What to Look for in a Benefits Package

Finding health insurance for employees is never easy. With the implementation of the Affordable Care Act, it makes it even more challenging. That’s why we’re here to help.

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At Steve Grady Insurance Services you’ll find the straightforward answers you want regarding all of your benefits questions. We won’t beat around the bush or sugar coat anything. We believe in giving direct, honest answers.

Some things we consider when recommending benefits packages include:

  • How much each plan will cost you and your employees
  • How each plan will benefit your employees’ needs
  • Whether a wellness program may be a beneficial addition to your health plan
  • Whether you are subject to the employer mandate and how that may affect you

Do you have questions about your benefits? Do you understand how the Affordable Care Act will affect your business and your current health plans in the future? Get the answers you want by contacting us today.

Still unsure whether you should give us a call? See what our clients have to say about us on Yelp.

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HMO vs. PPO: What’s the difference?

doctor with female patientInsurance can be complicated and difficult to understand. One of the biggest questions insurance agents get is, “What’s the difference between an HMO plan and a PPO plan?” Next people ask which route is better. All manager care plans have contracts with doctors, x-ray technicians, pharmacies, and other medical vendors. These contractors are part of your network. Some plans require you to seek medical attention within your network while other plans let you have more freedom in seeking medical care outside of your preferred network.

HMO Plans:

HMO stands for health maintenance organization. If you sign up for an HMO plan, you typically receive medical attention within your primary network. You also must sign up for a Primary Care Physician (also known as a PCP) before you can be treated. This doctor will manage most of your basic healthcare needs. In order to see a doctor or specialist outside of your preferred network, your PCP must refer you to someone. If you do not have a referral, you may pay a lot more for seeking medical attention outside of your network.

PPO Plans:

PPO means preferred provider network. This type of plan gives you a lot more freedom in choosing which doctors you see. This type of plan has contracts with preferred providers and you are able to select which doctors and physicians you would like to see among those providers. In addition, you are not required to select a PCP and you do not need a referral to get medical attention from a specialist within your preferred network. Typically, you are required to pay your annual deductible and co-payments when seeing a doctor within your network of preferred providers. If you go outside of that provider network, you must pay out of pocket directly to the doctor (which can be costly). You can then try to get reimbursed from the PPO by filing a claim.

So what’s the difference between an HMO & PPO?

  • HMO - must choose doctors, hospitals, and other providers within your network. You must also select a Primary Care Physician and get a referral to see anyone outside of your network. Usually, you only pay co-payments within your network if you see a doctor. If you go outside of your network without a referral, you won’t be covered by insurance.
  • PPO – can choose doctors, hospitals, and other providers within your network or outside of your network. You don’t need to choose a PCP and you don’t need a referral. Usually, you pay co-payments when seeing a doctor and some PPO plans require and annual deductible. If you go outside of your network, you must pay the provider and try to get reimbursed from your PPO.

Which is better? It really depends on what you are looking for and what’s important to you when it comes to a health insurance plan. If you rarely go to the doctors and don’t need to seek any special medical attention, an HMO plan may be the better option since they tend to be less expensive since you get less freedom to choose doctors. If you go to the doctor often and would like the ability to see other doctors and specialists outside of your network, a PPO plan may be more appropriate.

Still have questions? Feel free to give us a call and we can help you figure out your options. Learn what to look for in a business health insurance plan here.

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Why Should Businesses Have a Wellness Program?

Now more than ever, it is important to find ways to keep employes happy in the workplace. We understand that running a business is not easy and you’ll never be able to please everybody. Some of your employees may be frustrated with the economy and how new healthcare laws have impacted their employee benefits. If you are a business owner who no longer offers health insurance, contributes less to your employee benefits package, or chose less expensive plans with fewer benefits, your employees may not be too thrilled with you right now.

These changes in health care law do have an impact on business and employee morale so it’s important to offer other incentives and programs to keep workers happy and motivated. Evidence shows that if your employees are happy, they are more motivated in the office. A healthy and happy workplace is an essential ingredient to a successful businesses.

That’s why many organizations are looking to Employee Wellness Programs to provide a boost of positive morale. A wellness program is an incentive to promote health and fitness in the workplace.

Benefits of a Wellness Program Include:

  • employee discounts to gyms
  • health screenings
  • immunizations
  • diabetes management
  • weight loss programs
  • workplace fitness events and activities
  • cash rewards

Another reason to look into employee wellness programs: the Affordable Care Act offers rewards to some companies who implement wellness programs. Officials understand that preventative health care is important and may help decrease medical expenses later on in life. They want business owners to educate employees about weight loss programs, diabetes prevention, and even discourage tobacco usage. Programs that are designed to prevent tobacco usage, can receive up to a 50% reward! Other rewards for certain programs may include 20-30% off the cost of health coverage in the form of a government subsidy.

Overall, wellness programs improve employee health and happiness, may decrease employee absence for sick days, and could help prevent the onset of preventative diseases through educational offerings.

Contact us today and find out how we can help get a wellness program set up for you today!

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Covered California Expands Deadline to Enroll

Healthcare reformBy 2AM April 1st, there were 1.2 million Californians enrolled in the exchange. However, the late night surge in applicants attempting to enroll in Covered California by the March 31st deadline caused the website to crash and stall repeatedly. Officials have decided to allow consumers to enroll in person with agents or on the phone until April 15th.

Peter Lee, the executive director for Covered California, said during a teleconference late Monday that the deadline was not being extended. Rather, he said the state exchange was relying on the honor system to allow Californians one more chance to sign up.

Officials feel that they have an obligation to give people who were trying to enroll a chance to get the health insurance they want. Some argue that people shouldn’t have waited until the last minute to get covered, while others feel that the website should be able to withstand a high volume of applications and Californians should not be penalized because of that.

Even today, the website is slower than usual despite the “Preview Plans” option being removed from the interface. Wait times to get ahold of a Covered California representative are about 40 minutes long so be patient.

If you have any questions about whether you are still eligible to get covered under the exchange, please feel free to give us a call. Visit the Covered California website to get covered by April 15th.

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Another Delay in Healthcare Reform

Late Tuesday night on March 25th, the Obama administration decided to allow more time for people to enroll in health care coverage. People who still want to enroll in coverage will have about two weeks (or until mid-April) to purchase insurance under the exchange.

The administration argues that this extended time period to enroll will enable the officials to accommodate the last minute surge of people attempting to get coverage. People will be able to ask for an extension (though there is no definitive criteria for who will be able to get an extension). Officials agree that this extra time is helpful for those who have had technical issues with the website, especially in the last week as so many people are are trying to register.

In mid-April, people will no longer be permitted to get extensions through the Healthcare.gov site. However, there will be special enrollment periods for people who:

  • are having a baby

  • are getting a divorce

  • have lost a job

  • had technical issues signing up through Healthcare.gov

However, many Republicans are upset with this decision because it means another delay for the program.

The penalties for people who have not enrolled are still coming (though they may be delayed too…). Here is a list of 8 things you should know about Obamacare prior to the definitive deadline (date to be determined).

For information about this extended deadline and how it affects you, please feel free to give us a call!

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