a virtual visit allows you to speak with your healthcare provider at a time and place that is convenient for you- likely in the comfort of your own home. It eliminates the time you spend getting ready, driving to the doctor’s office, waiting in the waiting room, waiting for any delays, and more. 

Research found that telemedicine visits average about 13-15 minutes while in-person visits average about 2 hours. 

Time is valuable, and you want to spend less time in the waiting room, and more time healing. 

2. Consult With a Healthcare Professional if You Need to Go in Person 

Not all appointments require you to physically be in the healthcare provider’s office. Virtual visits are best used in cases of:

  • New patient onboarding 
  • Sharing test results 
  • Chronic disease management 
  • Medication management 
  • Consultation visits 
  • Lifestyle / health coaching

Skip the waiting room and use telemedicine to your advantage when seeking out services that do not require an in-person visit. 

Not all injuries or illnesses can be satisfied with a virtual telehealth visit. A benefit to taking advantage of telehealth services is by first making a telehealth appointment to speak with your health care team to see if you should in fact go physically into the office. In these instances, telemedicine visits help you and your physician determine if you should seek treatment in-person or if the condition can be treated or discussed virtually. 

Seeking the counsel of a professional through a telemedicine visit can save you time by first determining if you need to actually go into the office or not. If you don’t it saves you a visit, and at least 2 hours in the doctor’s office. 

 

3. Cost-Effective

Telehealth is more cost-effective than an in-person office visit. Why? The main reason is that the cost of a telehealth visit is typically less than the cost of an in-person visit. 

Standard telehealth visits cost, on average, about $50. A standard in-office visit, however, can cost upwards of $176. While these estimates may vary based on insurance co-pays etc. the fact remains the same, that the overall cost of telehealth services is dramatically more affordable. 

It also saves on the expenses of transportation to the office itself. 

4. Receive Equivalent Quality of Care 

The quality of care you receive with a telehealth visit is equivalent to the quality of care in an in-office visit. You still have access to a dedicated team of healthcare professionals equipped with the same resources you need in the provider’s office. Your healthcare provider is still actively seeking ways to improve your health no matter if they see you physically or through a screen. 

Reports conducted by American Well and Massachusetts General Hospital found the following regarding patient’s experiences with telehealth:

  • “Patients reported that telemedicine visits resolved their concerns 85% of the time, versus just 64% of the time for brick-and-mortar appointments
  • Patients believe telehealth services can meet their needs as effectively as in-person visits.
  • Telemedicine users are very satisfied with the service. 
  • 79% of respondents perceived telemedicine as more convenient in terms of scheduling
  • 83% felt that the care was as good or better than an in-person visit, and 66% felt personally connected to their telehealth practitioner”

Furthermore, the American Journal of Accountable Care found that telemedicine has created a space for better long-term care management and patient satisfaction. It provides a new way to find health information and allows practitioners a more streamlined method of communicating with patients (such as video conferences, e-mail, and interactive chats). 

5. Decreased Risk of Exposure to Viruses and Bacteria 

An in-person office visit exposes you to other people who could be fending off viruses or bacterial infections. Virtual visits decrease your exposure to others who have an illness that could be passed to you. Additionally, if you have an easily transmissible illness, a virtual visit keeps those around you, and your healthcare team safe. 

For more information about telemedicine, review the difference between mHealth, eHealth, Telemedicine, and Telehealth here. 

Telehealth is a tool to use to your advantage

Article originally published on SBMA Benefits.

 

 

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How Can You Add Value to Your Existing Benefits Plans?

Benefit plans serve as a great way to provide value to employees beyond their salary. Because benefits are becoming increasingly important, it’s important that you give your employees the option to tailor their benefits to their needs. At Innovative HIA, we believe in meeting your employee’s medical needs with additional benefit options. We offer our clients the option to choose various voluntary/worksite, ancillary, and virtual health benefit options. 

How do ancillary benefits (vision and dental insurance) bring value to your employees?

Oral and eye health are essential to our overall well-being. There are quite a few serious conditions that can be detected with regular check-ups for eye exams and oral exams. More than 90% of common diseases have oral symptoms. Among these diseases that can be identified and managed due to regular oral exams are diabetes and heart disease. 

The dental plans included in our benefit offerings include preventative care and basic procedures. The preventative care services include checkups, cleanings, and x-rays. They also include cavity fillings and other basic procedures.

Vision care plans can help make annual eye exams more affordable. With the greater use of screens and an increase in eye strain because of the usage, eye exams are essential to ensuring overall health and well-being. It can also help your employees save on eyewear, lens coating and enhancements, and corrective surgery. 

How do worksite/voluntary benefits bring value to your employees? 

Accident, term life, critical illness, and hospital indemnity insurance provide an avenue for you to meet your employees medical needs beyond benefits. Accident insurance helps employees pay for the medical and out-of-pocket costs that may incur after an accidental injury. Term life insurance is an affordable way to provide financial protection for your employee’s loved ones during working years. 

Critical illness coverage adds a safety net for under-insured persons. Lastly, hospital indemnity insurance can offset high deductibles and out-of-pocket expenses so that a hospital stay does not become a financial crisis. Giving your employees the chance to cater their benefits to their needs is essential to their happiness. 

How do virtual benefits bring value to your employees?

Lastly, virtual benefits provide a great way to ensure your employee’s needs are met. Right now virtual health benefits are essential to a well-rounded benefits program. With Innovative HIA, your employees get 24/7 access to doctors at no cost to them! They are able to speak to a licensed physician when and where you need one by phone or on video. 

Behavioral health is also essential to your employee’s benefit programs. Our virtual health plans offer behavioral health/therapy at a $50 copay. Your employees can speak to a therapist whenever they need one.* Lastly, our benieWALLET stores their health-related information in one easy place so they are easy to access anytime, anywhere. 

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What is the No Surprises Act?

The No Surprises Act (NSA) went into effect January 2022. This new law addresses surprise medical billing and requires new disclosures for employers, third party administrators (TPAs), brokers, and all participants in the healthcare industry including, but not limited to:

  • Hospitals
  • Hospital outpatient departments 
  • Ambulatory surgical centers  
  • Payors
  • Providers
  • Facilities 
  • Ancillary providers performing emergency and non-emergency services 

“[Surprise medical bills can] arise in an emergency when the patient has no ability to select the emergency room, treating physicians, or ambulance providers. Surprise medical bills might also arise when a patient receives planned care from an in-network provider (often, a hospital or ambulatory care facility), but other treating providers brought in to participate in the patient’s care are not in the same network.  

These can include anesthesiologists, radiologists, pathologists, surgical assistants, and others.  In some cases, entire departments within an in-network facility may be operated by subcontractors who don’t participate in the same network.  In these non-emergency situations, too, the in-network provider or facility generally arranges for the other treating providers, not the patient.”*

*Surprise Medical Bills, Karen Pollitz (Mar. 17, 2016). 

Now, patients are federally protected against surprise billing for the following services: 

  • Emergency Services *not including ground ambulance* 
  • Post Emergency Stabilization services 
  • Non Emergency Services provided at in-network facilities 

What are the Implications of the No Surprises Act? 

The Consolidated Appropriations Act (CAA), 2021 made major changes in the way that group health plans are regulated and operated. The addition of the No Surprises Act of 2022 adds complex new rules aimed at protecting against surprise billing and beefs up overall group health plan transparency. The many provisions require that plans provide:

  • A robust online price comparison tool
  • Advance explanations of benefits (EOBs)
  • Report claims information to state “all-payer claims” databases
  • Improve the accuracy of plan provider directory information
  • Remove gag clauses in vendor contracts
  • Examine and document compliance with mental health and substance standards
  • Report on pharmacy costs.

In addition, brokers and consultants to group health plans must disclose to plan fiduciaries the direct and indirect compensation they are paid each year. 

Collectively, these new rules impose potentially significant new regulatory and litigation risks on sponsors of group health plans. They also raise the standard for advisors who must keep their clients up to date on, and in compliance with, these new rules.

The new regulation takes the employee out of covering the cost of unexpected medical bills and puts processes in place for employers, insurers, and hospitals to resolve payment responsibilities for out-of-network medical bills. The goal of the No Surprises Act is to support individuals who receive emergency or needed medical services, but end up with a heavy medical bill that puts them in high unexpected debt. 

The new NSA regulations will create increased transparency in medical billing by providing coverage price lists, and potentially creating flat and/or set rates for medical services. The result of the NSA will be that insured individuals who receive medical treatment will not receive higher than expected bills for the treatments they are given. 

What Will the No Surprises Act Mean for Patients? 

Let’s frame the story: 

Andrew falls off the roof cleaning the gutters, the ambulance comes and takes him to the hospital where he is treated for emergency care by an anesthesiologist, a surgeon, and then, post-surgery receives rehabilitation care from a physical therapist.  The anesthesiologist is out of network, the surgeon is in-network and the PT is out of network. The hospital sends a bill to the insurer for $7,100.00.  

The insurer will have an agreed-upon contractual rate that is less than the billed amount, in this case, let’s set that at $4,600.00.  Andrew has insurance with a $1,000 deductible and a 20% co-pay, so he owes $1,720.00. The insurance pays the difference between Andrew’s responsibility and the agreed-upon amount (Contractual Rate) of $4,600.00, so the insurer pays the hospital $2,880.00.  

Before the NSA, the hospital would then bill Andrew not only the $1,720 of his deductible + 20% co-pay but also the additional $2,500.00 to make up the difference between their billed amount and the agreed-upon Plan Recognized amount of $4,600.00. This brings Andrew’s total payment burden to $4,220.00. 

The No Surprises Act would eliminate the ability for hospitals to collect the difference between the Plan Recognized amount and their higher bill.

 

What Does the No Surprises Act Mean For Employers? 

Employers should have monthly internal governance meetings to go over:

  • Health plans
  • Broker commissions
  • What plans cover
  • What the percentage of enrollment is
  • Every aspect of the health plan design 

Does the No Surprises Act Include Telehealth Services? 

In short, yes, the No Surprises Act does include telehealth services. Patients who see a healthcare provider through a telehealth visit are expected to be charged the in-network rate. 

The Covid-19 pandemic brought on greater demand for telehealth providers, especially in emergency services. As healthcare systems continue to lean on virtual patient services, providers must be aware of preset rates negotiated between insurance contracts and the healthcare network. 

Healthcare finance says it best, “Independent physician groups, which include telehealth docs, must now accept a rate that someone else has negotiated.”

Patients are protected from costly, unexpected fines, however, experts believe these new changes will result in cost shifts in other areas to account for funds. 

 

What are the Transparency in Coverage Requirements? 

CAA Section 114  dictates that insurance carriers and self-insured plans allow policyholders/participants to compare the amount of cost-sharing they would be responsible for paying for a particular medical item or service.  This tool is to be provided by phone or on a website. 

The Transparency in Coverage (TiC) Regulation permits policyholders/participants to request their cost-sharing liability for a particular medical item or service through an online tool or in paper form. 

Both of these requirements are in place to provide clarity around medical billing for insured individuals.

What does the No Surprises Act Mean for Insurers? 

The transparency in coverage requirements necessitate that group health plans and health insurance issuers in the group and individual markets disclose on a public website in 3 separate machine-readable files the following:

  1. In-Network Rates: Payment rates negotiated between plans or issuers and in-network providers (excluding information related to prescription drugs that are subject to a fee-for-service reimbursement arrangement [reported separately].
  2. Out of Network Billed Charges: Historical pricing information showing unique allowed amounts and billed charges for covered items and services furnished by out-of-network providers.
  3. Prescription Drugs: In-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level

These files must be updated monthly and must be made available without login, email, password, or other gated requirement to access the information.

What Does the No Surprises Act Mean For Brokers? 

Brokers must make sure they are fully informed about every aspect of the healthcare plans they are selling in order to comply with EOBs.  Additionally, brokers and consultants to group health plans must disclose to plan fiduciaries the direct and indirect compensation they are paid each year.

What Does the No Surprises Act Mean For Plan Sponsors/ Employers?

Internally, increased governance requirements mirror those for 401ks as dictated by the 1974 ERISA Act.  Employers and plan sponsors will be required to have monthly internal governance meetings of their Boards to review plan coverage.  Plan sponsors must know what their plans cover, what their broker fees are and they must provide access to the price comparison tools offered online by insurers.  

These increased internal governance requirements place a burden on the employer/ plan sponsor to be knowledgeable about the coverage offered and create increased liability for failure to implement required internal governance structures, policies, and procedures. 

How Do I Prepare for the No Surprises Act? 

With the NSA in full effect as of January 1, 2022, employers, insurers, and brokers must prepare for its disclosure requirements, internal governance requirements, and adherence to these new, stricter standards. 

 

As you prepare for the new year, refresh your memory on why millions of Americans enrolled in health insurance this enrollment season, and what it means for you, here. 

 

Article originally published on SBMA Benefits.

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Why You Should Encourage Preventative Care In Your Employee Workforce

Preventative care is the measure you take to prevent illness or disease before it grows into a more difficult problem. It can include:

  • Physical exams
  • Immunizations
  • Screenings

Preventative Care 

Encouraging preventative care benefits your company short and long term. When employees have access to resources to support their wellbeing, they are able to utilize them to continue on a healthier trajectory to be more present and engaging during day-to-day tasks.

If an employee uses the benefits and goes to their annual physical exam, they have a baseline of health. This results in employees becoming aware of chronic issues that need to be monitored. Physical exam visits are opportunities for your employee to ask their healthcare provider questions about their health, along with gaining tips on how to live a healthier lifestyle.

If said employee is diagnosed with high blood pressure at this office visit, their healthcare team will take preventative measures to ensure they stay healthy. If this same employee did not attend the preventative visit, the undiagnosed high blood pressure will continue to go unnoticed and could lead to a heart attack or stroke.

If your employee attends the visit and receives proper care, you have an employee who takes less sick leave down the line. On the other hand, if your employee was not encouraged to take preventative healthcare measures, they could end up suffering from a heart attack or stroke. This case ends up requiring your employee to take time off to heal and recover and less time at work. Preventative care increases overall productivity in the workplace.

Preventative care also covers immunizations and vaccinations like:

  • Influenza
  • COVID-19
  • Tdap

This promotes overall wellness for employees because they will be less susceptible to diseases and illnesses. This allows them to spend more time continuing the success of your business.

Around 50% of people without health insurance plans went to an annual physical. Without insurance, physicals can cost up to $300. Imagine half of your employees falling ill and needing to take leave due to worsening unseen underlying conditions.

Learn more about Affordable Benefits, talk with one of our team members!

Benefits for You 

Providing affordable healthcare for employees reduces the stress associated with healthcare, like expensive medical bills. Additionally, when employees and their families are healthy, they miss fewer workdays to tend to their medical conditions, resulting in overall increased productivity for your business.

Employees who are supported through covered preventative care gain access to resources that combat preventable illness and are more likely to be positive, engaged, and determined to do their best at their place of work.

Investing in your employees is a critical entity in the ongoing success of most businesses. Offering a comprehensive health plan to employees not only helps attract and retain talent but supports their general well-being.

Employees that are taken care of are more likely to invest themselves in your business. If you’re looking for a great health care benefits plan to offer your employees, look no further.

At Innovative HIA, our goal is to provide affordable health coverage to help keep your employees healthy and promote their overall well-being. If you’re interested in offering our benefits to your team, call or contact us today.

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Difference Between Hospital Indemnity and Accident Insurance?

Navigating insurance policies can be challenging for anyone. There isn’t a way to predict the future, so how can you know what you will need? There are so many options available, how can you decide?

Voluntary benefits can help supplement insurance policies that may not cover all of your employees’ needs. There are many options when it comes to voluntary benefits with a few differences. What’s the difference between hospital indemnity policies and accident insurance? Here’s a breakdown.

Accident Insurance 

Accident insurance is an option to help supplement out-of-pocket expenses for potential expenses incurred when an accident occurs. This insurance is used to cover expenses that your standard health insurance plan cannot cover.

Typical medical insurance directly pays the medical provider, and you receive the bill later. Accident insurance, on the other hand, pays the cash directly to you, then you choose the best way to use that money.

What Exactly Does an Accident Insurance Policy Cover? 

There are quite a few expenses accident insurance covers that your traditional health insurance plan may not. These can include:

  • Emergency room visits
  • Ambulance rides
  • Helicopter transportation
  • Hospital admission charges
  • Diagnostic exams
  • Follow-up treatments
  • ICU and rehabilitation unit care
  • Physical therapy

Ambulance transportation can be extremely expensive. Investing in accident insurance could save you thousands of dollars.

Deductibles for many medical insurance plans can also cost thousands. Other insurance simply doesn’t cover hospital stays, ambulance rides, or other non-preventative care. Accident insurance can be a great backup plan.

How Much Does My Insurance Go Up After an Accident?  

Unlike claims filed for car insurance or homeowner’s insurance, the premiums on accident insurance do not increase after an accident or diagnosis of an illness. In other words, covering an ambulance ride with insurance will not impact the premium.

The Affordable Care Act (ACA), created in 2010, halted any insurers’ ability to adjust insurance rates due to medical history or gender.

Now, once you are insured, your premiums will not increase as a result of filing a claim. However, premiums increase steadily over time due to healthcare inflation, increased prescription costs, and rises in chronic illnesses. Many insurance policies implement a fixed annual rate increase that in no way is based on claims filed on accidents.

As Verywell Health explains, “the overall rates for everyone on the plan will typically go up from one year to the next, based on the total claims that were filed by everyone on the plan. But they’ll go up by the same percentage for people who filed big claims, people who filed small claims, and people who filed no claims at all.” Rates reflect the usage of the group, not the individual.

What is Hospital Indemnity Insurance? 

Hospital indemnity insurance is very similar to accident insurance. Whether you choose one over the other or get both will depend on your lifestyle, expenses, and savings. It is also used to supplement any expenses incurred outside of your health coverage.

Hospital indemnity insurance provides a set cash payment to use for any bills you need to pay. This is especially helpful for paying housing, bills, and living expenses if you are unable to work.

What Does Hospital Indemnity Insurance Cover? 

Hospital indemnity insurance coverage depends on the plan and coverage options you choose. Some things covered under a typical hospital indemnity plan include:

  • ICU stays
  • Critical care unit stays
  • Outpatient surgery
  • Continuous care
  • Outpatient x-rays
  • Laboratory procedures
  • Outpatient diagnostic imaging procedures
  • Ambulances
  • Emergency rooms
  • Physician office visits

Generally, hospital indemnity plans have lower premiums compared to other insurance, but depending on your coverage that can increase.

Is Hospital Indemnity Insurance Worth It? 

It’s important to consider your own personal health and wellbeing when deciding on purchasing hospital indemnity insurance. Since this insurance does not cover typical doctor’s visits or prescription medication, it really depends on you and your lifestyle.

Keep in mind:

  • Your personal health—are you or your family members more likely to be hospitalized?
  • What level of coverage does your current health insurance plan cover?
  • Are you financially able to cover unexpected health costs?
  • How much would a hospital indemnity plan cost over time vs. the cost of benefits received?

This plan may give you peace of mind, and the support you need during an unexpected accident. However, if the plan does not seem like something you need, or if you are able to cover the price of an emergency out-of-pocket, you may not need hospital indemnity insurance.

So, How Do You Decide Which Coverage to Invest in? 

The important distinction between the two types of insurance is how often you frequent the hospital. If you have hospital indemnity insurance and do not go to the hospital, you will not get paid benefits. However, accident insurance plans apply to both hospital stays and treatment from your primary care doctor. Consider a few things before you make your decisions.

Consider Your Lifestyle

Do you enjoy running, hiking, and other activities that may be more prone to accidents? Accident insurance might be your best choice.

Do you have kids who play sports or are constantly playing outside? Accident insurance may be for you. If you lead a relatively healthy, active lifestyle, accident insurance might be a better option for you.

If you have a chronic health issue or have dependents with chronic health issues, hospital indemnity insurance may be a better bet for you.

How Much Money Do You Need to Get By?

If you live alone or if you are a relatively young person with fewer financial responsibilities, accident insurance is a great option to ensure you are covered for whatever comes your way.

 

Sometimes, the best solution may be to have both coverage options. If you have children, own a home, own a car, and have other expenses, purchasing both will give you the best coverage.

Consider How Much You Have Saved for Emergencies

If you don’t have a large amount of savings, (e.g. enough to cover three months of expenses), a small monthly premium for accident insurance may make sense for you. On the other hand, if you have enough money to cover potential accident expenses or medical expenses, and support your lifestyle, but a large hospital bill might drain your savings, hospital indemnity insurance may be the smarter option.

Curious about other benefit plan options available to you? Read our article about voluntary affordable benefits here.

Article originally published on SBMA Benefits.

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What Are the Advantages of the Affordable Care Act?

In 2010, The Affordable Care Act (ACA), aka Obamacare, was enacted to provide reform to the health insurance industry.

Overall, the Affordable Care Act aimed to accomplish 3 main strategies: make insurance affordable, emphasize prevention, and improve how health care is delivered.

Over a decade later, it’s challenging to ignore the new standards that were derived from the original push to pass this legislation. While the act originally caused disagreements nationwide, there are clear advantages to be noted that have resulted from ACA.

Make Insurance Affordable 

The first of the strategies that Obamacare aimed to accomplish was to make health insurance affordable for all Americans.

Oftentimes many assume that they have a clear understanding of the finances of their insurance coverage. However, after landing in the hospital or experiencing a need for emergent care, they would find themselves slapped with high deductibles, unexpected bills, and low maximum coverage. ACA was responsible for making changes to such events.

ACA was able to lower insurance costs for Americans in a variety of ways. The first of which was the provision of tax credits for insurance to middle-class Americans. By limiting out-of-pocket expenses to a maximum of $8,150 for individuals and $17,100 for families, in addition to extending the accessibility of Medicaid beyond 100% poverty level, health insurance became more affordable for many.

In addition to these initial cost caps, ACA allowed parents to keep their children on their medical plans until they reached age 26. It also established the Small Business Health Care Tax Credit, which serves to benefit businesses with less than 25 full-time employees. It provides such businesses with a tax credit that covers up to 50% of their contribution to their employees’ health insurance coverage.

Emphasis on Preventative Care 

The second strategy that ACA addressed was putting emphasis on preventive care. Prevention focuses on the promotion of a healthy lifestyle and frequent check-ups to attempt to identify and target potential health issues before they escalate.

The ACA enacted a list of 10 essential benefits that all insurance plans must cover. They include:

  1. Preventive and wellness visits, including chronic disease management
  2. Maternity and newborn care
  3. Mental and behavioral health treatment
  4. Services and devices to help people with injuries, disabilities, or chronic conditions
  5. Diagnostic lab tests
  6. Pediatric dental and vision care
  7. Prescription drugs
  8. Outpatient care
  9. Emergency room services
  10. Hospitalization

In addition to establishing these initial benefit requirements, ACA was responsible for expanding treatment for mental health, addiction, and chronic diseases. From an insurer’s perspective, these are often the most expensive patients for whom to provide ongoing care. ACA put emphasis on programs to combat and prevent this prolonged treatment including those that focus on smoking cessation and combating obesity.

ACA also eliminated lifetime and annual coverage limits and denial of coverage due to pre-existing conditions. Insurance companies are not able to drop or deny you coverage because you have a pre-existing condition, made a mistake on your application, or because you’ve been recently diagnosed with a life-threatening disease. Additionally, they are not allowed to require new members to wait more than 90 days before coverage starts.

Lastly, ACA changed the way that insurers spend premium dollars. It declared that 85% of premium dollars paid by insured members must be spent on healthcare services and quality improvement. If these requirements are not met, insurers are required to provide covered members with a rebate.

Improve Health Care Delivery 

The final strategy that Obamacare aimed to tackle was improving how health care is delivered by doctors and hospitals.

One example of such was the establishment of Accountable Care Organizations. Rather than ACA paying for each individual test, procedure, and visit, these organizations were designed to receive coverage payments based on the care and well-being of patients. So far, these organizations have shown significant results. As such, the ACA has continued to encourage them.

Additionally, ACA encouraged the transition to digital medical records. Traditionally, medical records were kept on paper and transferring them required doing so be done by mail or fax. Now, keeping electronic medical records provided a safer, more secure filing system that provided ease of transfer.

ACA also targeted the reduction of fraudulent doctor/supplier relationships. It provided guidance to states reviewing excessive insurance rate hikes and required background checks of all nursing home staff to prevent abuse of seniors.

Overall, the Affordable Care Act, or Obamacare, provided significant advantages to the healthcare industry. The Act was designed to best benefit both insurance suppliers and recipients to ensure that patients in need receive the best care possible without breaking the bank while still ensuring that the insurance industry was not crippled in the process.

While few fully recognize the benefits that were established as a direct result of the Affordable Care Act, many of the implemented changes have since become a recognized standard across the healthcare industry.

Innovative HIA provides a complete solution for ALE employers who want to provide affordable, ACA-compliant benefits to their workers. Our streamlined technology and personal services provide a complete solution for our clients and their employees. Learn more about what we do, here.

Why is Offering MEC Benefits More Affordable Than Not?

Article originally published on SBMA Benefits. 

The Affordable Care Act (ACA), created in 2010, was designed to ensure healthcare is affordable and available to more people. Under the ACA regulations, applicable large employers (ALEs) are required to provide minimum essential coverage (MEC) to 95% of their full-time or full-time equivalent employees (someone who works at least 30 hours per week). Companies who qualify as ALE have at least about 50 full-time employees in a calendar year. 

If you fail to provide minimum essential coverage to 95% of your full-time employees, your company will be subject to various penalties that could cost your business. If you do a cost-benefit analysis, investing in MEC for your employees can save you millions, while also increasing employee engagement. 

 

How Do You Determine Employee Benefit Eligibility? 

There are two methods for ALEs to determine employee benefit eligibility. They include the following: 

  1. Monthly Measurement Method 
  2. Look Back Measurement Method

In the monthly measurement method, an employer must count the total hours each employee worked per calendar year. If they worked for more than 130 hours in one calendar year, they are automatically considered an employee who should be eligible for employer benefits. 

On the other hand, the look back measurement method looks at the employee’s future employment status to determine benefit eligibility. It assesses the stability period and the predicted hours the employee will work monthly. 

Both methods help employers calculate benefit eligibility to avoid fines for failing to offer federally mandated benefits to their workforce. 

Other advantages of offering ACA benefits include: 

  • Providing affordable health insurance to your workforce 
  • Placing an emphasis on preventative care to maintain a healthy workforce 
  • Improving health care delivery 

 

What are ACA Employer Penalties?

ACA employer penalties are fines issued by the Internal Revenue Service (IRS) to noncompliant ALEs. The IRS takes non-compliance seriously and is issuing higher penalty amounts according to the ACA times.   

The two penalties they can issue are Penalty A and Penalty B. ALEs will receive one or the other, not both simultaneously. 

PENALTY A

Penalty A occurs when ALE does not offer ACA-compliant MEC benefits to 95% of their full-time employees along with their dependents. The IRS will issue a fine for every full-time employee, excluding the first 30 employees, who are not offered ACA benefits. Fine amounts vary depending on the tax year IRS penalizes. The 2021 tax year penalties will be $2,700.

 

PENALTY B

Penalty B occurs when employers do offer benefits to their full-time employees, but those benefits are non ACA-compliant coverage options. Fines issued for Penalty B are $4,060 per employee for the 2021 tax year for ALEs who issued non-compliant insurance options.

These fines aren’t worth the monetary financial burden of failing to provide ACA-compliant MEC benefits to your employees. Continue reading to learn about the affordable coverage options available to you as an employer, and how much you will save by providing MEC benefits. 

 

What Affordable Coverage Options are Available?

Employers seeking to provide affordable benefit coverage options for their employees have the opportunity to invest in ACA-compliant MEC benefits. 

There are three different levels of MEC coverage options available. Knowing the difference between the three different plans helps employers decide which plan benefits their employees the most. 

  1. Standard MEC plans are ACA compliant and include coverage for wellness, preventative services, prescription discounts, and telehealth services. 
  2. Enhanced MEC plans take coverage one step further than standard plans and are aimed at attracting and retaining top talent by also including primary and urgent care visits with low copays, and discounted specialist and laboratory services. 
  3. The highest-level MEC plans include the enhanced MEC plan benefits along with added coverage such as prescription coverage and low copays.

 

Investing in our ACA-compliant Minimum Essential Coverage (MEC) saves you money AND helps you hire and retain top talent in your company. 

With 60% of employees vocalizing the importance of offering employee benefits when accepting a job opportunity, it’s important to understand the value benefits bring to your company. Read more on how benefits help employee retention here.  

To help you see how much you actually save by providing our MEC benefits to your employees, we’ve broken down what you would pay in penalties by opting out of paying ACA-compliant benefits compared to our ACA-compliant MEC Benefit plan. Try out our functioning calculator by clicking the link here to see custom approximations for your business size. 

For a company with 100 employees, providing our MEC Benefits plan can save you $187,820.39 a month, which calculates to over two million dollars in savings in one fiscal year. Reach out to our team of brokers to learn more about our benefits packages that work best for you and your company.

 

What Does This Year’s Record Enrollment Mean For Employers? 

 

The 2021/2022 open enrollment period broke the record for the number of people enrolling in health insurance. Over 13.6 million people enrolled this season, slightly one million more than the previous record of 12.7 million in 2016. 

 

Advisors attribute the record-breaking enrollment to increased government subsidies that help lower out-of-pocket costs for participants.  This means that employers must be prepared to meet the demand. ALEs who don’t offer health insurance can be reported to IRS and thus be subject to heavy fines and penalties from noncompliance. Make sure your business is offering ACA-compliant insurance to avoid being reported. 

 

Offering benefits helps keep your business away from paying IRS penalties. Penalties add up quickly and take away the opportunities you could have used the redirected funds for. 

 

Did you know there’s another benefit to providing employees with benefits? With the Great Resignation becoming a very real workforce reality, employee retention should be top of mind for employers. Adding value to your business through employee benefits gives you as an employer an advantage in more ways than one. Read our article on how benefits improve employee morale here. 

ALEs who offer MEC benefits find it more affordable than not

Attention Brokers: Are You Offering Your ALE Clients the Most Affordable MEC?

Attention Brokers: Are you offering your ALE clients the most affordable Minor Medical Coverage (MEC)? How can you offer your applicable large employers a one-stop shop for all their needs? Benefits are no longer about simply meeting Minimum Essential Coverage options.  You need to offer worksite and voluntary benefits, telehealth options, call center availability, and easy portal management. Why should you offer these options to your employers? Because they want them.

In order for employers to attract and retain great talent, they need great benefit options. This means going beyond standard Minor Medical requirements and offering services that provide value and attract the best workers.

Let’s Start with Voluntary Benefits

Worksite and voluntary benefits include accident insurance, term life insurance, critical illness insurance, and hospital indemnity.

  • Accident insurance includes aid in payment for medical and out-of-pocket expenses that may occur due to an accident occurring.
  • Term life insurance includes a way to provide financial protection for loved ones while employees are working.
  • Critical illness insurance adds a safety net for those who are under-insured.
  • Hospital indemnity benefits help to offset high deductibles and out-of-pocket expenses so a hospital stay does not become a financial crisis.

Next, Consider Offering Your Employees Access to Telehealth Care 

With 24/7 access to doctors, telehealth–also known as Virtual Health–can help employees get care when they need it with added convenience. At Innovative HIA, we offer telehealth options that include behavioral health and therapy access, to give employees the ability to speak to a therapist whenever they need it.* In addition, it helps employees receive necessary prescriptions without having to go to a doctor’s office.

Employers look for convenience when looking for benefits, as a broker you can provide a one-stop-shop for all your ALEs benefits needs. This means 24/7 call center support and easy access to portal management, single-point billing, and US-based customer care.

At Innovative HIA, we offer portal management access to provide employers with the ability to make plan changes, order ID cards, and have them shipped within a few days, check their claim statuses, and give employees the ability to manage their own profiles.

With bilingual call center support, you’re getting licensed representatives to help manage enrollment and provide year-round support. All of our representatives are in-house, which means they understand your client’s needs.

Innovative HIA can provide a one-stop shop for all employers to handle their benefit needs. As a broker, it is your responsibility to provide your employers with the best possible options for their needs. Contact us to learn more!

For more information on how we support employee benefits administration, read our article here. 

Article originally published on SBMA Benefits. 

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