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As a business owner, you know that offering an insurance program is a significant investment for your company. Of course, it’s not just your investment; your employees are also paying into their insurance plans with their equally hard-earned money. So when you pay for insurance, you want to make sure that you and your staff are making the most of it.
One way to maximize the chances for success is to make sure employees are fully informed of the available benefits, how they work and what to expect – before they select their plans. Unfortunately, many employees don’t fully understand all aspects of their insurance during Benefits Enrollment, and as a result, are often unhappy with their coverage later on.
The good news is that you have the ability to help employees make sense of their plans. Here are some frequently asked questions that employees have when choosing their benefits, along with associated answers. These answers will help you provide your employees with the information and confidence they need to pick the plan that’s best for them.
How do I know which benefits to elect into?
There are many kinds of benefits that can be tailored to create the best plan for you. In order to choose the right plan for your life right now, think about what expenses you can see yourself having to pay over the next year and pick benefits accordingly. For more information on how to look ahead, contact your insurance agent who can help you tailor a personalized plan.
How are claims paid?
When you submit a claim, you’re basically asking your insurance company for a payment based on the terms of your plan. The insurance company will review your claim, and if everything checks out, they pay you (or pay your doctor, dentist, etc on your behalf).
What are out-of-pocket-costs?
Out-of-pocket costs are all those expenses that are not covered by your insurance that you’ll have to pay once you’re billed for services. Things like deductibles, coinsurance, copayments, and any service that your insurance plan doesn’t cover are all examples of out-of-pocket costs.
What is a deductible?
A deductible is the dollar amount you have to pay before your insurance kicks in. For example, if your deductible is $2000, you must pay all medical expenses out-of-pocket up to that amount. (Aflac insurance policies can be used to help pay deductibles as well as any other expenses major medical insurance may not cover like your copay, rent, grocery bills, streaming subscriptions, and more.)
How many chances do I have to reach my deductible?
A deductible doesn’t need to be reached in one medical expense, but can be accumulated over multiple expenses in the course of the calendar year.
Do I have to hit my deductible every year?
In order for your insurance to kick in, you must hit your deductible — but there’s no penalty for not reaching it. One thing to know: if you find yourself consistently not reaching your deductible, you should look into other plans that may be more beneficial for you!
Do co-payments made to service providers count toward meeting my deductible?
It varies depending on your insurance plan, but most plans do not count co-payments as money spent to meet your deductible. Check with your health insurance to find out if this is the case in your plan.
What is co-insurance?
Coinsurance is the percentage of your medical bill that you have to pay after you've finished paying your deductible. For example, if your coinsurance is 20%, you would pay $200 of a $1000 hospital bill, and your insurance company would cover the rest. (If you've got Aflac, the cash they pay you can be used to help pay your deductible, your portion of coinsurance, or any other expenses when you’re sick or injured, to ensure you can keep living the life you love.)
How is an out-of-pocket maximum different from a deductible?
A deductible is the amount you need to pay before your insurance kicks in, while an out-of-pocket maximum is the most you would have to pay in a year of your own money. After you reach your out-of-pocket maximum, your insurance will cover 100 percent of all expenses, including co-pays or co-insurance.
What is an FSA?
A Flexible Spending Account (FSA) allows you to set untaxed money aside for out-of-pocket medical expenses like deductibles, copays, coinsurance, prescription drugs, and more. Because FSA’s contain only pre-tax dollars, they are a great way to save money on healthcare-related expenses. To fill your FSA, you’ll take a certain amount out of each paycheck (before tax) to keep in a savings account that solely for medical expenses. In most cases, this money must be used by the end of the year or it will be lost.
Is an FSA the best option for me?
This option is best for those with consistent, larger expenses. If you’re young and healthy, an FSA may not be the right choice for you — but if you have an ongoing condition or anticipate upcoming medical needs, an FSA may be the right choice. Take stock of your health and think about your projected expenses for the next year before deciding if this is the right choice for you.
Is an FSA in addition to health insurance, or an alternative to health insurance?
An FSA could be both. Some employers offer to contribute to an FSA account in lieu of health insurance, or you can sign up for an FSA to help cover out-of-pocket costs that may not be covered by your existing insurance plan, like as co-pays, and deductibles.
What are ancillary benefits?
Ancillary benefits are a type of insurance offered in addition to employer-sponsored health plans, most often including dental, vision, and life insurance.
What are voluntary benefits and do I need them?
Voluntary benefits are types of insurance policies that pay cash to help cover expenses that may not be covered by major medical insurance, like dental, vision, life, accident, hospital, cancer, critical illness, and short and long-term disability insurance Voluntary insurance complements your major medical plan, they also offer you full control over which benefits you have. Help protect your lifestyle and feel more confident knowing that you have help to pay your bills in the event you have a covered accident/sickness.
Do I have to choose an insurance plan during Benefits Enrollment? What happens if I don’t?
You don’t have to choose a plan that your company offers, but under the current Affordable Care Act (ACA) laws, you must have health insurance or you can get penalized or have to pay a fine. If you’d like to purchase insurance that your employer does not offer, you may have to pay higher premiums. If you miss Benefits Enrollment, there may be certain qualifying events that allow you to enroll outside of your approved enrollment window, like getting married, getting divorced, or gaining a dependent. Without a qualifying event, you will have to wait until next year’s Benefits Enrollment period to apply for insurance if you miss this year’s deadline.
I’m already on my spouse or family member’s insurance plan. Can I still apply for voluntary insurance with my employer?
Yes! You are able to apply for voluntary insurance – or any other insurance for that matter – even if you are already covered on a spouse or family member’s plan.
Can I cancel my insurance?
You can cancel your health insurance at any time by contacting your provider via phone or online portal. However, unless you’ve gotten married, divorced, or gained a dependent, you can only sign up for health insurance plans during Benefits Enrollment periods, so make sure to time your cancellation right or you could get fined for not having insurance.
Insurance can be an overwhelming topic. Because your company’s benefits package is critical to your employees’ happiness and well-being, this glossary breaks down key terms you need to know.
Ancillary vs. voluntary benefits
Ancillary benefits are primarily those most known and requested by employees in addition to employer-sponsored health plans. These can include group dental, group vision and group life insurance, as well as employer-paid short- or long-term disability.
Voluntary benefits are benefits that, in addition to those which an employer sponsors, are offered to employees who can choose to pay for them on their own via payroll deductions. Voluntary benefits cover an array of categories (pretax deductions for qualified expenses, theft protection, health benefits such as employee-paid dental, etc.), but the health benefit categories often include insurance for critical illnesses, cancer and accidents, among others.
Short for “benefits administration technology,” ben-admin is used in the industry to refer to benefits management – establishing, offering, and maintaining the benefits packages offered to employees. Because this can be difficult for companies of all sizes, the technology and software industries have developed multiple services and electronic tools to help businesses with this task. HR solutions companies, brokers and insurers have all developed some level of solution, which vary in capacity and cost to employers.
Broker vs. career agent
A broker is a representative who ‘shops’ for the customer from as many insurance companies he or she chooses to. An agent, on the other hand, can be captive (exclusively representing one company or the partner products authorized by their company) or independent (able to act as a shopper for clients).
Core benefits, sometimes referred to as basic benefits, may often vary from employer to employer. While some may only include a health plan as a core benefit, other employers may refer to their core benefits as health, dental, vision and life insurance.
This technology eases the difficulty of Benefits Enrollment and keeps track of employees’ benefits selections. The industry has started to combine ben-admin and enrollment capabilities into single platforms, which vary in capabilities, reliability and cost.
Group vs. individual underwriting
Group underwriting is designed for companies who want to leverage the power of headcount, spreading risk for the insurance company. This usually makes it easier for all employees to get insured, whether it is in the form of lower rates or simply being able to obtain coverage an individual wouldn’t be able to get independent of the group.
Individual underwriting should always be considered because it tends to favor smaller groups, especially the ones skewing younger and healthier. There’s no clear better option as both platforms have developed competitive features, meaning a small business should always check all options.
This implies that coverage is guaranteed without questions. Most guaranteed-issued clauses come with specific requirements or specific limitations, which vary from insurer to insurer.
This means that as long as premiums are paid, the insurer cannot drop the covered person. If you pair guaranteed-renewability with rate stability, this is a very favorable combination for employees.
Minimum participation requirements
This sets a condition or requirement to issue desired coverage. Whether it’s a condition for a lower rate, or simply qualification for a specific product or product feature, a group may be asked to have a minimum number or percentage of committed participants enroll in it.
Underwriting is how insurers assess whether or not they are willing to take on the risk of insuring an individual or a group of people and can include questioning or medical examinations. When terms like “minimum” or “simplified” underwriting are used, it means there will be a lower number of questions or steps to qualify for insurability.