Benefits Design Resources, Inc.

05/13/2022

Please be advised that the Publix Pharmacy prescription program will be ending on June 1, 2022.

While Publix Pharmacy will no longer be offing medications for free, many options will still be available at little to no out-of-pocket cost with most insurance plans.

09/22/2021

A must read for any employers considering adding benefits deductions from employees who have not been vaccinated.

Under the ACA, the employee premium cost for your lowest-cost plan that meets minimum value must meet affordability guidelines.

06/26/2021

Great morning meeting yesterday with Miami-Dade Chamber of Commerce. Serveral South Florida organizations spoke on their commitment to diversity in their procurement for services. It was great to see people from the business community and finally get out to an in-person event after more than 12 months.

06/07/2021

The following is a reprint from a 6/7/2021 Healthcare.gov newsletter:

June is Pride Month, a time for the Centers for Medicare & Medicaid Services (CMS) to celebrate le***an, gay, bisexual, transgender, and q***r (LGBTQ+) persons and recognize their unique health needs. The week of June 6-12th CMS is recognizing the effort by focusing on our LGBTQ+ Week of Action. LGBTQ+ persons are comprised of a multitude of groups that have their own unique health needs. Transgender individuals, for example, are less likely to have health insurance than le***an, gay, and bisexual individuals.

Health disparities in this community are compounded by social determinants of health that are largely rooted in oppressive and discriminatory practices. Members of the LGBTQ+ community and their families and caregivers who are seeking health insurance can go to HealthCare.gov right now to take advantage of improved financial assistance and lower premiums during the Special Enrollment Period. We encourage you to help spread the word with your partners and members about helping members of the LGBTQ+ community enroll in health insurance through Healthcare.gov. Weeks of Action focused on other populations will continue to August 15, 2021 when the SEP ends

01/29/2021

Below is a message released 1/28/2021 from the Affordable Care Act Marketplace. This is an opportunity for people who did not enroll for healthcare insurance through the Marketplace during the normal Open Enrollment Period, 11/1 thru 12/15.

Today, in accordance with the Executive Order issued today by
President Biden, the Department announced a Special Enrollment Period (SEP) for individuals and families for Marketplace coverage in response to the COVID-19 Public Health Emergency, which has left millions of Americans facing uncertainty and exceptional circumstances while millions of Americans have experienced new health problems during the pandemic. This SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage.

Beginning February 15, 2021 and through May 15, 2021, these Marketplaces will operationalize functionality to make this SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application. State-based Marketplaces (SBMs) operating their own platform have the opportunity to take similar action within their states.

09/18/2020

Insurance companies are offering an alternative to traditional fully insurance plans to groups with as few as 5 employees. The product is called Level Funded which has some elements of self-funding but does not subject customers to a higher financial exposure than would a fully insurance plan. Level Funding can be an attractive alternative for some employers. Not all employers will qualify for Level Funded plans; but for those that do, Level Funded is an attractive option that can result in significant premium reductions. Additionally, since Level Funding is quasi self-funding, if a customer’s actual claims at the end of the plan year are below targeted claims, the customer will be entitled to a refund of the excess premiums. In some instances the insurance company refunds is 50% of the excess and other insurance companies refund as much as 100% of the excess. This month Aetna returned slightly over $10,000 to one of my Level Funded customer.

07/29/2020

Please check out the new and updated web site for Benefits Design Resources. An updated web site was well overdue so during this slower business cycle, I took the time to work with a vendor to update the web site. The new web site can still be found at https://bdrinsurances.com/. After taking a look, let me know your thoughts. Be Well and Stay Safe!

07/08/2020

In 2018 a group customer increased the insurance plan's deductible to $3,000 so the same year we added a Transamerica $3,000 Gap Plan that would cover the deductible for inpatient stays and it would pay up to $1,500 for certain out-patient services. During employee meetings, I always review all the benefits to help employees have a thorough understanding of the insurance but many times employees do not remember everything that's discussed during the meeting. A perfect example was during the Zoom open enrollment meeting for 2020 I was reviewing the benefits and again explained the Gap plan. An employee said that she had been in the hospital earlier this year in which she had to pay the $3,000 deductible but forgot about the Transamerica Gap plan. After the meeting she and I spoke and later I sent to her the claim forms and explained what she will need to do to get reimbursement from Transamerica. Yesterday I got an email from a very happy member because she had receive a check for $3,000 from Transamerica which will help to pay a significant amount of her debt for the hospital stay. I wanted to share this to emphasize the importance of understanding your insurance plan and secondly, the importance of attending your annual open enrollment meeting. Had this employee not attended the meeting and was reminded of the benefits, she would have missed out on getting a $3,000 reimbursement from Transamerica.

07/02/2020

Florida Blue (Formerly Blue Cross Blue Shield of Florida) provided their customers with a bonus for the month of July. A customer called to inform me that their premium payment for the month of July was approximately 15% below what the monthly premiums should have been. He was pleasantly surprise to learn that Florida Blue had provided the 15% premiums credit to customer's invoices for the July 1 premium payment. Florida Blue's premium credit for dental insurance was 50% premium credit. The company said...Florida Blue and Florida Blue Dental are announcing several programs aimed at reducing the cost of health care for our fully insured groups in response to the COVID-19 pandemic..... With so many businesses struggling financially these days, it's great that Florida Blue is providing these premium credits because every little bit helps.

06/26/2020

Humana announced today its continued support for group customers and employees who have been or could be affected by the current health crisis. Normally employees who participate in an employer sponsored insurance plan can only join or make benefit changes during their initial enrollment with an employer or during the annual open enrollment. To accommodate employees during this crisis, Humana is offering their clients a Special Open Enrollment for July and August. The Special Open Enrollment will allow the following:
1. Employees who waived coverage to enroll
2. Employees to change their coverage type (single to family,
family to single)
3. Employees will be allowed to disenroll
4. If multiple plans are offered, employees will be allowed to
change plans
During this health crisis, it's important for everyone to have a comprehensive healthcare insurance plan. For Humana customers, this is an opportunity for employees to revisit the insurance election they made when they initially enrolled or during the annual open enrollment. The healthcare insurance decision made earlier may not be appropriate now due to the greater health risk associated with COVID-19.

06/09/2020

Florida Blue announced a reward program worth $300.00 to cover the cost of some healthcare expenses for their fully insured group plan members. In recognition of the financial difficulties some employees are experiencing as a results of the COVID-19 crisis, Florida Blue is sending a gift card worth $300.00 to member that can be used to pay copays and coinsurance for doctor office visits as well the cost for other designated healthcare services. To be eligible for the reward, covered members must log into the Florida Blue web site and watch a short video on staying safe during the coronavirus pandemic. Taking the time to watch a short video to be rewarded $300.00 toward one's health care expenses is a small sacrifice. Hopefully Florida Blue customers will take advantage of this opportunity.

06/05/2020

It's really refreshing to see that insurance companies are "doing the right thing" for their clients considering the hardship many businesses are experiencing due to a slowdown in business because of COVID-19 and operational restrictions cities and states are imposing on company's ability to operate and generate business revenue. I had previously posted that UnitedHealthcare was providing their fully insured customers a premium credit on an upcoming invoice. For Florida customers, the credit is 10% of premiums which should be reflected on customer's June invoice. Now CIGNA is providing their dental group clients who were active in May 2020 a one-month premium credit. In order to determine the size of the credit, CIGNA will use information from each client’s May invoice. CIGNA anticipates the premium credits will be automatically applied by July 31, 2020.

In addition to helping clients financially, insurance companies had anticipated a significant spike in healthcare cost due to COVID-19 related illnesses and significant increases in hospitalizations so their 1st quarter premiums were adjusted upward accordingly but cost didn't escalate to the extent anticipated. Secondly, there was a major reduction in utilization. Many people, including myself, postponed non essential doctor visits and elective procedures during the "sheltering in place" period. Plus many healthcare facilities were not seeing patients so healthcare expenses for insurance companies were much lower than anticipated. Due to the excess revenue due to both of these unanticipated circumstances, insurance companies are now sharing revenue with clients in the form of premium credits. After making these concessions, I'm sure insurance companies are still making a windfall.

Hopefully we will see more rate and premium relief from insurance companies in the coming weeks.