By Tess Taylor. Employee Benefits Expert
Welcome to the Employee Benefits channel, your source of current information and news about benefits in the workplace and health care reform. Tess C. Taylor, CPC, PHR, SHRM-CP a certified Human Resource, Wellness Content Manager and Career Coach, is your Expert who will guide you through this exciting area of business.
The business landscape of employee benefits administration has changed dramatically in the last decade, with an increased focus on supporting health and wellness for employees and their dependents. Human Resource and Benefit Administrative professionals are tasked with securing affordable options in health and lifestyle wellness insurance to support this effort. Likewise, employees are empowered to take steps to improve their lifestyles through employee benefit and wellness programs that support weight loss, smoking cessation, and stress reduction programs.
Check back often at the Employee Benefits channel for important news and updates that can have an impact in the workplace. You are welcome to share them with your networks and link to them in your blog posts and online content.
When employee benefits include access to health insurance coverage, it may be difficult to decide what kind of health insurance to choose. However, health insurance is a topic that everyone should discuss with their partner, spouse and family members, especially since it can protect members in the case of unexpected illness or injury.
Walking through life without health insurance is a risky option to take, but unfortunately many people do it because they simply cannot afford the coverage.
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According to the most recent US Census, in 2009 there were 48.6 million Americans without adequate health insurance; almost 16 percent of the population. While the Affordable Care Act of 2010 has taken strides towards correcting this problem, giving access to healthcare to 10 million people since it went into affect, the fact is that everyone who is eligible for employee benefits or government funded health insurance should consider that this can help pay for preventative health care that can stop many illnesses that cost individuals billions in medical bills annually.
Why You Need Health Insurance
Everyone needs health insurance for the simple fact that you never know what will happen to you in the future. Like a ticking time bomb, an illness or disease can develop overnight, you could be injured in a car accident, or you could lose your life after a long battle with a disease.
No one knows what is waiting around the corner and we are not trying to scare anyone or be negative, but this is the truth. You cannot predict what will happen to you tomorrow. If you do not have health insurance and you contract an illness, you will be paying very high fees for medical treatment.
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Affordable Care Act Requirements for Minimum Health Insurance
When the Affordable Care Act went into effect, it brought with it requirements for minimum health insurance. Employers are
now required to provide their employees with health coverage if they meet certain staffing levels. The new minimum standards required by the Affordable Care Act include the following:
The minimum standards for benefits is known as the Essential Health Benefits package.
The minimum standard for cost-sharing is that the health coverage plan has to pay 60 percent of health care costs.
The benefits that must be provided in the program include ambulatory services, emergency services, maternity care, hospitalization, prescription drugs, laboratory services, mental health and substance abuse treatment, children’s dental and vision care, chronic disease management, rehabilitative services and preventive services.
How to Choose the Right Health Insurance for Your Needs
When deciding it is time to choose a health insurance plan, you need to perform a good amount of research so you can make an informed decision. When you browse the marketplace created by the Affordable Care Act, you will come across five categories of plans. Those categories are bronze, silver, gold, platinum and catastrophic.
One of the most important factors you need to consider is the monthly premium. This is the payment you make monthly to the insurance company. You pay this premium each month whether or not you use the medical coverage provided. This should not be your lone factor in making the decision.
You should also consider the out-of-pocket costs that come with each plan. These are paid on top of the monthly premium. For example, if you go to the doctor for a sick visit, you might have to make a co-pay for the visit. If you are taken to the emergency room for a broken arm, you might have to pay a fee before the insurance kicks in for coverage.
When looking for a health plan, find out which ones offer out-of-network coverage. This can be especially important for those who travel around the country frequently for their job. If you do not travel often, this will not be a major factor in your decision. Make sure you check if the plan will cover out-of-network pharmacies, hospitals, doctors and other medical providers.
Special Considerations for Choosing Health Benefits
Some of the things you need to take into consideration when choosing health coverage include the following:
Are your current medical conditions grandfathered in to a new plan?
Are there any changes to a plan prior to enrolling for another year (new family member, spouse, etc.)?
Will the plan allow you to see your favorite doctors or use your preferred health providers?
Do you need a more comprehensive plan because you are readying for children or have special health concerns?
Choosing a health insurance plan should not be taken lightly, which is why you must perform your due diligence prior to signing up for a plan. Select the right employee benefits from those that are offered to you through work and then get additional coverage for special health concerns or associated risks as needed.