Open Enrollment Series Part 2: What’s a Deductible Anyway? And 4 Other Health Insurance Terms You Need to Know

Now that the election is over, it’s time to turn the focus back to YOU as you begin to make decisions for your 2017 health benefits.  As I mentioned in the last blog, this series is about YOU and your Open Enrollment.

Certainly, anyone who has ever had health insurance is familiar with the term, deductible. However, I find that many people do not fully understand what a deductible is or how it impacts their health insurance plans, premiums and overall out-of-pocket costs. Today, I would like to review deductibles and four other frequently used health insurance terms.

  1. Deductible

The deductible is the amount you will need to pay for health insurance services before your health insurance begins to pay towards your healthcare services.  The deductible may come in at any point depending on what type of health insurance plan you have.  Some plans, specifically high deductible plans (see below), do not pay anything until the deductible has been entirely met, with the exception of some services such a preventative care.  Once you have paid your plan deductible, your health insurance will then cover the costs, and you will only have to pay the required copays or co-insurance.  Your plan’s Summary of Benefits will detail which type of payment is required.  On the Summary of Benefits, you may see the following: X-Rays and Lab Work – $0 after deductible.  This means that you must first pay your deductible, then, you will not have to pay for x-rays and lab work.

Example: Deductible = $2000. The cost of an x-ray is $150. If you have not paid any of your deductible, the cost of the X-Ray to you will be $150. However, if you have already paid your deductible, your cost for the X-ray would be $0.

It’s also important to note that your prescription plan may have separate deductibles from your medical plan.

Example: Medical Deductible – $2000; Prescription Plan Deductible – $100 (this means that you must pay $100 towards your prescriptions before your prescription plan begins to cover your medications.)   Some drugs are covered at no cost.

  1. Copayments (Copays)

Not to be confused with coinsurance, mentioned below, is the amount that you agree to pay as part of the service that you receive.

Example: A visit to your Primary Care Physician may have a visit co-pay of $20. Even if you’ve already met your deductible, $20 is your co-payment.  If you have not met your deductible, you will pay the co-payment + the allowable cost of the service.

  1. Co-Insurance

Similar to copays, except co-insurance is typically detailed in percentages.  Co-Insurance is the proportion of costs that you pay after your deductible is paid.

Example: The allowable fee for a service in your plan is $100, if the co-insurance is 20%.  You would pay $20 – once your deductible is paid.  If your deductible has not yet been satisfied, the amount you would be responsible for is $100.

  1. Flexible Spending Accounts (FSA)

A Flexible Spending Account is an account that you set up with your employer to put aside pre-tax money for qualified medical expenses and reimbursement.  Why should I do this? These funds you set aside for medical expenses are not taxed. Therefore, your overall taxable income is lower.  Below is an illustration from Benicomp.com of how you may benefit from enrolling in a Flexible Benefit Account.

 FSA Tax Savings Example
With FSA Without FSA
Annual Pay $35,000 $35,000
Pre-tax contribution to reimbursement account -$1,500 $0
Taxable income $33,500 $35,000
Federal income and social security taxes -$7,107 -$7,597
After-tax dollars spent on eligible expenses $0 -$1,500
Spendable income $26,393 $25,903
Tax savings with the FSA $490 $0

Before you go crazy with allotting funds to your flexible spending account, keep in mind that this money is not refundable and is forfeited if not spent by the end of the year (some plans offer the opportunity to carry-over a small amount – check with your Flexible Spending provider).  Therefore, it’s important to estimate your qualified medically related expenses before determining an amount to contribute.  FSA’s are great if you have predictable expenses such as maintenance drugs, glasses, contacts, braces, copays, coinsurance, deductibles, etc.  If you are unsure of what items are covered under a qualified medical expense, click here for a full list of what’s acceptable according to the IRS.

  1. High Deductible Health Plan (HDHP)

A High Deductible Health Plan (HDHP) is a plan with a higher deductible than traditional health insurance plans.  With HDHPs, typically, you are required to pay the deductible before any claims are covered. An exception may be preventative treatments and appointments that are 100% covered. The benefits of an HDHP are that you may use them in conjunction with a Health Savings Account (HSA) – not to be confused with an FSA, as mentioned above.  If you are interested in learning more about an HSA plan and what to consider in determining if this is the right choice for you, check out this article on MyFabFinance.com.

Today’s health insurance is not your parents’ insurance.  Gone are the days of health insurance plans with $0 deductibles, $0 co-pays and $0 co-insurance.  Those plans still exist, but they’re also extremely expensive.  It’s time to take ownership of your health insurance and shop it with the same research and intensity as any other major purchase.

Are there any other health insurance terms that confuse you? Sound off in the comments section below!

Check out Healthcare.gov for a glossary of terms related to your healthcare.                                                                                  

Photo copyright:http://www.episcopalhealth.org/en/blog/articles/do-you-really-understand-health-insurance-terms/

Advertisements

5 Things You Need to Know about the Affordable Care Act (ACA)

Happy November! We’ve successfully made it to Fall. This time of year means the changing of the leaves, pumpkin EVERYTHING, and for many of us, Open Enrollment for our benefits. Like me, many of your employer’s benefit plans begin on January 1st, which means that within a few short weeks, your employer will start to bombard you with emails, flyers, presentations, and fairs – all related to choosing your benefits for the upcoming year.

For some, this time is easy, perhaps you are still part of the group who can, thanks to President Obama, stay on your parents’ insurance until 26, or, you’re a dependent on your spouse’s or partner’s plan. For you, this time of year does not mean as much, although I encourage you to check out what your employer is offering. You may find that it’s a better option for you and your family. One of the things that I’ve found as both an in-house HR practitioner and as a consultant is that selecting your health insurance is a complicated and confusing process for many – even the smartest of us all. Therefore, over the next week, this blog will be devoted to Open Enrollment and to removing (hopefully) some of the intimidation from the process.

The first post in this series is related to health insurance and the Patient Protection and Affordable Care Act of 2010 AKA Obamacare.

If you read the paper or watch the news, you’ve heard of Obamacare. Obamacare, technically titled the Patient Protection and Affordable Care Act (ACA) is a law that was passed by President Obama in 2010. One of the main goals of the Affordable Care Act was to ensure that all citizens have access to quality, affordable health insurance coverage. In this political season, the ACA is something that we hear about almost daily, but I’ve found many people do not understand the law or how it relates to them. I hope this post will help to demystify the ACA and offer a better understanding.

5 Things you should know about the Affordable Care Act:

1) Affordability
You may be thinking that affordability is relative. However, when it comes to health insurance, the ACA has defined it for us. Under the ACA, affordability is no more than 9.5% of your monthly salary. That is, your employer must offer you a plan in which your monthly contribution to the premium is not more than 9.5% of your monthly salary*. If your plan is not affordable, you may shop for a plan within the Marketplace, where if there no affordable plans, you may apply for an exemption.

*If your employer’s plan is not affordable, the company may be subject to IRS penalties.

2) The Marketplace
Typically, the term Marketplace would have a lovely connotation. I picture Etsy, with beautiful handmade jewelry, clothing, and other artistic flares. However, when referring to the Health Insurance Marketplace, it can seem a little intimidating – but it shouldn’t be. It is exactly how it sounds. A place where you can purchase the health insurance of your choice based on your and/or your family’s needs.

Why would you need to go to the marketplace if your employer offers benefits? There may be a few reasons 1) Your employer’s plan is not affordable (see definition above). 2) If you do not meet your employer’s eligibility 3) You are unemployed.

Some states have their own Health Insurance Marketplace, others, defer to the federal Marketplace. You can access your state or federal marketplace here.

3) Minimum Essential Coverage (MEC)
Minimum Essential Coverage is the coverage you will need in order not to receive a fee for lack of insurance. To be in compliance with the law you must maintain minimum essential coverage throughout the year, get an exemption, or pay a fee for each month you go without it (although you are allowed less than three months in a row each year without coverage, due to a coverage gap exemption). You’ll report minimum essential coverage on your Federal Income Taxes for each month you or a dependent had coverage.[1]

4) No Cost Preventative Care
All health insurance plans must coverage certain preventative treatments at no cost. Therefore, procedures such as pap smears, annual physical, and mammograms are covered for free. This is an important part of the ACA to note. Many people choose their plans based on the co-pays, co-insurance, etc. However, if you’re a person who typically only uses insurance for annual check-ups, exams, and procedures, you may not have as many out-of-pocket costs as estimated.

5) The Law Holds Health Insurance Companies Accountable
To ensure premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers.[2]

Did you receive a rebate from your health insurance provider last year? This could be why.

I hope this short list helped to take some of the mystery out of the Affordable Care Act. Of course these “5 things” are just a few highlights of the Affordable Care Act. If you’d like to read the law, you may do so here.

Next up in this series related to Open Enrollment: What’s a deductible, anyway?

More information related to the Affordable Care Act can be found at the Health and Human Services website. http://www.hhs.gov/healthcare/about-the-law/read-the-law/


[1] http://obamacarefacts.com/minimum-essential-coverage/
[2] http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html
Photo Copyright: <a href=’http://www.123rf.com/profile_ismagilov’>ismagilov / 123RF Stock Photo</a>

Which Mask Are You Wearing?

Happy Halloween! While I have pumpkins in my entry way and will take the child out for treat-or-treating, I can’t say I’m a person who’s really into Halloween. There are some who goes “all out” for this holiday. However, coming up on Halloween made me think about masks and the ones we wear daily – and we all wear them. I don’t mean to imply that we are not always attempting to be our authentic selves, but there are definitely times when I feel like I’m wearing a mask – especially at work.

I don’t think that in wearing a mask, you’re completely inauthentic or fake. However, I do feel that when you don’t work for yourself and are representing someone else’s brand/image/product, you are wearing a mask of sorts. Also, let’s face it, these masks are often required if we want to sustain our livelihood. For many people, donning this mask is why they often branch out on their own and do things such as consult, open their own business or switch professions altogether.

Wearing a mask at work may simply involve selling a product that you don’t believe in, or the more extreme, not being able to be who you truly are. Some people are closeted at work or, some individuals feel that they cannot celebrate their cultural heritage and identity at work. These are more extreme cases of mask wearing, but you would be surprised how many people are wearing such a disguise.

In honor of Halloween (or maybe reverse Halloween ☺), I’d like to recommend that we take the masks off! Can you imagine how awesome our work environment would be if instead of wearing the masks we think are required, we were our true selves? What a culture of diversity and truthfulness it could bring?!

Are you wearing a mask? What mask are you putting on each day? What’s your scariest professional story? Feel free to share in the comment below!

 

Photo Copyright: tatyanagl / 123RF Stock Photo

Can’t Knock the Hustle

Today’s post is a short one. However, I had a bit of inspiration that I couldn’t ignore. If you’re familiar with this blog, I’m sure you know that I can find a Jay Z or Beyoncé song that’s relevant to just about any situation in life. Today is no different. I’ve been looking for a vendor to do some work for me, and I have been interviewing various people. Yesterday, I spoke with a young woman who impressed the boots off of me. What was so impressive was that she was the wrong fit for what I was searching, however, everything from her presentation to her passion, drive, professionalism, and style was great! Although this opportunity was not a match for us to work together, I’m sure we’ll connect on a future project. After I met with her, I just kept hearing Mary J. Blige singing the hook to Jay Z’s, “Can’t Knock the Hustle” in the back of my mind. I’m rooting for her success, and I don’t even know her.

We often allow ourselves to let rejection or a denial influence how we operate. The truth is, sometimes constructive criticism is helpful, and we often need to take a personal inventory to see if we’re heading in the right or wrong direction. However, there are other times when we’re rejected or denied simply because the objecting body is not a match. When this is the case, there’s no need to alter our style. Eventually, there will be a vessel large enough to handle all that you have to offer. This young lady was a great reminder that sometimes your wattage is too much for some lamps, but that’s no reason to dim your light.

Photo Copyright: <a href=’http://www.123rf.com/profile_idspopd’>idspopd / 123RF Stock Photo

Freedom Friday: Where’s your Gold?

Happy Friday! What better way to end the week than with a little non-HR related post (we can’t be all HR all of the time). Today’s post is completely off topic. In fact, each Friday, I’ll break away, and we will have a little Freedom Friday.

Like the rest of the world, I have spent the past two weeks in awe of the world’s greatest athletes. I am not a huge sports fan. I will watch a Sunday football game now and then (not the during the week Monday/Thursday games). And of course, I watched the Beyoncé concert this past February when she allowed two football teams (Panthers and Broncos) to open and close the show ☺. However, the Olympics are different; they’re special.

I, like many others, am partial to the Women’s Gymnastics portion. I love it! Every time one of those young ladies hits the floor, my heart beats like I am up for a medal. Since I am a native Marylander, and a fan of super athletes, I’ve also been obsessed with Michael Phelps and Katy Ledecky’s swimming performances. Also, don’t get me started with this year’s Track and Field Events. When the U.S. Women’s Relay team dropped the baton during the qualifying race, my heart fell onto the floor. Track and Field overall has me more pumped than usual. Usain Bolt. Enough said.

It started me thinking, where’s my gold medal? Of course not my literal medal, but at least a gold star or something. Let’s be clear; I’m no athlete – unless you count the Elliptical – I’m like this lady on the elliptical, lol. As I was saying, it started me thinking of what types of activities could I compete in where I could earn a medal? No one is great at everything; however, I do pride myself on a few outstanding accomplishments each day. I present to you my Top 3 Gold medal events…

1) The DODGE – The amount of people I manage to be pleasant to before obtaining my morning latte. I seriously feel like I’m running hurdles and dodging balls trying to get to the first sip before the next person who speaks feels the entire wrath of my commute.
2) The COMMUTE – Speaking of commuting, I definitely deserve a Gold medal for making it around the beltway without honking my horn, cursing someone out, or giving any hand gestures. It is a real talent, and if you have ever been on I-495 circling Washington, DC, you will appreciate what an accomplishment this is.
3) TARGETING – Finally, and I have little competition in this event. Going to Target with a list of 3 items and coming out with 37 additional things. Just call me the Simone Biles of extra spending at Target.

There you have it ladies and gentlemen, my top three gold medal events! What daily activities would earn you a gold medal? I cannot wait to hear them all!

It’s Never Too Late

I am the queen of saying “In my next life, I’m going to do…”. Recently, I’ve found myself saying it more often. Whether it refers to some small choice I’ve made related to the type of vehicle I drive, or, city living vs. suburbia. However, mostly when I say this, I’m referring to my career choices. I love what I do, but I often wish there was a different way for me to apply my experience. That’s part of the reason why I started this blog. I wanted to mesh my knowledge and passion about Human Resources (yes, I have a passion for HR) to my love of giving advice and helping people solve their personal problems.

Recently, I’ve received several signs from the universe that I simply can no longer ignore. I stumbled across an old Business Insider article which detailed several famous individuals; artists, authors, actors and many other known successful people who achieved success or switched careers later in life. Warning: later in life often refers to life after 30 (yikes).  Then, I ran across this quote: It is never too late to be what you might have been – George Eliot.

It finally occurred to me that while I had been saying it jokingly, the reality is that there isn’t another life (as far as I know). I only have one. I am not super-young, but, hopefully, have plenty of years ahead of me. Moreover, while I did not necessarily start the process when I wanted, there’s no reason why my goals must disappear, simply because I’m starting 15 years later.

It was not my intention to share this personal epiphany with the blogosphere. However, there are so many of us who stop short of our dreams because we got married, got divorced, had children, didn’t finish school, ran out of money, the task seemed too daunting, and countless other reasons why our goals may have been deferred. Contrary to what Drake told us, if you’re reading this it’s NOT too late. There are a million other mantras and clichés that say some form of the same thing. The point is, we only have one life. I’ve decided that instead of talking about what I could have done, I’m just going to do it – or die trying. I recommend you do the same.

— Andrea

New Overtime Regulations: What’s it to you?

Overnight, you may have seen in the news that President Obama will be signing into law new Overtime Regulations under the Fair Labor and Standards Act (FLSA) today. The FLSA, in addition to many other things, outlines overtime regulations.

What does this mean for you? If you are currently exempt from earning overtime payments – which is typically 1.5 times your hourly rate for any hours worked over 40 hours per week, you may now be eligible – if your current salary is less than $47,476.

But before you head out to buy those new Louboutins with your extra overtime dollars, please note that this law is not effective until December 1, 2016. This time gives your employer the opportunity to assess their current compensation strategy. Maybe they don’t need you to work those extra hours you’ve been putting in over 40 per week, and they’ll implement a no overtime rule, or perhaps they’ll bump your salary up to the $47,476 threshold, or pay the overtime. This change may have an enormous impact on your employer, and they will have to make adjustments.

This brief post details only a portion of the FLSA and the key provisions of the final rule.  If you are interested in learning more about the new FLSA Overtime Regulations, pop over to the DOL website for more information. overtime-rule-explanation

overtime-map
Number of workers impacted per state. 

Overtime updates will extend protections to 4.2 million workers across the country. *Infographic courtesy of http://www.dol.gov/featured/overtime.

Millennials Are Not Evil

Well, maybe some of the trolls on Twitter are, but, for the most part, they’re harmless. For some reason, whenever they’re mentioned in the workplace, someone inevitably rolls their eyes. Not to give away my age too much, but let’s just say Destiny’s Child (3 member version – not the 4) was singing “Survivor” when I was accepting my undergraduate degree. Therefore, I sit right on the cusp of being both a Generation Xer and a Millennial. When I first started my career in Human Resources, I read studies conducted on the interaction of Baby Boomers (born 1946 -1964) with the Gen Xers (1965 – early 80’s) and attended seminars on how the two will coexist and how we can all just-get-along. This was a major area of study during that time. Now, the hype is around the Millennials (early 80’s – mid/late 90’s)  and how this Uber loving, Snapchatting generation is going to take us all down (that’s a slight exaggeration, but you get the point). In my line of work, I’m often privy to people’s birthdates. Believe me, the first few times I saw 199x as a birthdate of a new employee, I thought we were hiring high school student workers. I couldn’t fathom that someone born in nineteen ninety-anything was old enough to have completed college AND entering the workforce. After all, I’m barely out of college (not really, but I still feel young). However, they’re here now, so let’s get over it.

I completely understand the feeling of no longer being the young starlet. It wasn’t that long ago I would give people my title, and they would say, “At your age?!”. Or, they would find out my age and could not believe the position I held. Now, I tell people my age and/or title and they respond, “That’s nice.” It’s a hard adjustment; especially if you’re a person who’s been a high achiever your entire life and now you’re no longer the child prodigy. You’re actually at a place in life where you are going to be held accountable, and no one is going to cut you any slack because of your youth or inexperience. Hopefully, you’re at a place in life and career where you’re okay with that.

Now, back to the Millennials – they’re here and here to stay. And unless there’s an Instagram apocalypse that wipes all of their users off the face of the earth, they’re not going anywhere. So here are four tips for coping with these newbies in the workplace.

1.  Mentor: It wasn’t that long ago you were in their shoes. You remember what it was like to be new, smart, excited and still no real clue of what you were doing. You’re young enough in age to relate, but old enough to have wisdom too – don’t be stingy. Share what you’ve learned, the good, bad and ugly. We all need coaching, and it’s nice to know that someone is in your corner and can help you navigate your way through your career and professional life.

2.  Teach (very similar to mentoring): I realize we’re talking about work and, for the most part, we just want to get in, do the work we’re hired to do and leave. However, whether you have Millennials who report directly to you, are peers, or even supervise you, this is your opportunity to share what you’ve learned with them. You don’t have to limit teaching to job specific tasks. Teaching can involve introducing someone to professional associations, guiding them through the nuances of the organization, or simply serving as a sounding board for ideas.

3.  Learn: While I’m sure you’re wondering what you could possibly learn from someone who has never taped a song from the radio. There is much to learn from a person who has grown up in such an insta-society. Their perspective is different, and it presents new ways to look at the world and possibly at the work.

4.  Embrace: Again, they’re not going anywhere. Instead of being the old person who sits around the water cooler complaining that the new girl is wearing yoga pants to work (btw, this is rarely okay). Help guide her into the role of the young professional she is capable of becoming. Also, maybe she can teach the marketing department how to cut the advertising budget by using social media outreach.

Follow my blog with Bloglovin

It’s Been a Long Time, I Shouldn’t Have Left You

Hello…again. I took a brief hiatus from the blog; however, I’m back with a new focus on you, the readers. I’ve returned with great information and a new format that I hope you’ll enjoy.

For those of you who may be new to HR Trendster, it’s a blog for YOU. As an HR Consultant, I usually work with business leaders, CEOs, and other executives to provide human resource advice and consultation for their organization. Yet, I find that my passion lies in working with individuals who are seeking advice and guidance for their personal career goals. I often meet or am connected with people who need professional help. It may be counsel on how to handle a difficult co-worker, employee, or boss to questions regarding interoffice romance (don’t worry I’ll address that soon) or interviewing techniques. I find that’s the work I enjoy most.   And that’s what I mean when I say, “this blog is for YOU.” It’s your opportunity to ask questions, get advice and read posts that relate to what matters to you.

I’m looking forward to a great conversation with you all.

Stay tuned. An exciting new addition to the HRTrendster site is coming, and you can join in the fun!

Be Safe (At Work) This Halloween

As Halloween approaches, I’d like to make a public service announcement. Don’t do it!

Does your company allow costumes to be worn to celebrate this fun, candy-filled holiday? As an HR practitioner, this makes me cringe. I hate to be a party pooper, and I do enjoy Halloween (see, I can get in on the action). What concerns me is the possibility of the inappropriate costumes that are sure to flood the workplace. I think most of us know not to wear racially insensitive costumes or ripped-from-the-headlines-inappropriate outfits, for example, a sexy Ebola nurse (yes, it’s real) costume. If not, check out some of the repercussions of doing such a thing in this article from SHRM. However, I’m most concerned with the other costume choices some people may make. I get it. If you’re in a professional work environment you often feel trapped by having to wear your business professional attire, it often feels like summer vacation when you can sport your best dressed down outfit. At last, you have an opportunity to let out that bit of your personality that you’ve been dying to release at work. Unfortunately, Halloween may not be the time to do this.

Once you wear something like this to work you cannot take it back. You may show up on Monday ready to get back-to-business, unfortunately, your co-workers will still have visions of you in the costume that showed way too much leg/cleavage/butt. Or, the decision you made to show up without a shirt because you thought it would be fun to come as a caveman to the office Halloween party, may continue to haunt you all year. I know a lot of people feel like it’s no big deal. We’re all adults and people understand that Halloween is for fun, and the best part of it is that you get to dress like you normally would not. Unfortunately, it’s not that simple, and you’re always under the microscope at work – no matter what someone else says. I’m not saying that your boss and peers are unable to separate the professional you and the Halloween you or that one costume will throw away years of hard work. But consider the last time you saw a CEO in thigh-high boots or with a necktie around his head. You don’t want this one outfit to call into question your judgment or limit your career growth because a co-worker posted a picture of you on their Instagram page.

I recommend playing it safe for the office Halloween costume. You can throw on those Mickey/Minnie Mouse ears or Superman shirt (minus the tights) and call it a day. If your inner-self feels compelled to go as a “sexy” anything – tell him/her no, and save that for the Halloween pub-crawl this weekend.