Tag / health insurance

by Medcon Benefit Systems Group, Inc.

Choosing A Benefits Broker

Choosing MedCon Benefit Systems Group, Inc. as your benefits broker – we aim to improve your bottom line and save you money – all at the same time.

We understand you need to save money on employee benefits.

With the rising cost of employee benefits, balancing employee needs with your capabilities and bottom line has never been more difficult. Let us help you meet your benefits goals, your employees’ expectations and your bottom line.

MedCon provides not only insurance, but also employee benefits consulting services. We save you money by delivering benefits solutions that meet your needs through strategic planning, professional services and technology-based solutions.

What You Should Expect from Your Insurance Broker

Your broker shouldn’t stop at obtaining competitive quotes for coverage and handling claims issues—you should expect more from your insurance broker.

MedCon goes above and beyond, providing quality service throughout the year. From custom employee communication materials to human resources tools and claims data analysis, we have the tools to make your benefits goals a reality.

The bare minimum doesn’t cut it anymore—get what you really need from your insurance broker.

Officially Obtaining Our Firm’s Services

There is no standard contract to sign to obtain services from an insurance broker. MedCon is an independent agency that works with a wide variety of carriers in order to provide you with the best possible benefits options.

Once you have chosen us as your insurance broker, you need only provide your current carriers with a letter establishing us as your broker of record. We even provide this letter for you—if you would like to see a sample, please let us know.

When we are established as your broker of record, we are able to do a detailed market analysis, getting quotes from more markets, better leveraging our relationships with carriers and taking advantage of a better negotiating position with carriers.

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Increase Value, Not Cost

Providing the best possible value and service to your employees is important—especially because they are paying a portion of the benefits costs and our commission.

While some brokers only provide quotes, we also provide clear and professional enrollment materials, wellness communication materials and other resources to help keep employees healthy and safe.

Saving You Money

The value-added services we offer can save your employees money and protect your bottom line. The educational materials we provide can do everything, from helping employees understand their health care needs to enabling them to make healthy lifestyle changes. Helping employees understand the benefits that are available and make educated decisions about which benefits are right for them allows them more say in their health care, and also saves you money.

Employees educated on the importance of preventive care may be less likely to rack up hospital bills resulting from leaving conditions untreated. Employees with large families and frequent doctor visits may choose a health plan with broader coverage than employees who live alone and visit the doctor infrequently.

Allowing employees to choose the level of coverage that is right for them saves you money in the short and long term.

Contact MedCon Benefit Systems Group, Inc. today to learn more about the value we can bring to your organization – we look forward to partnering with you!

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by Medcon Benefit Systems Group, Inc.

Legislative Brief: What is an ERISA Plan?

What is an ERISA Plan in the group health plan environment? ERISA has been amended many times over the years, expanding the protections available to welfare benefit plan participants and beneficiaries. ERISA violations can have serious and costly consequences for employers that sponsor welfare benefit plans, either through DOL enforcement actions and penalty assessments or through participant lawsuits.
ERISA applies to virtually all private-sector employers that maintain welfare benefit plans for their employees, regardless of the size of the employer. This includes corporations, partnerships, limited liability companies, sole proprietorships and nonprofit organizations. They exempt two types, those maintained by Governmental Employers and Church Plans.
ERISA generally applies to the following common employee benefits, regardless of whether they are insured or self funded:

  • Medical
  • Dental
  • Vision
  • RX
  • HRA’s
  • FSA’s
  • Group Life and AD&D Benefits
  • EAP’s
  • Short and Long Term Disability Benefits
  • Disease-specific Coverage (for example, cancer policies)

ALL Group health plans subject to ERISA are required to provide participants with a summary plan description (SPD). An SPD must be written in a manner calculated to be understood by the average plan participant and must be sufficiently comprehensive to inform the participant of his or her rights and obligations under the plan.

For additional information, please feel free to contact us at 214/739-5215.

by Medcon Benefit Systems Group, Inc.

Self-Funding: Points to Consider

Gaining popularity similar to it’s peak in the early 1980’s, self-funding is making a comeback. Many brokers / advisers are not well versed in this concept, and therefore are less likely to present the approach to clients. One point they will also likely not share with clients: commissions are paid on the stop loss premiums, not the entire premium amount.

There are reasons to consider self-funding that typically outweigh the reasons not to self-fund. Most importantly, you should be working with an experienced adviser. One who works with self-funded clients day-in and day-out. An adviser who has relationships with a number of Stop Loss Carriers, Third Party Administrators (TPAs) and Pharmacy Benefit Managers, just to name a few.

The first point to consider – self-funding is not a “one year” solution. I do not recommend self-funding to any of our clients if they are not willing to commit to an overall 3-5 year plan. Typically the concept is a win for the client on average four out of five years, but you must be prepared for the bad along with the good.

Additionally, the size of the group should not deter your group from exploring self-funding as an option for your plan. I hear many of my peers say a group has to be at least 200 or 100 employees to consider self-funding, and that is just not true. If a client is financially stable and the adviser understands and communicates all risks involved in the contract, self-funding can be offered successfully as an alternative for clients with as few as 20-25 employees. Some of our clients in the range of 25 employees have been self-funded for over ten years, and are very happy with the stability of the rates over that time period.

Many smaller to mid-size clients should consider a closer look at self-funding due to some distinct advantages under the Patient Protection and Affordable Care Act (PPACA).

This is the first in a series of posts that will focus on the concept of self-funding. With 30+ years experience in all things self-funded, we have a lot to share. We welcome questions and hope those who read will learn something. Continue to follow us for more information coming soon.

by Medcon Benefit Systems Group, Inc.

Let Us Reflect

Last week marked the two year anniversary of Health Care Reform, and this week begins with the Supreme Court starting to hear arguments over the law’s constitutionality. I think it is a good time to reflect back on what has happened as reform enters into its third year.

With the exception of young people, who has benefited by having coverage extended to age 26 under their parents’ coverage? More Americans lack coverage today than four years ago. The percentage of uninsured rose to 17.1% this year, the highest rate since 2008.

The Class Act, the part designed to provide long-term care insurance, has unfortunately been dismissed, thrown out, given up on.

“If you like what you have, you can keep it.” If you like your employer-sponsored coverage you can keep it. Unfortunately, according to a Gallup poll, the number of folks getting their coverage from their employer is decreasing. This number reached a record low in 2011, with only 44.6% getting health insurance from employers.

This week marks an unprecedented case. One that will impact most everyone in some way. The Supreme Court has several options, from upholding the law to striking it down in its entirety. It could also avoid the law’s constitutionality at all, if it finds the lawsuits challenging the law are premature.

Whatever happens – MedCon will be watching and keeping up with all updates. Please keep checking back to stay informed.

by Medcon Benefit Systems Group, Inc.

Summary of Benefits and Uniform Glossary Regulations

On Februray 9, 2012, final regulations were released regarding the Summary of Benefits and Coverage (SBC) and Uniform Glossary requirements for health insurance plans. The goal is to provide consumers with simple information on plan coverage and help consumers better understand the coverage they have in order to compare differences in benefits and coverages when they are shopping for a new plan.

Beginning on the first day of the first open enrollment period that begins on or after September 23, 2012, plans must provide the SBC to participants and beneficiaries who enroll or re-enroll for coverage during the open enrollment period. Additionally, an SBC must be provided to all participants and beneficiaries who do not enroll during an open enrollment period, including newly eligible individuals and special enrollees, on the first day of the first plan year that begins on or after September 23, 2012.

An SBC must be provided as either a stand alone document or in combination with other summary materials, but it must be prominently displayed at the beginning of the document. A template of the SBC is available for use here from the U.S. Department of Labor, in addition to the Uniform Glossary. Groups are also required to provide participants and beneficiaries who reside in a county where 10% or more of the population is literate in the same non-English language, a copy of the SBC and Uniform Glossary in the non-English language. The Department of Health and Human Services has agreed to provide written translations of the SBC template to comply with this requirement and post on their website.

Be sure to visit the U.S. Department of Labor Health Reform website for full details and instructions regarding the latest SBC regulations, and as always, feel free to contact us at MedCon Benefit Systems with any questions.

by Medcon Benefit Systems Group, Inc.

Self Funding – Act II

Having been in the insurance industry for over 25 years, collectively our agency specializes in “self funding.”  It is with great pleasure that we welcome the resurgence of this funding instrument back to center stage.

Self funding gives the employers back the control — the control over both plan design and the financing of their health care benefit plan.  While the employer assumes the risk of expected claims, you will purchase insurance (stop loss coverage, both specific and aggregate) to protect your plan against unpredictable or catastrophic claims.

The financial control is gained by paying for only the claims that your employees incur, when they incur them.  In a fully insured environment you pay a monthly premium up front for what the insurance company believes your claims are going to be, advance premium payments.  This also translates to the insurance company holding/investing your money.

By funding your own claims, you are also avoiding the costs of claim reserves as well as premium taxes.  Included in these charges are the insurance company’s profit margins, risk charges, and their administrative fees.  There will be administrative fees associated with your  self funded plan but typically much lower than those of a fully insured plan.

The self-funded vehicle allows the employer to design the health benefit plan to meet their specific needs.  It offers the flexibility to manage costs and make changes to better manage utilization and take advantage of discounts offered through third party vendors.  All of which can help in the making of a much more cost effective plan.

We will be discussing the advantages  of self funding in more detail in future blog posts.  Should you have a questions please feel free to contact Sharon McReynolds at 214/739-5212 or email smcreynolds@medconbenefit.com.

by Medcon Benefit Systems Group, Inc.

Could The Debt Ceiling Bill Affect Health Insurance?

IF Congress happens to fail to make the $1.2 trillion in the required cuts, the end result is a mandatory across the board cuts. The cuts would make up the difference between what Congress saves and the $1.2 trillion. If reading between the lines, the cuts could ultimately affect what the Patient Protection and Affordable Care Act of 2010 (better known as the PPACA), has set aside to help consumers and small business employers buy health coverage through the new health insurance exchange system set up to start in 2014.

Many items being considered for savings could all have significant impact on the future of healthcare. Stay tuned!

by Medcon Benefit Systems Group, Inc.

HealthCare Reform – What Changes Will Go Into Effect NOW?

You have no doubt been inundated with HealthCare Reform news- how the healthcare insurance landscape will see changes.  Most of what is being discussed, like employers paying penalties for not sponsoring a health plan is not effective until 2014.
So, what are the key changes you need to be dealing with NOW?
1.  Effective with renewals on or after September 23, 2010 plans that offer dependent coverage must extend that coverage to dependents up to their 26th birthday, even if they are married and not living at home, unless they are eligible for group coverage elsewhere.
2.  Insurance carriers can not deny claims on children (under the age of 19) related to pre-existing conditions, again for renewals on or after September 23, 2010.
3.  Health plans can not impose lifetime limits on the dollar value of coverage for plans that renew on or after September 23, 2010.
This is just a sample of some of the changes and impact of the HealthCare Reform, for more information check back or call us at 214/739-5215.