Why Should I Use SBHIN as a Benefits or Insurance Broker?

As your employee benefits broker, we represent you, the client, not the benefit providers

How can SBHIN help you?

§  We assess your needs

§  We provide you with product/provider information

§  We quote appropriate plans

§  We assist with employee enrollment

§  We manage the provider relationship

§  We repeat this cycle at time of renewal

Does working with SBHIN cost me anything?

All the services offered by SBHIN are provided at no extra cost to you. If you buy a health insurance plan through us, you'll pay the regular monthly premium to the insurance company you chose, but you'll pay nothing to us. Our fees are paid by the insurance companies in the form of commissions, which are built into the premium amount.

Do you offer the best prices?

Health insurance premiums are filed with and regulated by your state's Department of Insurance. Whether you buy from us or directly from the health insurance company, you'll pay the same monthly premium for the same plan. We provide a higher level of personalized service at no extra cost to you. This means that you can enjoy the advantages and convenience of shopping and purchasing your health insurance plan through us and rest assured that you're getting the best available price

Do you save money going direct to the providers?
No. More than ninety (90%) percent of all benefit plans are sold through brokers. Providers do not compete with brokers by offering lower pricing on direct sales. A benefits broker is essentially a free resource for your company.

Can you change brokers at anytime?
Yes. If your broker is not meeting your expectations, you may select a new broker at anytime and redirect commissions to your new broker with a simple letter. If you need a broker or are dissatisfied with your existing broker, please call us today

What is the basic difference between individual and group health insurance coverage?

An individual policy is purchased by you directly with the insurance company. With a group health insurance policy, the group is the master insured and the insurance company contracts with the group. Insurance certificates, issued to a participating member, act as your policy. Often group health insurance costs less than would have been charged had the insurance company sold individual policies to each member separately. In addition, group health insurance often contains special coverages that are not available or are very expensive on an individual basis. The purchasing power of the group makes this economically feasible.

What are the benefits of providing group health insurance to my employees?

It's no secret that employees value health insurance benefits. Surveys have shown that workers value health insurance coverage second only to monetary compensation. By offering group health insurance benefits to your employees, you may find it easier to hire and retain the best workers for your company.

Additionally, there are various tax incentives available to you and your employees when you participate in a group health insurance plan. For example, businesses can generally deduct 100% of the premiums they pay on qualifying group health plans and, by offering group health insurance as part of a total compensation package; you may be able to reduce payroll taxes. Plus, your employees can pay their portion of the monthly insurance premium with pre-tax dollars. Make sure that you take these incentives into consideration when determining the affordability of a health insurance plan for you and your employees.

What types of group health insurance plans are available?

The three most commonly available health plans are the following.

1.       HMO (Health Maintenance Organization)
In an HMO, you must select a primary care physician (PCP) who coordinates your care with other physicians within an HMO network. Your PCP must refer you to a specialist. From a financial perspective, the covered employee need only pay the small co-payments listed for services and prescription drugs. There are no deductibles or co-insurance.

2.       POS (Point of Service)
A Point of Service (POS) plan is essentially an HMO with one added benefit. A POS allows you to "self-refer" to another physician or specialist without the approval of a Primary Care Physician. When you do so, however, a deductible and co-insurance apply. An individual who self refers must first pay the deductible amount and then pay co-insurance (typically 20%) for any charges above the deductible. An "out-of-pocket maximum" places a cap on a covered employee's financial exposure when they seek care without a referral.

3.       PPO (Preferred Provider Organization)
A Preferred Provider Organization plan presents an employee with a different choice and more freedom. The distinguishing characteristic of a PPO is that an employee does not need to name a Primary Care Physician. If they seek care from a "Preferred Provider", the employee pays only small co-payments (like an HMO). If an employee seeks care from an out-of -network provider, the deductibles and co-insurance apply.

How are Health Insurance prices determined?

Monthly premiums for health insurance are typically determined for each group based upon employee characteristics such as: age, industry classification, location and coverage type (Individual or Family). Monthly premiums for Individual coverage may range from $160 to $300 per month while Family coverage can range from $500 to $1,000 per month. The cost of a health plan will usually be higher as you move from an HMO to a POS to a PPO plan

What Kind of Employer Premium Contributions are Required?

Each provider is slightly different, but most insurance carriers require the employer to contribute at least 50% to the monthly health insurance premium

How is Eligibility for Employees Determined?

An "Eligible Employee" is typically defined as a full-time employee regularly working 30 or more hours per week (including owners) and paid in accordance with state and federal wage requirements. For the purpose of meeting minimum participation requirements, an employee may be waived from the number of eligible employees if he/she is covered by a spouse, a parent, or Medicare.

What are Employee Participation Requirements?

Insurance providers will require a minimum level of participation by eligible employees in a group health insurance plan. You may exclude allowed waivers from your total number of "eligible employees". Of the remaining "net eligible employees", usually 75% must elect coverage under the plan. (Employer contribution to premium is usually adjusted to ensure sufficient participation.)

What are Voluntary Benefits?

(Also know as “Supplemental Benefits” or “Worksite Benefits”.) Voluntary benefits allow employers to expand their benefit offerings at no additional cost. These payroll deducted plans are rapidly gaining in popularity and many more employers are making them available to their employees.

Voluntary plans reduce the pressure for more company-paid benefits while providing more benefit choices to employees. Policies are paid for through payroll deduction and are owned by the employees. The benefits are portable – meaning the employee can continue coverage at the same discounted payroll rates even after leaving the company. Plans can provide family coverage as well.

Why is there a need for Voluntary benefits?

Today’s system is flawed. The Core Benefit plans in place today are not set up to properly protect employees against a critical health event. If they become sick or injured and are out for an extended period of time their income gets stripped and expenses increase. Even with medical insurance, there are substantial out-of-pocket costs.  Voluntary benefits fill gaps and pay substantial amounts of cash directly to employees and their covered family members.

Who Benefits the most from these plans?

Voluntary Benefits are a win-win for both the employers and employees. Employees benefit from the convenience of payroll deduction, discounted payroll rates, and the ability to expand benefit coverage customized to their specific needs. Most plans can be paid for on a pre-tax basis. When offered under a Section 125 Cafeteria Plan, there are tax savings for both the employer and employees.

What’s in it for employees?

Voluntary benefits are a powerful complement to every company’s benefit package. Surveys show that when employees can pick and choose their own benefits, employees are happier and retention is enhanced. Specifically, they appreciate the convenience, lower-cost, simplified underwriting, and payroll deduction offered by voluntary products. They also feel employers who supplement benefits packages with voluntary benefits are providing a valued service to employees.

What’s in it for employers?

The very nature of voluntary benefits speaks to the customization you’re looking for and employees are demanding.

§  Save money: employees typically bear all or most of the cost of voluntary benefits.

§  Attract new workers to join the company.

§  Retain talent: 84 percent of employers surveyed believe that offering voluntary benefits increases loyalty and retention.

§  Strengthen your partnership with your employees and increase loyalty.

§  Help employees protect and plan for their future financial security for themselves and their families.

What types of voluntary coverage are available?

Short term Disability

Our Personal Short-Term Disability insurance may help provide you with a source of income if you become disabled due to a sickness or off-the-job injury. It provides monthly benefits for periods of 3 months, 6 months, 12 months, or 24 months. When you own Personal Short-Term Disability insurance, your policy stays with you regardless of job change

ACCIDENT INDEMNITY

Our Accident Indemnity Plan helps cover the expenses associated with an accidental injury. It pays you directly, regardless of any other insurance you may have. Benefits include:

§  Accident Emergency Treatment

§  Accident Follow up Treatment

§  Accident Initial Hospitalization

§  Accident Hospital Confinement

§  Accidental Death and -Dismemberment

§  Many others

LIFE INSURANCE

Term life insurance, whole life insurance, and a combination of both to provide the level of coverage you need. You can apply for up to $200,000 ($100,000 for applicants over age 50) total coverage. In addition, the health questions on your application for coverage do not require a medical exam or blood test. Your premiums will be automatically deducted from your paycheck. Coverage automatically includes a Waiver of Premium Benefit in case of total disability and an Accelerated Death Benefit.

Cancer/Specified-Disease

When a covered individual is diagnosed with cancer, this plan provides benefits for hospital confinement, radiation and chemotherapy, and surgery, among others. In addition, it will pay a First-Occurrence Benefit when a covered individual is first diagnosed as having internal cancer. Benefits include:

§  Hospital Confinement

§  Radiation and Chemotherapy

§  Cancer Screening & Wellness

§  National Cancer Institute (NCI) Evaluation/Consultation

§  Many others

Critical illness - Specified Health Event

This plan pays a benefit when a covered individual is first diagnosed as having a covered life-threatening health event. We pay a First-Occurrence Benefit as well as hospital confinement and continuing care benefits for

§  Heart attack and coronary artery bypass surgery

§  Stroke

§  Major human organ transplant

§  Coma

§  Many others

Hospital Confinement Indemnity

Pays a benefit when a covered person is charged for required hospital confinement of 14 or more hours for a covered sickness or injury. Benefits are determined by state, but may include, among others:

§  Hospital Confinement

§  Hospital Short Stay

§  Surgical

§  Wellness

§  Separate Heart Attack, Stroke, Coma and Paralysis

Dental

Our Dental Plan provides basic, preventive, and major dental benefits to covered individuals. Eligible treatments are listed in the policy by American Dental Association (ADA) code. The Dental Wellness Benefit is payable once per visit, regardless of the number of treatments received. For benefits to be payable, 150 days or more must separate dental wellness visits. This benefit is payable twice per policy year, per covered person. A dentist or dental hygienist must perform the treatment. There is no waiting period for this benefit.

VISION

Coverage is provided for eye diseases and injuries in addition to eye exams and materials benefits. Coverage includes:

§  No provider network restrictions

§  Eye Examination Benefit

§  Vision Correction Benefit

§  Eye Surgery Benefit

§  Specific Eye Disease/Disorder Benefit

§  Permanent Visual Impairment Benefit

Is dental Coverage Really Important to employees?

Yes, surveys have shown that Dental Insurance is one of the most highly valued employee benefits, second only to health insurance

What types of group Dental Plans are available?

The three most commonly available Dental plans are the following:

1.       Dental Indemnity Plan
Under an indemnity plan, the covered employee may seek care from the dentist of their choice. (There is a risk of balance billing, however, if an employee seeks care from a dentist not contracted with the selected dental provider.) The annual maximum for dental plans is usually $1,000 - $1600. Most dental plans pay 100% for Preventative/Diagnostic services and there are no deductibles. For Basic and Major Restorative Care, a covered member would be expected to first pay an annual deductible (typically $50 for an individual and $150 for a family). After the deductible is met, the dental insurance plan would cover 80% of the cost for Basic services and 50% for Major and Orthodontic services. (A separate annual maximum is established for Orthodontic care.)

2.       DMO (Dental Maintenance Organization)
Similar to a health plan HMO, a DMO is a smaller network of contracted dentists. Monthly premiums are typically lower given the more limited choice of dentists. Unlike the "percentage" plan above, DMO's have no deductibles but rather specify a detailed schedule of employee co-pay amounts for each type of dental service. The list of co-pay amounts is often equivalent or better than the 100%/80%/50% levels of coverage under an indemnity plan.

3.      PPO (Preferred Provider Organization)
Coverage under a dental PPO is similar to that of an Indemnity plan except that the deductibles and co-insurance (percentages) are lower for the employee if they seek care from a "Preferred Provider

Are Employer Premium Contributions are Required on Group Dental Plans?

Each provider is slightly different, but most insurance carriers require the employer to contribute at least 50% to the monthly dental insurance premium.

How is Eligibility for Employees Determined?

 An "Eligible Employee" is typically defined as a full-time employee regularly working 20 or more hours per week (including owners) and paid in accordance with state and federal wage requirements. For the purpose of meeting minimum participation requirements, an employee may be waived from the number of eligible employees if he/she is covered by a spouse, a parent, or Medicare

What are Employee Participation Requirements?

Insurance providers will require a minimum level of participation by eligible employees in a group dental insurance plan. You may exclude allowed waivers from your total number of "eligible employees". Of the remaining "net eligible employees", usually 80% must elect coverage under the plan. (Employer contribution to premium is usually adjusted to ensure sufficient participation

What are Mini Med Health Plans?

What is a Medical Gap Plan?

Many companies can no longer afford the 12% to 30% and higher rate increases for group health insurance each year. Employers are forced to pass on to the employees these increased costs in the form of raising deductibles and coinsurance, increasing employee contributions, and reducing or eliminating benefits. Changing or eliminating benefits and increasing costs can cause dissatisfaction with employees, lower morale, and lower employee retention. Employers today are using Medical Gap Plans to reduce group health insurance costs. Medical Gap Plans can not only save employers money, but in some cases save employees money by allowing employers to keep the same benefits instead of lessening benefits, and employees have less out of pocket.

A Medical Gap Plan works directly with your group health insurance or Major Medical Plan. A Gap Plan will reimburse employees directly for Copays, Deductibles and Coinsurance depending upon the plan design chosen by the employer. The Gap Plan can work for both inpatient and outpatient care, including Doctors Office Visits, Diagnostic Testing, Surgery, Emergency Room visits, and Inpatient Hospitalization. If an employer can no longer afford their current plan design and would like to move to a higher deductible plan this sudden change can be difficult for employees. By implementing a Medical Gap Plan this can take the shock of larger deductibles, copays and coinsurance from employees. Medical Gap Plans can also be offered on a voluntary payroll deducted basis, where employers do not pay for the plans, and employees pay for them through payroll deductions.

Medical Gap Plans are important because reducing or eliminating benefits, raising deductibles and coinsurance, and shifting costs to employees reduces employee morale and affects job satisfaction.

What are the advantages of Medical Gap Plans for Employers?  

1. Easy to understand and explain to your employees
2. Quick to enroll
3. Lowers the cost of your group health insurance plan by allowing you to choose a higher deductible with lower premium.
4. Allows Employers to make a smooth transition from a low deductible plan to a high deductible plan
5. Allows some employers to still offer group health insurance.

What are the advantages of Medical Gap Plans for Employees?

1. Offers employees an affordable alternative to higher cost copays, deductibles and coinsurance.
2. Puts Employees in position of cost management
3. Easy to understand
4. Guarantee issue for all employees – no health questions asked.

Can I save Money on Health Insurance by Joining a Chamber of Commerce?

Yes. Your small business can qualify for the most competitive group health benefit rates by being becoming a member of a Chamber of Commerce or Association. Self Employed Individuals and Family Businesses with as few as one employee can qualify for lower group rates. Associations, Chambers of commerce and professional organizations have long recognized the power of an effective member insurance program to help drive membership. SBHIN markets a full range of benefits and insurance programs to groups of all sizes. Find out how you can qualify for the most competitive group health insurance and benefit rates as a member of a Chamber of Commerce or Association.

Group/Individual Life Insurance FAQ’s

Do I need life insurance?

You need life insurance if some person would experience a significant financial loss in the event of your death. A common example of this is the family breadwinner whose income totally or partially supports a family. The death of that person would result in loss of income and financial harm for the remaining family members. Other reasons are to put your kids through school, pay the car note, mortgage, or other debts you have left behind, and pay funeral expenses. Business partners are another important example. The death of one partner might obligate the other partners to buy out the heirs: the life policy can be the source of funds.

Wouldn’t my group insurance from work or social security or mutual fund assets pay these needs?

Maybe, but usually not. The needs are often greater than the available funds. To determine if your other “insurance” would be adequate, you should get a more extensive examination of your needs and currently existing sources of funds.

What is term life insurance?

Term life insurance is insurance that lasts for a specific time, such as 5, 10, 15, 20 or 30-year terms. The policy pays a death benefit in the event the insured dies during the specified period. Since term insurance is for a limited period and accumulates no cash value, the rates tend to be low for a given amount of insurance.

What is cash value life insurance?

In addition to providing a death benefit, cash value life insurance also accumulates a fund that can be used to pay future premiums or serve as a form of savings.

How does cash value differ from term?

In addition to providing a death benefit, cash value life insurance also accumulates a fund that can be used to pay future premiums or serve as a form of savings.

What is whole life insurance?

It is a popular type of cash value insurance that builds up cash value and continues coverage until age 90 or 100. Whole life insurance provides death protection, as its name suggests, for the whole of life. Typically the policyowner would pay the same premium for as long as the insured should live. Premiums can be several times higher than premiums you would pay initially for the same amount of term life insurance, but they are smaller than the premiums you would eventually pay if you were to keep renewing the term life insurance policy until the insured's later years. The value of permanent life insurance is that protection is ongoing – you never need to worry about the term of your policy ending or make decisions about what to do next, so your family’s security is always maintained. Although you pay a higher premium initially for whole life than for term life insurance, whole life policies develop cash values which may be available to the policyowner. Additionally, the policy's cash value can be used as collateral for a loan. If the policyowner borrows from the policy, interest is charged at the rate specified in the policy. Any money owed on a policy loan is deducted from the benefits upon the insured's death or from the cash value if the policyowner surrenders the policy for cash.

What are the traditional types of whole life policies?

In addition to regular whole life which is typically designed to continue until age 90 or 100, plans are available which become fully paid up in a certain number of years (for example, 20-year payment) or at a certain age (for example, life paid up at 65). There are also variations on the whole life concept that allow more than one person to be insured (joint life, family plans) or that have different premium paying structures (single payment life, graded premium life).

What is universal life insurance?

What is Group Life Insurance?

Group life insurance is a form of term life that is sold to companies to cover their employees. Since many people are covered under one policy the cost per covered person is low and the diversity of ages and health situations can often lead to low underwriting costs. For the covered employee, group insurance is usually free or inexpensive, but since it is only in effect while working at that firm, there are risks to making it your only or main insurance. Group life insurance normally includes a provision for conversion to an individual insurance plan when the employee leaves the covered group.

What are the basic types of group life insurance?

The life insurance coverage provided by most group plans is one-year term. The plan comes up for renewal each year, and both the insurance company and the employer have the opportunity to consider whether to continue it. For the insurance company, it is also an opportunity to revise the rates. The employer is the policyholder and each covered individual is issued a certificate showing his or her certificate number. Some group plans include cash value insurance as an option. For example, some employers offer group universal life, which the employee can purchase by salary deduction. Some companies offer individual (non-group) insurance policies purchased at the place of employment. A representative of the company that provides the group insurance coverage is often available at the worksite to answer questions about the group coverage as well as review other family coverage. Additional personal insurance to fill gaps in insurance protection can be purchased at the employee’s option. Other types of insurance include business-related plans such as split dollar insurance where individual policies are purchased. Typically, the employer pays the premiums, with the benefits to be split between the employee and the employer.

What are some of the contrasts with individual insurance?

Life insurance under a large group plan usually involves little or no underwriting. If you work at the company, you are automatically covered. Smaller group plans sometimes require some underwriting—the smaller the group, the more underwriting they may require. Individual policies often require you to prove insurability by supplying medical information and perhaps submitting to a medical examination. Under group life, the company is the policyholder, so company management determines if the insurance is to be continued or modified. In companies with unions, the union’s labor contract may also specify some of the terms of the coverage. If you have an individual policy, you control the policy and you can take steps to have it have it modified or terminated yourself. Group life coverage does not continue if you quit your job or are terminated, though you probably have an option to convert to a permanent individual policy within 30 days. A personal life insurance policy is not related to your employment and so it will continue when you change jobs.

What are the limitations of a group plan?

It is usually not portable if you leave your employer and go to work elsewhere. In addition, the employer makes the decisions about whether to continue the insurance, how much coverage you will have, and who the insurer will be. Some recent benefit plans, though, do offer a degree of choice in so called “cafeteria plans.”  If your employer goes out of business or eliminates your job, you lose not only your job, but also your benefits.

What are the advantages of a group plan to the employee?

The employer usually pays some or all of the cost. For a noncontributory plan the coverage is a nontaxable benefit up to $50,000. Above $50,000, the IRS charges tax on “imputed income.”  Because many people are getting their coverage under one policy, the per employee cost tends to be low and the underwriting minimal. You do not have to write checks to pay the premiums. If you contribute to the cost, it will usually be deducted from your pay.

What is Disability Insurance?

Disability Income Insurance is insurance coverage that provides monthly payments, up to a specified amount and for a specific time period after a covered illness or injury occurs. Insurance must be purchased prior to your illness or injury. Disability Insurance provides a way to protect your income and your standard of living.

§    Disability Insurance protects your most valuable asset - You, and your ability to earn income. If you become disabled, you most likely will not be able to earn enough income to cover your continued living expenses

§    Disability Income Insurance will provide monthly payments to help meet your daily living expenses.

Who needs disability insurance?

Anyone who works for an income should consider disability income insurance.

You may think the chances of becoming disabled are slim, but statistics tell a different story. Should the unforeseen injury or illness occur, be prepared and protected with a Disability Income Insurance Policy

§     Each year nearly 1 in 5 people become disabled for 1 year or more before the age of 65.

§     One in seven can expect to be disabled for five years or more.

§     Almost half of all home foreclosures are the result of a disability. While just 3% are due to death.

§     Nearly half of the 1 million Americans who filed for bankruptcy protection least year did so after being sidelined by an unexpected illness or injury.

§     Nearly 70% of all disabled people that apply are rejected for Social Security benefits.

Do I Need Disability Insurance?

Some compelling questions individuals need to ask themselves when considering the cost of disability insurance.

1. What do you want to happen if you become disabled?
2. If you spend the extra money to purchase disability insurance coverage and DO NOT become disabled, how will your lifestyle be affected?
3. If you do not purchase disability insurance and DO become disabled, how will your lifestyle be affected?
4. If you had been on the horse instead of Christopher Reeve, what would your life look like today?

What does disability insurance cover?

After an initial period called the “elimination” or “waiting” period, disability income insurance pays a specified percentage of your income while you are disabled. The payments continue for the duration of the disability or until the maximum time limit stipulated in the policy. As a rule, insurance companies will not allow you to have disability coverage for more than about 60 percent or 70 percent of your normal taxable income.

What Features Do I Look For In A Disability Income Insurance Policy?

§    A favorable definition of disability as it pertains to your "occupation" at the time of disability.

§    A "non-cancelable" provision that guarantees a company cannot cancel a policy or change the premium rates.

§    A "guaranteed renewable" provision that guarantees that the policy terms, except its premium, cannot be changed.

§    A feature that allows you to choose between various "waiting period" options.

§    A policy that covers a "partial disability" that prevents you from working full time.

§    A "cost of living" feature that allows your benefit payment to keep pace with inflation.

§    A "future insurability" feature that allows you to buy additional coverage, regardless of your future health, provided that you qualify financially.

What is short-term coverage? What is long-term disability coverage?

The exact definition of short-term coverage varies from policy to policy. Typically, short term can mean up to six months or even up to a couple of years. Social Security disability coverage usually begins after six months, so some people consider it the definition of short term. Long term coverage begins when the short-term coverage ends. Depending on how long term coverage is stipulated in the policy, it can continue for a few years, until normal retirement age, or for the entire life of the insured.

Some policies cover only accidents or only illness, or both. Should I buy a policy that covers both?

You are better off having a policy that covers both accidents and illness, since you do not know in advance what may cause you to become disabled.

Won’t the government take care of me if I become disabled?

No. Although Social Security and certain other government plans (such as your state’s worker’s compensation, Veteran’s disability, etc.) do provide some disability protection, they were not intended to give you adequate replacement income – only to provide a subsistence level of income. Any other coverage will add to this. Only a few states require employers to provide short-term disability coverage. Social Security may provide coverage after 26 weeks, but the requirements are quite strict (you must be totally and permanently disabled and unable to earn an income through any type of employment). Seventy percent of applications for payments are rejected. Even if you are eligible, the payments you would receive are usually not adequate to replace the income loss caused by your disability.

When do social security disability benefits kick in?

Social Security disability coverage usually begins after you have been disabled for six months, provided you meet Social Security’s rather tough requirements. About 70 percent of applicants fail to meet the requirements. If you qualify for benefits, the monthly payments are quite low. Social Security benefits are usually integrated with other disability payments so that the maximum benefit from all sources does not exceed the maximum allowable benefit – which may be close to 100 percent for the short term, but usually does not exceed 70 or 75 percent for the long term.

How does private disability coverage differ from worker’s compensation and state disability?

You buy the policy, select the benefit levels, and pay the premiums yourself. The plan is not based on you continuing to work with your current employer or in the state where you now live. Unlike workers compensation, it is not limited to work-related disabilities. Since private disability coverage is only for the person stipulated in the policy, it can be tailored to fit specific needs.

Do most employers offer group disability coverage?

Not as many as you might think. Only about 40 percent of full time workers have employer-provided long term disability coverage. Group disability coverage became popular after the great expansion of employer-provided benefits around the time of the Second World War. However, it was not as universally embraced by employers as life and medical insurance.

My employer's policy's definition of disability does not match mine. Does it make sense to supplement its policy with one of my own?

Probably. Most people are underinsured for disability and could benefit from supplementing their employer-provided coverage. You should study the details of your employer-provided plan and make sure that you design the right kind of supplemental coverage -- appropriate amounts, waiting period, etc.

Who decides if I am disabled and eligible for benefits, and when I should return to work: my boss or the insurance company?

The determination of when you are able to return to work is a medical decision. It should be made by your doctor. The insurance company or your employer may also want their doctor to be involved in the decision. Once your doctor gives you the O.K. to return to work, you may also be required to pass a physical examination by a company physician before your employer will allow you to return.

If an Employer pays all the premiums are the benefits taxable to a disabled employee?

The general rule is: if you pay the premiums for your policy with after tax dollars, your benefits will be tax free. On the other hand, if you do not pay for the policy (your employer pays), your benefits will be taxable.

What is Short Term Disability Insurance?

Short-term disability insurance provides covered employees with income in the event of a non-work related disability (work-related injuries are covered under legally required Worker's Compensation insurance.) Maternity is covered under most plans as a short-term disability. In a typical plan, benefits are paid at 60% of the employee's gross income. Payments begin on day one for an injury and day 8 for an illness. Payments are made for 90 days.

What is Long Term Disability Insurance?

Long-term disability insurance provides covered employees with income in the event of either a work or non-work related disability. In a typical plan, benefits are paid at 60% of the employee's gross income. Payments begin after a 90-day elimination period. Benefits may be paid until normal retirement age.

What is the typical Employer Premium Contribution on Short Term & Long Term Disability?

Most employers pay 100% of the premiums for group short-term disability and group Long-term disability plans. Voluntary (Employee-Paid) Disability insurance is available for groups with five (5) or more employees.

What is long term care?

Long term care refers to assistance with the very basic, everyday activities that most of us can do for ourselves. We call them ADLs or Activities of Daily Living. As a result of illness, injury or advanced age, many people need assistance in order to eat or dress or bathe. The need for long term care may also result because a person has cognitive impairment. Some people need supervision or reminders to accomplish every day activities, such as using the toilet, eating, bathing, dressing, and so forth.

What is Long Term Care Insurance?

A long-term-care insurance policy enables you to transfer a portion of the economic liability of long-term care to an insurance company in exchange for regular premiums. Long-term-care insurance can pay for skilled, intermediate, and custodial nursing care. Some policies even pay for home health care. It can help protect your family from the potentially devastating cost of a long-term disability or chronic illness

Who should consider purchasing long term care insurance?

Anyone who is age 45 or older should consider long term care insurance when planning his or her insurance needs. "Consider" does not necessarily mean "purchase". Depending upon a person's particular insurance budget, there may be other insurance needs that deserve priority. Certainly, the purchase of long term care insurance should never create a financial hardship.

Who Needs Long-Term Care?

Of those needing long-term care insurance 57% are elderly, 40% are working age, and 3% are children.  

Why Buy LTC Insurance?

Protect Your Assets
You work hard and save your money so that you can enjoy your retirement some day. Maybe you dream about the trips you might take or the fun you’re going to have with all that time on your hands. Chances are, you’re not thinking about the possibility of needing long-term care. Maybe you should. Long-term care is expensive. Today, the national average cost for home care is $20,000 and the cost of nursing home care is $50,000. In thirty years, average costs are expected to more than triple. Is that how you want to spend the savings you worked so hard to acquire? Long-term care insurance can help. It fills the gaps in coverage left by medical plans not intended to cover the cost of a home health aid or the expense associated with nursing home confinement. It provides benefits for long-term care services that may only be covered in a limited way by government programs like Medicare or Medicaid. Long-term care insurance is an affordable way to protect yourself and your family members from the financial burdens often associated with long-term care.

Preserve Your Independence
You’re an independent person. You’ve always enjoyed good health. You may not think of yourself as a candidate for long-term care services, at least not until you’re much older. But long-term care situations can happen at any point during your life, due to illness or an accident. Did you know that 40% of the 12 million people who are receiving long-term care are under age 65? That’s 4.8 million people who probably didn’t think they would need long-term care services either. What would you do if you could no longer manage to do everyday tasks without assistance? Could you depend on your spouse? What about other family members? If they work or live far away, your options become less clear. Long-term care insurance doesn’t just pay benefits for care provided in a nursing home. A comprehensive long-term care insurance plan can pay for services that help you remain at home, like visits from a registered nurse or home health aid or home modifications that can help you manage on your own. Long-term care insurance offers coverage that will give you the flexibility you need to make decisions about the kind and site or care that works best for you.

Why should someone 45 years old worry about long term care?

It is difficult to know in advance who among us is going to need long term care. Also, it is difficult to predict who will develop a medical condition between the ages 45 and 60 that would preclude the purchase of long term care insurance -- when the potential need for assistance with ADLs is just a few years away. Another consideration is the premium, which is generally lower at younger ages. Early purchase can make long term care coverage affordable later on, particularly after retirement.

Does medical insurance cover long term care?

Although medical insurance has some aspects of long term care, they are not the same thing. For example, some medical plans may pay for the services of a nurse while you are recovering from an illness or an injury that requires medical attention. This medical benefit is very limited. Once you are better or reach the maximum benefit for nursing services, this benefit would cease to be available. Medical insurance is not designed to cover activities of daily living. Long term care is designed to cover activities of daily living.

Does Medicare cover long term care?

Medicare will only provide for some skilled care in very limited situations. It was not designed to cover activities of daily living. Rather, it was designed to cover acute care or skilled care such as that provided during a short hospital stay.

Does Medicaid cover long term care?

Yes, but in very limited situations. Medicaid will generally apply only to those with very low incomes and very few assets. Even then, there is only limited choice of what and where benefits will be provided. For example, there might be limited choice of physician and facility, no control over the number of people sharing a room, or no ability for the family to pay for any extras.

Will a long-term insurance policy affect my eligibility for Medicaid benefits?

Medicaid rules vary from state to state. Most likely, when long-term care benefits begin, they would either disqualify you for Medicaid or the state will be entitled to the amounts that you receive

How are premiums calculated?

This depends on a variety of factors, including geography, level of care needed, and the setting in which care is provided. Nursing homes are the most costly -- as much as $300 per day. That amounts to about $109,500 per year. Daily skilled care performed in your home by a visiting nurse might cost about half of that.

How does a comprehensive policy differ from a non-comprehensive one?

In a comprehensive policy, benefits are paid for service delivered in nursing facilities, assisted living facilities, adult day care centers, or at home. However, you may elect a reduced level of benefits for care received outside of a nursing home. A non-comprehensive policy restricts the benefits to services that are provided in nursing facilities.

Where can I get long term care insurance?

In addition to the purchase of an individual policy directly from an insurance company, coverage is sometimes available through your employer, professional organization or other association. You can often get coverage for a spouse, parent or parent-in-law, as well. In addition, some life insurance policies provide for early payment of a portion of the death benefit to pay for long term care.

Group Long Term Care Insurance FAQ’s

Group Long Term Care Insurance is designed to preserve assets and lifestyle in the event of an extended illness or injury that requires costly long-term care. Coverage typically pays benefits for the loss of two or more "Activities of Daily Living" or severe cognitive impairment. Indemnity model plans pay the full benefit amount selected, regardless of the expenses incurred. A record of expenses is not required, and the money can be used to meet whatever needs the individual chooses. For example, Long Term Care insurance can be used to provide a needed respite for family caregivers. Group Long Term Care Insurance allows employers to tailor their plans to cover spouses or parents, or to include retirees and eligible family members. This product delivers a flexible combination of employer-funded and employee-purchased coverage, to meet a broad range of employer budgets.

What are the Benefits of Group Long Term Care Coverage?

Employees who obtain long-term care insurance through an employer sponsored plan enjoy a number of advantages. Typically the advantages are:

§    Guaranteed Acceptance
All actively-at-work employees who apply for coverage during the initial enrollment period and newly hired employees who apply for coverage within 31 days of becoming eligible for the employer’s benefit programs are eligible for guaranteed acceptance.

§    Rate Stability
Most Group Long-Term Care Insurance plans come with a multi -year rate guarantee. Most providers don’t raise rates.

§    Payroll Deduction
Insured’s enjoy the benefit of having their long-term care insurance premiums deducted directly from their payroll or pension check.

What are Dental discount plans?

Discount Dental Plans are designed to provide significant savings on members' dental care needs, and have quickly become an attractive alternative to costly dental insurance.

How discount plans compare to insurance plans?

Traditional dental insurance, once the only dental benefit option available, features many drawbacks including costly deductibles, tedious claim forms, long waiting periods and other limitations. On the other hand, discount dental plans are affordable, easy-to-use and free of these hassles.

What are some of the major differences between dental insurance and discount dental plans?

Some of the characteristics of Dental Insurance include:

• Limitations, deductibles and annual maximums
• Waiting periods for major dental procedures
• Tedious and time-consuming written claims process
• Limitations/exclusions on pre-existing conditions
• Certain dental specialties, such as cosmetic dentistry, are
  rarely covered
• Consumers pay expensive monthly premiums for defined coverage
• Typically inaccessible to individuals and families unless provided by their employer

Some of the characteristics of Discount Dental Plans include:

• No annual limits, members enjoy discounts on most dental services all year long
• Most plans activate within 1 - 3 business days
• No tiresome paperwork hassles, plan membership card is presented for discounts on most dental services
• No health restrictions
• Select plans include discounts on dental specialties, including cosmetic dentistry and orthodontics
• Consumers pay affordable membership fees for access to a network of providers offering discounts on most dental procedures
• Available directly to individuals, families, businesses and groups

In short, discount dental plans are an affordable and easy-to-use alternative to dental insurance, and offer plan members significant savings on most dental procedures and vision care.

What are Vision discount plans?

Discount vision plans are designed to provide significant savings on members' vision care needs, and have quickly become an attractive alternative to costly vision insurance. Coast to Coast Vision (CTC) has over 12,000 participating eye care locations nationwide.

What are some of the major benefits of a vision discount plan?

Members save on eyeglasses, contacts, non-prescription sunglasses, eye exams and surgical procedures. The CTC provider network is the most comprehensive in the U.S. and includes ophthalmologists, optometrists, independent optical centers and national chain locations such as Pearle Vision, JC Penney Optical, Sears Optical, LensCrafters, and EyeMasters stores.

Highlights:

·    Savings of 20% to 60% at over 12,000 provider locations nationwide

·    Most frames, lenses and specialty items such as tints, scratch resistant coatings and ultraviolet protection are available.

·    No limit on the number of times the membership may be used during the year.

·    Two guarantees - 30-day Guarantee: If for any reason a member is not satisfied, the merchandise may be returned within 30 days for an exchange or a full refund. Additionally, if a member finds a lower price anywhere else on the exact same pair of prescription eyeglasses within 30 days of purchase, the difference will be cheerfully refunded

·    Members may nominate their eye care professional to join the network.

Mail Order Contacts:

Members receive greater savings on contact lenses through our mail order program. Members simply call a toll-free number for price quotes and to place an order. Most orders received within 7 to 14 days.

Highlights:

·    Savings of 10% to 40% through the mail order service.

·    Most major brands of contact lenses are available, including: disposables, torics, bifocals, and gas     permeable lenses.

·    All prescriptions are kept on file for reorder purchases

·    No limit on the number of times the membership may be used during the year

Ophthalmology Services

Due to the growing interest in laser surgery procedures, the Coast to Coast Vision network constantly grows as new providers are recruited. In keeping with the CTC tradition of contracting with both chain and independent providers, CTC offers a national chain of laser surgery centers providing discounts on refractive laser surgery and independent ophthalmologists who also provide discounts on refractive surgery.

Highlights:

·     10% to 30% savings on surgical procedures including LASIK

·     Over 600 participating locations nationwide

·     Free screening for LASIK surgery at select locations