the end-of-employer-provided-health-insurance-zane-benefits
DESCRIPTION
Employer-provided health insurance is the greatest financial risk facing most American families. It is also the greatest challenge facing U.S. employers, small and large, when it comes to recruiting and retaining top-quality employees. The purpose of The End of Employer-Provided Health Insurance is to show you how to profit from this paradigm shift while helping you, your family, and your employees get better, cheaper, and safer health insurance. Using the techniques outlined in this book, you, your employer and your clients will save money on health insurance by migrating from employer-provided coverage to employer-funded individual plans at a total cost that is 20 to 60 percent lower for the same coverage. That's $4,000 to $12,000 in savings per year for a family of four for the same hospitals, same doctors, and same prescriptions. In this 45 minute session, you'll learn how to: - Avoid the disadvantages of employer-provided health insurance - Make individual health insurance work for you and your family - Choose a plan that fits you, your family, and your company's needs - Switch to reimbursing your employees for individual health insurance About your presenter: Rick Lindquist is the author of The End Employer-Provided Health Insurance and is President of Zane Benefits, Inc. Lindquist joined Zane Benefits as its thirteenth employee in 2007, and became Director of Sales in 2009 and President in 2011. As President, Lindquist has been responsible for the development of the firm’s flagship product, ZaneHealth, which helps employers ensure compliance with IRS, ERISA, and HIPAA regulations and the market reforms of the Affordable Care Act (ACA). Lindquist is a sought-after speaker and reference for his expertise on defined contribution health plans. In June of 2014, Lindquist was featured in an article on the front page of The New York Times Small Business Section explaining how Zane Benefits’ software addresses the challenges small businesses face in offering compliant health insurance solutions. Zane Benefits has also been featured on the front page of The Wall Street Journal and USA Today.TRANSCRIPT
Rick Lindquist, President of Zane Benefits
The End of Employer-Provided Health InsuranceWhy It's Good for You, Your Family, and Your Company
WEBINARS
Your Presenter
Rick Lindquist, President of Zane Benefits
Rick Lindquist is the author of The End Employer-Provided Health Insurance and is President of Zane Benefits, Inc.
Lindquist joined Zane Benefits as its thirteenth employee in 2007, and became Director of Sales in 2009 and President in 2011.
As President, Lindquist has been responsible for the development of the firm’s flagship product, ZaneHealth, which helps employers ensure compliance with IRS, ERISA, and HIPAA regulations and the market reforms of the Affordable Care Act (ACA). Lindquist is a sought-after speaker and reference for his expertise on defined contribution health plans.
In June of 2014, Lindquist was featured in an article on the front page of The New York Times Small Business Section explaining how Zane Benefits’ software addresses the challenges small businesses face in offering compliant health insurancesolutions. Zane Benefits has also been featured on the front page of The Wall Street Journal and USA Today.
@RickLindquist
#ZaneBenefits
Wiley, November 2014
Join the conversation
#ZaneBenefits
What is Zane Benefits?
Zane Benefits is the leader in individual health insurance reimbursement for small businesses. Since 2006, Zane Benefits has been on a mission to bring the benefits of individual health insurance to business owners and their employees.
Zane Benefits' software helps businesses reimburse employees for individual health insurance plans for annual savings of 20 to 60 percent compared with traditional employer-provided health insurance. Today, over 20,000 customers use Zane Benefits' software, services, and support to reimburse individual health insurance plans purchased independent of employment.
Zane Benefits' software has been featured on the front-page of The Wall Street Journal, USA Today, and The New York Times. Zane Benefits was founded in 2006 and is based in Salt Lake City, Utah.
DISCLAIMERThe information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state.
Zane Benefits' Partner Program is an opportunity for insurance professionals to provide clients with custom Zane Benefits solutions. Request a Partner Evaluation.
Join the conversation
#ZaneBenefits
Additional Resources
Additional FREE Resources: Small Business Health Insurance & Premium Reimbursement
View all of our free eBooks, Whitepapers, and On-Demand Webinars at: ZaneBenefits.com/Resources
Subscribe to our Blog at:ZaneBenefits.com/Blog
Join the conversation
#ZaneBenefits
The Book
The End of Employer-Provided Health InsuranceThe End of Employer-Provided Health Insurance is a comprehensive guide to utilizing new individual health plans to save 20 to 60 percent on health insurance. This book is written to ensure that you, your family, and your company get your fair share of the trillions of dollars the U.S. government will spend subsidizing individual health insurance plans between now and 2025. You will learn how to navigate the Affordable Care Act to save money without sacrificing coverage, and how to choose the plan that offers exactly what you, your family and your company need.
Download a Sample >>
Buy Now
Join the conversation
1. The End of Employer-Provided Health Insurance
2. The Advantages of Individual Health Insurance
3. How Companies Can Help with Individual Health Insurance
4. Key Compliance Considerations
5. Summary / Q&A
#ZaneBenefits
Agenda
The End of Employer-ProvidedHealth Insurance
zanebenefits.com | 1-800-391-9209
Join the conversation
A major shift is happening from group to individual.
#ZaneBenefits
Overview
“The Individual Market is expected to expand to more than 150 million
insureds by 2025.”
Join the conversation
● Group health insurance costs are unsustainable
● Individual health insurance is better value
● Individual health insurance costs less
● Individual health insurance is eligible for new premium tax credits
#TEOEPHC
“60% of Small Businesses Will Transition to Individual Health Insurance by 2017”
- The Inevitable End of Small Business Health Insurance
Primary Reasons for the Shift
Join the conversation
#TEOEPHC
The Economics
Single
Cost of Individual Plan $2,424 / year $7,248 / year
Cost of Employer Plan $6,492 / year $18,312 / year
Savings Per Employee $4,068 / year $11,064 / year
Percentage Savings 63% 60%
Based on 2014 health insurance costs for the state of Illinois.
Source: U.S. Health and Human Services, QHP Landscape Market Medical 2014 (See data.healthcare.gov).
Family
Join the conversation
Employer-Funded Individual Health Insurance Is the Common Sense
Solution
#ZaneBenefits
Why We Are Here
The question is: “How do employers continue to offer health benefits for recruiting and retention?”
The Advantages ofIndividual Health Insurance
zanebenefits.com | 1-800-391-9209
Join the conversation
Individual health insuranceis now better than group health insurancefor you, your family, and your company.
#ZaneBenefits
The Advantages of Individual Health Insurance
Join the conversation
#ZaneBenefits
Why Individual Health Insurance is Better
1. Individual health insurance is less expensive.
2. Individual health insurance enables choice.
3. Individual health insurance is portable.
How is it better?
Join the conversation
#ZaneBenefits
It’s Less Expensive
Individual health insurance is not overpriced -- in fact, it’s less
expensive.
Join the conversation
#ZaneBenefits
It’s Less Expensive
Nationwide, the average individual policy sold in 2014 costs about half the cost of comparable unsubsidized group health insurance. But since most Americans qualify for a federal subsidy based on their income, the average individual policy sold in 2014 actually costs, on average, about one-fourth the cost of group coverage.
For EmployeesThat’s $4,000 - $12,000 in savings
per year for a family of four for the same hospitals, doctors, and
same prescriptions.
Join the conversation
#ZaneBenefits
It Enables Choice
Individual health insurance is not limited -- in fact, it’s customizable.
Join the conversation
#ZaneBenefits
It’s Enables Choice
When an employee chooses their own individual health insurance policy, they get to choose which network of doctors and medical providers to use.
In addition, when they choose an individual health insurance policy, they get to choose from a seemingly unlimited array of amounts for copays, annual deductibles, and coinsurance. In contrast, they typically get only a few choices with group coverage.
Employees Get to Pick Their Doctors, Hospitals, Deductibles and Copays
Join the conversation
#ZaneBenefits
It’s Portable
Individual health insurance is portable.
Join the conversation
#ZaneBenefits
It’s Portable
With individual health insurance, there is no COBRA if an employee loses their job. This is because their job has nothing to do with their health insurance.
Your policy remains the same as long as you pay the premium regardless of what happens to your employment.
Employees Keep Their Health Insurance No Matter What
How CompaniesCan HelpEmployees
zanebenefits.com | 1-800-391-9209
Join the conversation
#ZaneBenefits
Help Employees
When switching employees to the Marketplace to purchase health insurance, it is vital to educate them about the advantages of individual health insurance.
Inform your employees that individual health insurance policies can be purchased from:
● The ACA Health Insurance Exchange (“Marketplace”)
● A licensed health insurance agent or broker● Directly from an insurance company
Educate EmployeesEducation Topics
1. They may keep their policy if they ever switch jobs
2. They can choose a policy with their preferred doctors and networks
3. Individual health insurance costs less
Join the conversation
#ZaneBenefits
Help Employees
A licensed health insurance broker can be very helpful to educate employees about the different health insurance plans and options. In addition, they can aid in determining whether your employees are eligible for premium tax credits and cost sharing subsidies.
Since health insurance brokers are independent and sell for multiple companies, they can typically provide a variety options and a broad view of the Marketplace.
Work with a Broker
Join the conversation
Option 1 - Taxable Stipend
Option 2 - Reimbursement Plan
#ZaneBenefits
2 Ways to Fund Individual Health Insurance
Today, fewer than 50% of small businesses offer employees health insurance, largely because of the cost. That’s over 2.3 million small businesses that don’t offer
health insurance.
Did you know?
Join the conversation
Taxable stipend—All similarly situated employees receive a fixed, taxable stipend to purchase individual health insurance, whether or not they actually purchase health insurance. The employee's monthly contributions are typically added to his or her paycheck. At the end of the year, employees receive a form showing the amount of their stipend that they should report as income on their personal income tax return.
#ZaneBenefits
Taxable Stipend
Pros:● Not a group health plan● No compliance issues● Very simple and easy administration (automatic payroll additions)
Cons:● Company is required to pay payroll tax on reimbursements (7.65%) ● Employees must claim reimbursements as income (20-40%)● Employees receive money regardless if put towards health insurance
premium
Join the conversation
Reimbursement Plan —All similarly situated employees are granted a fixed, defined contribution amount to purchase individual health insurance, but only receive money if they actually purchase health insurance. Employees purchase their own individual health insurance policy and submit proof to their employer (or the employer's third-party provider). Employees receive monthly reimbursements up to their defined contribution amount that are typically added to their paycheck tax-free (optional).
#ZaneBenefits
Reimbursement Plan
Pros:● Employees must show expense before reimbursement● Feels like a real, structured Health Benefits program● Tax-free optional to employees (20-40%)● No payroll taxes optional for employers (7.65%)
Cons:● Is a group health plan● Must take steps ensure compliance with group plan rules
Key ComplianceConsiderations
zanebenefits.com | 1-800-391-9209
Join the conversation
All group health plans, including premium reimbursement plans, must comply with applicable federal rules including IRS, HIPAA, ERISA, and the ACA.
#ZaneBenefits
Key Compliance Considerations
● Basic Considerations
● Key Plan Design Considerations
● Key Administration Considerations
Join the conversation1. Plan Documents and SPDs
Plan Documents define what expenses are eligible for reimbursement, the amount of employer
contribution, and other required details about the reimbursement plan.
The SPD is the primary vehicle for informing participants and beneficiaries about their rights and benefits under
their employee benefit plans.
2. Uniform Explanation of Coverage and DefinitionsThe ACA requires that group health plans, participants, and beneficiaries receive a standardized summary of
benefits and coverage (“SBC”) and a set of uniform definitions (“Uniform Glossary”).
3. Documentation HistoryThe IRS requires that employees submit proper documentation verifying their claim for reimbursement, and that
supporting documentation is saved on file for ten years.
#ZaneBenefits
Basic Considerations
**Reimbursement Plan != Minimum Essential Coverage (will not satisfy Employer Mandate)
Join the conversation
1. Annual Limit Compliance (Notice 2013-54)Section 2711 of the Public Health Services (“PHS”) Act, as added by the ACA, provides that
no annual or lifetime limits may be placed on essential health benefits (“EHB”). PHS Act 2711
provides that annual limits and lifetime limits may be placed on benefits that are not
EHB, such as health insurance premiums.
2. Preventive Care ComplianceSection 2713 of the PHS Act, as added by the ACA, requires group health plans
(including self-insured medical reimbursement plans) to cover basic
preventive health services without cost-sharing.
3. Non-DiscriminationMust treat similarly situated individuals the same.
#ZaneBenefits
Key Plan Design Considerations
Join the conversationOn September 13, 2013, the Internal Revenue Service and the U.S. Department of Labor released guidance addressing the issue of tax-free employer contributions towards individual health insurance policies (U.S. Department of Labor, 2013). The effect of this guidance was to make it more cumbersome, but not impossible, for employers to give employees tax-free reimbursement of premiums paid for individual health insurance.
1. Set up a Section 105 Health Reimbursement Plan (HRP) to give their employees a monthly allowance to purchase (only) individual health insurance and nothing else. Health insurance premiums are not an essential health benefit under ACA and thus an employer is not required
to offer unlimited annual and lifetime amounts for employees to purchase health insurance.
2. Specify in the HRP plan documents the coverage of unlimited basic preventive care services required by the ACA. Basic preventive care is an essential health benefit under ACA.
#ZaneBenefits
How to Comply with IRS Notice 2013-54
Join the conversation
The IRS may assess an excise tax on a noncompliant group health plan of $100 per day per affected individual under Code Section 4980D.
“The excise tax will not apply if the employer can show that it did not know that the violation existed (after exercising due diligence), or that the violation was corrected within 30 days of discovery of the failure.”
“If the violation is due to reasonable cause and not willful neglect, the amount of the excise tax will be limited to the lesser of (i) 10% of the amount paid by the plan for the preceding year, or (ii) $500,000. The IRS could also waive all or part of the penalty if the failure is due to reasonable cause and not willful neglect to the extent that the payment of the tax is excessive relative to the failure involved. See Code Section 4980D(c).”
#ZaneBenefits
What Happens If You Fail to Comply
Join the conversation
1. 90-Day Waiting Period ComplianceThe ACA prohibits waiting periods over 90 days for eligible employees.
2. Internal and External Claims Appeal ProcessThe ACA added new requirements to the internal and external
appeal process including how and when procedures are communicated to plan participants.
3. 60-Day Notice of Material ModificationThe ACA requires employers to provide 60 days advanced notice
to participants when making material modifications to their group health plan (including self-insured medical reimbursement plans).
4. ERISA ComplianceThe employer must not endorse specific individual health insurance policies or pay directly for them.
5. HIPAA Privacy The entity processing employee reimbursement claims receives Protected Health Information (PHI) that is
required to be held confidentially under HIPAA.
#ZaneBenefits
Key Administration Considerations
Summary + Q&A
zanebenefits.com | 1-800-391-9209
Join the conversation
1. A major shift from group to individual is occurring. This is largely due to rising premium costs for group health insurance.
2. Employers can help employees in a number of ways including education and offering assistance from a health insurance professional.
3. There are 2 ways to fund individual health insurancea. Taxable Stipendb. Reimbursement Plan
4. If you set up a reimbursement plan make sure you comply the key plan design and administration requirements to avoid penalties.
#ZaneBenefits
Summary
Join the conversation
#ZaneBenefits
What is Zane Benefits?
Zane Benefits is the leader in individual health insurance reimbursement for small businesses. Since 2006, Zane Benefits has been on a mission to bring the benefits of individual health insurance to business owners and their employees.
Zane Benefits' software helps businesses reimburse employees for individual health insurance plans for annual savings of 20 to 60 percent compared with traditional employer-provided health insurance. Today, over 20,000 customers use Zane Benefits' software, services, and support to reimburse individual health insurance plans purchased independent of employment.
Zane Benefits' software has been featured on the front-page of The Wall Street Journal, USA Today, and The New York Times. Zane Benefits was founded in 2006 and is based in Salt Lake City, Utah.
DISCLAIMERThe information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state.
Zane Benefits' Partner Program is an opportunity for insurance professionals to provide clients with custom Zane Benefits solutions. Request a Partner Evaluation.
Join the conversation
#ZaneBenefits
Additional Resources
Additional FREE Resources: Small Business Health Insurance & Premium Reimbursement
View all of our free eBooks, Whitepapers, and On-Demand Webinars at: ZaneBenefits.com/Resources
Subscribe to our Blog at:ZaneBenefits.com/Blog
Join the conversation
#ZaneBenefits
The Book
The End of Employer-Provided Health InsuranceThe End of Employer-Provided Health Insurance is a comprehensive guide to utilizing new individual health plans to save 20 to 60 percent on health insurance. This book is written to ensure that you, your family, and your company get your fair share of the trillions of dollars the U.S. government will spend subsidizing individual health insurance plans between now and 2025. You will learn how to navigate the Affordable Care Act to save money without sacrificing coverage, and how to choose the plan that offers exactly what you, your family and your company need.
Buy Now
Download a Sample >>
Q&A
zanebenefits.com | 1-800-391-9209
Zane Benefits 800-391-9209 | zanebenefits.com
Rick LindquistPresident
Zane Benefits