This document discusses best practices for designing employee benefits packages. It recommends that employers consider benefits an important tool for retention, productivity and cost control. It also notes that healthcare costs are rising significantly and represent a large portion of the economy. The document provides guidance on choosing the right medical plans by balancing premium costs with benefits offered and considering all costs of coverage, including employee deductibles and coinsurance. It suggests strategies for controlling costs over time such as encouraging wellness programs and generic drug use. The benefits package should also include other offerings like dental, disability and supplemental insurance.
The Pros and Cons of Self-Insured vs. Fully Insuredbenefitexpress
This webinar reviews which factors and employer should consider in self-insuring and full benefits. It will discuss the legal, administrative, and ee issues.
Taking a closer look at what your company needs to know about moving from a fully-insured to a self-funded health benefits environment. Originally presented by Greg Bass, Senior Consultant/Benefits Division Manager for The Starr Group, this presentation shares the "secret formula" for health insurance programs that successfully work WITH ObamaCare!
This presentation is designed to provide the information needed to understand self-funding, assist you in explaining the solution to clients and then determine whether it is right for their company by comparing and contrasting it to a fully insured solution.
The Pros and Cons of Self-Insured vs. Fully Insuredbenefitexpress
This webinar reviews which factors and employer should consider in self-insuring and full benefits. It will discuss the legal, administrative, and ee issues.
Taking a closer look at what your company needs to know about moving from a fully-insured to a self-funded health benefits environment. Originally presented by Greg Bass, Senior Consultant/Benefits Division Manager for The Starr Group, this presentation shares the "secret formula" for health insurance programs that successfully work WITH ObamaCare!
This presentation is designed to provide the information needed to understand self-funding, assist you in explaining the solution to clients and then determine whether it is right for their company by comparing and contrasting it to a fully insured solution.
Mid-Year Election Changes Under Cafeteria Plansbenefitexpress
This webinar reviews all of the events that affect employees to change their elections under a cafeteria plan and when/how they apply. All 14 events are discussed.
Understanding the concept of risk poolingHFG Project
Presented during Day Two of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Gafar Alawode. More: https://www.hfgproject.org/hcf-training-nigeria
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
Discussion Question (250-300 words long) Describe the princip.docxelinoraudley582231
Discussion Question: (250-300 words long)
Describe the principles of fee-for-service plans and managed care plans. What are the similarities and differences?
I want you to discuss and answer this question and to help you to do so I will upload a PowerPoint file helping you to answer this question.
Here are two of the classmates responses to this question read it and try to connect their responses to your answer and discussion.
Gabrielle
Fee-for-service plans (FSS) and managed care plans are both classes of insurance programs. In fee-for-service plans, the doctors and hospitals get paid for the service that they perform and test that they order. This plan provides protection against health care expenses in the form of a cash benefit that is paid to the insurer or directly to the health care provider after the employee has received health care services. However under this plan, the insurance company determines a deductible for the patient to pay and then they are responsible for the remainder of the amount. Under managed care plans, the plans emphasize cost control by limiting the patient’s choice of doctors and hospitals that they can use. The plan provides a list of physicians and hospitals that the plan holder can use at a reduced price.
These plans are both similar because they offer a reduced price for medical and health coverage. Some differences between the two include how a patient can choose a physician or hospital. Under FSS, you can see a physician whenever you want or feel necessary. However, under managed care, when you see only the physicians that are affiliated with the plan, they then receive a strong financial incentive.
Trevor
The principles of a fee-for-service plan include a health insurance programs that that use cash benefits in order to help protect employees of an organization from expense that come from health care. Some things that are covered by this are physician charges, hospital expenses, and surgical expenses. One type of these service plans are indemnity plans. These plans are when the insurance company and the employer have a contract that specifically covers certain expenses. The next type of these plans are self-funded plans. These plans are when a company pays benefits from their own assets. Managed care plans control costs by limiting employee's decisions on doctors and hospitals. Fee-for-service plans and managed care plans are similar because they both provide health insurance for employees. Managed health care plans are more confusing because they have so many specifications, meanwhile fee-for-service plans is more basic that offers cash benefit for expenses.
until after a probationary period of at least three months so that they can prove that they are going to be great asset to the company.
Instructions:
1. Login to our database using the phpmyadmin.soe.ucsc.edu interface.
2. Develop SQL query to answer each question.
3. In a WORD compatible document and for each question:
· State .
Mid-Year Election Changes Under Cafeteria Plansbenefitexpress
This webinar reviews all of the events that affect employees to change their elections under a cafeteria plan and when/how they apply. All 14 events are discussed.
Understanding the concept of risk poolingHFG Project
Presented during Day Two of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Gafar Alawode. More: https://www.hfgproject.org/hcf-training-nigeria
Pediatric Dental Benefits Under the ACA - What Employers (and dentists) Need ...Spring Consulting Group
With the ACA requiring health plans to cover pediatric dental plans, a number of questions have arisen from both employers and dentists. Here are a few of the basics that both groups need to know. Please note, that this information is specific to the State of Massachusetts, and some details may change from state to state.
Discussion Question (250-300 words long) Describe the princip.docxelinoraudley582231
Discussion Question: (250-300 words long)
Describe the principles of fee-for-service plans and managed care plans. What are the similarities and differences?
I want you to discuss and answer this question and to help you to do so I will upload a PowerPoint file helping you to answer this question.
Here are two of the classmates responses to this question read it and try to connect their responses to your answer and discussion.
Gabrielle
Fee-for-service plans (FSS) and managed care plans are both classes of insurance programs. In fee-for-service plans, the doctors and hospitals get paid for the service that they perform and test that they order. This plan provides protection against health care expenses in the form of a cash benefit that is paid to the insurer or directly to the health care provider after the employee has received health care services. However under this plan, the insurance company determines a deductible for the patient to pay and then they are responsible for the remainder of the amount. Under managed care plans, the plans emphasize cost control by limiting the patient’s choice of doctors and hospitals that they can use. The plan provides a list of physicians and hospitals that the plan holder can use at a reduced price.
These plans are both similar because they offer a reduced price for medical and health coverage. Some differences between the two include how a patient can choose a physician or hospital. Under FSS, you can see a physician whenever you want or feel necessary. However, under managed care, when you see only the physicians that are affiliated with the plan, they then receive a strong financial incentive.
Trevor
The principles of a fee-for-service plan include a health insurance programs that that use cash benefits in order to help protect employees of an organization from expense that come from health care. Some things that are covered by this are physician charges, hospital expenses, and surgical expenses. One type of these service plans are indemnity plans. These plans are when the insurance company and the employer have a contract that specifically covers certain expenses. The next type of these plans are self-funded plans. These plans are when a company pays benefits from their own assets. Managed care plans control costs by limiting employee's decisions on doctors and hospitals. Fee-for-service plans and managed care plans are similar because they both provide health insurance for employees. Managed health care plans are more confusing because they have so many specifications, meanwhile fee-for-service plans is more basic that offers cash benefit for expenses.
until after a probationary period of at least three months so that they can prove that they are going to be great asset to the company.
Instructions:
1. Login to our database using the phpmyadmin.soe.ucsc.edu interface.
2. Develop SQL query to answer each question.
3. In a WORD compatible document and for each question:
· State .
Medical care - compensation management - Manu Melwin Joymanumelwin
Benefits are a critical piece of an employee compensation package, and health care benefits are the crown jewel. Health care benefits, along with time-off benefits, are the most popular of benefits to employees.
Should an Employer Be Self-Funded?
That is quite a question. In the past we cautioned that claims savings was not guaranteed by self-funding. And with a small difference in fixed fees vs. fully insured retention, there was not much incentive for smaller employers to take the risk, given that they were more susceptible to wide fluctuations in claims cost.
Review our research and analysis on self-funding to help determine if the program is the right fit for your business. Contact McGohan-Brabender to discuss self-funding in detail.
https://www.mcgohanbrabender.com/
1. The Best Practices In Benefits Design
SEAN ZAYON
Agency Owner & Lead Benefits Consultant
P: 267-422-2881
E: myphillyinsurancebroker@gmail.com
2. The Value Of Employee
Benefits
Employees consider workplace benefits their personal safety net.
Employees consider health benefits nearly as important as their
salary.
Employees are more likely to take a job with better employee
benefits for a slightly lesser salary.1
1The 2014 Aflac WorkForces Report was conducted in January 2014 by Research Now
3. Benefits Package is a
Tool for Employers
Employers should consider employee benefits important tools for:
Retention
Productivity
Cost Control
5. Medical Plans are
Important – and Expensive
75% of employees rank medical benefits are the most important benefit
after salary.
Healthcare-related expenditures:
• Represent 17.8% of the U.S. economy(2013) and expected to reach 47%
by 2024.
• Equal three times U.S. defense spending budget (2013)
• Is greater than the amount Americans spend on food, housing and
transportation combined.
Choosing the right plan is a matter of:
• Balancing premiums and benefits
• Considering all costs of coverage
7. Balancing Premiums
and Benefits
But to choose the right plan………
You must consider all costs!
Benefits Monthly Premiums
Members Cost At
Point Of Service
Richer
More Modest
Higher
Higher
Lower
Lower
8. Three Main Cost
Categories
Immediate employer costs (PREMIUMS)
Longer-term employer costs
(COSTS AT FUTURE RENEWALS)
Employee costs (DEDUCTIBLES, OUT-OF-POCKET)
9. Copays, Deductibles and
Coinsurance Maximums
Copay Bucket
You never fill the copay bucket as they
continue throughout the plan year.
Deductible Bucket
After annual deductible is paid, the
deductible bucket is full
Coinsurance Max buckets
After the deductible is paid, the insurance
company begins cost sharing with
employees at the coinsurance level until
the maximum is met. When the
coinsurance max is met, the bucket is full.
11. Contributions
The basis of cost-sharing with employees
Common structures include:
• Employer pays 100% for employee-only coverage, employee
must contribute for dependent coverage.
• Employers and employees share the costs for both employee-
only and dependent coverage.
Can be structured according to employee
classification
Subject to non-discrimination rules
12. Plan Offerings
Important guidelines:
Keep offerings to two or three plans
maximum, preferably with a “base
plan/buy up” approach
Do not offer plans more than two benefit
levels apart
14. Relationship Between
Premium and Claims
20% of the population drives 80% of the healthcare
claims
Pools spread risk among many rather than just a few
Premium dollars are polled to help pay large claims
Every group may not have a large claim every year,
but every year groups have large claims
Healthier population = lower healthcare costs = lower
premiums
15. Strategies to Help
Control Costs
Consider higher cost-sharing with employees
Maximize network discounts with an extensive
provider network
Encourage generic substitution and use of home
delivery
Consider use of TeleMedicine services and
Supplemental Insurance (i.e. Aflac)
Educate employees on wise plan use
Encourage preventive care
Consider use of Wellness Programs
16. Reduce Exposure with a
Higher Deductible Plan
Higher deductibles
• Employees still have the benefit of copays from doctor visits and
prescriptions
• Preventive care covered at 100%
• Lowers premium costs
Adding Supplemental Insurance (i.e. Aflac)
• Helps employees with out-of-pocket expenses like copays and
deductibles pertaining to accidents or illnesses.
Adding TeleMedicine Services
• Phone a doctor – Saves time and money.
• Discount Dental, Vision, Prescriptions, vitamins
18. Dental Plans
Often considered an important part of a
benefits package
Very popular with employees
Can be offered as a voluntary benefit
Benefit plan options:
DHMO
PPO
Plan Limits
19. Disability Plans
Disability coverage protects both ministry assets – your people – and
your employees financial security
One in three employees will be disabled before retirement
The vast majority of disability claims arise from common conditions like
cardiovascular disease, arthritis, back pain, cancer, pregnancy or
joint issues
Shot and Long-term disability plans have benefits that coordinate to
provide maximum protection throughout a disability
Can be offered as a voluntary benefit.
Can help lower the cost of worker compensation by covering off the
job injuries and keeping employees from filing false claims
20. Supplemental Insurance
May be offered as a voluntary benefit
Policies include:
• Accident
• Hospital Confinement Indemnity
• Cancer/Specified-Disease
• Critical Illness (Specified Health Event)
• Vision
• TeleMedicine
21. Other Benefits
Life Insurance
Annuities
Retirement Plans
401(k), 403(b)
College Planning
Stock Options