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Health Insurance

Health Insurance Holiday Sale - Tis The Season…


It's not enough that health insurance cost so much, insurers have to remind us of this during the Christmas holiday season. It's like they are fiendishly saying, "add this to your holiday shopping list." Secret Santa Gift - $150. Gift for mom - $250. Gift for significant other - $500. Gift for my health (insurance) - $9,500!

I say, if health insurance open enrollment has to occur this time of the year, health plans should be on sale. And, no, not sale as in we are now selling high-priced health plans, but sale as in, discounts for everyone. Not just discounts for the poor (although I'm totally for that) and the employer-sponsored, but health insurance discounts for everyone. And if someone says, there are health insurance discount sales available if you shop wisely and focus on overall costs and not just premiums, I'm putting them on a separate list.

The idea that people who are not eligible for government subsidies to pay for health insurance can afford it if they only shopped wisely, is false. It’s a total cop out by reformers. And where did this idea come from anyway? Just because someone in Washington, no matter how brilliant they may be, decided that the cutoff for individual subsidies was a certain amount does not mean that everyone else can comfortably afford health insurance. They can't.
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2015 - There's More To Say About Health Insurance and Retirement Savings


I created the BenefitsAll website several years ago but it was not until January 2014 that I added the BenefitsAll blog. My three main reasons for writing the blog are:
  • to impart what I have learned over the years handling challenging employee benefit situations
  • to point out the skills every top benefits pro needs to be effective, including good writing, analytical and technology skills
  • to promote continuous learning that encourages questioning the status quo
But now it is time for me to open up more and even champion the changes I want to see in the employee benefits field. For example, real health care price transparency is extremely important to me and I am so over the medical care industry’s excuses for not providing it. And the huge variation in prices for the same medical procedure is also unacceptable and worthy of my protest. However, my greatest concern with group and individual health care plans is the cost of purchasing and using them, as well as the trend of passing on even more of the costs to consumers.


Seeing all the high deductible health plans (HDHP) listed on the federal exchange (healthcare.gov) makes me reevaluate my unconditional support for the Affordable Care Act (aka Obamacare). But because I know that we need an alternative to and an eventual replacement of employer-sponsored health care, I am not promoting repeal of Obamacare, just some major revisions. Non-subsidized Obamacare coverage is too expensive and does not meet the objective of freeing up entrepreneurs to pursue their passions. The not-too-poor but also non-too-rich, healthy young professionals that may be the entrepreneurs of the present and future, are the ones paying the most for health care coverage under Obamacare. We need a fix.
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2014 - A Historic Year in Employee Benefits


Now is the time of year for every writer to create their Best Of list or make predictions for the upcoming year. However, for me 2014 was too extraordinary a year in health insurance and retirement plan public policy to reduce to simple lists. This year we witnessed the implementation of historic health insurance legislation reminiscent of the passage of the Social Security Amendments that created the Social Security and Medicare programs. We also saw many states and the federal government focus their policy power on expanding access to workplace retirement plans.

But if I absolutely have to sum up the year in employee benefits and give fellow benefits pros something to think about for next year, I would say don't forget the origins of your field. And if you think there is too much regulation of employee benefit plans then you forget that that is where benefits got its start. You forget that health insurance plan and retirement saving plans are part of state and federal tax code and social policy. And that is why as a Certified Employee Benefits Specialist (CEBS) with a master's degree in public policy, I am excited about the current employee benefits environment and its future.

However, not everything employee benefits related is exciting or good to me. Health insurance plan prices are still too high, even on the exchanges. Health insurance concepts are too complex. The ascension of high deductible health plans is a crisis in waiting. Health care prices are still hidden. Workplace retirement plans are also too complex and risky. Retirement plan fees are too high and employer matches too low. Workplace wellness programs are a failure for nearly everyone except the workplace wellness industry. And public pension plans are under attack due to jealousy as much as economics.
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How to Assist With a Health Insurance Claim Dispute


Employee benefits professionals routinely assist employees in resolving disputes over denied or improperly paid health insurance claims. Next to the annual open enrollment and benefits fair, these encounters are the most one-on-one contact benefits pros have with employees. Therefore it is extremely important that these interactions are handled with professionalism and understanding.

To make sure that happens create a checklist or guide you can use every time you assist with a claim dispute. You can use an existing checklist like the one from ehow and add to it. For example, include a first step on how to prevent a claim dispute from happening and a final step of filing an appeal with the state department of insurance. You can also share these customized guides with employees, in the form of a brochure, as part of the new hire benefits package, as a newsletter article or on the company website.

Creating a claims dispute resolution guide or checklist is not difficult. Working with an upset and confused employee is. Therefore, it is important to know what to expect and establish some guidelines and expectations for the employee and you.

What to Expect From An Employee Disputing an Insurance Claim
  • Expect them to be upset
  • Expect them to talk too fast
  • Expect them to leave out relevant information
  • Expect them to want you to agree with them
  • Expect them to want an immediate resolution
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