Group Benefits

Worksite Benefits are sometimes referred to as ancillary or voluntary benefits. They are additional insurance products, plans or programs which an employee can purchase through their employer, through payroll deductions, at a discounted group rate to supplement their employer-paid benefits.

Examples of ancillary or voluntary benefits offered are listed below.

-Life Insurance
-Disability Insurance
-Dental and Vision Plans
-Long Term Care
-Cancer
-Heart/Stroke
-Critical Illness
Hospital Indemnity

Emergent Benefits, LLC offers traditional health plans through most major carriers. Depending on your needs, we have plans that offer the Minimum Essential Coverage (MEC) as required by the Affordable Care Act (ACA) to full customized packages that offer a rich variety of benefits.

A Health Maintenance Organization (HMO) requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Members are required to designate a primary care physician who treats and directs health care decisions and who coordinates referrals to specialties within the HMO network. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). Most HMOs charge a small co-payment depending upon the type of service provided.

With a Preferred Provider Organization (PPO) members save the most money on healthcare, if they use providers within their network. If providers outside of the network are used, it is possible that those services may not be covered at all. Deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits.

A Health Savings Account (HSA) combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute, tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.

A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax favored savings account. Employers contribute to the savings account, which can be used for to fund co-pays and other qualified expenses prior to the deductible being met.

Single, Dual or Triple Option Plans offer eligible employees a choice between several different types of plans as described above.

We can help you obtain the small business tax credit available to eligible employers through the Federal Marketplace, Small Business Health Options Program (SHOP). Eligible employers may have thier premiums reduced by as much as 50%. To be eligible, you must cover at least 50 percent of the cost of employee-only (not family or dependent) health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 (as adjusted for inflation beginning in 2014) per year.

We suggest you use our Business Tax Calculator to find out if you qualify. Those who qualify will be able to purchase traditional group health plans as described above through SHOP.

When employers self-fund their own health plan, they will benefit from a significant savings in premiums, increased cash flow, tax advantages in addition to having more control over the benefits that the plan offers. Although not always a popular choice for small employers, today self-insured plans are considered to be good options for both small and large employers. Emergent Benefits, LLC specializes in helping employers set up and maintain self-funded health plans and would be happy to give you a no cost analysis to determine if a self-funded health plan option is right for your company. Below you will find a little more information on exactly how self funding works.

A self-funded health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. A third party (a TPA) is engaged to handle claims and processing. Because self-insured employers run the risk of large catastrophic claims, they will purchase stop-loss insurance to protect them in such an event. Even with the additional expense of stop-loss insurance, employers can enjoy saving thousands in premiums and other advantages.

Many employers find that gap coverage, when combined with a low cost, high deductible major medical plan, are together much less expensive than one stand alone lower deductible, major medical policy. Gap insurance provides benefits that supplement a major medical and comprehensive benefit package. It works by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.

A Flexible Spending Account (FSA) is a cafeteria plan under Section 125 of the tax code and allows for benefits to be paid with pre-tax dollars which results in tax savings to both the employee and the employer.

The average working employee in America spends thousands of dollars annually on certain types of medical benefits, daycare expenses and transportation services. By participating in an FSA, an employee’s taxable income is reduced, which increases the percentage of pay they take home and allows them to pay for these benefits and services with the pre-taxed dollars, in essence giving them a discount on these services. Here’s how they work.

This tax-favored savings account is funded solely by the employee through regular pre-tax payroll deductions. Employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. Throughout the plan year, funds can be withdrawn from the account (tax-free) to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Some FSAs include work-related parking and transit costs. The administrator of the FSA account can issue a debit card that is tied to the FSA making it easy to use the account when needed.

A Premium-Only Plan lets employees purchase their own individual insurance with pre-tax dollars, potentially saving employees thousands annually in taxes and premiums combined. Employees elect a set amount of pre-tax dollars to be deducted from each payroll. The employee purchases an individual health insurance policy in which he/she chooses completely on their own and is responsible for paying the monthly premiums directly to the carrier. The employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars.

Shared Funding Plans allow small employers to take advantages of all the cost saving and benefit design features of a self-insured plan that typically is designed for larger groups. However, any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan.

Here’s how it works.
First, an employer will select any of the fully insured plans that the carrier offers and rates will be determined by the group’s claim history. Stop-loss insurance is added to protect against catastrophic claims. Just like with an insured plan, the carrier will handle the administration of the plan, processing claims and offering members on-line access to benefit explanations and other reporting tools.

Premiums for shared funding plans are generally much lower than fully insured plans because the employer shares some of the risk. Employers who opt for shared funding plans may save even more costs by implementing wellness programs into the workplace.

Mini-Med plans with self-insured reimbursement feature very low premiums for employees and are much like a self-insured (employer funded) plan. However, unlike a self-insured plan, claims are paid on an expense reimbursement bases. These plans are typically offered to employees who do not qualify for or cannot afford regular major-medical coverage. Benefits are available anytime during the plan year, but are typically capped very low, may have deductibles and copayments but cover many of the basic services a majority of people need such as physician visits, emergency room visits and prescriptions.

Along with Health Insurance, Life Insurance is considered to be a key part of the benefit package for employees. Besides being a valuable tool in attracting top talent, employees are happier and more productive feeling secure that their loved ones will be taken care of in the event of illness or an untimely death.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, mortgage and even their children’s education as well as offering additional added benefits. Emergent Benefits, LLC can help employers protect their employees and their employees’ families with a variety of different life insurance products.

Cash Value
Life insurance that ties premiums to various types of investment accounts (stocks, bonds, money market, etc.) in which the savings can be tax deferred and/or borrowed against, if needed. These policies are known as whole life, universal life and variable life insurance.

Term Policy
Life insurance that does not build cash value, however, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Some policies may also make payments upon terminal or critical illness.

Emergent Benefits, LLC offers Dental and Vision Plans through many of our major insurance carriers. These plans are offered on a stand-alone (voluntary or employer-sponsored) basis or incorporated into the group health plan offering. Whether as voluntary or paid benefit, employees appreciate both dental & vision coverage as part of their Employee Benefits Package. Below you will find detailed information on the benefits of Dental and Vision plans.

Dental Plans
Regular dental exams help employees stay healthier and more productive in the work place. Simple routine visits to the dentist, which are usually covered 100% by insurers, help to detect serious underlying conditions such as heart disease and diabetes. The National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with Dental Insurance plans have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

Dental Plans offer a variety of diagnostic, preventative care and corrective services including cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Vision Plans
Similar to dental policies, vision plans are inexpensive and save money on routine exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Monitoring your eye health with regular exams also helps to prevent serious eye diseases like glaucoma and cataracts and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol.

National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit. Here’s how Disability plans typically work.

Short Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period, although it could be much longer depending on the policy, but will continue to pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Group Long-Term Care plans are becoming an increasingly common voluntary benefit offered by employers today. The prospect of long-term care is one of the most important issues your employees may have to face. The cost of long-term care is expensive and generally not covered by other employee benefits, disability or even Medicare. If someone requires long-term care, it is not just an emotional strain but a financial one as well, impacting retirement savings and overall financial position.

Savvy employers know that access to additional resources can increase employee productivity when confronted with managing long-term care situations. Long-Term Care plans demonstrate to your current and prospective employees that your company cares about them–increasing the ability to attract and retain the very best talent.

Most LTC plans are designed to provide benefits for care through nursing homes, assisted living centers, home health care and adult day care. Employers can provide a base benefit while giving the employees the opportunity to “buy up” and obtain the level of coverage that they need for their families.