Schedule Flu Vaccine for Your Group
Schedule Flu Vaccine for Your Group
Now scheduling fall flu shot events!
|
Protect Your Employees from the Grips of the Flu. 
Health Insurance Glossary
Health Insurance Glossary
On occasion, there are questions about what a specific word or term means in the context of health
insurance. This glossary is intended to serve as a tool to assist you in understanding some of the
most common terms.
A
Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
Affordable Coverage: An employer-sponsored health plan covering only the employee, the cost of which
does not exceed a set annual percentage of the employee’s household income. Click here for more
information.
Allowed Amount: The maximum amount a plan will pay for a covered health care service. If a provider
charges more than the plan’s allowed amount, the plan participant may have to pay the difference through
a process called balance billing.
Annual Limit: A cap on the benefits an insurance company will pay in a year while a plan participant is
enrolled in a particular health insurance plan. Annual limits are sometimes placed on particular services such
as prescriptions or hospitalizations, on the dollar amount of covered services, or on the number of visits that
will be covered for a particular service. After an annual limit is reached, the plan participant must pay all
associated health care costs for the rest of the year.
B
Balance Billing: When a provider bills a patient for the difference between the provider’s charge and the
patient’s insurance plan’s allowed amount. For example, if the provider’s charge is $100 and the patient’s
insurance plan’s allowed amount is $70, the provider might bill the patient for the remaining $30.
Brand-Name Drug: A drug sold by a drug company under a specific name or trademark and that is
protected by a patent. Brand-name drugs may be available by prescription or over the counter.
C
CHIP (Children’s Health Insurance Program): Insurance program that provides low-cost health coverage to
children in families that earn too much money to qualify for Medicaid, but not enough money to buy private
insurance.
Claim: A request for payment of a benefit by a plan participant or his or her health care provider to the
insurer for items or services the participant believes are covered by the plan.
COBRA (Consolidated Omnibus Budget Reconciliation Act): A federal law that may allow a plan participant
or his or her dependents to temporarily keep their existing health coverage after certain qualifying events
(such as the participant’s employment ending or losing coverage as a dependent of a covered
employee). Click here for more information.
Coinsurance: The percentage of costs of a covered health care service the participant pays after having
paid his or her deductible.
Co-op Plan: A health plan offered by a non-profit organization in which the same people who own the
company are insured by the company.
Copay (also known as copayment): A fixed amount the participant pays for a covered health care service
after having paid his or her deductible.
Coverage:See Health Insurance
Cost Sharing: The share of costs covered by insurance that a plan participant pays out of his or her own
pocket. Cost sharing generally includes deductibles, coinsurance, and copays, but does not include
premiums.
D
Deductible: The amount a plan participant pays for covered health care services before his or her insurance
plan starts to pay.
Dental Coverage: Benefits that help pay for the cost of visits to a dentist.
Dependent: A child or other individual for whom a parent, relative, or other person may claim a personal
exemption that reduces their tax obligation.
Diagnostic Test: Test to figure out what the plan participant’s health problem is. For example, an x-ray can be
a diagnostic test to diagnose a broken bone.
Disability: A limit in a range of major life activities. This includes activities like seeing, hearing, and walking, and
tasks such as thinking and working.
Drug List: See Formulary.
E
Emergency Medical Condition: An illness, injury, symptom (including severe pain), or condition severe enough
that a reasonable person would seek medical attention right away.
Emergency Medical Transportation: Ambulance services for an emergency medical condition.
Emergency Services: Services to check for or treat an emergency medical condition.
Employer Mandate: Provision of the Affordable Care Act that requires certain employers with at least 50 full-
time employees (including full-time equivalents) to offer health insurance coverage to their full-time
employees (and their dependents) that meets certain affordability and minimum value standards, or pay a
penalty tax. The employer mandate is often referred to as “pay or play.” Click here for more information.
Employer Shared Responsibility Provision: See Employer Mandate.
Essential Health Benefits: A set of 10 categories of services health insurance plans must cover under
the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription
drug coverage, pregnancy and childbirth, mental health services, and more. Click here for more information.
Exchange: See Health Insurance Marketplace.
Excluded Services: Health care services that a plan does not pay for or cover.
F
Flexible Spending Arrangement (FSA): See Health Flexible Spending Arrangement.
Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering
prescription drug benefits. A formulary is also often called a drug list.
Fully Insured Plan: A health plan purchased by an employer from an insurance company.
G
Generic Drug: A drug that has the same active-ingredient formula as a brand-name drug.
Grandfathered Health Plan: A group health plan that was created—or an individual health insurance
policy that was purchased—on or before March 23, 2010. Grandfathered health plans are exempted from
many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered”
status if they make certain significant changes that reduce benefits or increase costs to consumers. A health
plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also
provide consumers with contact information for questions or complaints.
Group Health Plan: In general, a health plan offered by an employer or employee organization that provides
health coverage to employees and their families.
H
Health Care Provider: An individual or facility that provides health care services. Examples include a doctor,
nurse, chiropractor, physician assistant, hospital, surgical center, skilled nursing facility, and rehabilitation center.
Health Flexible Spending Arrangement (Health FSA): An arrangement an individual establishes through his or
her employer to pay for out-of-pocket medical expenses with tax-free dollars. These expenses include
insurance copays and deductibles, and qualified prescription drugs, insulin, and medical devices.
Contributions to an FSA are subject to an annual limit that is adjusted for inflation each year. These
arrangements are also referred to as Health Flexible Spending Accounts.
Health Insurance: A contract that requires a health insurance company to pay some or all of a plan
participant’s health care costs in exchange for a premium.
Health Insurance Marketplace: A service that helps people shop for and enroll in health insurance. The
federal government operates the Marketplace, available at HealthCare.gov, for most states. Some states run
their own Health Insurance Marketplaces.
Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care
from doctors who work for or contract with the HMO. There are generally two main types of HMOs:
- Traditional HMO: This type of HMO provides no benefits for services obtained outside of a network.
- Open-Access HMO: This type of HMO allows enrollees to receive services from an out-of-
network provider at a higher cost than the enrollee would pay at an in-network provider. The
additional costs may be in the form of higher deductibles, copays, or coinsurance.
Health Reimbursement Arrangement (HRA): Employer-funded group health plans from which employees are
reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts
may be rolled over to be used in subsequent years. Also referred to as a Health Reimbursement Account.
Health Savings Account (HSA): A type of savings account that allows an individual to set aside money on a
pre-tax basis to pay for qualified medical expenses, if he or she has a high deductible health plan. HSA
contributions are subject to an annual limit that is adjusted for inflation each year.
High Deductible Health Plan (HDHP): A plan with a higher deductible than a traditional insurance plan. To be
considered an HDHP, the plan must meet minimum deductible and maximum out-of-pocket limit
requirements, which are annually adjusted for inflation.
High-Risk Pool Plan: A state-subsidized health plan that provides coverage for individuals with expensive pre-
existing health care conditions.
Home Health Care: Health care services and supplies an individual receives in his or her home under doctor’s
orders. Services may be provided by nurses, therapists, social workers, or other licensed health care providers.
Hospice Services: Services to provide comfort and support for persons in the last stages of a terminal illness.
Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
I
Individual Health Insurance Policy: Insurance policy for an individual who is not covered under an employer-
sponsored plan.
Individual Mandate: Provision of the Affordable Care Act that requires every individual to have minimum
essential coverage for each month, qualify for an exemption, or make a penalty payment when filing his or
her federal income tax return.
Individual Shared Responsibility Provision: See Individual Mandate.
In-Network: Health care providers (e.g., specialists, hospitals, laboratories) that have accepted contracted
rates with the insurer in order to participate in the insurer’s network. The insured person typically pays a lower
price for using services within the network.
Inpatient Care: Health care that an individual receives when formally admitted as a patient to a health care
facility, like a hospital or skilled nursing facility.
Internal Limit: Limitation that applies to individual categories of care—for example, a $250-per-
procedure deductible for inpatient surgery.
L
Lifetime Limit: A cap on the total lifetime benefits a plan participant may receive from his or her insurance
company. After a lifetime limit is reached, the insurance plan will no longer pay for covered services.
M
Mail-Order Drugs: Drugs that can be ordered through the mail.
Marketplace: See Health Insurance Marketplace.
Medicaid: A joint state and federal insurance program that provides free or low-cost health coverage to
some low-income people, families, children, pregnant women, the elderly, and people with disabilities.
Medical Care: Services rendered by a hospital or qualified medical care provider.
Medical Loss Ratio (MLR): A basic financial measurement used in the Affordable Care Act to encourage
health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its
customers’ medical claims and activities that improve the quality of care, the company has a medical loss
ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each
premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and
agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do
some state laws.
Medicare: A federal health insurance program for people aged 65 and older, certain younger people with
disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a
transplant, sometimes called ESRD). Medicare consists of four parts:
-
- Medicare Part A: Covers hospital, skilled nursing, nursing home, hospice, and home health services care.
- Medicare Part B: Covers medically necessary and preventive services.
- Medicare Part C (Medicare Advantage): A type of Medicare health plan offered by a private
company that contracts with Medicare to provide the beneficiary with all of his or her Part A and Part B
benefits. - Medicare Part D: A program that helps pay for prescription drugs for people with Medicare who join a
plan that includes Medicare prescription drug coverage. There are two ways to get Medicare
prescription drug coverage: through a Medicare Prescription Drug Plan or a Medicare Advantage Plan
that includes drug coverage, both of which are offered by insurance companies and other private
companies approved by Medicare.
Minimum Essential Coverage (MEC): Any insurance plan that meets the Affordable Care Act requirement for
having health coverage (sometimes called qualifying health coverage). Individuals without minimum
essential coverage may be subject to the individual mandate penalty.
Minimum Value: A standard of minimum coverage that applies to employer-sponsored health plans. Click
here for more information.
N
Network: The facilities, providers, and suppliers a health insurer or plan has contracted with to provide health
care services.
O
Obamacare: See Affordable Care Act.
Open-Access HMO: A type of HMO that allows enrollees to receive services from an out-of-network provider
at a higher cost than the enrollee would pay at an in-network provider. The additional costs may be in the
form of higher deductibles, copays, or coinsurance.
Open Enrollment Period: The yearly period when people can enroll in a health insurance plan.
Out-of-Network: Services received outside an insurer’s network. These services typically carry a higher cost to
the insured person.
Out-of-Pocket Costs: Expenses for medical care that are not reimbursed by insurance. Out-of-pocket costs
include deductibles, coinsurance, and copays for covered services, plus all costs for services that are not
covered.
Out-of-Pocket Limit: The most a plan participant can be required to pay for covered services in a plan year.
The out-of-pocket limit does not include monthly premium amounts or spending for services the plan does not
cover. An out-of-pocket limit is also often called an “out-of-pocket maximum.”
Out-of-Pocket Maximum: See Out-of-Pocket Limit.
Outpatient Care: Care received where a doctor has not written an order to admit the individual to a hospital
as an inpatient (in these cases, an individual is an outpatient even if he or she spends the night in the hospital,
but typically it does not require an overnight hospital stay).
P
“Pay or Play”: See Employer Mandate.
Physician Services: Health care services a licensed medical physician provides or coordinates.
Plan Year: A 12-month period of benefits coverage under a group health plan. This 12-month period need not
align with the calendar year.
Preauthorization: A decision by a health plan that a health care service or product is medically necessary. A
health plan may require preauthorization for certain services before they are provided (except in an
emergency), though preauthorization is not a promise by a health plan to cover the cost.
Pre-Existing Condition: A health problem an individual had before the date that his or her new health
coverage starts.
Pre-Existing Condition Exclusion Period: The period during which an insurance policy will not pay for care
relating to a pre-existing condition.
Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as
hospitals and doctors, to create a network of participating providers. Under a PPO, a plan participant pays
less in out-of-pocket costs if he or she uses providers that belong to the PPO’s network.
Premium: The amount a plan participant pays for his or her health insurance every month.
Premium Tax Credit: A tax credit an individual can use to lower his or her premium when he or she enrolls in a
plan through the Health Insurance Marketplace. The Premium Tax Credit is based on the income estimate
and household information the individual provides on his or her Health Insurance Marketplace application.
Prescription Drugs: Drugs and medications that, by law, require a prescription.
Prescription Drug Coverage: A health plan that helps pay for prescription drugs and medications.
Preventive Services: Routine health care that includes screenings, check-ups, and patient counseling to
prevent health problems.
Primary Care: Health services that cover a range of prevention, wellness, and treatment programs for
common illnesses.
Primary Care Provider: A physician, nurse practitioner, clinical nurse specialist, or physician assistant who
provides, coordinates, or helps an individual access a range of primary care services.
Q
Qualified Health Plan: An insurance plan that is certified by the Health Insurance Marketplace,
provides essential health benefits, follows established limits on cost sharing (like deductibles, copays, and out-
of-pocket limits), and meets other requirements under the Affordable Care Act. All qualified health plans
meet the minimum essential coverage requirement.
R
Referral: A written order from a primary care provider directing a patient to see a specialist or receive certain
health care services. Under many health plans, a plan participant must obtain a referral before he or she can
receive health care services from anyone except his or her primary care provider.
Rehabilitation Services: Health care services that help an individual keep, get back, or improve skills and
functioning for daily living that have been lost or impaired because he or she was sick, hurt, or disabled. These
services may include physical and occupational therapy, speech therapy, and psychiatric rehabilitation
services in a variety of inpatient and outpatient settings.
Rescission: The retroactive cancellation of a health insurance policy. Insurance companies will sometimes
retroactively cancel an entire individual health insurance policy if an individual made a mistake on his or her
application for the policy that amounts to fraud or an intentional misrepresentation of material fact.
S
Screening: A type of preventive service that includes tests or exams to detect the presence of a health issue,
usually performed when an individual has no symptoms, signs, or prevailing medical history of a disease or
condition.
Self-Insured Plan: Type of plan, usually present in larger companies, where the employer itself collects
premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical
claims. These employers often contract with a third-party administrator for services such as enrollment, claims
processing, and provider networks.
Skilled Nursing Care: Services from licensed nurses in an individual’s home or in a nursing home.
Special Enrollment Period (SEP): A time outside the yearly Open Enrollment Period when an individual can sign
up for health insurance. An individual typically qualifies for a Special Enrollment Period as a result of certain
life events, such as losing other health coverage, moving, getting married, having a baby, or adopting a
child. By law, employer-sponsored plans must provide a special enrollment period of at least 30 days.
Specialist: A health care provider focusing on a specific area of medicine or group of patients to diagnose,
manage, prevent, or treat certain types of symptoms and conditions.
Summary of Benefits and Coverage (SBC): An easy-to-read summary that allows an individual to make
apples-to-apples comparisons of costs and coverage between health plans. An individual most commonly
receives an SBC when he or she shops for coverage or renews or changes coverage.
T
Traditional HMO: A type of HMO that provides no benefits for services obtained outside of a network.
TRICARE: A health care program for active-duty and retired uniformed service members and their families.
U
Urgent Care: Care for an illness, injury, or condition serious enough that a reasonable person would seek care
right away, but not so severe that it requires emergency room care.
Usual, Customary, and Reasonable Charge (UCR): The amount paid for a medical service in a geographic
area based on what providers in the area usually charge for the same or similar medical service. The UCR
amount is sometimes used to determine the allowed amount.
V
Vision Coverage: A health benefit that at least partially covers vision care, such as eye exams and glasses.
W
Waiting Period: The time that must pass before coverage can become effective for an employee or
dependent who is otherwise eligible for coverage under an employer-sponsored health plan.
Well-Baby/Well-Child Care: Routine doctor visits for comprehensive preventive health services that occur
when a child is 2 years of age or younger, and annual visits until a child reaches age 21. Services include
physical exams and measurements, vision and hearing screenings, and oral health risk assessments.
It is intended to serve as a tool to assist you in understanding some of the most common terms. Call (855) 667-4621 for more info.
ACA vs AHCA Comparison
ACA vs AHCA Comparison This chart by Kaiser provides a helpful side-by-side ACA vs AHCA comparison. Looking to compare another Republican alternative side-by-side-by-side? Try Kaiser’s tool. Click the column header to view available plans to compare. Summary ACA...
Employee Handbook Advantages
Employee Handbook Advantages 
The advantage of an employee handbook is that it is important communication tool between you and your employees. A well-written handbook is the foundation of risk management when it comes to employment-related claims and sets forth your expectations of your employees, and describes what they can expect from your company. It also should describe your legal obligations as an employer, and your employees’ rights.
Non-Disclosure Agreements (NDAs) and Conflict of Interest Statements
Although NDAs are not legally required, having employees sign NDAs and conflict of interest statements helps to protect your trade secrets and company proprietary information.
Anti-Discrimination Policies
As a business owner, you must comply with the equal employment opportunity laws prohibiting discrimination and harassment, including the Americans with Disabilities Act. Employee handbooks should include a section about these laws, and how your employees are expected to comply.
Compensation
Clearly explain to your employees that your company will make required deductions for federal and state taxes, as well as voluntary deductions for the company’s benefits programs. In addition, you should outline your legal obligations regarding overtime pay, pay schedules, performance reviews, salary increases, time keeping records, breaks and bonuses.
Work Schedules
Describe your company’s policies regarding work hours and schedules, attendance, punctuality, and reporting absences, along with guidelines for flexible schedules and telecommuting.
Standards of Conduct
Document your expectations of how you want your employees to conduct themselves including dress code and ethics. In addition, remind your employees of their legal obligations, especially if your business is engaged in an activity that is regulated by the government.
General Employment Information
Your employee handbook should include an overview of your business and general employment policies covering employment eligibility, job classifications, employee referrals, employee records, job postings, probationary periods, termination and resignation procedures, transfers and relocation, and union information, if applicable.
Safety and Security
Describe your company’s policy for creating a safe and secure workplace, including compliance with Occupational Safety and Health Administration’s laws that require employees to report all accidents, injuries, potential safety hazards, safety suggestions and health and safety related issues to management.
Safety policies should also include your company’s policy regarding bad weather and hazardous community conditions.
Add your commitment to creating a secure work environment, and your employee’s responsibility for abiding by all physical and information security policies, such as locking file cabinets or computers when not in use.
Computers and Technology
Outline policies for appropriate computer and software use, and steps employees should take to secure electronic information, especially any personal identifiable information you collect from your customers.
Media Relations
It’s a good business practice to have a single point of contact for all media inquiries. Your employee handbook should include a section that explains how your employees should handle calls from reporters or other media inquiries.
Employee Benefits
Make sure to detail any benefit programs and eligibility requirements, including all benefits that may be required by law.
This section should also outline your plans for optional benefits such as health insurance, retirement plans and wellness programs.
Leave Policies
Your company’s leave policies should be carefully documented, especially those you are required to provide by law. Family medical leave, jury duty, military leave, and time off for court cases and voting should all be documented to comply with state and local laws. In addition, you should explain your policies for vacation, holiday, bereavement, and sick leave.
Click here to schedule a 1 on 1 compliance consultation.
Taming the junk food cravings hormones
Taming the junk food cravings hormones
From our wellness partner, Cleveland Clinic
Ever sneak a late-night snack after a big dinner, or binge late into the night? Eating a huge meal, then going to sleep, is the sumo wrestler diet. Your body can’t process or burn those extra calories. So it stores them as fat, leading to weight gain and prediabetes. In functional medicine, we look at root causes, like how powerful hormones can trigger your night-time food cravings. Learn how to stop them.
See: Break Your Sugar Addiction in 10 Days (Infographic)
Don’t Tax My Workplace Health Plan
Don’t Tax My Workplace Health Plan
ISSUE SUMMARY
Don’t Tax My Workplace Health Plan. Congress is currently considering healthcare reform proposals that would eliminate or place a cap on the employer-tax exclusion for health insurance. These proposals would undermine the employer-sponsored health insurance system that provides coverage for more than 175 million Americans. Eliminating the exclusion would eliminate most of the advantages of employer-sponsored insurance, while capping it would degrade the benefit and serve as a tax increase for middle-class Americans.
Lets highlight one particular issue of concern to most of our clients. Today, employers may deduct as a valid business expense the full cost of health insurance and other employee benefits. One of the considerations being discussed would restrict this tax-advantaged status.
The infographic paints a picture of the importance of job-based health insurance and how valuable it is for employers as well as for American workers and their families.
Impact on American Workers
- A study by the City University of New York School of Public Health found that the “Cadillac Tax” will hit the middle class the hardest.
- A study by the Economic Policy Institute found that because the tax is focused on high premiums, not high levels of coverage, companies that tend to pay higher premiums — such as small businesses and employers with a high proportion of sick workers — could wind up paying the tax even though their benefits are not particularly generous. Also, if employers try to avoid the tax by shifting to less generous plans, workers will likely suffer when it comes to their overall compensation, even if they get a boost in wages to make up for the lost health benefits.
- The tax will disproportionately affect women, older employees and certain geographic areas. A 2014 report by actuarial and benefits consulting firm Millimani dentified that geography could potentially account for a 69.3% variation in premium. For example, a plan that would cost $9,189 in one area would cost $15,556 elsewhere. The report also demonstrates that the 40% tax’s age and gender adjustment fails to compensate for the impact those factors have on premiums when combined with a high-cost geographic area and/or lower provider discounts.
- According to a 2014 study by Truven Health Analytics, the 40% tax will result in a cost increase of up to $480 per employee per year for plans that are expected to incur the tax. Early retirees are projected to incur the tax at a much higher rate than active employees, with 81% of such plans likely to trigger the tax.
- A study by the American Health Policy Institute estimated the 40% tax “could cost 12.1 million employees an average of $1,050 in higher payroll and income taxes per year, if employers increase their taxable wages as they reduce the cost of health care benefits. Alternatively, these employees could see up to a $6,150 reduction in their health care benefits and little or no increase in their pay.”
Impact on Employers
- An issue brief by the Kaiser Family Foundation found that “a meaningful percentage of employers would need to make changes in their health benefits” to avoid the 40% tax, and this percentage grows significantly over time unless employers are able to keep heath plan cost increases at low levels. In fact, 19 percent of employers already in 2015 have a plan that would exceed the threshold when flexible spending accounts are included in the calculation. These firms would need to reduce their current plan costs over the next several years to avoid the tax. By 2028, 42% of employers would have plans where costs would exceed the threshold for some or all employees. And if health plan premiums continue to grow faster than inflation, as expected, all employers will eventually be affected by the tax.
- According to Tower-Watson survey48% of employers believe the plans they provide will be affected the first year the law is implemented. And that rises to 82% of employers by 2023, just five years later.
- The Lockton Companies wrote in a 2015 benefits guidance document, “When we project five and ten years into the future, based on current guidance, the majority of our clients will eventually trigger the tax.”
- Eventually, the 40% tax will apply to modest plans, not just high-cost coverage as intended. A recent study by actuarial and benefits consulting firm Mercer, found that the Federal Employees Health Benefits Program’s (FEHBP) Blue Cross Blue Shield standard option plan was projected to hit the 40% tax soon after it was originally set to go into effect.
- A study by the American Bankers Association’s HSA Council found that “If your current HSA-qualified family health plan costs more than $17,000, including wellness programs, your firm is likely to incur excise tax liability in 2018 if anyone makes a maximum contribution.”
Impact on Health Benefits
- The actuarial and benefits consulting firm Aon Hewitt reported in 2015 that 33% of employers surveyed are increasing deductibles and other cost-sharing, to avoid being on a trajectory to trigger the tax when it goes into effect. But fully 40% of employers expect at least one plan to unavoidably hit the tax threshold regardless.
- A survey conducted by the National Business Group on Health found that 42% of employers said they will increase employee cost-sharing, and 37% said they will reduce spousal subsidies or implement a surcharge for covering them to minimize the impact of the excise tax.
- A survey of 700 employers by Mercer in 2015 found that anticipation of the 40% tax is already leading many employers to consider excluding employees’ spouses from their health policies or imposing a surcharge for including them. The survey found that the tax has consistently been the primary concern of employers since passage of the Affordable Care Act.
- The 40% tax is triggered when the value of an individual’s health plan exceeds the threshold — a supposedly high-end number for “Cadillac” plans. But a 2013 Mercer survey found that the average price of all employer-provided health plans in the state of Florida, for example, was already approaching the threshold — years before the tax is set to go into effect.
Because its thresholds are indexed to general inflation instead of faster-growing medical inflation, more plans will be hit by the tax every year. The tax thresholds are indexed to the Consumer Price Index, which the Congressional Budget Office (CBO) estimates will rise annually by 2.4% on average over the next decade. But the Centers for Medicare and Medicaid Services (CMS) projects private health care spending to rise 5.8% on average each year, as health care costs increase significantly faster than general inflation. This insufficient indexing of the thresholds means more and more plans will trigger the tax, and to a greater extent, over time.
Take Action Today:
- Tell Congress to Oppose Eliminating or Capping the Employer Exclusion – click here
- Join Fight the Cadillac Tax – click here.
Contact Us Now Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
Understanding the Labels on Your Thanksgiving Turkey
Understanding the Labels on Your Thanksgiving Turkey
Use this cheat sheet to help navigate labels when shopping for your Thanksgiving turkey
From our wellness partner, Cleveland Clinic
There’s a lot to consider when shopping for your Thanksgiving turkey. Use this cheat sheet to help you navigate what the labels mean and ask the right questions so you’re bringing home a bird that suits your needs.
1. USDA-certified organic turkey
This means it was raised without antibiotics or pesticides, fed organic feed and given access to the outdoors. They are usually more expensive than grocery store turkeys and they need to be ordered a couple weeks before Thanksgiving.
2. Heirloom or Heritage turkey
Specific breeds of turkey that are naturally raised outdoors without hormones or antibiotics. This slower-growing turkey has a little more fat marbling, meaning a richer flavor and texture. These also need to be ordered a week or two ahead of Thanksgiving Day.
3. Conventional grocery store turkey
These are factory farmed turkeys known as the Broad Breasted White Turkey. They are bred to have more white meat and typically raised with antibiotics to promote growth.
4. “Enhanced,” “prebasted” or “marinated”
These labels mean the turkey has been injected with a solution to enhance flavor, increasing its sodium content from 75 mg to as much as 710 mg. Read the fine print so you know all of the ingredients.
5. “Hormone-free” or “No hormones added”
This is a misleading label you can ignore. It implies a healthier choice, but federal regulations already prohibit the use of hormones in poultry.
6. “Natural”
A turkey labeled natural can still be enhanced or prebasted and fed antibiotics. It is supposed to mean minimally processed, containing no artificial flavoring, coloring, ingredients, preservatives or other artificial ingredients. Read the fine print to know all of the ingredients and talk to your grocer.
7. Final Tip
If you’re buying a bird from a local poultry farmer, be sure to ask how it was raised and whether or not it’s been enhanced with a solution to add flavor.
test MMS quoting
Small Business Tax Credit
Find out if you are eligible for a Small Business Tax Credit.
Full-time Equivalent (FTE) Employee Calculator
Use the full-time equivalent employee (FTE) calculator to count the number of FTEs you have.
messages[“SELF”] = “Employee Only”;
messages[“SELF_SPOUSE_DEPENDENT”] = “Employees and Dependents”;
messages[“medical”] = “Medical Insurance”;
messages[“dental”] = “Dental Insurance”;
messages[“vision”] = “Vision Insurance”;
messages[“HRA”] = “HRA”;
messages[“HSA”] = “HSA”;
messages[“FSA”] = “FSA”;
messages[“DCFSA”] = “DCFSA”;
messages[“LPFSA”] = “LPFSA”;
messages[“BASICLIFE”] = “Basic Life Insurance”;
messages[“SUPPLEMENTALLIFE”] = “Supplemental Life Insurance”;
messages[“BASICADD”] = “Basic AD&D Insurance”;
messages[“SUPPLEMENTALADD”] = “Supplemental AD&D Insurance”;
messages[“STD”] = “Short Term Disability Insurance”;
messages[“LTD”] = “Long Term Disability Insurance”;
messages[“commuter”] = “Commuter”;
Small Business Tax Credit
Find out if you are eligible for a Small Business Tax Credit.
Full-time Equivalent (FTE) Employee Calculator
Use the full-time equivalent employee (FTE) calculator to count the number of FTEs you have.
Empire Strikes Back – 2017 Plans
Empire Strikes Back 2017 Plans
Empire Strikes Back 2017 Plans. Empire recently announced their re-entry back into the New York small group market for 2017. A legendary broad networked PPO is welcome news especially in the NY small group market of 1-100 employees. Recently, the broad national networks have diminished to only 2 national health insurers, Aetna and Oxford. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
Network Overview
3 distinct networks:
PPO Network Savings
- PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
- Blue Priority Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 65,796 physicians network.
- Pathway Network – HMO value based narrower gatekeeper referral network of 109 facilities and 60,535 physicians. Limited to 28 NYS Counties.
Additional Features:
- Telemedicine will be available on all products
- Vision – Limited adult vision will be available on all products at no additional cost.
- Pharmacy – All plans use their large BCBS formulary Except the HMOs, and the Silver and Bronze Blue Priority Plans. They will be utilizing what they call the Select Formulary.
- Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
- Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
- Healthy Support – Wellness program offers easy ways to earn up to $900 per member, per year. Gym Reimbursement $400 single/$600 couple, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
DOCTOR SEARCH: Click Here
BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze
Small Group Rates: 1st Quarter 2017
Drug Formulary: Click Here
Blue Priority FAQ: Click Here
Pathway FAQ: Click Here
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
Empire Strikes Back – 2017 Plans
Empire Strikes Back – 2017 Plans
Empire recently announced their re-entry back into the New York small group market for 2017. A legendary broad networked PPO is welcome news especially in the NY small group market of 1-100 employees. Recently, the broad national networks have diminished to only 2 national health insurers, Aetna and Oxford. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
Network Overview
3 distinct networks:
PPO Network Savings
- PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
- Blue Priority Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 65,796 physicians network.
- Pathway Network – HMO value based narrower gatekeeper referral network of 109 facilities and 60,535 physicians. Limited to 28 NYS Counties.
Additional Features:
- Telemedicine will be available on all products
- Vision – Limited adult vision will be available on all products at no additional cost.
- Pharmacy – All plans use their large BCBS formulary Except the HMOs, and the Silver and Bronze Blue Priority Plans. They will be utilizing what they call the Select Formulary.
- Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
- Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
- Healthy Support – Wellness program offers easy ways to earn up to $900 per member, per year. Gym Reimbursement $400 single/$600 couple, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
DOCTOR SEARCH: Click Here
BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze
Small Group Rates: 1st Quarter 2017
Drug Formulary: Click Here
Blue Priority FAQ: Click Here
Pathway FAQ: Click Here
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.