1. Employee Benefits
Chris Porter
(816) 434-3620
Chris.Porter@Assuredpartners.com
Health
HSA
FSA
Dental
Vision
Basic Life
Disability
Vol Life
Accident
Critical Illness
Medical
Gap
2. Civil War era / popular 1916-1920 - sickness funds -- Precursor to Private Health Insurance
Early 1930s – Hospital Service Plans – beginning of Blue Cross associations
1939 – Medical Service Plans – Blue Shield – paid patient similar to AFLAC plans (indemnity)
1940s - 1950s – expansion of private health insurance
Later came HMOs, Medicare/Medicaid
History of Health Insurance
4. Health Benefits
Health
Employer with fewer than 50 EEs
Grandfathered Plans Written prior to
the ACA
Renewal Pricing is based on health
of the employees
(according to claims)
Can be
negotiated
ACA Compliant Written after
the ACA
Pricing is based on age of
employee/dependent
Determined by the insurance carrier
and the state DOI
Not
negotiable
Level Funded /
MEWA*
Popularized
after the ACA
began
Pricing is determined by the health
of the employees.
(Based on expected claims)
Generally be
negotiated
*MEWA is a Multiple Employer Welfare Association (Chamber plan)
5. Health Benefits
Health
Employer with 50 EEs or more
Fully Insured Pricing is determined by the health
of the employees.
(Based on expected claims)
Generally No
Claims Data
Self Insured Set up Stop Loss
to avoid large
claim impacts
Pricing is determined by the health
of the employees.
(Based on expected claims)
Claims Data
Provided
Level Funded /
Captive
Provides for
claims surplus
refund
Pricing is determined by the health
of the employees.
(Based on expected claims)
Claims Data
Provided
6. Health Benefits
Health
Considerations for Medical Plans
- Types of plans and pricing available are based number of
employees (enrolling) and overall health of those employees
- Plan Designs
- Deductible and Copay Combinations
- HSA-compatible versus Traditional Copay Health Plans
- Multiple Plan Options
- Doctor / Hospital / Pharmacy Networks
7. Health Benefits
Health
Medical Plan Designs
Traditional Copay HSA Compatible
Lowest Deductible
$0
Lowest Deductible
$1,250 plus coins
Highest Maximum Out of Pocket
$9,450 (individual)
$18,900 (family)
Highest Maximum Out of Pocket
$9,450 (individual)
$18,900 (family)
8. Health Savings & Flexible Spending
Accounts
Health
Health Savings Account (HSA)
• Can be entirely employee contribution or include employer contribution
• Annual maximum contribution: $4,150 for employee only or $8,300 for family
• Individuals 55 or older can contribute an additional $1,000 (catch up contribution
Flexible Spending Account (FSA)
• Can be entirely employee contribution or include employer contribution
• Annual maximum contribution: $3,050
• Can also include Dependent Care FSA with contribution maximum of $5,000
• Special considerations regarding FSAs and company liability to discuss
9. Dental, Vision, Basic Life
• Can be bundled with Medical plan
• Employer Paid vs Contributory or Voluntary
Dental
Vision
Basic Life
10. Dental & Vision Insurance
Dental
Vision
Basic Life
Considerations for Dental and Vision Plans
- Plan Designs
- Percentage of coinsurance / copays
- Include orthodontics for children and/or adults (dental)
- Include implants (dental)
- Dual option (in some cases for dental)
- Include a better frames frequency (vision)
- Pricing is lower when Employer Paid
11. Considerations for Basic Life
- Plan Designs
- Flat Benefit Amount
- Percent of Salary
- Plans can offer dependent life options
- Generally Basic Life is paid by the employer
Basic Life Insurance
12. Disability & Voluntary Life
• Short Term Disability
• Employer Sponsored, Contributory or Voluntary
• Long Term Disability
• Employer Sponsored, Contributory or Voluntary
• Voluntary Life
Disability
Voluntary Life
13. Considerations for Short Term Disability / Long Term Disability
- Elimination Periods / Benefit Periods
- Short Term Disability can be used for leave after pregnancy
- Pricing is lower (on average) when it is Employer Paid
- Voluntary disability plans most often have participation
requirements and pricing will be based on age and salary of
employee
Disability Insurance
14. Considerations for Voluntary Life
- Maximum Life Insurance benefit is set by the insurance carrier
($100,000 or $200,000 benefit for example)
- Sometimes offered as Guaranteed Issue (no medical questions)
Sometimes they will require medical questions over a certain
limit
- Voluntary Life Insurance is portable – employees can continue to
pay for it at home if they leave your company
Voluntary Life Insurance
15. Accident, Critical Illness, Medical Gap
• Help fill the gap left with health insurance
• Helps to cover out off pocket expenses
• Generally 100% voluntary, but can create a “benefit
bank” to have some employer contribution
Supplemental Plans
Supplemental
plans
16. Other Considerations
- Benefits Administration System (Ben Admin)
- Enrollment Support
- Analytics
- COBRA Administration (20 or more employees)
- 1095 Reporting (if applicable)
- Employee Communication and Education Pieces
- Wellness Solutions
- Compliance Solutions
Added Services
Chris Porter
(816) 434-3620
Chris.Porter@Assuredpartners.com
