HSA vs HRA vs MERP

If there is one thing rising costs can provide, it’s creativity. Business owners all over are taking this opportunity to reevaluate not only from whom they purchase their health insurance, but also how they purchase it. But what the pros and cons of all these different solutions?

First, some quick definitions:

  • HSA (Health Savings Account) – A tax-deductible savings account for medical expenses only. Contributions can be made by the plan subscriber or by an employer.
  • HRA (Health Reimbursement Arrangement or Account) – An agreement where an employer reimburses an employee for qualified medical expenses not covered on a company’s standard insurance plan.
  • MERP (Medical Expense Reimbursement Plan) – An arrangement where an employer pays providers directly for qualified medical expenses not covered on a company’s insurance plan.

All these alternatives have one big thing in common: they allow businesses to raise the deductible on their group health insurance plan. It’s the fastest way to lower that initial sticker price on the company health plan while still providing some sort of benefit.

So what’s the difference between them?

HSAs seem like the easiest way to provide cash on hand for employees. But these plans often require employees to invest in the account as well employers, and once the funds are in the account they can only be used for medical expenses. For most, estimating how much to put into the account is tricky business. Invest too much and employees feel the account is a waste, but invest too little and the account isn’t serving its purpose, which is to provide tax-free dollars to improve the plan benefit.

So perhaps you move onto an HRA – a seemingly simple way to give employees company dollars for medical services rendered. Many employees never ending up using this benefit though. For many, the filing process for reimbursement seems complicated and arduous. Others simply forget the benefit is there because of the extra processing requirements. So at the end of the day, employees are really only experiencing the high deductible health plan.

Finally moving onto a comprehensive MERP. These plans can enable employees to get back that feeling of full coverage. Because the employer is paying the provider directly for services, the employee does not have to pay for them upfront. There is still a second level of processing for the medical claims but it is not left up to the employee exclusively to sift through paperwork and requirements. All of this is done through an outside third party administrator.

All in all, there are a lot of options out there for health insurance now. That’s why it’s important you have someone to help you look at and weigh all the options.

 

Savings creates opportunity to reinvest in employees with Aflac

ClaimLinx and Aflac – they go together like salt and pepper. Good on their own but even better together.

As experienced consultants, ClaimLinx shows businesses how to save money on their health insurance. Using a unique, time-tested strategy for purchasing benefits that combines traditional insurance through a major carrier with a self-funded plan, businesses can save 20 percent on their health insurance plan.

But what should owners do with all that savings?

We suggest taking that cash and reinvesting it in employees. The lower fees for the health plan easily free up funds to start a Benefits Bank with enhanced coverage through Aflac.

Owners can choose plans for employees or set up a specific dollar amount and let employees choose which coverage they would like for themselves and their families.

Aflac has so many insurance plans available there’s something for everyone. Employees can choose from options like accident, life, critical illness, short-term disability, dental, vision and more. And the best part is employees also get the exclusive perks Aflac provides, such as a wellness benefit, one-day pay and a wide range of coverage options.

Supplemental insurance is often an important component to having a complete plan should tragedy strike for an employee. It can be a vital source of funds if gaps in coverage on a regular health plan occur. After all, the last thing anyone wants to worry about during an emergency is how to pay for care.

It sounds like a luxury for most employers – providing that level of coverage. But it doesn’t have to be.

Because ClaimLinx helps lower the cost of the overall health plan. Then the additional coverage through Aflac is purchased with pre-tax dollars. That means at no extra cost than your current health plan, you are able to not only keep current employees happy by improving benefits but also increasing your competitiveness in the job market.

So with all these additional benefits, can you really afford not to make the switch?

Due date for 1095 forms moved to March

Tax filing deadlines are coming up so some of you may have employees asking questions about their 1095 health coverage information forms. Please be advised at the end of last year the Internal Revenue Service (IRS) extended the deadline for issuing these forms to March 2, 2018.

This means insurance carriers and other insurance providers have until this date to provide Forms 1095-B or 1095-C to members. This 30-day extension is automatic and does not require any paperwork to request it.

However, this does not mean that employees are required to wait to receive this information to file their individual income tax return. The IRS states these forms can be used to assist in preparing a return but are not required to file.

As a reminder, these forms are issued from the primary insurance carrier on your plan, not by ClaimLinx. If employees have not received this form after this deadline, they can request it from the insurance carrier directly.

If you have received any additional instructions from your primary insurance carrier regarding these forms, such as if your carrier is National General, please follow their instructions for filing as soon as possible.

 

Billing errors cost members and employers on services

As many as 80% of medical bills in the United States contain errors, according to Derek Fitteron, CEO of Medical Cost Advocate, a partner of ClaimLinx. And those errors can lead to an unnecessary increase in a bill’s overall cost. In fact the credit agency Equifax reported that for bills totaling $10,000 or more, there is an average error of $1,300.

A big reason these errors occur is the way healthcare providers classify diagnosis, symptoms and procedures. They use a coding system called the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification). The system is incredibly complex with mistakes leading to patients potentially being charged for procedures or testing they did not receive or more expensive versions of their care.

Errors can occur on any medical bill, but tend to be found on bills for complex medical procedures, inpatient care, care from a medical specialist or when patients receive care at a facility outside their insurance carrier’s network.

To prevent this issue for all ClaimLinx clients with a Medical Expense Reimbursement Plan, any high dollar medical claims are automatically sent to Medical Cost Advocate for review and negotiation. But employees can also help to combat this issue by being sure to check any medical bills for procedures or testing they do not recognize, especially bills totaling over $1,000.

Members should contact their provider first with questions about any bill. Then if a change must be made to a previously processed claim, they can contact the Claims Department at help@claimlinx.com.

Some of this information was taken from an article which featured our partner, Medical Cost Advocate, published in Employer Benefit News. Read the article.

 

Tips For Helping Members With Claims Issues

Administrators for the Medical Expense Reimbursement Plan (MERP) sometimes have members reach out with problems or questions regarding their claims.

Here are some tips to give employees if they have questions or issues with the claims process:

  • Be proactive – Remind members to check their primary insurance network and any required preauthorization before a procedure or appointment. Changes to networks or primary insurance carrier’s policies can be made at any time during the year.
  • Check during processing – A claim goes through many steps before a provider or facility receives payment – see the attached step-by-step diagram – and it’s important to follow all claims throughout this process. Members can check claim status at any time using the ClaimLinx member portal by going to http://www.ClaimLinx.com and clicking the green “Member Login” button.
  • Communicate with provider billing – Some provider billing departments have short timelines as to when they begin pursuing patients for payment. If a member is receiving calls from a provider billing department and is waiting for a claim to be processed, he or she can explain this to the office to be noted on the claim.
  • Be patient – The process can sometimes take time, which can be frustrating. But it’s important for members to remember there are many resources to help, including the the claims department at your primary insurance carrier and at ClaimLinx. Members may contact the claims department at any time by emailing help@claimlinx.com.