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Employee Benefits
- Q:What is the difference between "Network" versus "Non-Network" benefits?
A:"Network," or contracted providers, have agreed to accept negotiated fee schedules. They are not allowed to charge you for covered services in amounts beyond your specified co-pay, deductible, and/or coinsurance amount. The combined amount paid by you and the plan must be accepted as payment in full. "Non-network," or non-contracted providers, may charge considerably higher amounts. Therefore, if the billed amount exceeds the Allowable Charges fee schedule, your provider may bill you the difference. The balance-billed amounts are not covered by the plan, and therefore not applied to plan deductibles or out of pocket maximums. It is best to utilize Network providers whenever possible. If you should decide to obtain services from a non- network provider, it is recommended you discuss additional charges with your provider before services are rendered.
- Q:What about terminal liability?
A:Terminal Liability is a term used to describe the provisions of some self-funded plans wherein claims that are incurred prior to termination of the plan are not covered if they come in for processing at a later date. Typically, these provisions are more common in custom plans for larger groups. Occasionally, these provisions will still exist in other plans that attempt to work in the small group market as well.
This is one of the major competitive advantages to the ClientFirst Health Plans.
ClientFirst Health Plans utilizes an extended settlement period contract that covers all valid claims incurred during the plan year, submitted within 4 months and paid up to 6 months after the termination of the contract. This allows groups 6 months of continued claims payment, claims administration, and coverage after termination for claims incurred before termination. Additionally, ClientFirst Health Plan groups are billed at the maximum (including what would otherwise be terminal liability) throughout their plan year; so additional funds are not necessary upon termination. This includes administration costs that are pre-funded as well.
The contract term for stop-loss coverage is annual.
- Q: What about new hires and medical underwriting?
A: ClientFirst Health Plans are subject to the HIPAA guidelines for self-funded plans. New hires will be guaranteed issue as long as they are timely and actively at work on their effective day of coverage (timeliness will be verified on the wage and tax statement, and other sources, if necessary). An application will be required, as with all employees, to determine if a pre-existing condition clause would apply based upon the existence of medical conditions and whether prior medical coverage was in place. All employees with 12 months prior creditable coverage that are timely will have their waiting period waived (or any portion that has been satisfied by prior creditable coverage*). All employees who are added in a timely fashion without prior coverage will be subject to a 12- month pre-existing condition clause. * A total of 12 months prior continuous coverage is required to waive the entire waiting period, so be sure to list multiple carriers if necessary.
Reminder: HIPAA allows as much as a 62-day break for coverage to count as continuous. Employer imposed probationary periods do not count as a break in coverage. Late enrollees will not be allowed to come on the plan until the next open enrollment period occurring 91-60 days prior to the anniversary date of the plan with coverage effective on that anniversary date and subject to an additional 6 months pre-existing condition clause, as allowed under HIPAA. Late enrollees are anyone that does not apply for coverage within 30 days of their eligibility date, with the exception of those with a Special Enrollment, as defined by HIPAA. Enrollment at the time of eligibility should be emphasized to avoid delay in coverage for a condition that develops prior to the plan anniversary date.
- A: How many plans can be offered to one group?
Q: Up to two plans can be offered in a group. Only one prescription drug benefit can be offered to the group (except that any Investor's Choice selection will receive the integrated drug option only, regardless of the prescription drug benefit selected for other plan options within the group.) - A: What if my group's average age changes?
Q: A group rate is locked in at the inception of the group, and absent of specific contract violations or changes, no changes will be made to those rates during the contract year.
Special Note: Significant changes in group size, whether positive or negative, may impact rating mid-year as determined by underwriting. Please refer to your contract for specific information.
Term Insurance
- Q: What is Term Life Insurance?
A: Term Insurance is designed to provide death benefits for during a specified period of time, such as 10 years, 20 years or 30 years. It may be used when the need is for a relatively short period of time such as a mortgage or other loan. Most Term Insurance products offer a level premium during the 10, 20 or 30 year period. They may be renewed after the level premium period for considerably higher premiums. If the need is for a longer period, Permanent Life Insurance should be considered.
- Q: Should I buy Permanent or Term Life Insurance?
A: Which type of Life Insurance you purchase depends on how much coverage you need, how long you anticipate needing the coverage and what you can afford to pay for the coverage. You should meet with a licensed insurance agent to discuss your individual situation.
For more information or for a proposal, please click here.
- Q: What is Permanent Life Insurance?
A: Permanent Life Insurance is designed to provide death benefits for the rest of your life. The premiums are generally higher than the premiums for Term insurance, but may be set up to remain level for the rest of your life.
For more information or for a proposal, please click here.
- Q: What is a single premium immediate annuity?
A: A SPIA is designed to produce an immediate guaranteed structured payout for a specific time. SPIA's are generally used to produce an income stream. Some Medicaid SPIA's are designed to generate a minimal income stream now, while protecting the principle against Medicaid restrictions.
- Q: Do I have to annuitize the contract to produce an income stream?
A: No. While most annuities offer a structured payout, annuitization is not required. Many individuals withdraw only the interest or a fixed amount each year, without giving up rights to the capital investment.
- Q: What is an Equity Indexed Annuity?
A: Unlike a fixed annuity that pays a fixed interest rate declared by the insurance company, an Equity Indexed Annuity is a fixed annuity that credits interest based upon the performance of a stock market index, usually the S&P 500. This offers the client the downside protection of a fixed account, while offering the upside potential of the stock market. These products offer: locked in annual gains, annual reset, and safety of principle.
- Q: Does an agent need a securities license to offer Equity Indexed Products?
A: No. Remember, an Equity Indexed Annuity is a fixed annuity. It does not invest money directly into the stock market. It links the interest crediting, to the performance of the stock market index.
- Q: What are some of the advantages of an annuity?
A: -Tax deferred growth
-Guaranteed income stream available
-Systematic withdrawals
-Avoidance of probate
- Q: What is an annuity?
A: An annuity is a savings vehicle that allows flexible or large lump sum contributions to grow tax deferred, and has the ability to generate a guaranteed lifetime income stream. Annuities can be used for Non-Qualified or Qualified plans. (401k, IRA, 403b...) There are three types of annuities: fixed, indexed, and variable.
- Q: What is a single premium immediate annuity?
A: A SPIA is designed to produce an immediate guaranteed structured payout for a specific time. SPIA's are generally used to produce an income stream. Some Medicaid SPIA's are designed to generate a minimal income stream now, while protecting the principle against Medicaid restrictions.