RX Drug Look-Up

Complying with the Affordable Care Act

When you work with Westwood Insurance Agency, we, along with our trusted carriers and other partners, will assist you in complying with the requirements of the Affordable Care Act in many ways. We are continually monitoring and updating ourselves on the ever-changing law and have designed our services to keep our clients compliant and informed.

• Design benefit coverage to meet the requirements of the ACA
• Assist with tracking hours
• Ensure eligible employees are offered coverage
• Assist with the reporting process and necessary tax forms
• Handle employee notices

What You Need to Know, More on the ACA

You could incur a tax penalty, if you don’t offer coverage.  Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. If you are in non-compliance, you will incur a penalty of $2,140 per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).

What are the “Essential Benefits”

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Prescription Drugs
• Mental health and Substance —Abuse disorder services
• Rehabilitative and habilitative services and devices
• Pediatric services, including oral and vision care
• Preventive and wellness services, and chronic disease management

Group Dental Plans

Employees consider Dental and Vision Insurance part of the core essential benefit package.  Studies have shown that regular dental and vision exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease, diabetes, high blood pressure and other conditions through regular dental and vision exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental and vision insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

We offer Preferred Provider Organization (PPO) designs, Pre-paid and Health Maintenance Organization (HMO) designs as well, with a wide range of deductibles, coinsurance, and maximums options.  These plans offer offer a variety of diagnostic, preventative care and corrective services.  We work with multiple national carriers with the largest dental and vision provider networks in the country for your employees’ benefit.

Dental Plans

Dental coverage includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Group Vision Plans

Vision care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK.

What is the difference between a Fully-Funded Health Plan and a Self-Funded Health Plan?

A fully-funded health plan is one where the insurance carrier assumes all the risk in exchange for a monthly premium.  They will pay all claims on the plan, and service the plan’s administration.  A self-funded plan requires the employer to assume all the risk, paying all claims on the plan, and will often partner with a PPO to provide healthcare services for the plan.  They will also hire a third-party vendor TPA to service the plan’s administration.  In other words, the employer becomes the insurer.

The main advantage of a fully-funded plan is the employer knows exactly what the plan is going to cost them.  With a self-funded plan, employers benefit from a significant savings in the overall cost of their benefit programs.  Additionally, employers have more control over the benefits that the plan offers.

The downside of a fully-funded health plan is when benefits go unused, the employer does not get any money back.  The downside of a self-funded health plan is the employer runs the risk of a large catastrophic claim and must purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers save a significant amount of money on premiums and other advantages.

Partially-Funded Plans (aka Level-Funded) are a variation of a Self-Funding and allows small employers to take advantage of all the cost saving and benefit design features of a fully self-insured plan, however, they share the risk with one of our top national carriers. The premiums for shared funding plans are generally much lower than fully insured plans. An employer may save even more by implementing wellness programs into the benefit strategy.

Following are Group Health Plan Options

A Health Maintenance Organization (HMO)
An HMO group health plan requires employees to appoint a primary care physician who directs treatment utilizing service providers affiliated with the HMO. HMOs offer access to a comprehensive package of health care for a low monthly premium. A small co-payment is often required for services, depending upon the type provided.

Preferred Provider Organization
PPO group health plans offer a vast network of quality healthcare providers and facilities. Employees save the most money on healthcare if they use providers within the network, as some services may be only partially covered or not even covered at all when outside providers are used. Also, many services may not be covered if deductibles are not first met, however, the plan includes important wellness and preventative services provided outside of the deductible with a small co-pay.

Point of Service Plans (POS)
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.

Gap Plans

Gap benefits allow employers to strengthen the benefit package, while saving significantly on group health premiums.  A Gap plan provides benefits that follow and augment a low cost, high deductible major medical and comprehensive benefit package, as it will pay benefits directly to the provider, up to a maximum amount.

With healthcare costs skyrocketing, employees with extensive or on-going medical issues and high out-of-pocket costs will value a low-cost Gap plan.  Even with the added monthly premium, an employee’s overall maximum out-of-pocket costs are greatly reduced with a Gap coverage.

Gap plans work by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.

Group Disability Plans

When an employee is unable to work due to illness or an accident, the financial impact can be devastating for them.  When this happens, Disability Insurance replaces a portion of your employee’s income, while they are unable to work.  While worst case scenario might seem remote, employees are often surprised to learn statistics show chances of becoming disabled are greater than dying between the ages of 25 & 45.  In fact, more than one in four 20-year-olds will experience a disability for longer than 90 days before the age of 67.

With these statistics, it is no wonder that national surveys continue to show that Disability Insurance remains of high importance for most employees as an affordable strategy to widen their financial safety net. Those who wish to purchase a wrap-around policy to augment their employer provided coverage may do so.  Bottom line, savvy employers attract and retain top talent by offering Short Term and Long Term Disability as part of the employer paid benefit package or as a voluntary (worksite) benefit.

Short Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Group Life Insurance

It has been proven that employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death.  That’s why smart employers consider life insurance a key part of the benefit package, and a valuable tool in attracting top talent. A good life insurance policy provides for an employee’s final expenses, taxes, mortgage and more. Additionally, it may even pay for their children’s education.

We offer the following life insurance options, either as part of the main benefit offering, or on a voluntary bases.

Term Life Insurance

This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

Permanent Life Insurance

A Term Life policy protects employees during their working years, however Permanent Life provides additional coverage that employees can utilize later in life.  Employees can widen their safety net with premiums and benefits they can count on, as they don’t ever change.

Several advantages of Permanent Life include borrowing against the policy or building a tax deferred investment income, in addition to paying a death benefit.

Whole Life, Variable Life and Universal Life are all types of cash value life insurance. Cash value insurance is also known as permanent life insurance because it provides coverage for the policyholder’s entire life.