4 Things Life Insurance Is Not

What is life insurance? People often get confused about what life insurance is and what it is not. Read this blog post for four things life insurance is not and a few tips on understanding them.


Are you confused about life insurance? I don’t blame you. When I first started writing about finances more than a decade ago, my understanding of life insurance was limited.

I knew about life insurance because it was offered through my employer, and I thought a $50,000 policy was a lot of money. I also recognized insurance company names from late-night TV commercials and the occasional bit of junk mail.

I understood “insurance” to be that stuff that you had to have for your car, your home, and your health. The “life” part was a big, blurry blob of “other.” If that’s how you’re feeling, here are a few tips that might help bring things into focus—by understanding the “nots.”

1. Life insurance through work is generally NOT enough. Since learning this myself some years back, I’ve noticed that many people never explore life insurance past what is offered through their work. Policies through work are a great benefit to have, but are usually limited to one- or two-times your salary or a fixed amount like $50,000. Plus the coverage typically ends when your employment there does.

How far will an amount like that go when you consider what’s left behind for your loved ones: the loss of your income and mostly likely debts and bills. What about things like rent or mortgage, child-care and education costs?

An easy way to get a working idea of how much life insurance you need is with a Life Insurance Needs Calculator from a neutral source like www.lifehappens.org/howmuch.

2. Life insurance is NOT a luxury item. Many people have not even considered buying life insurance because they’re convinced it’s a luxury. In a recent study by Life Happens and LIMRA, consumers thought the cost of a 20-year, $250,000 level term life insurance policy for a healthy 30-year-old was three times higher than it generally is. Younger people, in particular, overestimate the cost of a term policy by a factor of five.

If you took a guess at what that policy above would cost, what would you say? It comes out to about $13 or so a month for that policy. Definitely not a luxury—most of us spend more than that on a meal out.

3. Life insurance is NOT just about covering funeral expenses. While covering funeral expenses is very important, and a major reason people purchase it, life insurance does so much more. If something happens to you, life insurance benefits can help replace lost income, or pay off a mortgage, or help ensure a college fund or safeguard a retirement nest egg.

The proceeds of a life insurance policy are generally tax-free and can be used for anything your loved ones may need now and well into the future. Amazing, right?

4. Life insurance is NOT just for really healthy people. Granted, life insurance is less expensive the younger and healthier you are but don’t discount it just because you’re not in triathlete shape!

Many people don’t considering buying life insurance because they think they won’t qualify. But when certain health conditions, such as diabetes or high blood pressure, are under control with a doctor’s guidance or medication, it’s often possible to qualify. You may even be able to get coverage after a heart attack. Just know that it is probably best to work with an experienced insurance agent if you are concerned about a health issue and qualifying for coverage.

Now, if you’re a bit overwhelmed with this information and perhaps don’t know where to start, just know that a life insurance agent will sit down with you at no cost to go over your needs and help you get life insurance coverage to fit your budget. If you don’t have an agent or advisor, go here for suggestions on how to find one. You can also tap the Agent Locator there to find someone in your area.

Remember, the right agent or advisor can help you make sense of the confusion and get you on track for the financial future you want—with the protection your loved ones need.

SOURCE: Mosher, H. (30 October 2018) "4 Things Life Insurance Is Not" (Web Blog Post). Retrieved from https://lifehappens.org/blog/4-things-life-insurance-is-not/


9 Reasons Why Stay-at-Home Parents Need Life Insurance

It's not just parents with full-time jobs that need life insurance. Stay-at-home parents also need coverage. Read this blog post for 9 reasons why stay-at-home parents should have life insurance as well.


You’re probably already aware that a parent with a job outside the house most likely needs life insurance to protect their loved ones in case something were to happen. But it’s not just breadwinners who need coverage—stay-at-home parents do, too. Here are nine reasons why.

1. To replace the value of their labor. Stay-at-home parents are caretakers, tutors, cooks, housekeepers, chauffeurs, and so much more 365 days a year. And all that work comes with a price tag: Salary.com reports that stay-at-home-parents contribute the equivalent of a $162,581 annual salary to their households. If the unthinkable were to happen, a surviving partner would be on the hook for a slew of new expenses that the stay-at-home parent previously shouldered. Term life insurance is generally a quick and affordable way to get a substantial amount of coverage like this for a specific period of time, such as 10 or 20 years—often until you pay of your mortgage or the kids are grown and gone.

2. To factor in the contributions of any future income. Many stay-at-home parents return to the workforce once their kids are older. Life insurance could help bridge the gap that their future earnings would have contributed to the household.

3. To pay off any debt. From student loans to credit card debt to an informal loan from a family member, there are lots of ways to owe money. Life insurance can help settle any debts left behind so they don’t create stress for grieving loved ones.

4. To cover funeral expenses. Would you believe that the average funeral runs between $7,000 and $10,000, according to parting.com? And that may not cover the cost of the burial, headstone and other expenses. Many families want to honor a loved one’s memory but have trouble finding the funds to cover all the costs. Fortunately, the payout from a life insurance policy can help cover final wishes.

5. To leave a legacy. If a stay-at-home spouse has a passion for a place of worship, an alma mater, or another nonprofit organization, life insurance proceeds can be used to leave a meaningful charitable gift.

6. To boost savings. Permanent life insurance, which offers lifelong protection as long as you pay your premiums, may offer additional living benefits such as the ability to build cash value. This can be used in the future for any purpose you wish, from making a down payment on a house to paying for college tuition. Keep in mind, though, that withdrawing or borrowing funds will reduce your policy’s cash value and death benefit if not repaid.

7. To guarantee insurability. Your health can change in an instant. Getting a permanent life insurance policy when you’re young and healthy means you’ll have lifelong coverage. Then you won’t have to worry if later on, you develop a health condition that would make it hard or even impossible to get life insurance.

8. To receive tax-free benefits. Life insurance is one of the few ways to leave loved one's money that is generally income-tax free.

9. To give loved ones peace of mind. Losing a parent and partner before their time is already hard enough without having to worry about unsettled debts, childcare costs, funeral bills, and other expenses.

As you can see, life insurance for stay-at-home parents is just as important as it is for parents who work outside the home. Schedule a time to talk with an insurance professional in your community to learn about your options and get coverage that fits your lifestyle and budget.

SOURCE: Austin, A. (11 December 2018) "9 Reasons Why Stay-at-Home Parents Need Life Insurance" (Web Blog Post). Retrieved from https://lifehappens.org/blog/9-reasons-why-stay-at-home-parents-need-life-insurance-2/


Finding the Hidden Benefits within your Offered Health Insurance Plan

Benefits packages offered by employers are just one of the many elements an employee considers when joining, remaining at or leaving a company. Striking the right balance of what employees want and what your business has to offer will allow for a return on investment. In this installment of CenterStage, Kelley Bell, a Group Health Benefits Consultant at Saxon Financial, explains how to unlock and bring forth benefits often overlooked by employers and employees.

The Reason for Employee Benefits

Employers of all sizes within the United States aim to offer attractive health insurance benefits that will both attract prospective employees and retain those talented individuals who are currently employed. Aside from looking to earn money to put food on the table, pay bills and set aside for later, people seek employment for assistance in alleviating the burden of having to pay for insurance plans singlehandedly. Thus, they plan where they will work and for how long they will work based on what your company has to offer.

When looking at benefits plans, most people assume the usual: a comprehensive health plan that assists in providing medical insurance and reduces pharmacy costs. However, a benefits package you receive from an employer today is no longer your parents’ benefits package. Just as trends in fashion and pop culture come and go, so should the benefits within an employer’s plan.

It is unique offerings that attract potential employees and retain current ones. Additionally, it is in the hands of employers to offer methods to achieve and shift culture in a positive way by offering necessary methods to do so. Employee benefits packages today are shaped to fit the needs of the employees.

As the nation’s health has declined, an uptick in the popularity in offering benefits such as discounted or free gym memberships has become a major plus. How are employees to be aware of the perks of employment with your business? They need to be properly educated about their plans. Kelley explained, “Employers must take time to educate employees as they are their most valuable asset.”

Benefits That Get Overlooked

Every employer, no matter how big or small, has something to offer. With over 25 years of experience in the financial industry, Kelley has seen and heard it all from employers with whom she partners with in selecting benefits for their employees. “I’ve heard people say they have a horrible plan but in reality, it is not a horrible plan, they don’t understand it or how to use it.” When investing in an ‘add-on’ benefit, there is typically a large sum injected into a new initiative, but the results are often short-lived, a short spark of novelty. The benefits that carry stamina are usually those that hold tremendous value in both a sense of time and money. Kelley continued, “Some of the embedded benefits in their existing plans will help save them money, become a wise consumer and ultimately choose to live a healthier lifestyle.”

What are some examples of benefits that fly under the radar of employers and their employees?

  • Telemedicine medical services. Telemedicine is a fantastic way to recover and receive treatment for an illness or injury from the comfort and convenience of their car, work or home rather than in a doctor’s office.
  • Wellness initiatives are another fantastic offering which is simply implementing a wellness committee dedicated to the well-being of your employees.
  • Saxon offers a free portal with wellness information available to clients. Becoming a member includes receiving newsletters, email blasts, wellness information and challenges your business can utilize.
  • Consumers of healthcare have historically been conscious purchasers. Within your plan, check for the ability to leverage multiple doctors and pharmacies to find the most cost-effective option for each employee. Medical offices inside pharmacy’s, or retail outlets, as well as Urgent cares, have seen increased rates of attention simply for their competitive prices as opposed to a traditional hospital.
  • Employers looking for additional ways to offer savings for employees on their prescription medications can turn to mobile apps such as GoodRx which offers money-saving coupons for medications.
  • Online wellness tools allow you to view claims, ID cards, locate doctors, browse medications and estimate costs. Many of the plans have teams to help people who are pregnant, want to stop smoking, lose weight or have specific health conditions such as asthma, diabetes, heart disease, etc.”

How Saxon Helps

Kelley understands every business is unique and is dedicated to proactively serving the needs of each client. At Saxon, Kelley and our team of advisors begin by engaging experts that truly listen, building successful strategies that stay focused on your vision and goals.

Saxon exists to care, cultivate and empower through relationships, expertise and exceptional standards of service. Saxon’s WIN team is always available at your convenience to unlock the benefits you did not know you had in order to excel your organizational efforts upward.

To begin the conversation about putting your overlooked benefits into action, contact Kelley Bell today at (513) 774-5493 or (937) 672-1547 or via email at kbell@gosaxon.com.


More part-time workers getting access to benefits

A new study by the International Foundation of Employee Benefit Plans found that more employers are moving toward extending more benefits to part-time workers. Continue reading this blog post to learn more.


Gone are the days that new talent might come to work for a company part-time in exchange for some extra cash and the promise of discounted merchandise.

Employers are moving toward extending more benefits to part-time workers, according to a new study by the International Foundation of Employee Benefit Plans. The Flexible Work Arrangements: 2017 Survey Report found that 78% of organizations employ part-time workers, and 90% of those organizations define part-time work as fewer than 30 hours a week.

And part-time workers can thank the tight labor market for the increase in benefit offerings.

“In order to attract and retain key talent, employers are seeing the need to broaden the scope of work from the traditional ‘40-hour per week model,” says Julie Stich, CEBS, associate vice president of content at IFEBP. “They’re also seeing that benefit offerings and other workplace perks are essential for growing any talented organization, regardless of the number of hours employees work per week.”

The most favorable medical benefits among employees working fewer than 30 hours a week were healthcare coverage (54%), prescription drug coverage (53%), dental and vision care (52%), flexible spending accounts (47%) and health savings accounts (33%), according to the report.

In addition, paid leave benefits offered to part-timers saw an uptick to include holidays, bereavement leave, sick pay, short-term disability, maternity leave, parental/family leave and personal leave.

Clothing retailer H&M recently announced its plan to offer six weeks of paid leave to the company’s 18,000 employees — including part-timers.

In addition, Eataly, said in September its new paid parental leave policy — eight weeks of time off for both mothers and fathers following the birth or adoption of a child — is available to all employees who have been working at the company for at least a year, regardless of hours worked per week. Dollar General also introduced a new paid parental leave benefit in March, offering two weeks of paid time off for all eligible full-time and part-time employees, and eight weeks of paid time off for birth mothers.

“U.S. organizations are not required to provide paid leave to part-time workers, but many do for several reasons: to retain high-performing workers, attract high-quality applicants, build worker loyalty and provide work-life balance,” Stich adds.

Paid time off and healthcare were also key benefits identified in the Society for Human Resource Management’s annual survey, with a 10% increase in companies offering healthcare benefits and more than half saying they offer some sort of paid time off to part-time workers.

More employers will likely offer benefits to part-time workers as the workforce shifts toward more flexible work options, Stich says. “Certainly, each organization is structured differently, and company cultures vary, but if offering part-time work arrangements and benefits is appropriate, they can be a vehicle for attracting top-tier talent while providing additional flexibility for current employees.”

SOURCE: Otto, N. (12 December 2018) "More part-time workers getting access to benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/more-part-time-workers-getting-access-to-benefits?brief=00000152-14a7-d1cc-a5fa-7cffccf00000


The case for self-funded health benefit plans and reference-based pricing

Small businesses are starting to explore self-funded plan designs that use reference-based pricing. Continue reading for more about self-funding and reference-based pricing.


Self-funding and reference-based pricing are hot topics with small businesses. They are so popular, in fact, that a recent survey shows an overall increase in their 2019 projection of small employer clients having a reference-based pricing health benefit plan design. Small businesses are seeing these savings, and they’re starting to explore how reference-based pricing can help them, too.

Before we get to why self-funded plan designs that use reference-based pricing are becoming more popular for small businesses, let’s review the basics.

Reference-based pricing is a methodology of calculating payment to providers for covered treatments and services using a “reasonable fee” based on a reference point. A common reference point is the Medicare fee schedule. Some self-funded health benefit plans calculate the reasonable fee as a percentage of the Medicare fee schedule to determine reimbursement for services rendered.

Bottom line: Self-funded health benefit plan designs that use reference-based pricing can allow for a great deal of flexibility with a variety of arrangements and overall cost-savings.

So, what’s behind the recent trend toward reference-based pricing for smaller employers? A few key factors.

First, a self-funded health benefit plan design that uses referenced-based pricing can mean less expensive coverage for employees and employers.

When coupling a self-funded health benefit plan with stop-loss insurance, reference-based pricing provides an affordable way to extend coverage to employees through lower employee contributions. So, employees are happy because they’re saving money.

And employers are happy, too, because they’re allowing for more coverage to more employees. There’s a refund potential for employers if claims dollars are less than funded. There’s also a premium tax savings of around 2% since self-funded claim dollars are not subject to state health insurance premium taxes.

Moreover, self-funded health benefit plan designs that utilize reference-based pricing may also include transparency reports with aggregate health claims data and demographic information, which allow employers to better manage costs. Overall, anytime you can design a plan that’s beneficial for employees and employers, it’s a win.
Second, reference-based pricing can provide employees more flexibility when it comes to choosing a provider. Typically, an important feature of any health benefit plan design for employees is the ability to choose the provider they want. Some self-funded plan designs that use reference-based pricing give employees the chance to pick the provider that’s right for them. And, when employees are happy with their health plan, employers are usually pretty happy, too.

Finally, self-funded plan designs that use reference-based pricing can help employees become smarter healthcare consumers because of all the transparency and choice involved. When employees better understand the healthcare processes and system, costs come down for both the employee and employer. In fact, just understanding their coverage better may help employees better use their health benefit plans.

For example, using telemedicine when appropriate, establishing a relationship with a primary care doctor and using client advocacy services can all help employees better utilize their health benefit plans. In the end, employees get smarter about how they manage their care, and employers win with reduced costs.

These factors are driving more small businesses to consider reference-based pricing self-funded health benefit plan designs with stop-loss insurance. And, for good reason. These plan designs can give employers the opportunity to offer their employees affordable health benefits, provide more choice in their health plans and providers, and encourage more employee engagement. While moving to reference-based pricing may be too big of a leap for some employers, self-funding continues to provide a means for employers to offer comprehensive major medical health benefits at lower costs.

SOURCE: MacLeod, D. (6 December 2018) "The case for self-funded health benefit plans and reference-based pricing" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/the-case-for-self-funded-health-benefit-plans-and-reference-based-pricing


8 ways to maintain HSA eligibility

Is your high-deductible health plan still HSA qualified? Ensuring your high-deductible health plan remains HSA qualified is no easy task. Read this blog post for eight ways employers can maintain HSA eligibility.


For employers sponsoring high-deductible health plans with health savings accounts, ensuring that the HDHP continuously remains HSA qualified is no easy task. One challenge in this arena is that most of the rules and regulations are tax-related, and most benefit professionals are not tax professionals.

To help, we’ve created a 2019 pre-flight checklist for employers.

With 2019 rapidly approaching and open enrollment season beginning for many employers, now’s a great time to double-check that your HDHP remains qualified. Here are eight ways employers can maintain HSA eligibility.

1. Ensure in-network plan deductibles meet the 2019 minimum threshold of $1,350 single/$2,700 family.

To take the bumps out of this road, evaluate raising the deductibles comfortably above the thresholds. That way, you won’t have to spend time and resources amending the plan and communicating changes to employees each year that the threshold increases. Naturally, plan participants may not be thrilled with a deductible increase; however, if your current design requires coinsurance after the deductible, it’s likely possible on a cost neutral basis to eliminate this coinsurance, raise the deductible and maintain the current out-of-pocket maximum. For example:

Current Proposed
Deductible $1,350 single / $2,700 family $2,000 single / $4,000 family
Coinsurance, after deductible 80% 100%
Out-of-pocket maximum $2,500 single / $5,000 family $2,500 single / $5,000 family

This technique raises the deductible, improves the coinsurance and does not change the employee’s maximum out-of-pocket risk. The resulting new design may also prove easier to explain to employees.

2. Ensure out-of-pocket maximums do not exceed the maximum 2019 thresholds of $6,750 single/$13,500 family.

Remember that the 2019 HDHP out-of-pocket limits, confusingly, are lower than the Affordable Care Act 2019 limits of $7,900 single and $15,800 family. (Note to the U.S. Congress: Can we please consider merging these limits?) Also, remember that out-of-pocket costs do not include premiums.

3. If your plan’s family deductible includes an embedded individual deductible, ensure that each individual in the family must meet the HDHP statutory minimum family deductible ($2,700 for 2019).

Arguably, the easiest way to do so is making the family deductible at least $5,400, with the embedded individual deductible being $5,400 ÷ 2 = $2,700. However, you’ll then have to raise this amount each time the IRS raises the floor, which is quite the hidden annual bear trap. Thus, as in No. 1, if you’re committed to offering embedded deductibles, consider pushing the deductibles well above the thresholds to give yourself some breathing room (e.g., $3,500 individual and $7,000 family).

For the creative, note that the individual embedded deductible within the family deductible does not necessarily have to be the same amount as the deductible for single coverage. But, whether or not your insurer or TPA can administer that out-of-the-box design is another question. Also, beware of plan designs with an embedded single deductible but not a family umbrella deductible; these designs can cause a family to exceed the out-of-pocket limits outlined in No. 2.

Perhaps the easiest strategy is doing away with embedded deductibles altogether and clearly communicating this change to plan participants.

4. Ensure that all non-preventive services and procedures, as defined by the federal government, are subject to the deductible.

Of note, certain states, including Maryland, Illinois and Oregon, passed laws mandating certain non-preventive services be covered at 100%. While some of these states have reversed course, the situation remains complicated. If your health plan is subject to these state laws, consult with your benefits consultant, attorney and tax adviser on recommended next steps.

Similarly, note that non-preventive telemedicine medical services must naturally be subject to the deductible. Do you offer any employer-sponsored standalone telemedicine products? Are there any telemedicine products bundled under any 100% employee-paid products (aka voluntary)? These arrangements can prove problematic on several fronts, including HSA eligibility, ERISA and ACA compliance.

Specific to HSA eligibility, charging a small copay for the services makes it hard to argue that this isn’t a significant benefit in the nature of medical care. While a solution is to charge HSA participants the fair market value for standalone telemedicine services, which should allow for continued HSA eligibility, this strategy may still leave the door open for ACA and ERISA compliance challenges. Thus, consider eliminating these arrangements or finding a way to compliantly bundle the programs under your health plan. However, as we discussed in the following case study, doing so can prove difficult or even impossible, even when the telemedicine vendor is your TPA’s “partner vendor.”

Finally, if your firm offers an on-site clinic, you’re likely well aware that non-preventive care within the clinic must generally be subject to the deductible.

5. Depending on the underlying plan design, certain supplemental medical products (e.g., critical illness, hospital indemnity) are considered “other medical coverage.” Thus, depending on the design, enrollment in these products can disqualify HSA eligibility.

Do you offer these types of products? If so, review the underlying plan design: Do the benefits vary by underlying medical procedure? If yes, that’s likely a clue that the products are not true indemnity plans and could be HSA disqualifying. Ask your tax advisor if your offered plans are HSA qualified. Of note, while your insurer might offer an opinion on this status, insurers are naturally not usually willing to stand behind these opinions as tax advice.

6. The healthcare flexible spending account 2 ½-month grace period and $500 rollover provisions — just say no.

If your firm sponsors non-HDHPs (such as an HMO, EPO or PPO), you may be inclined to continue offering enrollees in these plans the opportunity to enroll in healthcare flexible spending accounts. If so, it’s tempting to structure the FSA to feature the special two-and-a-half month grace period or the $500 rollover provision. However, doing so makes it challenging for an individual, for example, enrolled in a PPO and FSA in one plan year to move to the HDHP in the next plan year and become HSA eligible on day one of the new plan year. Check with your benefits consultant and tax adviser on the reasons why.

Short of eliminating the healthcare FSA benefit entirely, consider prospectively amending your FSA plan document to eliminate these provisions. This amendment will, essentially, give current enrollees more than 12 months’ notice of the change. While you’re at it, if you still offer a limited FSA program, consider if this offering still makes sense. For most individuals, the usefulness of a limited FSA ebbed greatly back in 2007. That’s when the IRS, via Congressional action, began allowing individuals to contribute to the HSA statutory maximum, even if the individual’s underlying in-network deductible was less.

7. TRICARE

TRICARE provides civilian health benefits for U.S Armed Forces military personnel, military retirees and their dependents, including some members of the Reserve component. Especially if you employ veterans in large numbers, you should become familiar with TRICARE, as it will pay benefits to enrollees before the HDHP deductible is met, thereby disqualifying the HSA.

8. Beware the incentive.

Employers can receive various incentives, such as wellness or marketplace cost-sharing reductions, which could change the benefits provided and the terms of an HDHP. These types of incentives may allow for the payment of medical care before the minimum deductible is met or lower the amount of that deductible below the statutory minimums, either of which would disqualify the plan.

SOURCE: Pace, Z.; Smith, B. (22 October 2018) "8 ways to maintain HSA eligibility" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/8-ways-to-maintain-hsa-eligibility


4 FAQs about 2019 Medicare rates

Some high-income enrollees of Medicare Part B may experience premium increases of 7.4 percent. According to Medicare managers, Medicare Part B premium increases will be held to about 1.1 percent for most enrollees in 2019. Read on to learn more.


Medicare managers announced last week that they will hold increases in Medicare Part B premiums to about 1.1 percent for most enrollees in 2019. For some high-income enrollees, however, premiums will rise 7.4 percent.

Medicare Part B is the component of the traditional Medicare program that covers physician services and hospital outpatient care.

Here’s a look at how the monthly Part B premiums will change, by annual income level:

  • Individuals earning less than $85,000, and couples earning less than $170,000:$135.50 in 2019, from $134 this year.
  • Individuals earnings $160,000 to $500,000, and couples earning $320,000 to $750,000: $433.40 in 2019, from $428.60 this year.
  • Individuals earning $500,000 or more, and couples earning $750,000 or more: $460.50 in 2019, from $428.60 this year.

The annual Medicare Part B deductible will increase by 1.1 percent, to $185.

Another component of the traditional Medicare program, Medicare Part A, covers inpatient hospital bills.

Medicare managers use payroll taxes to cover most of the cost of running the Medicare Part A program. Few Medicare Part A enrollees pay premiums for that coverage. But, for the enrollees who do have to pay premiums for Medicare Part A coverage, the full premium will increase 3.6 percent, to $437 per month.

The Medicare Part A deductible for inpatient hospital care will increase 1.8 percent, to $1,340.

Why are high earners paying so much more for Medicare Part B?

Congress has been increasing the share of Medicare costs that high earners pay in recent years.

For 2018, the top annual income category for Medicare Part B rate-setting purposes was for $160,000 and over for individuals, and for $320,000 and over for couples. Premiums from those Medicare Part B enrollees are supposed to cover 80 percent of their Part B claims.

In the Balanced Budget Act of 2018, Congress added a new annual income category: for individuals earning $500,000 or more and couples earning $750,000 or more. Premiums from Part B enrollees in that income category are supposed to cover 85 percent of those enrollees’ Part B claims.

Who do these rate increases actually affect?

Medicare now has about 60 million enrollees of all kinds, according to the CMS Medicare Enrollment Dashboard.

About 21 million are in Medicare Advantage plans and other plans with separate premium-setting processes.

About 38 million are in the traditional Medicare Part A, the Medicare Part B program, or both the Medicare Part A and the Medicare Part B programs. CMS refers to the traditional Medicare Part A-Medicare Part B program as Original Medicare. The rate increases have a direct effect on the Original Medicare enrollees’ costs.

How do the Medicare increases compare with the Social Security cost-of-living adjustment (COLA)?

The Social Security Administration recently announced that the 2019 Social Security COLA will be 2.8 percent.

That means the size of the COLA will be greater than the increase in Medicare premiums for all Medicare enrollees other than the highest-income Medicare Part B enrollees and the enrollees who pay the full cost of the Medicare Part A premiums.

Why should financial professionals care about Original Medicare premiums?

For consumers who already have traditional Medicare coverage, the Part A and Part B premiums may affect how much they have to spend on other insurance products and related products, such as Medicare supplement insurance coverage.

For retirement income planning clients, Medicare costs are something to factor into income needs calculations.

Because access to Medicare coverage is critical to all but the very wealthiest retirees, knowledge about how to get and keep eligibility for Medicare coverage on the most favorable possible terms is of keen interest to many consumers ages 50 and older. Some consumers may like to get information about that topic from their insurance agents, financial planners and other advisors.

Resources

Officials at the Centers for Medicare and Medicaid Services, the agency that runs Medicare, are preparing to publish the official 2019 Medicare rate notices in the Federal Register on Wednesday. A preview copy of the Part A notice is available here, and a preview copy of the Part B notice is available here.

SOURCE: Bell, A. (16 October 2018) "4 FAQs about 2019 Medicare rates" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/10/16/medicare-posts-2019-rates-pinches-high-earners-412/


Are you ready for self-funding? Three tools to help you decide

Are you ready for a self-funded health plan? Self-funding and other alternative funding options may seem risky to many HR professionals. Continue reading for three tools to help you decide if you’re ready to switch.


When your health plan is fully insured, it’s easy for your finance department to budget for the cost — you just pass on the health insurer’s annual renewal premium amount to them and that becomes the annual budget number. But you and your broker may have come to suspect that you are leaving money on the table by continuing on a fully insured basis, and you may want to test the self-funded waters.

By now, you may already know there are significant benefits to self-funding, but actually making the switch is a scary prospect for HR directors.

Before you can transition to a self-funded plan, you need to be financially stable and willing to take a bit of a risk. As a safeguard, you also need to familiarize yourself with the two forms of stop-loss insurance. One caps the impact on any one covered member’s claims (individual or specific stop loss), and the other caps your total annual claim liability (aggregate stop loss). Your broker can guide you on which stop loss levels and which stop-loss coverage periods are right for your population when transitioning from fully insured to self-funding.

Beyond these stop-loss safeguards, size will dictate how you pay. If you have fewer than 100 covered employees, you may be able to pay the same amount monthly, just as you do with your fully insured premium. This monthly payment equals projected claims plus an aggregate margin, a monthly administration fee and the stop loss charge. This eliminates unpredictable monthly payments for a small self-funded group.

However, for larger groups of over 100 employees, moving to self-funding will mean paying claims as they are processed (which means uneven claim payments), plus stop loss and administration.

To help you determine if you’re ready for self-funding, you may want to analyze your plan in a few different ways.

1. Look back: A look back analysis is just what it sounds like — a view of how your plan would have performed over the last couple years had you been self-funded, compared to how it did perform under a fully insured model. This should be an easy enough task for your broker to take on, especially if they have sought out self-funded quotes from claim administrators and stop-loss carriers on your behalf. In addition, they should know what your actual claims costs were. The result is that you’ll know whether you would have saved money or not.

2. Look forward: You may already know what your upcoming fully insured renewal looks like. But even if you don’t have hard numbers yet, you can work with your broker to determine a strong estimate of what your proposed premiums will be. Then, your broker should get a self-funded quote, which includes the expected and maximum claims, plus the administrative fees and stop-loss premiums. This is your expected self-funded costs for the upcoming policy period. Compare that estimate to your fully insured renewal costs. (Make sure the self-funded costs are on the same “incurred claims with runout” basis that the fully insured costs would be, for a fair apples-to-apples comparison.)
3. Probability. While the “look forward” analysis compares your fully insured costs to your expected self-funded costs, it is based on “expected” claims. The risky part of self-funding is that your actual claims will not ultimately materialize exactly as expected. There are some more sophisticated tools that combine group-specific data (such as your claims history, demographics and the proposed fixed costs) with a fairly large actuarial database to come up with thousands of possible outcomes.

By charting all of these outcomes, you can produce likelihood percentages of where your actual claims will come in at — versus the “expected” level, and versus the fully insured renewal rate. Not all brokers have this tool on hand, and as a result, there may be a cost associated with producing one. The output from this tool may appeal to your colleagues in the finance department.

Other considerations

During your analysis, you may want to set your self-funded policy year liability based on incurred claims (plus fixed costs), even though your actual paid claims within that policy year may be less due to the lag between when provider services occur and when you actually fund them. The lag is a cash-flow advantage but it does not represent a reduced claim liability.

Finally, don’t lose sight of the cost of high claimants, an important part of planning if you choose the self-funding route. Will your past high claimants continue into your renewal period? Are you aware of new high claimants on the horizon? Stop-loss carriers generally insure only “unknown risks,” not “known risks.” If a plan member has an expensive chronic condition, such as kidney failure, a stop loss carrier may “laser” that individual and set a higher individual stop-loss threshold. It’s important that you know what’s excluded and factor in any uncovered catastrophic claimants into your analysis.

In the end, it may turn out that self-funding is not a good fit, or possibly that this year is just not the year for it. But whether it is, or it isn’t, it is comforting to know that you’ve done your due diligence and have documentation supporting the decision you’ve reached.

SOURCE: DePaola, Raymond (5 October 2018) "Are you ready for self-funding? Three tools to help you decide" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/ready-for-self-funding-three-tools-to-help-you-decide


Identity theft protection benefits and the business case for employers

Employees are turning to their employers for identity theft protection benefits with the rise in identity theft news. Continue reading to learn more.


With identity theft in the news constantly, many employees are turning to their employers to ask for an identity protection benefit.

Let us focus on productivity and wellness. Identity theft can wreak havoc on an employee’s personal and work life. According to SANS Institute, it takes an average of six months and up to 200 hours of personal time to resolve issues related to the theft. This includes hours calling banks, credit card companies, filing police reports, notifying the Social Security Administration, and alerting credit bureaus. Most of these calls and follow up activity must be made during business hours. According to ITRC’s latest study, 22% of respondents took time off of work when dealing with issues of identity theft.

Identity theft also impacts wellness and mental health. According to the ITRC study, 75% of respondents reported that they were severely distressed by the misuse of their information, and many sought professional help to manage their identity theft experience — either by going to a doctor for their physical symptoms or seeking mental health counseling.

These findings make it clear that identity theft directly impacts productivity and wellness. That is why comprehensive and compassionate restoration services should be a key element of any ID Protection plan offered by the employer.

Restoration services are the fixers in a comprehensive identity protection plan. For victims of identity theft, the restoration specialist will do the required work to restore the victim’s identity. Specialists make the calls during business hours, complete the necessary paperwork, and manage the process. They free up the employee to focus on their job, and alleviate the stress of dealing with the challenges of identity restoration.

There are a range of features to look for when evaluating restoration services across plans. Some plans only offer advice and information kits to guide members on what steps they need to take. Those services typically do not do the work for the member.

For plans that provide a full restoration process, consider if the plan provides victims with a dedicated restoration specialist as a single point of contact. Since the restoration process can take months or years, it’s best if a victim has a consistent person to speak with who knows the case and can provide periodic updates. Restoration services should be available 24/7 so victims can initiate the process immediately to lessen the damage. Plans should also provide multilingual specialists to best serve all members and handle all types of identity theft.

Although monitoring may alert individuals that are a victim of identity theft, the even greater value is in fixing the situation. Be sure to fully evaluate the restoration features of an identity protection plan as part of the selection process.

SOURCE: Hazan, J (31 August 2018) "Identity theft protection benefits and the business case for employers" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/identity-theft-protection-benefits-and-the-business-case-for-employers


7 wellness program ideas you may want to steal

Need more energy and excitement in your office? Keep your employees healthy and motivated with these fun wellness program ideas.


Building your own workplace wellness program takes work–and time–but it’s worth it.

“It’s an investment we need to make,” Jennifer Bartlett, HR director at Griffin Communication, told a group of benefits managers during a session at the Human Resource Executive Health and Benefits Leadership Conference. “We want [employees] to be healthy and happy, and if they’re healthy and happy they’ll be more productive.”

Bartlett shared her experiences building, and (continually) tweaking, a wellness program at her company–a multimedia company running TV outlets across Oklahoma –over the last seven years. “If there was a contest or challenge we’ve done it,” she said, noting there have been some failed ventures.

“We got into wellness because we wanted to reduce health costs, but that’s not why we do it today,” she said. “We do it today because employees like it and it increases morale and engagement.”

Though Griffin Communication's wellness program is extensive and covers more than this list, here are some components of it that's working out well that your company might want to steal:

  1. Fitbit challenge.Yes, fit bits can make a difference, Bartlett said. The way she implemented a program was to have a handful of goals and different levels as not everyone is at the same pace-some might walk 20,000 steps in a day, while someone else might strive for 5,000. There are also competition and rewards attached. At Griffin Communications, the company purchased a number of Fitbits, then sold them to its employees for half the cost.
  2. Race entry.Griffin tries to get its employees moving by being supportive of their fitness goals. If an employee wants to participate in a race-whether walking or running a 5k or even a marathon, it will reimburse them up to $50 one time.
  3. Wellness pantry.This idea, Bartlett said, was "more popular than I ever could have imagined." Bartlett stocks up the fridge and pantry in the company's kitchen with healthy food options. Employees then pay whole sale the price of the food, so it's a cheap option for them to instead of hitting the vending machine. "Employees can pay 25 cents for a bottled water or $1.50 for a soda from the machine."
  4. Gym membership."We don't have an onsite workout facility, but we offer 50 percent reimbursement of (employees') gym membership cost up to a max of 200 per year," she said. The company also reimburses employees for fitness classes, such as yoga.
  5. Biggest Loser contest.Though this contest isn't always popular among companies, a Biggest Loser-type competition- in which employees compete to lose the most weight-worked out well at Griffin. Plus, Bartlett said, "this doesn't cost us anything because the employee buys in $10 to do it." She also insisted the company is sensitive to employees. For example, they only share percentages of weight loss instead of sharing how much each worker weights.
  6. "Project Zero" contest.This is a program pretty much everyone can use: Its aim is to avoid gaining the dreaded holiday wights. The contest runs from early to mid- November through the first of the year. "Participants will weigh in the first and last day of the contest," Bartlett said. "The goal is to not gain weight during the holidays-we're not trying to get people to lose weight but we're just to not get them to not eat that third piece of pie."
  7. Corporate challenges.Nothing both builds camaraderie and encourages fitness like a team sports or company field day. Bartlett said that employees have basically taken this idea and run with it themselves- coming up with fun ideas throughout the year.

SOURCE:
Mayer K (14 June 2018) "7 wellness program ideas you may want to steal" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2015/10/10/7-wellness-program-ideas-you-may-want-to-steal/