As I am invited to visit with small and large employers, I am a good listener. What are the ages, wants, budgets and needs of the employees? The employees make the employer successful, so it is ultimate that we consider every aspect of this puzzle. In the end, the numbers will tell the story.

The employer and I begin with some preliminary strategic ideas to contain the skyrocketing costs. When I say that, I mean the premiums and the out-of-pocket expenses. The employees and their families are paying more than ever before as a result of the realities of healthcare in our country.

There are three points that I would like to focus on for your consideration:

• The networks of providers that we can access are shrinking along with the formularies on pharmacy items being narrowed. Some plans are leaving families with an excess of 40% of the medical costs. The average outlay is over $11,500, with an approximate $4,500 being out-of-pocket expenses. This illustrates a consistent increase of about $1,000 per year for the last several years. So, you may ask yourself, “How does the rising cost of care and smaller networks affect me?”. Nearly one third of patients are referred to specialists each year. The primary care physician is referring more than ever, in part due to liability. However, 50% of those referrals are out of network. So, the end result is rising premiums, smaller networks and high out-of-pocket costs that are a burden for most employees. I take extra consideration when suggesting network choices based on the known demographics of the group. It is prudent to offer choices, so that there are appropriate network options for all.

• Foregoing care drives even higher costs for the family and the employer-provided medical plan. I encourage high-deductible health plans as a strong option for lower premiums and tax incentives combined with the idea that employees would be better consumers. The risk is that families will forego care, with a noted 55% reduction in office visits. This means that they are skipping both appropriate and inappropriate care. Missing an early diagnosis of a major health issue or failing to maintain an existing condition lands folks in the ER. With a plan like this in place, I take extra steps to provide the tools and education for them to enjoy the benefits of this option. This is a great choice, but some employees would be better off with different choices.

• A large contributing factor of the out-of-pocket expense is the pharmacy utilization. The price increases on prescription drugs is amazingly high and disproportionate. There is an increasing use of specialty drugs which is the fastest-growing component in any medical plan. Most people don’t feel like they have options when it comes to this topic. Removing this benefit from plans to save premium, sometimes proves to be a mistake. I take extra steps to educate your employees to uncover more cost-effective options.

I cannot encourage employers enough to implement health incentives, wellness and fitness programs, tips, blogs, or newsletters. This is important enough that mid-sized to large employer groups are investing in employees dedicated and focused on nothing other than this. What a great way to attract and retain employees. This is a win-win. Investing in family’s health (the bread winner in some cases), the productivity of the employee for the company, and the personal rewards, make a difference.

With the points above being major issues, we offer you 40 years of knowledge and expertise to guide you to wiser decisions. Information is free, but experience is necessary for proper implementation.  Please call or email me for an appointment. My consultations are free.

I do not expect an employer or the employees to navigate an industry alone in which they are not trained, experienced or proficient. This industry has also experienced more change, complexities and regulations that ever before.

We are proud to say that our clients have made us successful. One hundred percent of my business is referral. I owe a deep appreciation for the professional confidence that has been placed in me to recommend coverage that is affordable and appropriate for your employees and their family’s needs.

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Please visit my site at www.searsinsurance.com to learn more about what we can offer.

CMS announced some long anticipated new rules surrounding of Short Term Limited Duration health plans.
Today’s rule provides consumers with more affordable options for health coverage. They will now have the ability to purchase short-term, limited-duration insurance policies that:

• Are less than 12 months;
• Contain important language to help them understand the coverage they are getting; and
• May be renewed for up to 36 months.

Short Term Limited Duration plans are a good fit for many people in certain situations. We work with three major carriers offering Short Term products in many states, including UnitedHealthcare, National General and IHC. Medica will be releasing short term policies for sale in some states starting later this month.

There has been a lot of excitement over the repeal of the Affordable Care Act (ACA) provision that requires most Americans to have health insurance; many people are confused about whether the mandate is still in effect this year.

The insurance mandate has been removed, but the repeal doesn’t take effect until 2019. The scrapping of the requirement was part of the new tax law President Trump signed in December.

A recent Kaiser Family Foundation Health Tracking Poll found that 40 percent of those surveyed did not know that the health insurance mandate has been repealed. Some 21 percent were aware it has been removed but mistakenly thought that it took effect immediately and that they don’t have to have insurance this year.

Not having health insurance this year will cost you: The penalty is $695 per adult and $347.50 per child for a maximum of $2,085 per family, or 2.5 percent of the household income, whichever is greater. The dollar amount for the 2018 penalty may change because it’s subject to an increase for inflation. If you owe a penalty, you’ll pay it when
you file your income tax return.

Taxpayers can get an exemption from the insurance requirement if, for example, they can show they can’t afford the coverage; that they experienced a personal hardship, such as homelessness, a death in the family, or unpaid medical bills; or they live in a state that did not expand Medicaid.

The Internal Revenue Service has created an Affordable Care Act Estimator Tool, which can assess your potential penalty – https://www.irs.gov/affordable-care-act/individuals-and-families/calculating-an-individual-shared-responsibility-payment

The IRS announced last year that for the first time it will not process any electronically filed tax return that doesn’t include proof of health insurance in 2017. Paper returns could also be held up and refunds delayed. Employers and government health insurance programs had until March 2 to send taxpayers the 1095 forms that provide evidence o health insurance.

The Affordable Care Act does not require businesses to provide health benefits to their workers, but applicable large employers may face penalties if they don’t make affordable coverage available. The employer shared responsibility provision of the Affordable Care Act penalizes employers who either do not offer coverage or do not offer coverage that meets minimum value and affordability standards. These penalties apply to firms with 50 or more full-time equivalent employees. This flowchart illustrates how those employer responsibilities work.