There  has been a lot said about Health Care Reform, with all the talk it’s been difficult to figure out exactly what the facts are. So here are some quick facts as I understand them to be at the current time. While this law is being tested on the legality of certain elements, and the politicians continue to politic,  the back bone of this great country (yes that’s you and I!) need to know how, when and if we are to be effected. I hope this helps sort out the fact from the fiction. 

Coverage Mandates Scheduled to take effect in 2014

• Individuals will be required to obtain coverage under a qualified health insurance plan or pay a tax penalty. 
• Employers will be required to offer qualified health insurance to their employees or pay a penalty in some circumstances.
  • Small businesses with fewer than 50 employees will be exempt.
  • If an employer is subject to the penalty and fails to offer any full-time employee health coverage, and if any full-time employee enrolls in the exchange and receives a tax subsidy to purchase coverage, the employer is subject to a penalty equal to the number of full-time employees it has times $2,000 per year. For purposes of calculating the penalty, however, the first 30 employees are disregarded.
  • Employers with more than 200 employees that offer a health plan must automatically enroll all new employees in the plan. The employee will have the opportunity to opt out of the coverage. Employers will also be required to notify each employee at hiring about the existence of the insurance exchange and that the employee might be eligible for a subsidy to purchase a plan through the exchange under certain circumstances.
  • Employers who offer coverage but have employees whose required contribution for that coverage would be between 8 and 9.8 percent of household income must provide employees with a “free choice voucher.” The voucher must be equal to the amount of the contribution that the employer would have made to its own plan and can be used toward the purchase of plans through the exchanges.

Insurance exchange

• Individuals who do not obtain health insurance through their employer will have a mechanism set up by the states to help them find qualified health insurance coverage on an individual basis. The individual must be a citizen of the United States or an alien who is lawfully present in the U.S. to purchase coverage through the exchange.

Small employers (fewer than 100 employees) will also be able to access coverage for their employees through the exchange. For years prior to 2016, states may limit this to employers with fewer than 50 employees

*Note: Voluntary Supplemental products such as Short Term Disability, Cancer, Critical Illness and Accident are not offered through the exchange.

Market reforms

• Health insurance companies will be required to make their policies available to individuals on a guaranteed-issue basis, and no pre-existing condition exclusions can be applied.  This takes effect in 2014.
• Health insurance plans may not impose lifetime limits on the value of any essential benefits, as established under the law. Annual limits may also be restricted by the Secretary of Health and Human Services (HHS). Plans that cover dependent children must cover all children (married and unmarried) of the insured until the child reaches age 26, provided that the child is not eligible for employer-provided coverage himself. Plans must provide first-dollar coverage for certain preventive care and immunizations. Plans may not rescind coverage except in cases of fraud or intentional misrepresentation. Children under age 19 may not be denied coverage due to a pre-existing condition. This takes effect for plan years beginning October 1, 2010, or later.

• Health insurance companies or plan administrators of self-funded health plans must prepare and distribute a paper or electronic summary of coverage to all applicants and enrollees for the coverage. The Secretary of HHS will establish standards for the summary. HHS must establish the standards within 12 months after the law is enacted, and the summary must be provided within 24 months after the date of enactment.

Excise Tax 

• “High-cost” health plans will be subject to an excise tax, paid by the insurance company selling the plan. A plan is considered a “high-cost” plan if the annual value of the coverage is greater than $10,200 for single coverage and $27,500 for family coverage. Special rules apply for plans for retirees and employees in high-risk professions and multi-employer plans. This provision is intended to encourage employers to hold down the value of the plans they offer to employees and could possibly result in reduced medical spending. This takes effect in 2018.
• Employers will be required to include on employees’ W-2 forms the value of plans subject to the excise tax. This takes effect for W-2s filed in 2012 for the 2011 tax year. 

Cafeteria Plan Changes

• Health flexible spending arrangement (FSAs) salary reductions are capped at $2,500 per year. That amount is indexed for inflation beginning in 2014. The cap takes effect in 2013.
• Health FSAs, HRAs and HSAs may not reimburse over-the-counter medicines without a doctor’s prescription. This takes effect in 2011.
• Cafeteria plans of small employers have a new safe harbor from the nondiscrimination rules. For purposes of this rule, a small employer is one who employs 100 or fewer employees during either of the two years preceding the year for which the discrimination test is being run. This takes effect in 2011.

Timeline

Here is a summary of the years in which the health care reform changes listed above will take place. 

2010

• No lifetime limits allowed, possible restrictions on annual limits in plans.
• Coverage on children up to age 26.
• No rescission except for fraud or intentional misrepresentation.
•  No pre-existing condition exclusions for children under 19.

2011

• Employers must disclose value of certain health plans on W-2 forms.
• Over-the-counter medications no longer reimbursable.
• Special non-discrimination safe harbor for small-employer cafeteria plans.

2012

•  Plans must provide summaries of coverage.

2013

• FSA salary reductions capped at $2,500.

2014 

• Individual and employer mandates take effect.
• Health insurance plans have new guaranteed issue and pre-existing condition requirements.
• Exchanges are available for purchase of insurance coverage by individuals and small employers.

2018

Excise tax on “high-cost” plans takes effect.

10 Reasons to work with an Independent Insurance Agency/Agent

For most people insurance and all things having to do with insurance is frustrating and confusing.  Fortunately there is help available.  Listed here are what I would consider the top 10 reasons to use a Independent Agent/Agency when purchasing insurance protection for you and your family. With that being said by no means am I saying that a captive or direct agency is any less professional or capable. However there are some differences. You can decide what works best for you.   

1.  Treats you like a Person not a policy number   

WOW! What a concept. To think that your business is actually appreciated. Relationships with clients are the life blood of any Independent Agency.   

2. A Person who understand your unique situation and your priorities   

Acting as your consultant they will want to understand your particular situation so that they will be able to give you sound advise.    

3. Excellent service and competitive prices because of the professional relationships developed with multiple insurance companies   

These two elements are key portions in the formula to keep you as a long term client. Exceeding your expectaions in the way of customer service and always having a competitive price are paramount for the Independent Agencies survival.          

4. You get an unbiased opinion on multiple carriers and their particular product lines   

To me this is a really a huge benefit. Each insurance company has a certain “appetite” for certain situations or to say things they specialize in covering. Perhaps it’s a high risk auto policy or life insurance for a individual that has a medical condition. Just having an expert on your side that has access to multiple companies and the knowledge of those companies, can potentially save you thousands of dollars over the life of the policy.   

5.  One stop shopping for all your protection needs   

One word Walmart. A part of their success has been the convenience to go one place for all your needs. The same holds true for your Independent Agencies. Most agencies will have all the protection products available to you so you truly will only need one agency to handle all your insurance needs. Oh and by the way they aren’t made in China.   

6. Independent Agencies invest in long term relationships   

I’ll let the cat out of the bag. Independent Agencies don’t have multi million dollar marketing campaigns. Unlike direct or captive agents who work for the company and benefit from the large add campaigns of the Geicos, Progressives, State Farms, Allstates (you get the picture). Independents, rely on long term relationships for the stability of their agencies.  Each client represents more than a market share. It’s an opportunity to serve their client and grow their agency at the same time.    

7. They are value hunters looking for ways to save you money while maintaining the best price, coverage and service   

If you read #6 then this is a no brainer. The primary goal is to keep you as a client one part of the formula  is to consistently shop for the best rates on the market. If I only represented one company and they raised the rates what would I be able to do for you? I can give you an excuse or some how try to spin it so that it’s your fault. By have multiple sources an Independent is always positioned properly to assist with rates.   

8. They don’t have a quota to make thus ensuring your always getting the right coverage, at the right time, with the right company at the best price   

Most Independent Agencies don’t have a quota to make thus eliminating the appearance of an agent recommending one company to meet production goals. You will always know that you are the top priority.        

9. They are not beholding to any particular company, so there is no need to change agencies as your insurance and service needs change     

The insurance protection needs you have today likely will not be the needs you have in the future. Its reassuring to know that as those needs change you won’t have to look for another agency to handle those needs. As an Independent you will find they are as flexible and fluid as the times. Yet another part of the formula to keeping you as a client.   

10. Same Pricing    

The best part of it all is partnering with an Independent Agency doesn’t cost you a thing.

    CapStone Insurance Group designed the Flexible Benefit System at the urging of our clients. Providing a comprehensive, flexible plan that is presented in a simple to follow format, has proven to be a win-win formula.  We know the small business owner wears many different hats throughout the day and that time is a valuable commodity.  We have stream lined the process ensuring the time you spend with us is valuable. There are 3 plan types, Platinum Plus, Platinum and Gold. Each plan is designed for specific levels of an organizations development. Knowing that every business is unique and face uniqe challenges, we wanted to design plans that lay solid foundations but yet are  flexable to address your specific areas of concern.    

     We understand that the largest benefit an organization provides is employment itself. By specializing in small business we have been able to leverage years of experience to provide benefit solutions at NO-COST to your organization. For years the small business owners have been competing against corporate America for quality employees. In many cases these small business have been able to deliver a much better work environment and have even been able to be competitive in pay. However, offering employee benefits for some have been out of reach.  

     Funding employee benefit programs remain a top concern for business owners of all sizes. This is especially true for the clients we serve.  Unfortunately these are real concerns that  don’t look to change in the near future.The key strategy for most employers is to find a program that their employees can participate in without the business owner having to contribute. The plans we have developed allow for this strategy.  

Platinum Plus

• Group Health Coverage (Company contribution required)
• Personal Retirement Counseling
• Flexible Spending Accounts (F.S.A.)
• Section 125 Pretax Plan
• Disability (Group/Individual)
• Life Insurance (Group/Individual)
• Medical Bridge Plan
• Cancer Plan
• Accident Plan
• Critical Illness
• Dental/Vision
• Computerized Enrollment System
• Cost Containment Strategy Counseling
• Monthly Employee Appreciation Awards
• Human Resource  Data Base Website (CHR Answers Now)
• Hidden Pay Check Analysis
• Stay Fit Health Programs

Platinum

•  Limited or Individual Health Plans (Company Contribution Optional)
• Personal Retirement Counseling
• Section 125 Pretax Plan
• Disability (Group/Individual)
• Life Insurance (Group/Individual)
• Cancer Plan
• Accident Plan
• Critical Illness
• Computerized Enrollment System
• Cost Containment Strategy Counseling
• Monthly Employee Appreciation Awards
• Human Resource  Data Base Website (CHR Answers Now)

Gold

•  Limited Health Plans (Company Contribution Optional)
• Personal Retirement Counseling
• Section 125 Pretax Plan
• Disability (Individual)
• Life Insurance (Individual)
• Cancer Plan
• Accident Plan
• Critical Illness
• Computerized Enrollment System
• Cost Containment Strategy Counseling
• Quarterly Employee Appreciation Awards
• Human Resource  Data Base Website (CHR Answers Now)

According to a recent survey employer-sponsored health coverage premiums have rose 87% over the last 6 years. Employers recognize the value of voluntary benefits as a cost containment strategy to those increases. As well, these products have no direct cost to the employer. Employees embrace these types of plans because of their versatility to be tailored to the individual persons needs. Our clients report higher employee satisfaction, increased productivity and a competitive hiring advantage after establishing these types of programs. Many Americans have found themselves in financial crisis as a result of a serious illness or accident. 

        Current studies indicate that many Americans live pay check to pay check. Missing a week or more of work can be catastrophic to their financial stability. Because typically these policies pay cash directly to the policy holder, and in many case much more than a Short Term Disability policy would allow under Federal Law. Numerous policy holders have expressed that these policies where the only financial support they received while recovering from their debilitating event. It’s easy to see why so many Employers have made this a part of their benefit packages.

It’s not a matter of If but When…..

Life Insurance is one of the most versatile and flexible protection products available. Life Insurance is often times misunderstood and certainly it’s not something most of us are comfortable talking about.  Let’s call it what it is, it’s death insurance. Ok, the cat is out of the bag, the cards are on the table.  Why do people need this type of protection? It’s really pretty simple if suddenly you weren’t in the picture would your loved ones be able to afford the life style that you have helped create for them? More often than not the answer is no. In today’s society it takes two incomes to support a family so if suddenly your income was not available how could your family survive financially. Some of the most current stat show that anywhere from 23-68% of Americans are living paycheck to pay check. This is a staggering number.  We know that YOU can never be replaced, however your income can. This is really the basic concept of life insurance. Protecting your income.  Earlier we mentioned that life insurance was a versatile and flexible protection product. Life Insurance can be used as a mortgage protection plan, college education funding, private retirement plan, legacy ensuring and many more scenarios. 

There are 3 types of Life Insurance they are TERM, UNIVERSAL and WHOLE LIFE. All three have some common features but their application is broad. The policy that best suits you will be dependant on what you are wanting to accomplish with the policy. Here are some basics about the 3 different types. 

Term Life -

•  Premium payments are level for designated length or term (if selecting a level term policy)
•  Temporary as it is for the designated time (term),  i.e., 10, 15, 20 years, after that time  the coverage will expire
• Lowest premium payments for the highest amount of insurance for your money
• Temporary death benefit; it is possible to out live the “term”
• Suitable for temporary needs like college planning, mortgage insurance or as your first, least expensive coverage

Universal Life -

•  Flexible or guaranteed premium payments
• Permanent or temporary (depending upon your choice)
• Policy builds cash value however it is dependent on the interest rates, amount of premium paid, and certificate charges
• Lowest priced permanent death benefit; meaning when you pass the policy will be enforce  
• Opportunity to build cash value
• Higher premium compared to term.
• Very flexible.
• Cash value can be used for different purposes

Whole Life -

• Guaranteed premium payments
• Guaranteed permanent until you die
• Cash value is guaranteed; set interrest rate; Dividends may be awarded but are not guaranteed
• Permanent death benefit and guaranteed cash value
• Higher premium compared to term.
• Very safe, conservative addition to a retirement portfolio

As you can see there are certain incidences where one type of policy would be more approprate than the other based upon the situation. Please contact a professional to ensure the policy you own is correct for you and your family.

 Most people relate a Critical Illness Policy with a heart attack or stroke. However these types of policies cover more than just those events. In most cases they will cover for any reason that you are admitted into an Intensive Care Unit (I.C.U.).  Lets talk about the reality of a heart attack/stroke for the section.

The Reality of Heart Disease 

No one likes to think about getting heart disease. But 61,800,000 Americans have one or more types of cardiovascular disease according to current estimates. While you may not be able to prevent the cardiovascular disease, you can protect your finances from it.

Estimations from the American Heart Association suggest the total direct and indirect costs of Cardiovascular Diseases and Stroke in 2002 in the United States to be $329.2 billion. The good news is protection from these costs is available. Heart/Stroke insurance covers a portion of the costs for ambulance, surgery and physicians.

Critical Illness (Heart/Stroke) insurance helps you: 

* Manage the high expenses of treatment 

* Preserve your savings

Why It Is So Important?

It’s unfortunately, but safe to assume that someone in your family or very close to you has received treatment for heart disease or stroke. And you may know first hand the ways it has affect your life and your loved ones. But have you considered how cardiovascular diseases could impact your financial security.

Medical insurance often stops short of considering these costs but some of these costs may be covered with Heart/Stroke Insurance.

Heart/Stroke Insurance Might Be Right For You If:

There are cardiovascular diseases in your family’s history

You don’t have much money set aside for an unexpected cardiovascular illness

You want coverage you can take with you if you leave your job

What You Get:

Pays you benefits that can be used for non-medical expenses that health insurance might not cover.
Benefits are paid as you go and cover the costs of specific treatments and expenses (up to the maximum allowed) as they happen.

 Supplemental coverage, it works in addition to other insurance you may have, such as medical and disability income.

      * Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than insured individuals

• According to one study, over a third of the uninsured have problems paying medical bills. The unpaid bills were substantial enough that many had been turned over to collection agencies – and nearly a quarter of the uninsured adults said they had changed their way of life significantly to pay medical bills. 

• One study concluded that a lapse in health insurance coverage during the two years before filing was a strong predictor of a medical cause of bankruptcy. Nearly 38 percent of debtors who had a “major medical bankruptcy” had experienced a lapse, compared with 27.1 percent of debtors with no medical cause.  

Nearly 47 million Americans, or 16 percent of the population, were without health insurance in 2005, the latest government data available.  The cost of health care has become a national concern.  There are a variety of options available for you to consider when it comes to providing health coverage.

 

See how many of these life insurance myths you currently believe:

   - My employer pays for my life insurance so I don’t have to worry about it.

   – I already have enough life insurance. 

  – I can’t afford life insurance. 

  – I’m single so I don’t need life insurance. 

- My spouse has a good income so even if I don’t have coverage it wouldn’t have a major impact on my family.

- My spouse doesn’t work outside the home so we don’t need life insurance for them.

- There’s no need to buy life insurance for my children.

- I’m healthy.

-I can worry about life insurance when I’m older.

   . 

 Myth #1: My employer pays for my life insurance so I don’t have to worry about it.      

 Truth: If your employer is paying for your life insurance coverage, it’s almost certainly a group policy that only covers you while you’re employed there. In fact, only 41 percent of adult Americans have individual life insurance.* This means you could be vulnerable if you lose your job or have a break in employment.  “Individual voluntary life insurance you buy at work is a good solution for many people,” explains Monica Francis, director of product development for Colonial Supplemental Insurance. “Individual plans are portable, so you can keep the coverage if you change jobs or retire.”         

Myth #2: I already have enough life insurance.       

Truth: The U.S. Justice Department calculated compensation needed to meet the needs of families of victims of the September 11, 2001 terrorist attacks and recommended 12 times income for couples without children and 20 times income for households with children.* The average family is under-insured by more than $300,000.* .

Myth #3:  I can’t afford life insurance.          

Truth: There are many types of life insurance available to meet different needs and budgets. Term life plans are often available for a few dollars a pay period. Even a little life insurance is better than none at all. “A voluntary plan bought at work offers the convenience of payroll deduction,” Francis says.  

Myth #4: I’m single so I don’t need life insurance.    

Truth: Even if no one else is depending on your income, you’re still likely to leave behind bills, credit card balances and final expenses such as funeral costs. These expenses could be an unnecessary burden on parents or siblings at a difficult time.           

Myth #5: My spouse has a good income, so even if I don’t have coverage it wouldn’t have a major impact on my family.        

Truth: Widows and widowers say it takes four to five years before their financial circumstances returned to what they were at the time of their spouses’ death*. One to two years after the death, half the widows and a third of the widowers were just getting by financially.*           

Myth #6: My spouse doesn’t work outside the home so we don’t need life insurance for them.           

Truth: You probably depend on your spouse for many things you might have to pay someone else to do: child care, laundry, cooking, shopping, cleaning, home maintenance, transportation, errands. Adequate life insurance for a nonworking spouse can provide the income needed to protect your family’s way of life.           

Myth #7: There’s no need to buy life insurance for my children.           

Truth: Children who die prematurely will still leave behind final expenses such as medical bills and funeral costs. In addition, buying and keeping coverage for children while young protects their insurability if they should develop a health condition later in life that could make it expensive or impossible to get coverage.           

Myth #8: I’m healthy – I can worry about life insurance when I get older.           

Truth: It’s usually more cost-effective to buy life insurance when you’re younger. The cost of buying insurance tends to increase as you age. And buying a policy when you’re young and healthy means you’ll already have the coverage if you develop a health condition later that could make you uninsurable.  “Nobody likes to think about their own death or a family member’s,” Francis says. “But we also hate to think about leaving our loved ones to deal with financial problems at an already difficult time. Taking time to review your life insurance needs and coverage is one of the smartest things you can do to protect yourself and your family.”

* Source: LIMRA International FastFacts, August 2004 

Medicare was established to help pay basic health care needs for people ages 65 and over, but it was never intended to cover all medical expenses. Over time, the cost of items not covered by Medicare has grown – to the point where it is often more than an individual can afford to pay.  

To help cover your out-of-pocket medical costs, Medicare Supplement insurance policies help pay for items that Medicare may not cover, such as:

•  Medicare deductibles

•  Hospital and medical care co-insurance

•  Extended hospital care

•  Physician’s services, hospital outpatient services and supplies

•  Ambulance services

Additionally, with Medicare Supplement insurance plans:

•  You choose your own doctors – no need to select a primary care physician

•  No referrals are needed to see a specialist

•  Virtually no claim forms to fill out – medicare pays your providers directly so you don’t need to file claims yourself

•  Coverage is guaranteed renewable for life

CapStone Insurance Group All Rights Reserved. This website is a general description of benefits for Medicare Supplement plans and Health Advantage plans. Although every effort is made as to the accuracy of the information on this website there is always the possibility of an error. If you see an error please contact us so we can correct it. The insurance policy will always determine benefits. Please contact us for an outline of coverage provided by each of the insurance companies we represent. If you submit a quote or information request a licensed agent will contact you. We engage in insurance sales only in the states in which we are properly licensed. Not affiliated with, authorized by or endorsed by the U.S. government or the federal Medicare program. For more information feel free to contact us

We offer the Medicare supplement insurance, commonly referred to as Medigap insurance. This coverage can be for both for healthy individuals and for those with pre-existing health conditions. Twelve standardized plans make researching and shopping for Medicare supplements much easier than ever before.

    Every where you turn today there seems to be much talk about the state of Medicare and the future of the program.

Consider These Facts: The US is approaching a Medicare insurance crisis as insurance premiums continue to rise, while retirement incomes are falling.  While at the same time the number of eligible persons (Baby Boomers generation) continue to increase an effect called by many as the “silver tsunami.” Experts estimate for the next 20 years, 10,000 new retirees will be added to Medicare each day, representing 3.6 million people new to medicare each year. This fact, in conjunction with increasingly complicated Medicare insurance options, has caused many Medicare recipients to join Medicare plans that are not suitable.  This never be the case. There is no reason you or a loved one should not have the Medicare supplemental coverage you deserve. 

We specialize in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
*The benefit information provided is not comprehensive. Additional information should be requested before making a decision about your coverage.* 

How much does your service cost?

Our service is provided free to the Employer. 

What can I do to control the cost of my Health Insurance?

There are many cost containment strategies. Such as raising the deductible amount and providing a Voluntary Supplemental policy as an option to cover the increase. The single most important thing you can do as an employer is promote a healthy life style. 

As a small business owner I’m not in the position to offer my Employees Health coverage. What does your company offer as a solution?

Traditional health coverage can be a struggle for many employers regardless of the size. We offer Mini-Medical plans that have made a positive impact on many organizations. These plans are affordable, have no deductibles, help cover the expenses that most employees are likely to incur, National network of physicians. 

Do you provide Major Medical/Health Insurance?

Through our partnerships we can assist you in obtaining an accurate competitive quote for Group Health Insurance. 

What are Voluntary Supplemental Products?

Voluntary Supplemental Products are policies that are designed to provide cash benefits directly to the policy holder in the event of a serious injury of illness. These types of policies have become increasingly popular. Statics show that many Americans live paycheck to paycheck and could not afford to be off of work for any amount of time while recovering from such an event. These types of policies make that recovery time possible. 

What is a Hidden Paycheck?

A “hidden paycheck” is made up of all of the cost that are paid upon the employees behalf that many are unaware of. Typically this includes FICA Tax, Social Security Tax, Federal Unemployment Tax, Health Insurance premiums. Employers know that this can be up to 25% of the total compensation.