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The Virtual Blue plans give members (small and large groups) the choice of virtual or in-person care. Virtual care includes $0 unlimited visits to primary care, behavioral health and specialty care through a new partnership with AccoladeCare. In-person care is available through the Tandem PPO network in California and via BlueCard when outside of the state.
The two Virtual Blue small group plans available in PRISM are the Virtual Blue Gold Tandem PPO 1500/45 and Virtual Blue Bronze Tandem PPO 7500/75. These can be identified by ‘Virtual Blue’ in the plan name.
When using the PRISM filter options for Narrow or Broad networks, select ‘All’ networks instead of ‘Broad’ only networks to generate plans for Blue Shield’s Virtual Blue, Trio HMO, and Tandem PPO plans.
If you need assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
Login To PrismBRI is offering a new Health Account Outlook Series which will run from February 2023 through April 2023. Through this series they will tackle a variety of topics affecting health accounts including generational and behavior trends, consumer attitudes, how legislation and rules impact your strategy, and some of the hidden challenges (and opportunities) of health accounts.
The Session Will Cover:
Webinar Details
All registered attendees will receive a recording following the live event. Register now!
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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The IRS has announced the annual plan contribution limits for Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), commuter benefit plans, and adoption assistance programs. For a summary of the 2023 inflation-adjusted amounts and plan limits, check out BRI’s overview by plan type and access the IRS official announcements.
*Includes limited purpose FSAs that are restricted to dental and vision care services, which can be used in tandem with HSAs.
To learn more visit Benefit Resource (BRI) and SHRM.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Join BRI to explore some of the key legislative and regulatory issues affecting employee benefits including:
Webinar Details
All registered attendees will receive a recording following the live event. Register now!
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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Healthcare is a significant investment for your clients, and it’s important that their employees understand coverage options and see value in their benefits. To ensure employees have the proper health coverage and are protected from unexpected expenses, it’s best if they thoroughly review their budget and healthcare needs. The three questions below will help employees prepare for open enrollment before signing up for pre-tax benefits.
Start with looking at how much was spent on healthcare last year. Reviewing spending habits will provide a foundation for the types of financial choices that might be made in the future and how enrolling in a pre-tax account could help.
It may be helpful to place healthcare costs into three categories:
If a spreadsheet or budgeting app was used, consolidate the medical expenses. Then determine, at a high level, what the healthcare expenses were. Make sure to understand how much was paid out of pocket by reviewing exactly what insurance covers annually, and factor that into the plan for healthcare costs. To be safe, add an extra 10-20% to the estimated costs to account for unexpected expenses.
If last year’s medical expenses are unknown, no worries. Review all of the insurance company and healthcare provider receipts and go through bank and credit card statements to identify healthcare costs paid out of pocket last year. Or contact the insurance and healthcare providers for documentation.
According to a report from the Bureau of Labor Statistics, on average, healthcare costs account for about 8% of annual household spending or nearly 7% of pretax income. Even if health insurance covers an expense, the budget for healthcare costs still needs to include health plan premiums.
To determine pre-tax income, look at a recent pay stub before taxes. To calculate after-tax income, look at a bank statement showing paycheck deposits.
These general guidelines will provide a basic understanding of healthcare expenses from the past year and help guide the decisions for open enrollment.
Next, determine if there will be any changes in expenses for the coming year. Specifically, consider out-of-pocket expenses which pre-tax accounts can help pay for.
An out-of-pocket expense is an amount paid after insurance has covered a service.
Determining out-of-pocket expenses can be more difficult. As a starting point, look at current benefits to determine any co-pay or co-insurance amounts. Also factor in the deductible – the amount needed to pay before insurance begins to cover costs. As a general rule, plans with a lower deductible require a higher premium.
For this reason, high deductible health plans (HDHP), also called low-premium plans, have become more popular. HDHPs can also be paired with a Health Savings Account (HSA), which can be a great savings tool for employees.
An HSA lets the employee put money away on a pre-tax basis for eligible healthcare expenses, including certain dental work, eyeglasses, and prescriptions. Contributions can come from the employee, employer, or a relative—anyone who wants to fund the account. Also, the funds roll over from year to year with an HSA, which makes it a great long-term tool for budgeting for medical expenses. Note there is an annual limit for how much they can contribute.
The employee should log into a benefits portal or ask their HR department for their company’s benefits information to find out what these out-of-pocket expenses are.
To determine a dollar amount for out-of-pocket expenses, multiply the co-pay amount by the number of expected healthcare visits. However, keep in mind that some healthcare visits are covered since they are preventative in nature.
For example, if there’s one physical per year, one dental cleaning, and 12 physical therapy visits, most likely only the physical therapy would require a co-pay. If the co-pay is $20, then multiply 20 by 12 for the out-of-pocket costs.
These are expenses for everyday household and personal care items such as adhesive bandages, thermometers, and pain killers.
While these items should be included in the initial review of expenses last year, it’s best to double-check and make sure they’re included.
After accounting for day-to-day healthcare costs, consider unexpected costs for medical emergencies (such as a procedure or medication that is not fully covered by an insurance plan) and create an emergency fund. While the size of the emergency fund will vary depending on lifestyle, monthly costs, income, and dependents, the rule of thumb is to save at least three to six months’ worth of living expenses. A starter emergency fund of $1,000 is recommended.
To budget for healthcare costs effectively, evaluate health insurance options to find the best plan for the employee and their family. For each plan, consider the type of plan (are preferred doctors, hospitals, and pharmacies covered?), as well as the cost of premiums, deductibles, copays, and prescriptions. Health history may also be an important factor when considering different coverage options.
With a healthcare budget in place, employees will be better empowered to make decisions that are good for their health and finances.
To learn more, check out these articles:
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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According to a June 2021 research study from One Medical, 65% of workers would give up bonuses, paid vacation, and flexible hours for better healthcare benefits.
One of the results of the pandemic is that many people now realize the importance of their health and the health of those they’re closest to. Given this shift, it’s no surprise that health and well-being have risen to the top of the priority list for many workers.
However, workers also want more from the companies that are responsible for their benefits. Many aren’t completely satisfied with their healthcare benefits and expect their employers to improve their healthcare options now that well-being is a top priority for them.
While 85% of HR leaders believe their company is invested in the physical and mental health of its workforce, just 32% of employees rate their healthcare benefits as “excellent” and less than two-thirds believe their company is invested in their physical health (64%) and mental health (63%). Other findings reveal that employees are, in fact, desperate for better healthcare. This should be a strong signal to employers that a change is badly needed – and soon.
The vast majority of workers noted the importance of affordability (89%), ease of using their benefits (89%), top quality and trustworthy providers (87%), fast (86%) and convenient (82%) access to in-person care, a focus on preventive health (85%), and seamless specialty care coordination (82%). While more than half (55%) of employees and HR leaders said their healthcare is too costly and thought companies should cover “more” or “all” of employees’ health care costs.
The study revealed 87% of employees agreed that providing a healthcare offering that is a good value, high-quality, and patient-centered increases job satisfaction, engagement, productivity, retention, recruitment, or the likelihood to recommend the company.
Companies that prioritize the health of their workforce and invest in better healthcare benefits will not only be doing what’s right for their employees, they’ll also be more likely to retain their workers and be better positioned for success in an increasingly competitive marketplace. Download the report to learn more.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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While COVID-19 has pushed many companies to offer greater flexibility around where employees work, more adaptation is required to meet the needs of today’s evolving workforce. Companies must consider not just a hybrid or fully remote work model, but also their benefits package.
With home, health, and work stress mounting, employees want more support from their employers to manage the changes and stress from COVID-19. By providing that support and enhancing benefits packages with Specialty Accounts, employers can better meet the employees’ needs, attract and retain talent, and drive business recovery.
Cover Employee Work Essentials
Design an Alternate Commuter Benefit Program
With fewer employees commuting every day, switching to a flexible benefits provider can be beneficial with a hybrid work model. Or use a Specialty Account to cover other commuting-related expenses.
Specialty Account plan options outside the scope of a pre-tax commuter benefits plan:
Wellness/Well-Being
Wellness Accounts are one of the most popular Specialty Account programs, and for a good reason: a healthy workforce = reduced medical costs and higher productivity. Consider expanding beyond the standard gym/fitness reimbursement. Create a general well-being account and cover:
Meal Services
Having everyone in the office makes it easy to treat employees to something delicious. Whether it’s early-morning breakfast, sweet treats, or a full catered lunch, it’s a great way to show employees you care.
With meal delivery services, employees can choose what they want to eat and from whom. Here are some options:
Adapting to the changing workforce can be easy with Specialty Accounts. To learn more, visit Benefit Resource Inc.
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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Last week the IRS published guidance on the COBRA Subsidy introduced in the American Rescue Plan Act. BRI has produced a summary of the guidance to help employers, brokers, and administrators better understand and manage the subsidy.
To learn more, visit the U.S. Department of Labor (DOL) Employee Benefits Security Administration and the U.S. Department of Health & Human Services (HHS).
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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The passage of the Coronavirus Aid, Relief, and Economic Security (CARES) act on March 27, 2020 expands how you can use Flexible Spending Account (FSA) and Health Savings Account (HSA) funds. However, FSAs do not allow certain types of purchases, including the three mentioned below.
1. Masks
Even though recommended by the CDC, masks are an ineligible expense and cannot be purchased as an over-the-counter item using an FSA card. Learn more.
2. Multivitamins
Over-the-counter vitamins and supplements are not considered an eligible expense because of how the IRS determines eligibility. They are considered a dual purpose item and require a doctor’s note before purchasing. You’ll then need to submit a claim.
FSA funds can be used to purchase doctor-prescribed specific supplements with a Letter of Medical Necessity (LMN).
3. Weight Loss Items
When signing up for a weight loss program and purchasing items to support your health journey, you must have an LMN to back up your purchase. This includes scales, weight loss program costs, and supporting material such as training videos or online coaches.
If your pre-tax benefits are administered by BRi, have your doctor fill out an LMN. Otherwise, it’s best to not use your FSA funds for weight loss.
Visit the healthcare.gov website for eligible FSA expenses.
If you’re a Benefit Resource Inc. client, view the Eligible Expenses Table through your online account. The list contains a breakdown of items and their eligibility status. Just log in to BRiWeb and view the Eligible Expenses Table in documents.
To learn more, visit Benefit Resource Inc.
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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Health Savings Accounts (HSAs) are the hot new accessory in the benefits world these days and here are five reasons why you may want to consider offering them to your employer groups.
The funds contributed to an HSA are kept year over year through the employee’s tenure. And the funds are kept into retirement and stay with the employee even when they switch employers. No matter where someone is in their career, or in life, their Health Savings Account will remain with them.
Some people choose to treat their HSA like they would a retirement account: they put money in, invest that money, and leave it untouched until they retire.
By implementing an investment strategy, HSA funds can grow over time. What’s more, contributions made to an HSA are made before taxes are applied. They also grow tax-deferred while providing a reliable source of funds to turn to for both emergency and everyday medical expenses. A win-win!
HSAs and 401(k)s pair well together and have similar functionality. HSAs have an extra degree of flexibility in accessing the funds when it comes to eligible expenses.
With FSAs and HRAs, claims need to be substantiated by the plan administrator. This means submitting supporting documentation within a specific time frame with consequences, such as deactivation of your debit card, if this process isn’t completed on time according to IRS rules and regulations.
HSA expenses still need to be eligible, however, HSAs are a self-substantiation process. Self-Substantiation is basically adhering to the Honor Code. HSA funds used for eligible expenses don’t require proof unless there’s an audit. So while it’s still a good idea to keep itemized receipts, they can be kept filed away.
To avoid the shoebox full of old receipts, take pictures of receipts with a smartphone! Expensify, a receipt specific app, will help keep everything organized. Adobe Scan can be used as a document scanner. Just scan and send those digitally preserved receipts to a computer for future access.
According to the 2020 Midyear Devenir HSA Market Survey, there were over 29 million Health Savings Accounts as of July 2020. The key findings included:
The increasing popularity of HSAs isn’t slowing down any time soon. To learn more, visit Benefit Resource Inc.
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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While there are many advantages to tax-free Health Reimbursement Arrangement (HRA) Voluntary Employee Benefit Accounts (VEBAs), including rolling funds and investing options, you may be surprised to learn about the additional hidden advantages of an HRA VEBA.
While HRA VEBA funds are accessible in retirement, they are not viewed as qualified retirement plans and are not subject to the same rules as other retirement accounts, namely 401(k) and 403(b) plans.
Instead, account members can withdraw funds from their HRA VEBA at any time. The only rule is to use the funds to reimburse an eligible expense.
This means employees have more freedom on withdrawals. They can withdraw money from the account to pay for eligible expenses before the standard deadline (age 59) without a tax penalty.
The debit cards that come with an HRA VEBA are provided at no additional cost. Plus, the cards come with smart-card technology and the ability to stack multiple plan types on one card.
When a member is enrolled in another pre-tax account and then enrolls in an HRA VEBA, the funds for both accounts are available on the same card. In most cases, the card will automatically pull from the correct account when purchasing eligible items.
While an employer-funded HRA VEBA might raise concerns among employees about enrolling, there is more flexibility with account usage than employees might think.
Not only do employees have access to HRA VEBA funds during their employment, but they can also use the funds in retirement and if they change employers.
This plan’s flexibility is less common among other pre-tax accounts and is one of the more significant hidden advantages of an HRA VEBA.
HRA VEBAs are a great fit for a variety of groups. Municipal/public-sector employers, schools, and universities, as well as Taft-Hartley union groups can benefit the most.
To learn how your employer groups can leverage HRA VEBA accounts to reduce costs and offer employees the healthcare coverage they need, download this flyer.
Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
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