HealthyTexas is a new set of employer based insurance plans offered by United Health Care and Celtic Insurance. They were designed to assist small business owners in offering more affordable health insurance for their employees and families. The plans are sponsored and partially funded by the State of Texas. They include all of the benefit requirements that are part of the 2010 federal health care reform.

In order to make the plans more affordable some of the standard guidelines that you may be familiar with have been slightly modified. Premium rates are determined by age, gender, and residential zip code. Unlike standard major medical plans there is no medical underwriting allowed for the HealthyTexas plans. Also, unlike standard major medical plans, the participation requirements drop from 75% of benefit eligible employees to 60%. This makes it a little easier for a group to get enough participation to qualify for the program.

What companies are eligible to enroll?
• Employee size between 2 and 50
• Have not provided group health insurance in the past 12 months
• Must be located in Texas and employees must all reside in Texas
• At least 30% of employees must receive wages at or below 300% of the federal poverty level which for 2011 is $32670
• Employer is still obligated to pay 50% of the employee’s cost
• Employer must offer dependent coverage but is not obligated to pay any of the cost for covering dependents
• Employees must be a US citizen or an alien lawfully present in the US.

What are some of the benefits of the plans?
• $25 copayment for most physician services
• 100% coverage for Preventative care as required by new federal healthcare reform law
• 80% coinsurance for hospitalization and surgery
• Network only savings
• Prescription drug plan $10/$25/$50 ($200 and $500 annual deductible)
• Optional coverage available: Dental, Life and Vision

FOR MORE INFORMATION AND A FREE PROPOSAL CONTACT:
Rosemarie Swaim- BenefitsMart LLC
817 565-8558
Or at rswaim@benefitsmartllc.com

Did you know that every ten (10) minutes 490 Americans become disabled?

According to the National Center for Health Statistics in a publication issued in 2008 and the findings of the Social Security Administration we know the following:

• About 62 million people in the US have some type of disability that adversely affects their daily activities
• Of those approximately 2/3 are under the age of 65
• Approximately 3 in 10 in the workforce now will become disabled before they retire.

If you answer yes to any of the following statements, you probably need to reassess your insurance portfolio and add additional coverage for disability.

1. Do you rely solely on your income to pay for everyday living expenses and bills
2. I have life insurance to protect my family but I would like to explore some options for protecting my income.
3. I have disability coverage from my employer but it only covers about 60% of my income.
4. I am an independent business owner/practitioner and I don’t know whether I have enough coverage for my income and my business if something happens to me.
5. I have set up a retirement plan, but a disability might force me to dip into those assets thus endangering my quality of life at retirement age.

Some of the carriers we work with include: Aflac, Mutual of Omaha, Principal, Met Life, The Hartford and many more….

We can work with you to find a plan for your company or you as an individual that can fit your budget and your needs.

For more information, please contact us at: rswaim@benefitsmartllc.com or submit a request for quote on our website: www.benefitsmartllc.com.

The History:

Health Savings accounts were created to be used in conjunction with consumer driven health plans (CDHC). These plans were developed by the insurance carriers to provide the consumer with a better way to manage how, when, where, with whom and how much they spend their health care dollars.

The Benefits:

You can claim a tax deduction for contributions you, or someone other than your employer mad to your Health Savings Account , even if you do not itemize your deductions on Form 140
Contributions to your Health Savings Account made by your employer may be excluded from your gross income.
The contributions remain in your account from year to year until you use them and usually in an interest bearing account.
The interest on the assets in your account are tax free
Distributions will be tax free if they are used to pay for a qualified medical expense
Health Savings Accounts are portable so the money goes with you wherever you go

How Do you Qualify for Health Savings Account?
You must have a High Deductible Health plan $1200 for individual, $2400 for family. There are limits on maximum annual deductible and other out of pocket expenses as well. $5950 for individual and $11,900 for family
You have no other health insurance coverage except for those ancillary insurance products such as accident, disability, dental, vision, long term care, a plan that pays for a specific disease (such as Cancer) or illness, or a plan that has a fixed amount per day or period of hospitalization.
You cannot be enrolled in Medicare
You cannot be claimed as a dependent on someone else’ tax return. Note per the IRS each spouse who is an eligible individual who wants a Health Savings Account must open a separate Health Savings account, you cannot have a joint Health Savings account even though you have joint insurance coverage.

Having set out the most significant requirements of eligibility put forth in IRS publications, let’s turn to what a Consumer Driven Health Plan is and why having one is a good idea for most people. Again, a consumer driven health care plan comes from the need and desire of people today to control how, how much, when and with whom health care dollars are spent. Some of the immediate goals of a person seeking to utilize a consumer driven health plan include but are not limited to:
Participants are actively involved in making decisions about their own health
Participants will seek out and use non-traditional sources for health care, including online resources, wellness incentives, phone-a-nurse service, etc.
Participants will look at health care and saving for health care expenses as a long term venture rather than just another visit to the doctor’s office, and more

High Deductible Health Plans have a “safe harbor” for preventative care. What this means to the consumer is that there is no cost for specific preventative measures. This coverage is provided before any deductibles have been met. Under some plans there may still be a co pay required but that is based solely on the benefits of the individual plan one purchases. Some of the more common preventative care included in this “safe harbor” are:
Annual physicals
Screening services (such as mammograms, Pap Smears, PSA tests)
Routine pre-natal and well child care
Child and adult immunizations
Tobacco cessation programs
Obesity/weight loss programs.

The individual plans should be scrutinized to determine what is covered. Preventative care will not include services to treat an existing illness, injury or condition. Some drugs can be considered preventative if , for example, they are taken by a person who has developed risk factors for a disease that has not yet manifested itself or to prevent the recurrence of a disease. Common examples of this would be cholesterol drugs to prevent heart attack or heart disease and ACE inhibitors to prevent a second heart attack. Again, care must be given to understand the plan one is signing up for to ensure the proper coverages.
Simply speaking the “average” adult only goes to the doctor for an annual physical and is carrying health insurance for the ”catastrophic” event. What better way to get a tax deduction, have your annual physical paid for and save money to cover your deductible in the event of that catastrophic event…?
HEALTH SAVINGS ACCOUNT coupled with High Deductible Health Plan.
The literature on the whys, how’s, etc is almost limitless. Health Savings Accounts with High deductible plans may not be the answer for everyone. It is recommended that you speak with your insurance advisor to work on the best plan to suit your needs. I work diligently to achieve these goals with my clients.

Benefitsmart, LLC, is now located right here in Weatherford, Texas, and would love to help you with any questions about Heath Savings accounts, please contact us to found out more.

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Report finds even cancer patients with insurance may incur severe medical debt.

The CBS Evening News (2/5, story 10, 2:25, Couric) reported, “The economic crisis in this country is affecting people in so many ways. It’s even affecting their health. More than a million cancer patients are forgoing care because of the cost, even though 70 percent of them have health insurance.”

ABC News (2/5, Brownstein) reported on its website that a report by the American Cancer Society and the Kaiser Family Foundation “outlined the serious financial consequences families face when a member is diagnosed with cancer. In addition to dire statistics and figures, the report featured the stories of 20 patients who have faced severe debt and other challenges in their struggle to get treatment for their disease.”

Specifically, the report found that “hefty out-of-pocket expenses, high cost-sharing requirements, caps on benefits and lifetime maximums on some policies are among the factors that can contribute to financial problems and lead many people to resort to bankruptcy,” according to the San Francisco Chronicle (2/6, Colliver). Of the 20 patients profiled in the report, “nine had coverage through an employer, one paid for employer coverage, seven had individual insurance, two received coverage through a state high-risk pool and one became uninsured.” Debt, stress, and “delays in treatment” are among the problems the patients experienced, despite insurance coverage. “People who become too sick to work usually can continue their employer’s coverage for up to 18 months by paying the full premium, but the added expense of that coverage can pose a hardship because patients often are living on a reduced income,” the Chronicle noted.

Additionally, “many private insurers…have exclusionary policies and reject applicants with pre-existing health problems,” the Detroit Free Press (2/5, Anstett) added. And, according to the report, titled “Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System,” there are “long waits and delays for Medicaid and Medicare.” Moreover, “high risk pool insurance coverage that cancer patients can purchase only is available in 35 states,” with most policies costing “so much, many can’t buy” them.

WebMD (2/5, Zwillich) noted that a separate survey by Kaiser in 2006 found “one in five cancer patients who had insurance throughout their illnesses still used all or most of their savings. Nearly one in 10 were contacted by collection agencies.” Ohio’s Plain Dealer (2/5, Townsend) and HealthDay (2/5, Gardner) also covered the story.

• Health care costs are continuing to increase forcing more cost shifting to the employees
• Benefits managers are moving more towards allowing the employees to be decision makers rather than acting as a parental unit
• Employers are looking for technology to assist with enrollment and benefits management
• More and more employers are moving to voluntary benefits as a supplement.

Voluntary benefits complement an employers core benefits program by offering employees choices to help fill coverage gaps in major medical, disability or life insurance.

An employer may be able to reduce major medical premiums by increasing the deductible and adding a voluntary supplemental health prgram like Aflac that helps employees cover the higher out of pocket costs. As a voluntary supplemental plan, the employee who feels they need additional coverage, or who want to fill in some of the gaps can elect additional coverage and those that are secure in their base medical plan can opt out. The plans offer the employees a way to manage major medical costs and to fill gaps if necessary.

Selling voluntary benefits to the employer and employee requires a consultative approach where the broker understands the major medical benefits being offered, the gaps that may exist, the make up of the employee base. Voluntary benefits are best sold in a one on one environment where a broker can work with each individual to custom fit a program to fit not only their pocketbook but correctly assess the gaps in coverage.

Voluntary benefits fit with high deductible plans, with Health Savings accounts and can even supplement the Flexible Spending Accounts.

Voluntary benefits are typically sold to employees on a pre-tax basis thus saving both the employee and employer some Federal and FICA tax monies.

• 51% of employees surveyed say they don’ have a clear understanding of what their health insurance covers for cancer realted treatment
• When asked if their health insurance would cover most of the expenses if they or a family member were diagosed with cancer, six percent said “no” and 40% said they didn’t know.

The survey also found thahe lack of understanding is relatively the same amoung both gender and age groups.

These answers show that most employees don’t have an accurate understanding of what their benefits will cover because statistics show more than half of cancer treatment costs are not covered by major medical insurance.

Cancer costs the American public more than $219 billion a year and only 41% ofthese costs are direct costs covered by most major medical plans…The remaining 59% are indirect costs the consumer pays for things such as lost wages or salary, deuctibles, travel expenses to and from treatment centers, child care, lodging and meals, experimental treatment, second surgical opinions, etc Statistics also say one in two men and one in three women will be diagnosed with cancer in our lifetimes. Early detection can ensure a better survival rate.

Source Cancer Facts and Figures American Caner SOciety 2008

Aflacs Cancer coverage pays for experimental treatments, travel, lodging, private nursing, second surgical opinion, hopsital stays, annual wellness exams and much more. For the cost of approximately one Starbuck per week, or a pack of cigarettes, can you afford not to have the extra protection.