New options for small business health plans

Three major changes in federal law are rocking the boat on small business health plans. This blog posts summarizes the three most significant changes this past year.


CHANGE #1: No more individual mandate penalty in most states.

WHAT IT MEANS: Without a steep tax penalty for not having a specific type of health insurance, some people are free to consider a wider range of options. Some of these options will save money and expand choices.

WHAT FREEDOM BENEFITS IS DOING: Our financial planning conversations with clients include a wider range of options.


CHANGE #2: Expansion of short term health insurance.

WHAT IT MEANS: This adds a simple, fast, cheap coverage option for healthy people who are in life transitions.

WHAT FREEDOM BENEFITS IS DOING: Building relationships with insurance companies that offer these short term medical insurance products, reviewing specific products, expanding online enrollment


CHANGE #3: Health Reimbursement Arrangements may pay for individual insurance.

WHAT IT MEANS: Small employers are no longer persuaded to offer a group health plan. The same advantages or more

WHAT FREEDOM BENEFITS IS DOING: Emphasizing the HRA’s ability to control health costs for the employer, the ability to increase choice and value to the employee and a new tax advantage. For 2020 employee benefit plans, we include an HRA option at no additional cost in all small business benefit plans and all small business clients where we handle payroll processing.

New cost saving options for some small business health plans.

Wide range of state responses to new health insurance options

Freedom Benefits completes its state-by-state analysis of non-ACA low cost health plan options. Summary results are now online.

Beginning with the executive order he signed on the first day he took office, president Trump and his administration have taken many actions to dramatically affected the health insurance and care options available to individual consumers.  The White House web site recently removed some of the press releases and links to many of the politically sensitive actions but nevertheless they remain a part of the legal and market structure. Endorsements of inexpensive alternative health plans rated by health and age of the applicant and short term health insurance remain promoted on Whitehouse.gov web site. Behind the scenes, health insurance companies rushed to create a wide range of new product offerings and get them approved for sale to the public. These plans offer choice but do not include the protections intended by the 2010 Affordable Care Act. That means that consumers may need more information and education about the range of new health plans on the market today. But that’s not the whole story.

Regulation of health plans rests primarily with state government, not federal government. Every state reacted differently to the federal government’s changes intended to loosen legal requirements and make health insurance options available to consumers. This means that it was important for firms like Freedom Benefits, that follows these legal changes for their impact on consumers, to expand our coverage  on current legal events in each state.

Each state has the ability to regulate or restrict health insurance plans issued within its boundaries. States do not have the authority to regulate or restrict health insurance issued in another state or nation that cover individuals who live in or visit their state. As a result, the medical insurance travel industry was born. People who do not qualify for coverage where the live can visit another state and purchase a short term medical insurance policy, for example, that covers them everywhere within the U.S., including their home state where the coverage cannot be purchased. It’s created an odd market scenario!

Freedom Benefits investigated the status of health insurance laws of each of the 50 states and the District of Columbia. The summarized results are included as a news item on “Status of alternative non-ACA health plans” available by clicking on the state page icons on the right sidebar of this page. We do not endorse any product or strategy but support every individual’s right to have access to information and the widest possible range of health insurance and treatment options.

 

choose your state

Access to primary healthcare varies based on state

National Health Interview Survey data published last week showed that 16.4 percent of adults living in the South region of the U.S. (defined in this survey as Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia) said “there is no place” where they typically received healthcare. In this survey result the people who said they got care at more than one place were counted as having a regular provider.

In contrast, adults in the northeast region (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont) were most likely to say they have a regular primary healthcare provider.

Health care turmoil triggers more consumer use at Freedom Benefits

The past week was a crazy period for U.S. health insurance. Consumers are understandably confused. The turmoil resulted in a higher level of user activity for Freedom Benefits, a web-based service that directs online consumers to various health insurance exchanges.

Within a period of just one week – Monday April 25 to Monday April 1 – we saw the executive branch of the federal government make a surprise announcement that it will not support the popular features of the Affordable Care Act in federal court, then the Trump administration’s new alternate small business health plan was defeated in federal court, then the President denounced Obamacare and promoted his party’s health plan that does not exist, then the White House announced that it will not make any more health care push until after the 2020 election. Whew!

The commotion triggered a higher than usual amount of consumer web traffic, calls and emails to the OnlineNavigator service supported by Freedom Benefits. Our focus is to direct consumers and small businesses on the options as they exist under the law now, and deliberately staying away from the confusing news headlines that cause speculation about what options may or may not exist in the future.

Freedom Benefits’ simple strategy of focusing on facts, not opinion, is apparently paying off in this tumultuous and otherwise divisive environment. The number of enrollments in currently available health plan options effective April 1 appears to be at the highest level since the implementation of the Affordable Care Act that began in 2010.

Freedom Benefits was founded by Philadelphia accountant Tony Novak to provide health insurance support to regional construction workers. It grew to a national service by 1999 when Novak joined the Board of the National Association of the Remodeling Industry. Novak believed that by being insurance-licensed and up-to-date on health insurance legal and market issues in all 50 states and DC, consumers would use an online adviser that eventually became the trademarked OnlineNavigator service. Novak was then asked to testify before Congress on Republican Party ideas to modernize healthcare for small businesses under the Bush administration. Most of Freedom Benefits’ business assets were sold to a public company prior to passage of the Affordable Care Act (ACA). After enactment of the ACA, Yahoo Finance and the Better Business Bureau were critical of our fee-based business model  and so Freedom Benefits has been mostly dormant since then. Freedom Benefits is not an insurance company, producer, exchange or agency. It has no direct revenue and web site operating expenses are paid by another related business. It is still not clear that a business model that does not collect leads or make sales can be successful. Freedom Benefits’ sole function has been to make referrals – both paid and unpaid – based on specific consumer circumstances. Occasionally that advice is combined with basic related personal or business financial planning.

The recent surge in consumer activity triggered discussions about reviving the Freedom Benefits brand and updating the services offered. Last week a Philadelphia area employee benefits and health insurance business wrote that they now perceive Freedom Benefits as a competitor. That strategic business planning is ongoing and no decisions are finalized.

 

Anti-vaxers listed as worst health risks

For the first time ever, the World Health Organization listed “vaccine hesitancy” on its 2019 list of 10 worst global health risks. That list was published in January. Since then, we have epidemic outbreaks in New York and New Jersey, with Pennsylvania not far behind. The problem is getting worse.

In my early adulthood I supported Rotary International’s efforts to get vaccinations distributed to third world countries. I never imagined that there would be a problem with these old diseases right here at home where vaccines are available and covered by health insurance plans.

Social media outlets that allowed anti-vax propaganda are now being shut down. Crowdfunding platforms like Go Fund Me now disallow these campaigns. Research into the motivations of anti-vax social media posters is underway. Meanwhile, companies like Facebook realize they may be held legally accountable for the deadly impact of false information spread on their platform.

New research on anti-vax propaganda exploring the motivations of those who post propagande was published two days ago. Most anti-vax propaganda appears to be attributable to ‘social media ignorance mindset’; a situation with which we are all too familiar. However, even with this limited data, we cannot dismiss the possibility that not all propagandists are driven by ignorance or exercise of free speech rights. There might be more sinister motivations.

Some, maybe most, scientists believe that the planet is overpopulated with humans Past the point of  sustainability. If so, some mechanism of depopulation is in our future. It seems logical to conclude that bad actors taking advantage of health propaganda would have an open path toward this end.

Child vaccinations are covered by health plans for good reason. Unfortunately, parental ignorance or the requirement to do the right thing is not covered. Freedom Benefits has long supported the rights of individuals to make their own health decisions including the right to make bad decisions. However, our support does not extend to the right to transfer the pain, cost or suffering of your poor decision to another person.

Pharmacy industry’s powerful political base with seniors

Much of the media attention critical of the pharmacy industry focuses on the lobbying actions directly with lawmakers and administrative officials. But there is another potentially more powerful force available to the industry.

Seniors are overwhelmingly satisfied with their prescription drug plans. The pharmacy industry has taken action to make it clear that senior voters would be likely to vote out of office an elected official who damages those prescription drug benefits.

The latest demonstration of this power base is the focus of a polling report by the Pharmaceutical Care Management Association released on Mar 18, 2019. The leading point of the press release accompanying the poll result said “Senior registered voters enrolled in Medicare Part D will be less likely to support the reelection of their members of Congress and presidential candidates if those elected officials back proposals eliminating prescription drug negotiations and price concessions that would result in Part D premium increases, according to a new poll from North Star Opinion Research”. Point taken.

The pharmacy industry wants us all to know: the political power of the status quo cannot be ignored.

American Health Shield alternatives

A representative from the former administrator of American Health Shield Dental Insurance and American Health Shield Short Term Medical Insurance wrote to me by email today with a reminder that these products are no longer available but that their company information is still associated with previously published materials that explain and market the products. In an effort to prevent consumer confusion, I removed the outdated pages.

But what does that mean to consumers who look for the products? There are alternatives in most states. It makes sense to do a search for available products listed where you live through the online insurance exchanges and request a call if you want to discuss the options with an agent. We can help connect you with a licensed agent in your area.

FAQs about American Health Shield dental insurance

American Health Shield Dental Insurance is no longer available but some carriers may wish to refer to the design elements.

Reproduced from the American Health Shield online quoting and enrollment Web site. Other pages about the former product were removed to prevent confusion.

What is the difference between Plan A, Plan B and the PPO Plan?

Plans A and B are traditional indemnity options which give you freedom of choice in providers and reimbursement is based upon usual and customary charges. Maximum yearly benefit is $1,250. The PPO Plan is a Preferred Provider Organization, which provides richer benefits for “in-network” based upon contracted, negotiated fees. Should you choose to go “out-of-network”, the benefits are reduced and reimbursement is based upon usual and customary charges. Maximum yearly benefit is $2,000.

How do I look up a preferred dental provider in my area?

Preferred dental providers can be found by searching here:

Who is eligible for this coverage?

This plan is offered to individuals and their spouse age 18 or older, and their unmarried dependent children (from birth to age 19 or 25 if a full-time student -subject to state requirements). All persons listed on the Application for Coverage must reside at the same home address.

When does my coverage start?

Your insurance coverage will begin on the 1st of the month (at 12:00 am), following receipt of the completed Application for Coverage form and payment of the first month plan cost.

What are my payment options?

You can pay in monthly installments by credit card (MasterCard or VISA) or Electronic Funds Transfer (EFT) from your bank.

Can I enroll my dependents?

Yes, your legal spouse, your dependent unmarried children to the end of the calendar year in which they turn 19, or your unmarried children who have not reached their 25th birthday, are allowed to enroll if the child is (1) dependent upon you for support and (2) living in your household.

How do I file a claim?

Download a Claim Form, complete it and mail to:Renaissance Dental = Payor RLHA1 P. O. Box 17250 Indianapolis, IN 46217Or, you may call our Customer Service department at Co-ordinated Benefit Plans at 866-753-1002 to request a claim form during daily business hours, 8:30 am – 5:00 pm EST Monday-Friday.

How can I check the status of my claim?

You may call Renaissance Dental Customer Service at 888-358-9484. (Please be sure to have your membership ID# available at the time of the call.)

Am I covered for all dental services?

You are covered only for the services provided under the Plan option you selected. Please refer to your Summary of Dental Plan Benefits for a complete description of the dental services provided by this Plan. Please read them carefully. For a complete listing of Exclusions and Limitations, refer to your Certificate of Coverage or master Policy.

Are these dental plans available in every state?

No, these plans of dental insurance are NOT currently available to residents of the following states:

PLAN A: AK, CO, HI, MT, NE, NV, NY, ND, VT, WA
PLAN B: AK, CO, HI, MT, NE, NV, NY, ND, VT, WA
PLAN PPO: AK, CO, CT, DE, DC, GA, HI, KY, ME, MD, MN, MT, NE, NV, NH, NJ, NY, NC, ND, OK, SD, TN, TX, UT, VT, VA, WA, WY

The PPO Plan is not available in the following counties:

Massachusetts – Dukes County, Nantucket County

Pennsylvania – Adams County, Bradford County, Cameron County, Forest County, Fulton County, Montour County, Potter County, Sullivan County, Warren County, and Wyoming County.

What is the benefit year maximum?

The benefit year maximum is the maximum amount payable for all Covered Dental Charges in any benefit year as shown in the Coverage Schedule. The Benefit Year Maximum will apply to each insured person.

Is there any kind of waiting period?

Yes, all Certificate Holders (and their Dependents, if covered above) will be eligible for coverage for Class II Benefits 6 months following the effective date of the Certificate Holder or Dependent. All Certificate Holders (and their dependents, if covered above) will be eligible for coverage for Class III Benefits 12 months following the effective date of the Certificate Holder or Dependent. All Dependents under age 19 (if covered above) will be eligible for coverage for Class IV Benefits 24 months following the date the dependent enrolled.

Is a benefit year based on a calendar year?

No, the benefit Year is based on a 12-month period beginning with the covered person’s effective date.Do these plans cover orthodontic services?Yes, the plans cover orthodontic services for dependent children to the age of 19. The 24-month waiting period applies.May I choose any dentist?Yes, you are free to choose any Dentist, as long as the Dentist is licensed to practice dentistry in the state or country in which you receive care.

Will RLHICA send payment to the Dentist, or will I receive payment?

RLHICA will either send payment to you or directly to the dentist if you have assigned benefit payments to the dentist who rendered the covered services.

What if I decide to cancel my policy?

The primary insured may cancel his or her coverage with written notice received 31 days prior to the next billing cycle. Any and all future payments will be discontinued. We will not refund any portion of payments collected before receipt of cancellation.

What are the plan’s benefits, exclusions and limitations?

The following forms are available in PDF format:

Benefits, Exclusions and Limitations for Plan A and Plan B
Benefits, Exclusions and Limitations for PPO Plan

Where can I find more information?

More information is available on the American Health Shield product page and the online quoting page. A brief profile of the Renaissance Life and Health Insurance Company of America is also available.

Simplify the business of life

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How do you plan to simplify the business of life?

This blog title is a slogan used by the world’s most popular personal and small business software maker. For my purposes as an adviser, I’m using it here to refer to the accounting for essential financial transactions between an employer and employee: payroll, taxes and employee benefits.

Small businesses have wide latitude in some areas of their financial operations (offering employee health insurance, for example) and little margin for variance in others (like employee wage taxes) . Yet the goal is the same for all: accomplish these transactions and reporting requirements timely and accurately at minimal time and expense.

The best practice

Today’s small businesses have enormously powerful tools available at minimal cost. To make the most of these technologies it almost always makes sense to integrate the small business banking, payroll, taxes and employee benefits under one platform with one internal person (often the small business owner) and one outside person (usually the accountant) in charge of these systems. Have a clear written agreement on who is responsible for specific tasks, a timeline and provisions to handle unexpected events. (A copy of my small business engagement agreements are available at tonynovak.com). Integration of services using the latest AI driven technology almost always saves time and money.

What can go wrong?

Of course, very few small business owners deliberately choose to fail on these essential accounting areas. Yet available data indicates that a high percentage have run into trouble in the past. Limited data using newer technology is far more favorable. As an anecdotal observation, the percentage of employers with a wage tax violation is somewhere around 25%. The percentage of clients with a violation using current wage tax platform is 0%. The technology works! The most common problem issue is lack of appropriate budget to accounting functions. A typical small business devotes 2% to 4% of its gross revenues on these requirements. These are benchmarks and certainly some fall outside that range. But businesses that go much below are typically the ones that run into tax, accounting or financial management trouble.

How to look for savings

The easiest way to is to request an initial analysis of your current financial accounting operations. An experienced adviser can compare this to the norms among similar small businesses and recommend approaches that are working better lately. This service is available for a small fee that is likely only pennies on the dollar of savings available. The analysis process from beginning to end likely takes a few discussions totaling an hour or two. When I handle these engagements I prepare a one page report for the business owner in checklist format so that we can discuss and easily prioritize the areas of potential gains. In today’s rapidly evolving technology environment, it makes sense to re-evaluate every two years or so. In most cases, business owners tell me they were not even aware of the existence of the most common cost-saving and time-saving tools.


My question to other small business owners: How do you plan to simplify the business of life? I would be pleased to hear your thoughts. Reach me online or call/text 302-404-3263.

Does a waiting period apply to coverage for accidents and injuries?

Health insurance coverage is complex so clarification is often requested on specific issues. We are pleased to provide that personal assistance as requested.

The most popular supplemental insurance plans include some type of exclusion of coverage for claims that exist prior to the policy. This helps keep premium rates affordable and, of course, discourages members from enrolling immediately prior to receiving planned medical treatment. For Core Health Insurance, that exclusion applies during the first 30 days of a newly issued policy. Other policies will have their own waiting period details.

That exclusion does not apply to claims for accidents or injuries, the types of claims that may require medical treatment.

For a more complete explanation see the coverage details from the online quote page and contact us for clarification on any details.