Employee Benefits Blog

Insurance terminology sometimes makes discussions about healthcare feel like we’re all speaking in different languages. The jargon insurance companies use is oftentimes confusing for the average person to understand, only further exacerbated by the legalese in which everything insurance-related is written. It feels like we all need a translator just to figure out what insurance policies cover and what participants will be responsible for.

The truth of the matter is that people understand less about health insurance than they like to believe. A 2016 survey by PolicyGenius found that just 4 percent of those polled could correctly identify four common insurance terms: copayment, copay (some people think they mean something different), deductible, and coinsurance. And while 83 percent of people believed they understood the word “copay,” only 52 percent could actually define it correctly. To make matters worse, only 36 percent of millennials could define any of the four terms properly.

As a member of the human resources team, the responsibility of bridging this knowledge gap and educating your workforce oftentimes falls to you. An educated workforce will make better employee benefit enrollment decisions, and will be less of a burden on your employee benefits hotline.

With that in mind, we’ve put together a glossary of common insurance terminology that you can easily slip into your employee benefits enrollment guide or your employee handbook. While we’ve included 11 of the most common terms here, you can download another 52 by clicking here.  

As much as we hear about large companies and their impact on the economy, small businesses employ nearly half the workforce. According to data from the Small Business Administration, small businesses employed 58.9 million people (or 47.5 percent of the workforce) in 2015, creating 1.9 million net jobs in 2015 alone.

Small businesses have a major impact on the economy and on the welfare of their employees’ lives, but they don’t typically have the resources (cash or otherwise) that larger employers do, limiting their options when it comes to providing health insurance (which is still the most important employee benefit).

Of course, small businesses with fewer than 50 full-time employees aren’t held to the employer mandate — it’s up to each employer to decide if they want to offer health insurance to their employees. However, many small business owners view health insurance as one of the most effective ways to attract and retain the best employees and improve productivity (by keeping everyone healthy).

But when the numbers game counts against them, what options are available to small employers?

Human resources personnel are used to helping older employees transition into retirement. But now that baby boomers are retiring en masse, it seems to be happening all the time. In fact, as many as 10,000 baby boomers are putting in their retirement papers every single day, and while not all 10,000 will be in your company, you’ll probably be dealing with quite a few.

As all these boomers retire, your employee benefits package may need to undergo some changes and you may experience a shift in the cost of providing medical benefits as well. Here are some of the things you need to keep in mind as the baby boomers on your staff begin to retire.

Employee Benefits and Medicare

As your baby boomer employees near retirement age, some of their spouses might be a step ahead of them. The way employee benefits work with Medicare is sometimes complicated — especially when it comes to HSAs, which may be a major theme of the bulk of questions posed by those looking to retire. If your employees need to learn more about how to navigate Medicare, and if they should drop their spouse from your employer-sponsored coverage, make sure you’re as informed as possible regarding the regulations at hand before advising them.  

A frequently asked question by those turning 65 concerns penalties. People who are still working and enrolled in an employer-sponsored health plan aren’t likely to incur penalties for enrolling in Medicare late. However, it’s common for people turning 65 to enroll in Medicare Part A even if they’re still enrolled in their employer-sponsored program because it’s free (provided that the person has worked and paid into Medicare for at least ten years).

So it was with great interest that we took note of last Friday’s White House Rose Garden announcement by President Trump to “bring soaring drug prices back down to earth” by promoting competition among pharmaceutical companies, and giving private entities more tools to negotiate better deals on the behalf of consumers, insurers and employers.

Somewhat surprising in his announcement was his abandonment of some of the more populist proposals which he boasted about during his presidential campaign, including his promise to authorize the Feds to negotiate directly with drug companies in an effort to lower Medicare drug prices and disallowing American consumers from importing low-cost prescription drugs from overseas.

Nevertheless, both Republican and Democrats (as well as all of us here at the JP Griffin Group) welcomed the President’s attention on combating high drug prices. The looming question remains just how the President’s promises to lower drug prices will play out and if the concepts proposed will ever come to pass.

We certainly hope the plan gains traction as both employers and employees alike could sure use a break from escalating drug prices which have now become a primary driver of health-related expenditures.

As if there weren’t enough questions surrounding the type of health insurance plans you offer your employees, there’s also the question of how to best fund the program. Fully funded, self-funded, and level funded health plans can be found throughout every industry, but small businesses tend to face more funding challenges with health insurance than their larger counterparts.

While they aren’t required by law to offer healthcare to their employees, many small businesses (as defined by the ACA) nevertheless feel inclined to do so. Some choose to do it simply because they want to take care of their employees, while others do it to strengthen their recruitment and retention strategies. Of course, many employers do it for all three reasons.

Regardless of their intentions, small employers who offer healthcare to their workforce know the cold, hard facts: health insurance is still ranked among the most important factors for potential employees in a compensation package. Job-seekers see how volatile the individual marketplace is and understand that the most reliable and cost-efficient way to obtain healthcare is still through an employer.

Because fully funded health insurance plans tend to be expensive for small businesses, many are turning to level funded health plans, which blend the economic advantages of self-funding with the financial predictability of fully funded plans. That said, level funded plans aren’t without their detractors.

What is a Level Funded Health Plan?

A level funded health plan (also known as a partially self-funded plan) is a type of health insurance plan that combines the cost savings and customization of self-funding with the financial safety and predictability of fully funded plans. Employers still contract with insurance companies, but agree to take on more of the financial risk. 

Employers have been struggling to find the best way to provide affordable health benefits to their workers for many years now. One promising option, especially for those with smaller workforces, is to offer insurance through multiple employer welfare arrangements (MEWAs) and association health plans (AHPs).

The idea behind MEWAs is to bundle small groups into a larger community, thereby spreading risk over a larger and more diverse pool of covered individuals. It’s the same principle large employers benefit from by way of lower insurance premiums.  

If your small business is looking for cheaper healthcare options, MEWAs and association health plans may be good options for you to investigate.

What is a MEWA?

MEWA stands for multiple employer welfare arrangement, but is also sometimes referred to as a multiple employer trust (MET). MEWAs allow small employers to essentially team up to create a larger pool of employees to capitalize on the economies of scale that larger employers enjoy. This could mean as few as two employers in the group, or as many as deemed necessary to form a large enough employee pool.

Each employer gets a say in plan design, as well as plan offerings. If one employer has an older population who prefers more traditional plans, they can request such for their workforce. If another employer has a younger workforce for whom high deductible health plans would be more appealing, they could request more consumer-driven healthcare options for their employees. With these groups banded together, the premium costs should be lower than if each employer tried to get insurance on their own.

Around 10,000 baby boomers turn 65 every single day, which means 10,000 more people become eligible for Medicare. If your human resources department hasn’t yet been inundated with questions from your older employees about Medicare eligibility, they will at some point — and soon.

After all, many boomers are choosing to work a bit longer than the standard retirement age of 65 for a variety of reasons — some are still physically able to work, so they’re taking advantage of it, others are trying to save more for retirement (because so many people haven’t saved nearly enough, if anything), and others just aren’t ready to give up their day jobs yet.

It’s possible that some of your employees have deferred Medicare eligibility because they haven’t actually retired yet, but some people who are still employed find it’s cheaper to take the leap into Medicare (and all its parts) than to stay on their employer-sponsored health plan (though many choose to enroll in both). That said, it’s not quite that cut and dry when it comes to those enrolled in health savings accounts (HSAs) through high deductible health plans (HDHPs).

Here are the things that need to be considered when an employee or covered spouse turns 65:

Medicare Part A

With the exception of those employees actively contributing to an HSA, there’s really no reason for them not to enroll in Part A, which covers hospitalization, home health care, care at nursing homes, and hospice care. As long as employees have worked and paid Medicare taxes during a minimum 10-year period of time (the period of time deemed long enough by the government), Medicare Part A comes premium-free (however, it does come with coinsurance). The situation gets a bit more complicated when employees who are ready to enroll in Medicare are also contributing to an HSA.

Editor's Note: This post is a follow-up to one of our most popular blog posts, "3 Great TED Talks in The Era of Consumer-Driven Healthcare (CDHC)". This post features new Ted Talks for fans of our past article to enjoy.

When it comes to the decisions we make, it can sometimes feel like we are strangers in a strange land. Our motivations are often a mystery to us. But researchers in the world of behavioral economics are able to give us some insight into what informs our decision-making and why it often defies logic.

Over the years, there have been some incredibly useful TED Talks that can help us better understand the human mind and the motivations that drive our decisions. As an employer who must consider the decision-making process of your employees, you too can gain some important insights that can help guide you in creating more effective employee benefits packages.

Here are five TED Talks which we consider to be some of the very best on this subject:

Everyone is looking for ways to save money on their healthcare costs — especially employers, who are shouldering a large portion of the burden when it comes to insurance premiums. If you’re looking into self-funded insurance options, you’re certainly not alone. Self-funding is surging in popularity among companies of all sizes, including those with as few as 50 employees.

Employers are drawn to self-funding because of the promise it holds to curtail costs, the freedom it provides to customize plans, and the desire to be unburdened by strict regulation. Regardless of whether or not you choose to move to a self-funded insurance option, it’s worth exploring this funding alternative so you can make the right decision for your business.

What is Self-Funded Insurance?

Self-funded health insurance is a form of employer-sponsored healthcare that doesn’t use traditional insurance carriers as a conduit for medical care. Instead, premiums are paid to the employer, which the company uses to pay for medical claims. Self-funding has traditionally been found in larger businesses, typically 1,000 employees or more, because they’re more likely to have larger reserves and cash flow to absorb a bad claim year than a small business.

The financial upside of self-funding is that employers get to keep any premiums which aren’t spent on claims. In a fully-funded environment, those savings are retained by the insurance company as profit.

The downside is that you’re opening yourself up to greater degrees of expense variability. In a low claims year, you’ll save money — but in a high claims year, you'll have to be prepared to absorb any overruns in healthcare expenses. Regardless, in our opinion, employee benefit expenditures should always be looked at over a multi-year time horizon. 

At some point or another, every human resources employee helps to facilitate a leave of absence under the Family Medical Leave Act (FMLA). HR personnel can probably recite FMLA guidelines and regulations in their sleep, but the average employee is pretty much out of touch with what the law entitles them to, and quite often they don't realize what’s actually required of their employers.

FMLA rules are designed to protect both the employer and the employee. From an employee’s perspective, they’re able to take necessary medical leave without fear of losing their job. For employers, it helps them work toward the goal of true, equal opportunity employment for both men and women.