Archive for May 2014

Do you really need to outrun the bear or just be self-insured?

Stop and take a breath because if the term “Self-Insurance” made you stop breathing, you need to relax and keep reading.

The purpose of this post is to introduce you to a concept, not to get real technical.  I will get technical in future messages.

There is an old joke that goes like this. Two guys are camping and one of them sees a bear coming into the camp. He begins to put on his running shoes. His buddy says “Why the shoes…you can’t outrun a bear?” The guy with the shoes says “I don’t need to outrun the bear I only need to outrun you!”

So, you might now be asking, how does that relate to being self-insured?

What if this year, your medical plan did not have a rate increase but all of your competitors saw 10% to 45%? That might be between $30 and $135 per month, per employee assuming an average cost of $300 per employee. Would that give you a competitive edge?

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For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900.

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Remember that Exotic dancer that received life insurance money because she was the legal beneficiary?

Hopefully, readers will remember the post I recently did about the importance of beneficiary statements?

 
An announcement at the Proskaur.com practice blog today tells the following story.

 
Eighth Circuit: ERISA Plan Beneficiary Designation Trumps Will.

 
In Hall vs. Metropolitan Life Hall had a group life policy making it an ERISA life plan. (This is where HR people need to remember this case.)

 
Hall remarried and completed a will, naming his spouse the beneficiary of his life insurance. However, he did not apparently contact the HR department and change the beneficiary statement. On his subsequent death, the new spouse attempted to collect the life insurance proceeds. She was denied!

 
There are other complications and questions, but from standpoint of the HR person it would be important to be able to document that you were never aware of Hall’s intentions to make changes to his estate.

 
In the majority of cases, HR will not be informed of changes like this because employees forget about the group life plans. But, if you are informed of a change of status on the Medical or Dental plans, you should make it policy to ask if changes need to be addressed in any other benefits that might be affected.

 

 

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For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900.

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What do you mean my doctor is not accepted in your network? I asked if they accept my insurance before I went!

I read a post in the NAHU agents blog today that said “..Always add the caveat that the client needs to confirm with the doctor/hospital that their insurance is in fact accepted, ideally in an e-mail.”  (NAHU (nahu.org) is the National Association of Health Underwriters and is the professional organization for people like me who work in health insurance and employee benefits.)

OK back to the subject. Yes it is important to ask if your physician “accepts” your  insurance but it is even more important to ask  “Are you a contracted provider?”

The majority of medical providers will say yes if you ask if they accept your insurance. (unless it it Medicare and they may say they do not accept Medicare patients.) This does not mean they will be “in network” and thus be subject to the contracts that limit what the physician may charge you.

Here are some terms you need be aware of:

Contracted Provider: A medical provider who has agreed to a contract to provide services for a medical plan that you are a currently covered by.

Balance billing: If you use a “non contracted” provider they may accept what your insurance pays and then bill you for the “balance” which is whatever they feel remains of the bill.

Out of Network: This refers to a provider that is not contracted with the network of medical providers you have an agreement with. They may tell you they “accept” your insurance but they do not have to accept any limits from your insurance nor PPO network.

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For more information, contact Bill Weaver, Focus Benefits Group, 602-381-9900.

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