Life Insurance/Long Term Care
Individual and Family Health Insurance
You may still qualify for a policy after open enrollment Open enrollment is closed, but you may qualify for an ObamaCare/ACA policy if you have one of the following events:
•You moved to a different state.
•You lost your group health insurance.
•You got married/divorced.
•You had/adopted a baby.
•You turned 26 and are no longer on your parents’ plan.
It’s the law. If you can afford health insurance but choose not to buy it, you will pay a penalty on the federal income tax return you file. If you don’t have health insurance in 2016, you’ll pay the higher of these two amounts:
•2.5% of your total yearly household income OR
•$695 per person ($347.50 per child under 18).
The maximum penalty per family using this method is $2,085.Parents, grandparents and guardians - is there a young adult in your life age 18 to 34 who doesn’t have health insurance, or a 25-year-old coming off your plan soon? They may qualify for free coverage. If your household income is less than $90,000 (family of four) you could qualify for a subsidy.
Individual / Family
More people than ever are finding themselves without the security of employer-provided health insurance. Do you worry that you or a member of your family could need extended medical treatment or hospitalization? Individual or family health insurance protects you. Let Benefits by Design’s licensed, exchange-certified agents help you find security and peace of mind.
We have helped thousands find the individual or family health insurance plan in their local area that fits their needs without breaking their budget.
We can help you find out whether you qualify for a subsidy on the marketplace exchange plans options.
Employer / Group
The marketplace is changing and costs are rising. Let us show you the most effective plans that can help you control your health insurance costs, whether you have a group of 2 or 200 lives.
If you are a small business, organization, a municipality or group in need of a health insurance plan for your employees or members, Benefits By Design can help you.
We represent only the premier insurance companies and give you the current overview of what is available in the Marketplace. Therefore, we can design the right plan, with the best coverage to fit the needs and budget of your employees/members.
In many cases Benefits By Design has reduced employer’s health insurance costs by as much as thirty percent by providing innovative solutions like partially self-funded, level premium, and captive plans that avoid cost shifting to your employees.
When your employees are dealing with claims and provider issues, we become your advocate. We handle enrolling and
For information about white paper on benefits of self-funding, CLICK HERE.
Here are three models that lower your cost by 30%.
There are 2 models: stand-alone self-funding and the captive model.
Under a fully-insured health benefit plan, an insurance company assumes the financial risk of loss in exchange for a fixed premium paid to the carrier by the employer. Employers with self-funded plans retain the risk of paying a defined portion for their employees’ health care cost (up to a limit, typically between $10, 000 - $25,000) themselves, then the reinsurance carrier steps in.
Most employers with more than 200 employees self-insure some or all of their employee health benefits. Employers with fewer than 200 employees also commonly self-fund, but these employers require greater stop-loss insurance protection than larger employers. As a general rule, employers with less than 50 employees fully-insure their group medical benefits.
Employer owned group captives allow smaller employers (50-500 employees) to reap the benefits of self-funding while minimizing their risk and volatility. As compared to a fully insured program, captive programs offer the employer:
• Projected costs (expenses plus claims) estimated to be 4-8% lower in the first year (and potentially compounding after that)
• Funding (cash out the door) similar to fully-insured
• Limited one-year downside of approximately 15% of their fully-insured premium(Very little, if any, additional risk when viewing across multiple years)
Level-Funded Premium Plans
A Level-Funded Premium plan is a self-funded option for employers with less than 50 employees, including groups with as few as five employees. Employers pay the same premium every month for the plan year, and are not subject to the community rating process or 4 percent Obamacare taxes. These are also known as Administrative Services Only (ASO) plans.
No Obama tax or community rating.Self-funded health plans are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA preempts state insurance regulations, meaning that employers with self-funded medical benefits are not required to comply with state insurance laws that apply to medical benefit plan administrators. On the other hand, insured plans must comply with some of ERISA’s requirements, but are primarily governed by the state where covered employees reside.
The distinction between state and ERISA regulations is important when determining if self-funding is right for an organization. Multi-state companies with insured health plans must comply with the regulations of each state in which they have plans and covered employees. Multi-state self-funded plans need only comply with ERISA
What are some of the Components of Self-Funding?
The risk an insurance company takes with an insured plan can be translated into a dollar amount for the employer. That dollar amount is the premium an employer pays each month for the insured group medical benefits. The premium amount includes the following:
Current and predicted claims cost (employer pays)
Administrative fee (not paid)
Premium tax paid to the state (not paid)
Insurance company profit (not paid)
Employers who self-fund their medical benefits do not pay the premium tax or insurance company profit. They do, however, assume the costs of paying for claims and administrative functions Typically, employers with self-funded health plans will outsource plan administration to a third party administrator (TPA) or insurance company who charges the employer a fee for performing administrative services.
Employers with self-funded health plans typically carry stop-loss insurance to reduce the risk associated with large individual claims or high claims from the entire plan. The employer self-insures up to the stop-loss attachment point, which is the dollar amount above which the stop-loss carrier will reimburse claims. Stop-loss insurance comes in two forms: individual/specific stop-loss insurance and aggregate stop-loss insurance Individual/Specific Stop-loss Insurance Individual/specific stop-loss insurance protects a self-funded employer against large, individual health care claims. Essentially, it limits the amount that the employer must pay on a specific individual. For example, an employer with a specific stop-loss attachment point of $25,000 would be responsible for the first $25,000 in claims for each individual plan participant each year. The stop-loss carrier would pay any claims exceeding $25,000 in a calendar year for a particular participant.
Aggregate Stop-loss Insurance
Aggregate stop-loss insurance protects the employer against high total claims for the health care plan. For example, aggregate stop-loss insurance with an attachment point of $250,000 would begin paying for claims after the plan’s overall claims exceeded $250,000. Any amounts paid by a specific stop-loss policy for the same plan would not count towards the aggregate attachment point.
Why Do Employers Choose Self-Funding?
Answer: To control their health insurance costs. An employer may choose to offer a self-funded health insurance plan for a number of reasons. Instead of trying to purchase a “one size fits all” health plan, self-funded plans can be customized to fit the needs of an employer’s workforce.
Employers with self-funded plans control the health plan cash reserves, allowing them to maximize interest income (insurance companies otherwise generate interest income for themselves by investing premium dollars).
Self-funded coverage is not prepaid, as it is when the employer pays premiums to an insurance company. Therefore, companies who self-fund their health plans have improved cash flow. Self-funded plans are not subject to conflicting state health insurance regulations and benefits mandates. Instead, these plans are regulated by federal law.
Employers with self-funded plans are not subject to state health insurance premium taxes. Employers can contract with the providers or a particular provider network that will best meet the needs of its employees.
Protect Yourself With Medicare Supplement Insurance or Medicare Advantage
Are you protected on the health care costs that Medicare does not cover? There are many medical services that Medicare does not cover and you have to pay Medicare’s coinsurance and deductibles.
For example on Medicare Part B: $150,000 dollar open heart surgery and hospital stay — 20% is $30,000 dollars (that’s what you pay).
Also, there are many medical services that Medicare does not cover and you have to pay Medicare’s coinsurance and deductibles.
Medicare Supplement insurance policies provide reimbursement for the out-of-pocket costs that are not covered by Medicare.
Medicare Advantage plans have very low or zero premiums, defined networks and out-of-pocket costs. Part D prescription coverage is included in Advantage plans.
Let Benefits by Design assist you in determining the best Medicare supplement or Medicare Advantage plan that fits your needs.
Reasons You Should Have Life Insurance
It’s about putting your family first--protection for you and your loved ones’ future. Life insurance is an expression of love and caring. Because you care about your family, you want to ensure their financial security in case you are suddenly not around to do so.
Life insurance can pay for your children’s education.
Life insurance can pay off your mortgage.
Life insurance can.
If you are not completely certain that your coverage is in line with your family’s need, please contact us to today.
How much life insurance should you have? The answer most financial planners and underwriters agree on is eight to eleven times your annual income as the main bread winner.
Long Term Care Insurance
Most people think medicare covers the cost of nursing home or assisted living facilities. WRONG! Medicade covers nursing home and assisted living facilities as a loan against your estate. Have you even walked into a medicade nursing home? What’s the first thing you notice? The smell! Should I buy it or not?…When should I buy it?
Did you know that today the cost of being in an assisted living home is between $5,000 and $6,000 per month? Yes, that is today’s cost. That means it could cost as much as $72,000 a year. Having long term care insurance in place enables you to afford the high costs of assisted living and nursing home facilities as well as home health care without wiping out your savings and your estate or forcing your children to find a solution as caregivers or payers.
Let’s look at the cost of a typical plan for a 60-year-old female with a three-year benefit at $200 a day costing $3,721 a year. If you pay premiums for twenty years, the total premium is $74,420, which just about equals the cost of one year in a nursing home or assisted living facility. If you paid for the nursing home out of your pocket for three years with no coverage, it costs you $216,000 versus the long term care policy at $74,420.
When should you buy Long Term Care Insurance? Did you know the younger you are the lower your monthly premium will be? Contact us today.