Is Your Healthcare Plan Covering People It Shouldn’t?

healthcare eligibilityIf you provide an employer healthcare plan, it’s vital to ensure only the correct people are covered. Comprehensive healthcare insurance is one of the most important benefits you provide to employees, so keeping premiums down matters to everyone.

One of the main causes of rising premiums and healthcare costs is when ineligible people continue to be covered on a healthcare plan. For employer-provided health insurance, ineligible people are typically:

  • Former employees who have now left your business.
  • Employees whose status has changed, meaning they are no longer eligible under the plan, or should be on a different plan.
  • Dependents of an employee, where the status of the dependent has changed.

Examples of ineligible people for a healthcare plan

The following situations could all cause people to become ineligible.

  • A dependent child who ages beyond the dependent eligibility requirements in the plan.
  • A former spouse who separated from your employee.
  • An employee who leaves your business.
  • An employee whose status has changed, for example through changing the number of hours worked or moving to a different position, and whose new status requires a different healthcare plan.

Creating a healthcare eligibility audit

You need a process to understand and remove people from your employer-provided healthcare plan. Here’s how to put an “Employee and dependent healthcare eligibility audit” together.

Understand the eligibility requirements of your current employer-provided healthcare plans

Go through any existing employer-provided plans and note down:

  • All employees currently covered by the plan.
  • All dependents currently covered by the plan.
  • Eligibility requirements for employees.
  • Eligibility requirements for employee dependents.
  • Benefits and coverage provided.

You may hold this information internally, or you can get the data from your broker or healthcare insurance provider.

Analyze your existing employee data

Match your existing employee data against the healthcare plan eligibility requirements. Check:

  • Any employee listed as being on the plan is still employed by you.
  • Any dependent listed on the plan is still a dependent on the employee.
  • The type of healthcare plan is appropriate for the status of the employee.
  • All eligibility requirements are being met by any active plan participants.

Find gaps in the data

It’s likely that you will find gaps in the information. You may not have the latest details of dependents or employees. Complete a gap analysis to understand the data you need to ensure only appropriate people are covered by the plan.

Carry out a healthcare eligibility audit to close any gaps

Once you know what data you need, you will need to audit the information with your employees. Approach each employee with the details of their health insurance for them and their dependents and ask if all the information is factual and correct. If it is, get them to sign off on the information.

If the data is incorrect, get it updated and see how it affects healthcare eligibility. Communicate this back to the employee.

Careful communication is key

You will need to communicate carefully throughout this process. Employees may see the eligibility audit as a tool for taking away healthcare coverage. It’s important to manage the message carefully — The audit ensures only appropriate, eligible people are covered. That means less cost-leakage and medical expenses on plans, which keeps premiums down and ensures the right people have the right coverage.

You may want to complete the healthcare eligibility audit every year. This will ensure your records are up to date and reduce the premiums you and your employees need to spend.

Jill Goulet
Risk Management Consultant

healthcare eligibility

CT Employee Benefits Planning: Assessing Voluntary Options

CT Employee Benefits Planning: Assessing Voluntary Options CT Employee Benefits Planning Assessing Voluntary Options

An effective Employee Benefits program is key to attracting and retaining top talent. While voluntary benefits plans are still paid by employees, the company-run programs offer employees discounted prices for coverage compared to the open market. These employment perks often help employees with life needs and expenses they might otherwise not have the means to afford. When establishing an employee benefits program it is important to assess your capabilities as an employer as well as your employees’ wants and needs.

According to the 2012 Mercer Making Smart Benefit Choices survey, which gathered data from over 10,000 international employees, employees value some benefits more than others. The survey findings indicate that when it comes to voluntary benefits, there are mixed reviews about what types of coverage workers prefer that their employers to offer.  Some 38 percent of respondents indicated that disability insurance tops their list of insurance benefits they would pay for and thirty-four percent of respondents indicated that they would purchase life insurance. However the same survey also revealed that 22 percent of employees would prefer a $500 salary increase as opposed to 9 percent who would prefer a $500 healthcare premium reduction, indicating that cash in hand is higher on employees’ priority list than low cost or additional benefits.

While going without benefits may seem too much of a financial burden on your small business or medium sized firm, not doing so could hinder growth and employee retention in the long run. Choosing the right employee benefits plan for your operation requires careful analysis, planning and strategizing. At Sinclair Risk & Financial Management, we specialize in helping Connecticut employers do just that. We have developed a comprehensive branded risk management platform that integrates approaches to business insurance and employee benefits planning. Our CT employee benefits planning specialists will help you strike the right balance in offering employees a benefit plan that is attractive, diverse, customizable, and flexibility with your organization’s financial ability by spending smarter. To learn more about our Connecticut business solutions, give us a call today at (203) 265-0996

Employee Benefits: The Value of Flexible Benefits Plans

Employee Benefits: The Value of Flexible Benefits PlansEmployee Benefits: The Value of Flexible Benefits Plans

New concerns have made significant changes in our approach to healthcare & flexible employee benefits

According to a survey by a major national consultancy, 62% of employers currently offer flexible benefits packages and a further 21% plan to do so in the future. Flexibility in options can be a great draw to employees and can help cover a wide diversity of families and illnesses. It has the potential to be both recruitment value for employee engagement and retention.

It is a new approach to traditional forms of healthcare as new healthcare concerns rise. Obesity rates are skyrocketing, putting more and more people at risk for heart disease. Increasing healthcare costs have companies struggling to provide for their employees, while the Affordable Care Act is only going to further alter the industry.

There are now a wide range of options companies are taking to protect their employees’ health, ranging from the norm to the unconventional. Wellness programs are implemented, including everything from exercise plans to nutrition information to help educate employees on the benefits of a healthy lifestyle. Treadmills have been incorporated into desks, and some companies are even providing exercise classes or have made “walking tracks” around their office to encourage people to get up and move.

The benefits of a strong benefits plan are undeniable. It is key to attracting and retaining employees. Many of the new benefits plan incorporate healthy lifestyle choices, and reducing their risk of disease. This preventative approach through a flexible wellness/benefits plan can also cut down costs for the employer.

Sinclair understands that an effective Employee Benefits program is key in hiring and keeping top talent and in helping employees with life needs. We’ll help you strike the right balance in offering employees a benefit plan that is attractive, offers more choices, customization, and flexibility with your organization’s financial ability by spending smarter, not more. Contact us today for more information about our Flexible Employee Benefits Plans

Source: HI Magazine

Health Insurance Exchange Becomes Federal Responsibility

Health Insurance Exchange Becomes Federal ResponsibilityHealth Insurance Exchange Becomes Federal Responsibility

Health insurance exchanges were originally meant to be set up by each individual state. However with many states resisting the creation of exchanges, the job has fallen to federal officials.

“We realize that not all states will be ready to establish these exchanges by 2014, so we are setting up a federally facilitated exchange in those states,” Michael Hash, the top federal insurance regulator, told the New York Times.

Governors of 13 states have sent letters to the federal administration saying they intend to set up exchanges. Health policy experts expect that the federal government will run exchanges in about half of the 50 states.

The implementation of the health insurance exchanges is navigating murky waters. Running the health insurance exchanges is a huge undertaking that federal officials did not expect to have any part of. The original responsibility was relegated to each state, however many have come out in opposition of the healthcare reform and are resisting creating the exchanges.

The health insurance exchanges will be marketplaces of sorts, designed to create a more organized and competitive market for buying health insurance, according to Kaiser Family Foundation. They are designed to serve primarily individuals buying insurance and small businesses.

As a business owner, you want to make sure you protect your business and your employees. Many employers are looking for health insurance alternatives to help with skyrocketing medical costs and the regulatory changes that have impacted their expenditures. Sinclair Risk & Financial Management works with companies of all sizes to design and implement Group Medical options that rethink the traditional way of offering benefits and meet the financial needs of employers while also addressing the choices and flexibility employees want. Contact us today for more information.