6 Common Mistakes to Avoid When Choosing a Health Insurance Plan

health insurance plan

health insurance planHealth insurance may be one of the most critical annual purchases since it impacts your physical, mental and financial wellness. Unfortunately, selecting a health insurance plan can feel overwhelming. With so many options, it can also be easy to make a mistake when selecting coverage.

This article explores six common missteps related to selecting a health insurance plan. Once armed with this information, it’ll be easier to avoid these mistakes and choose the best plan coverage for your situation.

1) Rushing Through Enrollment Options

Many people rush when buying their health insurance or only rely on recommendations from friends, family and co-workers. Others may simply reenroll with last year’s choices. But health insurance provides personal coverage, so it’s important to research and find what will work best for your health needs and budget.

When it comes time to enroll in a plan, compare different policies and understand their coverages and associated costs (e.g., premiums). One of the best ways to ensure the policy is right for your health needs is to consider your medical requirements and spending in the next year. Don’t forget to confirm in-network coverage to ensure your preferred doctor, clinic and pharmacy are connected in the new plan. Then, you can find the most suitable plan and coverage in an effort to simplify your health care and make it more affordable.

2) Overlooking Policy Documents

Another common mistake is skipping through or not thoroughly reading the policy’s terms and conditions. However, carefully reading a policy is the best way to know what to expect from the health plan and what the plan expects of you.

As such, read the fine print on each plan you consider before enrollment. Reviewing the policy’s inclusions and exclusions will help you make an informed decision and potentially avoid surprise bills later on.

3) Misunderstanding Costs

A cost-sharing charge is an amount you must pay for a medical item or service covered by the health insurance plan. Plans typically have a deductible, copays and coinsurance. Here’s what those terms mean:

  • The deductible is the amount you pay out of pocket before your health insurance starts to cover costs.
  • A copay is a flat fee you pay upfront for doctor visits, prescriptions and other health care services.
  • Coinsurance is the percentage you pay for covered health services after you’ve met your deductible.

When shopping for a plan, keep in mind that the deductible is tied to the premium. As such, a low deductible plan may seem attractive, but understand that it generally comes with a higher premium—and vice versa. Consider keeping your deductible to no more than 5% of your gross annual income. When shopping for a plan, look closely to see when you’ll have a copay and how much it will cost for various services.

4) Concealing Your Medical History

It may be tempting to avoid sharing your medical history if you’re worried about being rejected or receiving higher premiums. However, it could hurt you in the long run when insurance claims are denied for existing conditions or undisclosed medical information.

5) Ignoring Add-ons

Health insurance add-ons are often included separately and require an additional premium, which means many people don’t look at them. A standard health insurance plan may not cover certain situations, so reviewing all available options is essential. An insurance add-on could help bolster your overall health insurance coverage by offering extra protection.

Review the add-on covers offered with your health insurance policy and see if any would be helpful for you, your family or plans in the next year. For example, some common add-ons include critical illness insurance, maternity and newborn baby insurance, hospital daily expenses and emergency ambulance services.

6) Selecting Insufficient Coverage

People may hold back on purchasing certain coverage to pay a lower premium. While that may seem advantageous in the short term, you’ll be on the hook for out-of-pocket costs when facing a medical emergency. This mistake may be accompanied by physical, mental and financial health consequences.

When selecting a plan, check that the policy provides adequate coverage for your medical needs and other essentials. The right health insurance can take care of yourself and ensure financial security.

Summary

Health insurance is an essential investment for you and your family. By avoiding common mistakes while buying health insurance, you’ll be better informed to enroll in a plan and other coverages.

As health care costs continue to rise, it’s more important than ever to carefully review available policies, consider your options and health needs, and, ultimately, select the best plan to protect your health and finances.

Answers To The 7 Most Frequently Asked Benefit Questions

Frequently Asked Benefit Questions

Frequently Asked Benefit QuestionsWhen it comes to benefits, such a health insurance, many can agree that it is confusing. Unless you are involved in health insurance or Human Resources it can be hard to make sense of everything. We have compiled a list of some of the 7 most frequently asked benefit questions and their answers. We hope this makes things a little easier to understand. 

What is a Deductible?

A deductible is the amount of money you or your dependents must pay toward a health claim before your organization’s health plan makes any payments for health care services rendered. For example, lets say you have a $1,000 deductible. You would be required to pay the first $1,000, in total, of any claims during a plan year.

What is Coinsurance?

On top of your deductible, coinsurance is a provision in your health plan that shows what percentage of a medical bill you pay and the percentage a health plan pays. This usually starts after your deductible has been satisfied.

What is an Out-of-pocket Maximum (OOPM)?

An OOPM is the maximum amount (deductible and coinsurance) that you will have to pay for covered expenses under a plan. Once the OOPM is reached the plan will cover eligible expenses at 100 percent.

What is an Explanation of Benefits (EOB)?

An EOB is a description your insurance carrier sends to you. It explains the health care benefits that you received and the services for which your health care provider has requested payment. It will explain what your insurance carrier will pay and an cost your will be responsible for. This would include Deductible, Coinsurance, Copays, etc.

What is a Preferred Provider Organization (PPO)?

A PPO is a group of hospitals and physicians that contract on a fee-for-service basis with insurance companies to provide comprehensive medical service. If you have a PPO, your out-of-pocket costs may be lower than in a non-PPO plan.

What is Utilization Management (UM)?

Utilization Management is the process of reviewing the appropriateness and the quality of care provided to patients. UM may occur before (pre-certification), during (concurrent) or after (retrospective) medical services are rendered. 

For example, your health plan may require you to seek prior authorization from your UM company before admitting you to a hospital for nonemergency care. This would be an example of pre-certification. Your medical care provider and a medical professional at the UM company will discuss what is the best course of treatment for you before care is delivered. UM can reduce unnecessary hospitalizations, treatment and costs.

What is a High Deductible Health Plan (HDHP)?

An HDHP is a type of insurance plan that offers a low premium offset by a high deductible. Because of the low cost of the plan, the insurer will not cover most medical expenses until the deductible is met. As an exception, preventive care services are typically covered before the deductible is met. HDHPs are often designed to be compatible with heath savings accounts (HSAs). HSAs are tax-advantaged accounts that can be used to pay for qualified out-of-pocket medical expenses before the HDHP’s deductible is met.

We hope you found this list of 7 most frequently asked benefit questions and their answers helpful. If you did, please take a moment to share this post. 

Would you like to know more about health insurance? Click here for Individual or Click here for Employee Benefits. 

7 Mental Health Benefits of Exercise

mental health benefits of exercise








mental health benefits of exerciseWhile physical exercise is known to be good for your body, it also can help your mind. Research continues to validate that exercise can improve mental health by reducing anxiety, depression and a negative mood. When you include exercise as part of your everyday routine, you’ll be reaping both physical and mental well-being benefits.

This article explores the connection between your body and mind and the mental health benefits of physical activity.

The Connection Between Body and Mind

People who exercise regularly often report having better mental and emotional well-being. Consider the following mental health benefits of exercise:

  • Mood boost—Exercise triggers the production of endorphins, serotonin, dopamine and oxytocin, mood-boosting chemicals in the brain. Those four chemicals are responsible for feelings of happiness.
  • More energy—Increasing your heart rate and boosting oxygen circulation in your body can make you feel more energized. It may seem counterintuitive, but expending energy can actually provide a spark of vitality you may need to get through the day.
  • Better sleep—Exercise can help regulate your sleep patterns and reduce the time it takes to fall asleep. The more active you are, the more your body pushes you to sleep and reset at night. Try to exercise for at least one to two hours before bed so your brain has enough time to wind down.
  • Reduced stress—Physical activity reduces the levels of your body’s stress hormones (e.g., adrenaline and cortisol). It’s also linked to lower physiological reactivity toward stress, so exercise can also be a coping strategy for stress.
  • Improved memory—Endorphins can help you concentrate and feel mentally sharp for work or other tasks.
  • Higher self-esteem—When exercise becomes a habit, you may feel more powerful or confident. You may also feel accomplished when you meet your fitness goals.
  • Stronger resilience—Exercise is a healthy way to build resilience and cope with mental or emotional challenges instead of turning to negative behaviors, alcohol or other substances.

Any movement helps since physical activity is what can be beneficial to mental well-being. Exercise can take your mind off problems or negative thoughts by redirecting them to the activity at hand.

Getting Started

The U.S. Department of Health and Human Services recommends that adults get moderate-intensity aerobic activity for at least 150 minutes each week and muscle-strengthening activities two times per week. It may seem like a lot at first, but if you break it down, that’s 30 minutes of moderate exercise five times a week.

Even if you don’t have time for 30 minutes to exercise, find something that works for you. Any physical activity is better than none. Understandably, motivating yourself for a workout can seem more challenging if you’re battling depression, anxiety or other mental health issues. Consider these tips for incorporating exercise into your routine:

  • Start with short exercise sessions and slowly increase your time. The goal is to commit to moderate physical activity and build it into your daily routine.
  • Find an activity you enjoy and incorporate it into your routine for a body and mind boost.
  • Schedule workouts when your energy is the highest.
  • Exercise with a friend. Companionship can make it more fun, so work out with a friend or loved one to make it more enjoyable or help you stick to the routine.

It comes down to making exercise a fun part of your everyday life so you can gain both physical and mental health benefits. Talk to your doctor if you have any questions or concerns about incorporating exercise into your day.








5 Strategies for Reducing Health Benefits Costs in 2022

health costs








health costsFor the past two decades, health costs have increased each year. This happens for a variety of reasons, such as inflation or, say, a global pandemic. With that in mind, employers can bank on prices going up in 2022.

According to a PricewaterhouseCoopers (PwC) report, medical costs are projected to increase 6.5% in 2022. This is about average for the past decade; although, it is slightly lower than the 7% increase projected this year (as more spending goes toward the COVID-19 pandemic).


Yet, 6.5% is still a considerable increase, especially when so many budgets have been reallocated or slashed due to the pandemic. That’s why employers must think both strategically and creatively about how they can lower their health benefits expenses in 2022.


This article includes five ways to help reduce spending without compromising benefits quality.

1. Control Drug Spending

Drug prices are rising faster than any other medical service or commodity. Prices are now 33% higher than they were in 2014, according to GoodRx. This is a significant problem during inpatient procedures, where individuals aren’t usually given an option to select a generic medication—patients rarely know what drugs they’re given until after the fact. Even in routine prescription scenarios, employees may be prescribed name-brand medications simply due to physician preference.

Employers can educate employees on the price differences between name-brand and generic medications. Doing so can help employees understand that they can save money while still receiving the same quality treatment.


Additionally, employers may consider introducing varying levels of prescription drug coverage. For instance, fully covering generic prescriptions or drugs used for chronic conditions. For higher levels (e.g., specialty drugs), employers may cover less of the costs. Ultimately, employers will need to determine the appropriate coverage levels for their unique workplaces.

2. Encourage Active Benefits Participation

Beyond drug spending, employers can help limit overall health costs by making employees active participants in their health care. This means encouraging employees to improve their health literacy, research treatments and price shop.

Price shopping, in particular, should be easier in 2022, given the new hospital price transparency rule that takes effect Jan. 1, 2022. Employees will now be able to see specific prices for procedures and other services. This incentivizes employees to educate themselves before making costly health decisions.

3. Offer Savings Accounts with Carryovers

Health plans with savings components are becoming more popular each year. That’s because these tax-advantaged savings accounts empower employees to control their own spending and improve their health literacy. The accounts include health savings accounts (HSAs), flexible spending accounts (FSAs) and others.

Many accounts allow for fund carryover year to year, or allow employers to add that option onto their plan designs. Allowing carryover encourages employees to contribute more funds, since they’re no longer “use it or lose it.” Since many employers match contributions up to a limit, more money added to these accounts means greater tax savings for everyone.

4. Embrace Virtual Health Options

One major takeaway from the COVID-19 pandemic has been that virtual solutions can offer high-quality outcomes. This is so true that many companies are allowing employees to work remotely permanently. Virtual health options are no exception to this trend.

There are countless telehealth services available these days. Individuals can connect with health professionals in just a few clicks—no waiting times or driving to a clinic. Additionally, individuals will not need to take large chunks of time off work, allowing for greater productivity. As such, telehealth solutions are often much less expensive than a typical in-person doctor visit. Even the Centers for Medicare and Medicaid Services (CMS) acknowledges the usefulness of telehealth services, seeking to expand access.

Employers can consider adding telehealth services into their plan designs. In some cases, it may be cost-efficient for employees to schedule a virtual health visit before an in-person appointment, under certain circumstances. In any case, having a telehealth option expands access to care and lowers expenses for everyone.

5. Consider Plan Funding Alternatives

A more drastic option for reducing health costs is restructuring how plans are funded. For instance, a self-funded plan may be more cost-effective than paying a monthly premium for a fully insured plan. Other options include level-funding or reference-based pricing models, each of which carries its own set of administrative rules and legal constraints.

Funding decisions should not be taken lightly and should be based on several factors, such as the size of an organization, risk tolerance, and financial stability. Employee financial stability should also be considered, especially while the effects of the COVID-19 pandemic can still be felt. Employees may not be able to burden large premium increases, constraining some plan funding flexibility options.

Historically, employers have shifted costs onto their employees (usually through higher premiums) as a way to reduce spending. However, that trend is not expected to be widespread in 2022. Considering the tight labor market and how many individuals are struggling financially due to the pandemic, employers will likely be hesitant to shift too much of the burden. Doing so may cause employees to seek other jobs or simply forego preventive care, which can lead to chronic conditions and higher future health care costs.

Conclusion

Employers have a variety of ways in which they can help contain health care expenses. Choosing the right method will depend on unique employee populations and budgets.

Reach out today for help strategizing your best options.








What Is An Employee Assistance Program? Should My Business Offer One?








Employee productivity is a vital contributor to the success of any business. At times, employees may be too overwhelmed by personal or behavioral problems to perform at their highest levels. Furthermore, higher stress can lend itself to higher health risks and more costly health claims. Similarly, psychological problems, substance abuse, financial troubles and other personal issues can lead to lower productivity and focus during work, increased absenteeism and higher health care costs. An employee assistance program (EAP) can address these issues and help employees tend to their personal needs, leaving you with healthier, happier and more productive employees.

What is an Employee Assistance Program (EAP)?

An EAP is an employer-sponsored program that offers services or referrals to help employees deal with personal problems. Traditionally, the focus was drug and alcohol abuse, but many employers have expanded programs to include a variety of issues.

Why Offer an Employee Assistance Program (EAP)?

When employees are distracted by stressful personal or life situations, they are unfocused at work and tend to be absent more often. Their health may suffer as a result, leading to higher medical costs. Obviously, these circumstances are undesirable for an employer, but it is costly to recruit and train a replacement for the struggling employee, especially if that individual was formerly, and has the potential to once again be, a valuable asset to the company.

A better solution for many employers is to offer their employees assistance in handling their personal issues in order to improve their situations and regain their former productivity levels and value to the company. EAPs can provide that assistance. Once an EAP is implemented, it can help the employer attract and retain employees, lower health care and disability claims costs, increase productivity and morale, and lower absenteeism.

In addition, any government contractors or employers receiving federal grants are required to maintain a drug-free workplace. Part of fulfilling that requirement can include an EAP with a drug-free component that offers education, awareness, testing and counseling.

Designing an Employee Assistance Program (EAP)

EAPs vary from employer to employer, but most have common elements. Some programs are limited and focus on alcohol and drug abuse, but many programs offer expanded services that address a variety of areas in an employee’s life. The most important consideration is whether the problems and issues covered are ones that adversely affect the employee’s job performance. Typical issues addressed include the following:

  • Alcohol or substance abuse
  • Divorce or marital problems
  • Stress management
  • Crisis intervention
  • Child care or eldercare
  • Eating disorders
  • Gambling addiction
  • Psychological or psychiatric problems
  • Financial or legal problems
  • Consultation services and training for managers regarding employee performance

Depending how an EAP is structured, it could offer employee education, evaluation, hotlines, counseling and/or referrals. It could be an in-house program, outsourced through an independent EAP provider or a combination of the two.

There are different types of EAPs, but research suggests that the most effective ones offer more comprehensive services and integrate with the employer’s health plan, prescription drug plan, disability benefits and wellness program. Integration can allow the EAP to serve as a preventive measure to address lifestyle issues that could lower health care and disability costs in the long run.

Cost versus Return on Investment (ROI)

The cost of an EAP can vary depending on which services are offered, whether it is administered in-house or outsourced and the number of counselors employed. Also included in the cost is the time employees spend away from work while receiving EAP services. Start-up costs for an EAP program can be high because many employees might be referred for counseling or treatment all at once; however, the ROI can be well worth the initial costs. The following are ways that EAPs can reap savings for employers:

  • Lower health care costs
  • Fewer disability claims
  • Less absenteeism
  • Higher productivity and focus
  • Improved employee morale
  • Fewer workplace accidents
  • Higher retention (saves the cost of hiring and training a replacement)

ERISA and COBRA Considerations

If an EAP is considered a welfare benefit plan, it must comply with ERISA’s reporting and disclosure requirements. The key distinction, typically, is whether the EAP offers direct counseling or simply referrals. Because employee welfare plans are defined as providing medical benefits or benefits in the event of sickness, an EAP that provides counseling would generally fit that description and would be subject to ERISA standards (there is some uncertainty about these distinctions, however).

Similarly, the COBRA implications are a bit unclear regarding EAPs. Generally, if an EAP is a welfare benefit plan and provides medical care, it is subject to COBRA. Medical care can include the diagnosis, cure, mitigation, treatment or prevention of disease; EAPs that offer those services in some form (even through counseling) are likely considered health care plans subject to COBRA. COBRA regulations do not address EAPs that offer both medical and nonmedical benefits. It would seem, though, that an employer is at least obligated to offer eligible beneficiaries the option to elect to continue the portion of their EAP that provides medical benefits.

Legal Considerations and Confidentiality

Offering an EAP could open an employer for certain legal liability situations for actions taken by EAP counselors or outside vendors. Employers should ensure that their liability insurance covers all aspects of the EAP program.

In addition, confidentiality is essential for an EAP. Employees need to be certain that participating will not damage their career or reputation. EAP records and counseling sessions should be strictly confidential, including the fact that the employee contacted the EAP in the first place. Employers are entitled to employee surveys evaluating the EAP or statistical information as a whole, but employee names should not be revealed. If the release of information or records is necessary or advantageous in a certain situation, the employee must sign a written consent form. Exceptions include situations where disclosure is legally required, such as cases involving child abuse, or homicidal or suicidal intentions.

Employee Communication

An EAP should include a policy statement, which communicates to employees the services offered, how to obtain those services, an assurance that the program won’t jeopardize their jobs or reputations, a promise of confidentiality and any exceptions to the confidentiality agreement. Employers should also create a communication campaign to generate employee awareness and understanding of the program.