Small Business Employee Benefits


How Much Does Group Health Insurance Cost?

5 Things You Must Do During Open Enrollment.

What decisions do I need to make during my employer’s open-enrollment period this fall?

Here are five ways to consider when selecting your 2016 options.

1. Pick the best deal in health insurance. Health-care-reform changes and ever-increasing health-care expenses are prompting most employers to boost premiums, co-payments and deductibles for their health-insurance plans in 2012. If you have several plan options, the one you picked in the past may no longer be your best choice.

It’s important to compare premiums, but you also need to add up your potential out-of-pocket costs for each plan. For example, if you take a lot of medications with high co-payments, the plan with the lowest premium may actually cost you more in the long run. Many employers are steering employees toward high-deductible health insurance policies as a way to encourage them to pay closer attention to their medical expenses. As an incentive, some are offering competitive premiums and contributing to employees’ health savings accounts, which give employees tax-free savings to use for medical expenses at any time. Many employers offer tools on their intranet sites to help you run the numbers for your plan options.

2. Spousal Coverage. If both spouses have health-insurance coverage through work, it’s important to compare the overall costs of both policies again. Some employers are charging more to cover dependents than other employers are, so you could come out ahead by switching your children from one spouse’s policy to the other’s. And if your spouse’s employer has boosted premiums significantly but your coverage has remained fairly stable, then you might do best by having the whole family — including your spouse — on your employer’s plan.

As a result of health-care reform, you can add adult children up to age 26 to your health-insurance coverage, even if they had aged off the policy in the past. And a child can be covered under your plan even if he or she doesn’t live at home, isn’t your dependent for tax purposes and is married. You need to add your child during open-enrollment season for coverage to begin the next plan year (generally January 1).

If your employer charges one rate for family coverage and you already have younger children on your policy, you might not have to pay extra to add your older child. But if your employer charges separately for each dependent, it might be cheaper to get your adult child a policy of his or her own. Healthy adults in their twenties can usually buy a policy for less than $200 a month.

3. Make the most of flexible spending accounts. FSAs can help lower your taxable income and give you tax-free funds to pay out-of-pocket medical expenses throughout the year. Starting in 2013, the maximum amount employees can stash in a medical FSA will be capped at $2,500 per year. Currently the maximum limit varies by plan, but many employers allow employees to set aside $4,000 or more in these pretax accounts for medical expenses. In light of the impending change, find out how you can make the most of your FSA in 2016.

4. Get tax-free money for child care. Many employers also let you set aside up to $5,000 in a dependent-care flexible spending account, which gives you tax-free money to use for dependent care for children under age 13. Before you sign up for your employer’s dependent-care flex plan, though, it’s important to calculate whether or not you’ll come out ahead by using the money from the FSA for those costs or claiming the child-care credit on your taxes. See FSA or Child-Care Credit? for more information about who qualifies for these benefits, how to calculate which is a better option for your family, and a strategies to help you take advantage of both the FSA and some of the child-care credit if you have two or more kids.

5. Benefit from special deals on other insurance coverage. You may also be given the choice during open-enrollment season to buy extra life insurance, disability insurance and long-term-care insurance beyond any coverage already provided by your employer. You usually have to pay for this extra coverage yourself, but you could benefit from a group discount. However, the quality of these deals can vary a lot, depending on the type of insurance.



5 Ways Your Group Health Insurance Plan May Change in 2016.

Most employers are passing along at least some of the premium hikes. But you may see more generous incentives if you participate in wellness programs.

Employers are just starting to announce their health insurance options for 2016, and you may need to make your decisions during open enrollment in the next month or two. The National Business Group on Health recently came out with its annual survey of large employers, which offers the first glimpse of the changes employees are likely to see in their health plans for 2016.

1. Higher premiums. Large employers expect their health care costs to increase by about 5% for 2016 – the same size increase they expected in 2014 and 2015. They plan to pass along some of the extra cost to employees but more of it to dependents, with employees contributing 20% of their own premiums and 24% of the premiums for dependents (higher-income employees may pay more). About one-third of the companies plan to add a surcharge for spouses who could get coverage elsewhere but don’t. But very few (only 4%) plan to exclude spouses who have similar coverage available through their own employer.

2. More high-deductible health plans. Employers are continuing to try to contain rising costs by forcing employees to take more control of their health care: 83% of large employers plan to offer a consumer-directed health insurance plan in 2016 (primarily high-deductible health insurance paired with a health savings account). Half of the employers plan to offer the high-deductible plan as an option, and 33% plan to offer it as the only option. More than half contribute to employees’ HSAs, giving them tax-free money for medical expenses; some add more if you participate in a wellness program or take a health risk assessment. For more information about HSAs, see FAQs About Health Savings Accounts

3. Restrictions on expensive drugs. Employers identified the cost of specialty drugs as one of the major causes for health care cost increases, and they’re imposing more restrictions on coverage. More than three-quarters of the employers surveyed plan to use prior authorization for some of these specialty medications – requiring physicians to fill out forms explaining why you need the specific drug. Three-quarters plan to use step therapy, covering the drug only after you’ve tried a list of less-expensive medications first.

4. New telemedicine options. Nearly three-quarters of the employers will offer telemedicine, which provides virtual visits with a doctor, as an option. “It’s still primarily phone-based, but the video component is starting to take off,” says Karen Marlo, vice president of benchmarking and analysis for the National Business Group on Health. “You can take a picture of a rash with your phone and e-mail it to someone who can look at it, for example. It’s a good way to provide good quality care at a lower cost, and it improves access in parts of the country where you have to travel a long distance to go to a physician.” A telemedicine doctor’s appointment may cost $40 or $50, while an actual office visit may cost $150.
5. Cash for wellness programs. Employers continue to focus on plans to improve your health, which they hope will ultimately help lower their medical expenses, and they’re giving employees more incentives to participate. Thirty-nine percent plan to offer a break on health insurance premiums or cost sharing for employees who participate in a wellness program, health assessment or biometric exam. Thirteen percent plan to offer breaks for participating in a disease management program, which provides special care and resources for people with complex conditions, such as diabetes. You may also get more money in your HSA: Nearly one-third of employers plan to contribute to an HSA for employees who complete a wellness or health education program, and 8% plan to make HSA contributions if you achieve a health goal.


Premiums for Employer-Sponsored Health Insurance Plans to Rise in 2016.

Your Benefits Package At Work: Health Insurance.

Your Benefits Package At Work: Health Insurance.

One of the most overlooked parts of an overall financial plan is the benefits package you receive from your employer.   Making benefits decision can often be a difficult process.  Most of the time, I have found that people wait until the very last day of open enrollment with their employer only to quickly check the boxes that they checked last year without any research on what may be their best options.  Remember, that your compensation package from your employer should always be looked at from a total economic package point of view.  This means looking at your cash compensation plus benefits plus stock options, fringe benefits, etc.  If you view your compensation only from a myopic point of view such as salary, you won’t be able to really analyze what you are getting paid from your employer nor the true value of your benefits package.

One of the first decisions you will have to make upon your benefits election is to choose the type of health insurance coverage you want for the next year.    It is important to note that your company may have changed health care providers, deductible, or the overall plan they use with the current health insurance carrier so compare closely when you make this election.   Here are some items to consider when you select your health insurance through your employer’s benefits package.

  1. What were my ‘real’ out of pocket medical costs for the prior year? Most employer sponsored retirement plans will have the option of allowing you to put money in an FSA (Flexible Spending Account) which is a way to essentially put away dollars pre-tax for items such as medical, dental, and dependent care expenses and use them on a tax-free basis during the year.  The rub on these accounts is that they are use or lose during the calendar year, so you don’t want to bank away too much on an annual basis.   However, what I have found to be more of the case is that employees either don’t participate at all or participate at a very low amount because they haven’t taken the time to really calculate their out of pocket costs from the prior year.
  2. Can I take advantage of a Health Savings Account plan within my employer’s plan? Although not all employer sponsored plans offer this type of solution, I predict that you will see more and more of these as annual enrollments continue in the years ahead of us.   The Health Savings Account really means that you are choosing a high deductible health insurance plan through your employer (it will most likely be the same insurance company).   This will automatically reduce your medical premiums you pay out of pocket, and it will also allow you to bank dollars pre-tax into an account that is NOT use or lose for items such as medical, dental, and vision expenses.   This could help you reduce your tax liability for the current year, and it may actually reduce your overall medical cost out of pocket if you don’t go to the doctor that often.   This is absolutely something to look into come benefits time.
  3. Do my doctor’s still take this type of insurance? If your employer changes insurance companies or sometimes even the type of plan, the doctor’s you currently use may not take that particular type of insurance.   If you really like the doctor’s you currently use, it may make some sense to call their offices and give them the particulars around the insurance company and type of plan you are going to choose so you can stay in the group of physicians you really like.
  4. Did anything change with co-pay or in/out of network costs? If you don’t look at this closely, it may appear to you that your overall premiums out of every paycheck are only going up slightly.  However, if there was an increase to co-pay items such as doctor’s visits or prescription drugs, then you could see an overall increase for the year.    In addition, your plan may have originally covered 100% after your deductible is fulfilled for in network and 80% for out of network procedures.   When open enrollment comes, you need to really look at the plan line by line to see if there were any major changes so you don’t get hit with unexpected bills.


What Types of Insurance Do I Need?

When you find a new job and sit down to look at the benefits you may be surprised at the options that are available to you. It may seem overwhelming to consider all of the insurance that you can purchase. Do you really need all of the insurance or can you pass on some of the policies? Is it possible to be over insured? It is also important to check on your insurance to see if you qualify for better rates. Some insurance like home insurance or car insurance is a given> Learn about the other insurance options.

health-insurance-need.jpg - PhotoAlto/Federic Cirou/PhotoAlto Agency RF Collections/Getty Images

1.  Do I Need Health Insurance?

Health insurance is something your should have. You run the risk of financial ruin without it. Even if you are relatively healthy, if you are involved in a serious accident or suddenly develop appendicitis, you may end up owing tens of thousands of dollars in medical bills before you are done. If your employer covers you, you should take advantage of that plan, if you are self-employed you may want to consider high deductible health insurance as a money saving option. More »

2.  Do I Need Life Insurance?

Life insurance is another benefit that is offered by many employers. Generally employers will offer a basic life insurance policy equal to one year’s salary at no cost to you. You may have the option of purchasing more insurance through your benefits package. If you are single and do not have children, you may be fine relying on just the insurance provided by your employer. However, if you have responsibilities towards a spouse or children you should insure yourself to help them in the event of your death.  

3.  Do I Need Disability Insurance?

Disability insurance will help to cover you in the event that you are no longer able to work. This insurance will help you to pay your bills and make ends meet while you are coping with an illness or injury. This is generally good insurance to have. Short-term disability will help to cover maternity leaves and fill in the waiting period before disability insurance kicks in.  

4.  Do I Need Dental Insurance?

Dental insurance can help to pay for your dental checkups and other work that you need done. You need to carefully look over your policy to make sure that your dental benefits are more than the premiums you are paying. If the plan will not save you money, you may want to shop around for a dentist and look for a dental discount card to save on the cost.

5.  Do I Need Long Term-Care Insurance?

Long term care insurance will help to pay the cost of care if you end up needing to be in a nursing home or an assisted living facility. Since you are young and in your twenties you may opt to wait on this insurance. A good time to get this insurance is in your late thirties, after that the rates begin to rise rapidly. If you have a condition that makes you think you will need this sooner, you should get it. If you have a family history of certain conditions such as Alzheimer’s you may consider purchasing it earlier to lock in lower premiums.

6.  Types of Insurance: Do I Need Cancer Insurance?

Cancer insurance may also be available to you. Unless you have a strong family history of cancer, this is one insurance that you are pretty safe not having. You should make it a priority to save money to cover the extra medical bills that may arise from this or any other serious health problem.


Cancer insurance is a benefit that will pay you money if and when you are diagnosed with cancer. The policies vary widely, so it is important to carefully read the policy before you purchase. Some policies will be pay a designated amount once you are diagnosed with cancer. This is to help defray costs such as missed work and out of pocket expenses. Other cancer insurance is supposed to cover the amount that your insurance would not cover.

Many cancer policies are risky because they have so many exclusions and limitations. Additionally your traditional health insurance may decrease the amount it covers as a result of the cancer insurance. You should carefully examine every limitation and benefit before you sign up.

6 “Benefits” to Having Group Employee Benefits.

As a small business owner, you may be thinking about providing group employee benefits for your employees. There are many “benefits” (no pun intended) to providing this kind of service for your employees. There are many different insurance companies with many different programs. Generally speaking, there are six types of benefits you should at least consider when selecting which to include in your package.

1)      Health Insurance:  Health insurance protects against the risk of medical expenses. There are many health insurance companies with many different types of programs and options. It is best to do some research to see which insurance company is best for your company and employee’s needs. Two very popular insurance programs are HMOs and PPOs.

  • HMOs, or health maintenance organizations, provide managed care for insurance companies. HMOs cover services of doctors who agree to treat patients under HMO guidelines. Under HMOs, individuals usually select a primary care physician and need to obtain referrals in order to see other doctors or specialists. These referrals are only given when the HMO plan deems the services necessary.
  • PPOs, or preferred provider organizations, are subscription based and the employee can visit a network doctor without going to a primary care physician for a referral. Doctors and hospitals work with insurance plans in order to provide care at reduced rates.  Most PPO plans also allow you to visit a non-network doctor, but you pay a higher deductible and/or Co Pay.
  • High deductible HSA plans are also gaining popularity.  The premiums can be significantly lower than a PPO and this option allows the employee to set up a qualifying bank account and make contributions from which they pay the expenses that fall within the deductible.   The contributions to the HSA that are not used in the calendar year roll over to the next year.

2)      Vision Plans: Usually offered as an addition to a general health insurance plan, but can be purchased stand alone, vision plans provide reimbursement for vision services.  This insurance would be used when visiting an optometrist or ophthalmologist for services such as eye exams, eye glasses or contact lenses.

3) Dental Coverage: Generally offered in addition to a general health insurance plan, dental insurance provides individuals with insurance for dental care. Dental plans vary, but generally speaking they cover (partially or in total): basic cleanings, fillings, x-rays, periodontics, endodontics. Some plans may even cover parts of oral surgery, crowns, implants or dentures.  Some carriers offer HMO and PPO dental options.

4) Group Life: Life Insurance can be purchased on the group with a set limit for the group or set limits by job/class.  The coverage is term, is reasonably priced and is available while the individual is employed by the company.  While a Group Life program can be purchased stand alone, most employers will combine as part of the overall benefits package.

5) 401K : 401K plans are a great way for employers and the owners to provide a vehicle to create a retirement income pool.  Individuals contribute a percentage of pre-tax income into a qualified plan while they are working and later receive funds from the plan upon their retirement.   The investment income accumulates tax free and the recipient pays income taxes as the funds are distributed, usually at a lower rate.  Individuals can start withdrawals without penalty upon turning 59 ½.  Many employers will provide a matching contribution based on a formula that may include company profitability.

6) Disability (Short and Long Term): this type of insurance protects those who become disabled and are unable to work. Short-term disability insurance generally pays a percentage of a disabled employee’s salary for a certain amount of time after a short waiting period of 7-14 days. Each state has different guidelines and rules regarding short-term disability; some states require benefits be provided for up to 26 weeks. Long-term disability insurance is more popular among employers. If an employee is unable to work for a long period of time due to disability, this coverage will pay a part of the employee’s salary. The amount of money that an individual will receive often depends on their position and how much coverage their company provides.  Many employers will provide both STD and LTD as complimentary products.

Cobra Insurance Coverage

What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) was established in 1986 and is also known as continuation coverage. COBRA allows qualifying individuals who lose their group health coverage due to certain events like termination of employment to continue their coverage temporarily. Generally under COBRA individuals must pay the full cost of the coverage and a two percent administrative charge. Certain employers may subsidize COBRA fees, but they are not required to do so. As a result, continuing health insurance coverage through COBRA can be costly.

Why Enroll in COBRA?

  • Many people enroll in COBRA to offset the expensive costs associated with receiving medical care
  • While in between jobs, individuals enroll in COBRA to prevent a lapse in health insurance coverage
  • For individuals with a pre-existing condition, COBRA is often the only option to ensure coverage through a health insurance plan

How Do I Know if I am Eligible for COBRA?

Employers are required to provide general information about COBRA coverage when hiring new employees. When a worker is no longer eligible for health coverage through the employer’s insurance plan, the employer must notify the worker of his or her rights to COBRA benefits. These rights may also be extended to the employee’s spouse and dependent children.

Events that may make you or your family members eligible for COBRA may include:

  • Termination of employment
  • Reduction in number of hours worked
  • Retirement
  • Divorce or legal separation from the beneficiary
  • Death of the beneficiary
  • Loss of dependent child status

COBRA and the Affordable Care Act

The Affordable Care Act, also known as Obamacare, requires insurers to sell health insurance to virtually everyone (often called “guaranteed issue”) regardless of health status. As a result, individuals with a pre-existing condition need not enroll in COBRA in order to have healthcare coverage after leaving a job. However, the mandates of the Affordable Care Act do not go into effect until 2014.

Even after the Affordable Care Act goes into effect, individuals may elect to enroll in COBRA since the benefits under their old group health insurance plan may be better than the health plans provided under ACA.

Alternatives to COBRA

Individuals can find healthcare coverage as an alternative to COBRA:

  • If your spouse is covered under a group health insurance plan, you may have a right to special enroll without waiting until the next open season for enrollment
  • Starting in 2014, an individual can enroll in an individual health insurance plan even with a pre-existing condition
  • Individuals and families may become eligible for government programs such as CHIP or Medicaid after one of the COBRA qualifying events

White House delays employer mandate requirement until 2015.

White House delays employer mandate requirement until 2015

By Sarah Kliff, Updated:

The Obama administration will not penalize businesses that do not provide health insurance in 2014, the Treasury Department announced Tuesday.

Instead, it will delay enforcement of a major Affordable Care Act requirement that all employers with more than 50 employees provide coverage to their workers until 2015.

(Photo by Jessica Rinaldi/Reuters)

(Photo by Jessica Rinaldi/Reuters)

The administration said it would postpone the provision after hearing significant concerns from employers about the challenges of implementing it.

“We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark Mazur, Assistant Secretary for Tax Policy, wrote in a late Tuesday blog post. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so.”

The Affordable Care Act requires all employers with more than 50 full-time workers provide health insurance or pay steep fines. That policy had raised concerns about companies downsizing their workforce or cutting workers’ hours in order to dodge the new mandate.

In delaying the enforcement of that rule, the White House sidesteps those challenges for one year. It is also the second significant interruption for the Affordable Care Act, following a one-year delay on key functions of the small business insurance marketplaces.

Together, the moves could draw criticism that the administration will not be able to put into effect its signature legislative accomplishment on schedule.


Individual Health Insurance

Frank West Insurance Services | Individual Health Insurance, Family Health Insurance, HTH Travel Insurance, CA Medical Insurance, Affordable San Diego Health Insurance, Insurance Quotes, Whole & Term Life Insurance Policies, Medicare Supplement Insurance, Medigap Plans, San Diego Medical Insurance, Medical Coverage, Health Care Reform & Affordable Care Act Assistance, CA Health Insurance Exchange, Group Health Insurance, Business Health Plans, Health Care Insurance, Long Term Care, Group Health Insurance, Employee Benefits, Dental Insurance, Disability Insurance, San Diego Life Insurance, Anthem Blue Cross, Aetna, Blue Shield of CA, Cigna, Health Net, Kaiser Permanente, San Diego, Coronado, La Jolla, Pacific Beach, Rancho Penasquitos, Poway, Rancho Bernardo, Oceanside, Solano Beach, Pacific Beach, Cardiff-by-the-Sea, Encinitas, Carlsbad, Carmel Valley, Del Mar, Olivenhain, Rancho Santa Fe, Aviara, Lakeside, San Diego County CA, Southern California | 309 Miami Trail, Oxford OH 45056 | (858) 484-1894