I have been selling New Jersey Employee Benefits and group health insurance to small and medium sized businesses since 1997. Each year I see the plan design change slightly; there was higher co-pay, a split co-pay, higher drug card, two tier drug card, three tier drug card, and Hospital deductibles, in network deductibles. During this period the rates were rising. It was a challenge to bring a plan to the employer that was a slight increase over last year. Well things have changed, there are very few insurance carriers now offering the plans. The ones that do have raised the rates so much that a thirty percent increase over last year’s is the norm. I sit at my desk wondering what is happening, I have no options for the employer any longer, the rates go up, the plans keep offering less and less benefits. I do not see people utilizing the services less, what I see are companies forgoing the benefits all together. Is this what the insurance carriers want? Do they want to make it so the only people that take the insurance are the very ill and wealthy? What are employers supposed to do? Their employees think it is the employer that is reducing the coverage or lowering their contribution to raise the rates. I have no answers, all I have are questions. The most important one I have is what is Washington going to do to address these issues? The bickering between the Democrats and the Republicans and an ineffective President only delays and stalls the issue. Seems to me the Insurance and Drug companies are in control. In the end it is the American worker that is bearing the brunt of this problem and the final resolution is not even flicker of light at the end of a very dark and long tunnel.
I recently had the extreme pleasure of reading a well thought out opinion column in the Wall Street Journal by the Republican Governor of Indiana, Mitch Daniels. Mr. Daniels shared his experience with Indiana state employee’s usage of Health Savings Accounts.
In review of the usage and cost savings, Indiana will stand to save $20 Million Dollars due to high enrollment in the HSA. An HSA is an outstanding addition to a company’s benefit plan and in the case of Indiana State workers in my opinion is successful due to high contribution rates provided by the government.
For example, the whole deductible of $2,750 is put into the HSA for the employee to use for any qualified medical necessity. For employees, “about 6 percent last year, who use their entire account balance, the state shares further health costs up to the maximum-out-of-pocket of $8000, after which the employee is completely protected.”
This generous level of contribution by the state is seldom seen in the private sector. Our New Jersey Employee Benefits Specialists have implemented many HSA plans and usually the deductible is funded by the employer, but beyond that it is the employees responsibility to pay out of pocket for expenses or contribute themselves to the HSA plan.
I would like to see a wider adoption of HSA plans in the public and private sector. I hope the current administration in Washington makes consumer directed healthcare a bigger priority and looses the mentality that regular workers can not afford HSA plans due to the high deductibles present. The focus should be on providing incentives for employers to at least contribute to the HSA in the amount of the deductible since the savings on the premiums are so significant.
We have had a few issues recently with regard to employees trying to figure out how to apply for NJ Short Term Disability. New Jersey, New York and Rhode Island are the only states that require employers to have this coverage. The NJ form (WDS-1) is available from the NJ State website. This form has all the detailed instructions for the EMPLOYEE to file a claim. The 3 part form needs to be filled out by the employee, employer and doctor. Submission is required within 30 days of the disability. We will make the form available on our website you can also contact my office for the form. As with most forms that deal with claim issues timely filing is most important.
One of our goals at CG Benefits Group is to help employees understand their benefits. Many employees are often confused about how various components of their health care work such as deductibles, co-insurance, and co-pays.
In the first of our series aimed at helping you understand your benefits, we will discuss what a co-pay is in health insurance plans and how to find out what your co-pays are.
A co-pay is a defined amount of money that is used by the insurance company to charge you for utilizing a service. Commonly you are charged a co-pay for doctor, specialist, and hospital visits. Typical co-pays can range from fifteen Dollars for a doctor visit to one hundred and fifty Dollars per day for a hospital visit.
If you are unsure about how much you co-pays are, then look on your insurance ID card. Most insurance carriers print the co-pays for your primary care physician and specialist visits on the ID card for convenience. If you insurance carrier does not list the co-pay, or if you would like to find out how much your co-pay is for other services, then you can call CG Benefits Group and speak to your assigned customer service representative at 888-242-4675.
You may have recently received a letter from your insurance company advising you to switch to a generic drug instead of a costly name brand medication, or maybe your doctor has recommended you stay with a brand name prescription, despite a generic being widely available. You might be asking yourself, what is the difference?
First of all, a brand name drug becomes a generic drug after a brand name drug maker’s patent expires. Competitors are then allowed to apply to the Food and Drug Administration to make a generic form of the prescription without repeating the original developer’s clinical trials and other development activities that raise the cost of the prescription. This allows the new manufacturer to sell the generic drug at a substantial discount. According to the FDA, generic drugs must have the “same quality, strength, purity and stability,” as brand name drugs. A generic drug however may have different inactive ingredients such as colors or flavors.
One common misconception is that generic drugs are made in substandard or antiquated facilities. This is not true as the FDA conducts inspections of facilities to ensure their high standards are met. In fact, almost half of generic drugs are manufactured or sponsored by brand name manufactures who produce brand name and their generic counterparts.
If a generic and a brand name are the same, then why do doctors prescribe brand name prescriptions? Some patients have been switched to a generic drug and seen their symptoms come back or experienced some side effects that were not present with the brand name drug. According to a New York Times article in December of 2009, some antidepressants, heart medicine, and antiseizure medicines have been linked to patients having “symptoms returned-or even worse than before they were medicated.” One study in particular, focused on Budeprion XL a generic of Wellbutrin XL. The generic drug released the active ingredients at a different rate than the brand name drug. This may have caused different side effects and a lower effectiveness of the Budeprion dose.
For the consumer, the best practice is to ask your doctor if a generic drug is available, and if it is available then ask if it performs the same. Different doctors will have their own opinion on this topic and should definitely be consulted before you switch to a generic.
I am disturbed at the failure of Congress to do anything regarding the health insurance issue in this country. It is getting difficult for employers to have an affordable health insurance program for their company. The issue however might also be the fault of the employers that do not take responsibility for their health plan. They allow the employees to go on and off the plans arbitrarily. They accommodate the employee’s wishes without regard to the rules that the carriers put in place. This has an impact on the rates. We are seeing renewal rates of 15 to 40% a trend that is impossible to sustain. Someone has to take hold of this issue and act.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) established in 1986 is a federal law that allows employees when terminated, for any reason other than gross misconduct, to continue their health insurance coverage.
Benefits can typically be extended for 18 months or as long as 36 months in certain situations.
For the group to be eligible it must have 20 or more employees. If your employer does not meet this requirement, then state continuation laws will go into effect and may provide extended coverage after employment.
COBRA laws also apply to products such as dental or vision insurance.
The employee will be required to pay the full cost of the insurance and a two percent administration fee may be added to the COBRA premium.
Searching for a doctor is very important. If you utilize a doctor that is not in your insurance carrier’s network then you may be reimbursed at a lower rate or not reimbursed at all, in the case of HMOs. Watch this video and learn how to search using Horizon Blue Cross Blue Shield of NJ’s online provider directory.
Health insurance forms can be very complicated and just the slightest error can be costly. You’ll have to provide a lot of personal information including, but not limited to social security number, martial status, proof of prior coverage, dependencies (and their social security numbers), medical history, prescription medications and more. When filling out your name and address, your handwriting needs to be clear and legible. Incomplete, illegible or false information can result in coverage delays or loss of coverage completely.
Watch our video to help walk you through how to fill out a health insurance enrollment form.
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We specialize in providing affordable business insurance plans to IT companies and small businesses in New Jersey and nationwide. Our goal is to provide small businesses with valuable information about insurance and how it impacts their day to day operations.
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