Tag Archives: Business

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/

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

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

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.

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.

This Blog is for you!

Welcome to the HR Trendster Blog.

What’s a Trendster?

There doesn’t seem to be a good definition for the word. However, I can tell you – it’s me! I follow (and comment) on what’s current and hip in the world of Human Resource Management. I offer knowledge, opinions, and advice on the subject. I’m a trendster!

Who’s the audience?

You. This blog is for anyone in the Human Resource profession, those who have Human Resource-related questions, managers with a desire to do what’s right, or anyone who has ever known or seen a Human Resource professional (that covers nearly everyone). Mostly, this blog is for those of you who have questions, and are looking for a little advice. I don’t have all of the answers, but I’m a certified Senior Human Resources Professional (SPHR), (the HR folks really like the certification thing), with more than 10 years of Human Resource experience in a variety of industries and positions. Currently, I am the Director of Human Capital Management for a non-profit.

In other words, try me out!

Pop in to read a post, ask a question, or stalk my page.  Everyone’s welcome.

Send your questions to the HR Trendster.