Words to Know - ClaimLinx

WHAT TO DO WITH FORM 1095-A

by ClaimLinxMarch 4, 2021May 4, 2021Leave a comment

In case, you or anyone in your family has decided to get insurance then you need to fill out Form 1095-A. You must get them to initiate the complete procedure of getting insurance. Form 1095-A is available at your Healthcare.gov account for all users.

What is Form 1095-A comprised of

Your 1095-A provided information about Marketplace plans anyone in your family has had including:

Any paid Premiums
Utilized Premium Tax Credits
Your SLCSP (Second-lowest-cost silver plan)

You’ll use information from your 1095-A to fill out Form 8962, Premium Tax credit. This is often how you’ll “reconcile” — determine if there’s any difference between the premium tax credit you used and therefore the amount you qualify for and if you didn’t take any advance payments for your premium tax credit despite having Marketplace coverage.

Important Facts to Remember:

Form 1095-A shall provide information about your family’s marketplace plans in 2020.
It is important to keep this Form readily available and store it where you keep your tax information and other details.
Keep in mind that the IRS does not provide Form 1095-A, you can get it from the marketplace.

How to find your 1095-A online

Your 1095-A is available in your HealthCare.gov account

Below “Your Existing Applications,” go to our 2020 application.
Choose “Tax Forms” from the left-hand side menu
Save all the 1095-A files

In case you couldn’t find 1095-A in your account, you can reach out to the service center for any inquiries.

What to do if your information on Form 1095-A is wrong

It is very important to carefully analyze information filled out on your Form 1095-A in order to rule out any discrepancies.

Read the instructions at the back end carefully and make sure the information is accurate. If anything about your coverage or household is wrong, contact the Marketplace call center. Also, it is very important to make sure that your SLCSP information is mentioned correctly.

How to know if your SLCSP information is correct

You can easily check your SLCSP information by following these steps:

You’ll notice Column B in Part 3 titled “Monthly SLCSP”. This would include facts and figures for all of your family members and their marketplace plans.

You’ll know that the SLCSP premium information is wrong if:

There is a blank portion in Column B, Part III, or if it has a “0” during the months where your family members had the marketplace plan.
If there were significant changes that weren’t communicated to the marketplace, i.e. getting divorced or married, losing a family member or having a baby, etc.

Use the knowledge from your 1095-A to “reconcile”

Once you’ve got an accurate 1095-A and your SLCSP premium, you’re able to fill out Form 8962 easily and reconcile your premium tax credit.

What Does a Third-Party Administrator Do?

by ClaimLinxNovember 8, 2019October 18, 20191 Comment

ClaimLinx is a full-service insurance company. We take care of anything and everything, such as finding the best possible employer-paid benefits and competitive health insurance rates. But at the core of the ClaimLinx Solution our consultants use, is the third party administration we offer employers. Today’s blog from ClaimLinx explains what a third-party administrator does for businesses.

Definition of a Third-Party Administrator

A third-party administrator accepts and processes medical insurance claims from healthcare entities and patients. Think of this as a service that makes sure everyone’s paperwork lines up with what’s covered, what’s not, and who pays what in terms of health insurance coverage. They connect and communicate among health insurance providers, employers, healthcare companies, and people who file health insurance claims for payment. Third-party administrators are experts in their field, and they typically only work with insurance.

Duties of a Third-Party Administrator

Many employers choose to self-fund employee healthcare plans, and technology makes it possible to streamline payments to healthcare providers. However, a third-party administrator takes the hassle out of this process. ClaimLinx ensures everyone fills out the proper forms and that each participant receives the right amount of money. Employers and employees log in to our convenient online system to see their forms, claims status, and finances on a health insurance plan. Our team reduces paperwork and educates everyone on how to file claims for coverage.

What ClaimLinx Does

ClaimLinx accepts claims from employees and providers and processes them to determine the correct payout for the employer and the member. We keep track of each client’s custom schedule of benefits and each member’s usage. Meaning we track who has hit their deductible and through which claims. All of that data lets our team help when it comes to finding new ways to save. Our system works for medical, prescription, dental, and vision coverage. We process claims and payments to providers and members while following strict HIPAA guidelines for privacy. Our team works for you, not for insurance companies. With Claimlinx as your third-party administrator, you and your workers are our top priority.

Hire ClaimLinx as a Third-Party Administrator

ClaimLinx does so much more than serve as a third-party administrator. We offer the security and convenience of all of your healthcare resources in one platform. Our employer benefits consultants teach employees how to take full advantage of their health insurance. Contact ClaimLinx or call toll-free 1-800-858-1772 to find out about the ClaimLinx Solution for your small business.

ClaimLinx Glossary: Secondary Coverage

by ClaimLinxNovember 1, 2019May 10, 20211 Comment

Employers offer health insurance for employees for so many reasons. It gives employees peace of mind for themselves and their families in case they have expensive medical bills. However, the plan couldn’t possibly cover every single type of high-tech MRI scan, prescription medication, or medical procedure. Then secondary coverage comes into play. ClaimLinx explains precisely what secondary coverage is, and how it can save your employees money on their healthcare costs.

What Exactly Is Secondary Coverage?

Simply put, secondary coverage is any health insurance plan that supplements your main plan. Your primary plan usually comes from your employer. ClaimLinx uses secondary coverage as a way to restore good benefits to employees. One of the first steps in using the ClaimLinx Solution is to raise the deductible on the primary plan in order to lower premium costs. But that means employees would have to shoulder most of the costs for office visits, prescriptions, testing, etc. A secondary plan can pay for the medical expenses not covered by your primary plan. This is why secondary health insurance represents a vital tool for helping employees pay for health care. The ClaimLinx Solution sets up a custom secondary plan for your employees, called an employer-funded medical expense reimbursement plan (MERP).

How Does Secondary Coverage Work?

A primary plan pays money directly to healthcare providers while you pay the balance. Secondary coverage pays you directly to reimburse you for expenses not covered by the primary plan. Or secondary coverage can also pay medical providers directly so employees don’t have to. For example, your primary plan covers 60 percent of the costs of an MRI, and you receive a bill for $1,000 for the scan. You must pay the $400 not covered by the primary plan. Your secondary coverage would pay part or all of that $400. The added benefit with ClaimLinx is that employees experience seamless administration. They don’t have to worry about paying that $400 up front. They arrive at the provider’s office with a custom ID card with benefits listed. ClaimLinx then takes care of the rest.

What Does Secondary Coverage Pay?

Secondary coverage might pay for medical care not covered by your primary plan, including eyeglasses or visits to the dentist’s office. A secondary plan may cover copays and coinsurance to help alleviate the costs associated with the primary plan. Some secondary coverage specializes in paying for expenses related to accidents, critical illnesses, cancer, long-term care, and disabilities. ClaimLinx’s Solution aims for employees to receive the same benefits as an expensive plan from a major carrier. Secondary coverage can pay for that, but at a much lower cost.

Why Have Secondary Coverage?

The average person in the United States spends $10,739 per year on healthcare. Secondary coverage can help you spend less money on healthcare, which may insulate your finances from high medical bills. Consider a secondary plan if you know you’ll have high medical expenses in a given year. The ClaimLinx Solution finds the best way for employers to save money while giving workers a great employer-paid benefit.

ClaimLinx and Secondary Coverage

ClaimLinx can save companies as much as 40 percent on health insurance costs. Contact ClaimLinx or call toll-free 1-800-858-1772 to find out what we can do for you.

ClaimLinx Glossary: Medical Expense Reimbursement Plan (MERP)

by ClaimLinxOctober 25, 2019October 18, 20192 Comments

A medical expense reimbursement plan (MERP) is part of the ClaimLinx Solution. A MERP allows business owners to make a tax-deductible contribution to employees’ medical expenses. Our employer benefits consultants combine a high-deductible health insurance plan from a national carrier with a MERP. This arrangement gives both workers and owners an optimal choice for health insurance benefits. Today’s ClaimLinx blog defines and explains how a MERP works with regards to health benefits.

Short Definition of a MERP

A MERP lets business owners deduct any portion of medical expenses paid by the company or employees for their medical care. The idea is to reduce the out-of-pocket expenses that employees pay for medical care before health insurance starts to cover the costs. Contributions to these costs lower the amount of money the IRS calculates for a business’s income taxes. ClaimLinx helps you find the optimal funding levels for MERPs to give you the best way to provide health insurance for workers.

Example of How a MERP Works

Suppose ClaimLinx has determined a plan with a $3,500 deductible works best for your company. That means the employee would normally pay $3,500 before the health insurance coverage starts paying for his or her medical care. A MERP can help lower someone’s up-front costs for medical care. ClaimLinx designs a custom schedule of benefits for you and your employees based on medical needs and company budget. In this case, the employee would actually have a much lower deductible and may even experience copays for regular visits and procedures. Business owners receive the tax deduction only when an employee has a qualified medical expense when they pay part or all of the medical expenses.

Why Employers Need a MERP

All the time, employers tell ClaimLinx they would not be able to have viable health insurance benefits without a MERP. Small businesses often have slimmer margins and can’t afford good benefits when premium costs go up. MERPs allow employers to keep offering great benefits on a smaller budget. When you take the administration of first-dollar benefits like copays for office and specialist visits away from the insurance company, you don’t have to pay as much for those benefits. The flexibility of MERPs let companies fund their employees’ medical expenses based on the budget and needs. And as a bonus, MERP funds transfer from year to year. So a company can build up funds over time.

ClaimLinx Navigates MERPs for You

The employee benefits consultants at ClaimLinx help business owners select the correct funding levels for MERPs, so employees save money on health insurance costs. Not only do owners lower their costs, but they also help retain employees with lower-cost employer-paid benefits. Contact ClaimLinx or call toll-free 1-800-858-1772 for more details on our ClaimLinx Solution.

What is an employer-sponsored, or self-funded, plan?

by ClaimLinxApril 24, 2018May 24, 20182 Comments

Note: The below information refers only to a ClaimLinx Simple Option Solution plan. There are other types of self-funded plans that these details would not apply to.

As our members know, the ClaimLinx SOS plan uses a different type of strategy for providing the health insurance benefits employees need. It combines two types of insurance coverage: a traditional insurance plan with a major carrier for primary coverage and a self-funded Medical Expense Reimbursement Plan (MERP) for secondary coverage.

See how these two levels of coverage work together so an employer can provide better benefits at a lower cost. But what exactly is a self-funded plan and how does it make benefits less expensive for the company?

A self-funded plan, also referred to as an employer-sponsored plan, is one in which a company pays directly for medical services.

In the case of a ClaimLinx SOS plan, an employer pays only for qualifying services according to a MERP determined at the beginning of the plan. Following its effective date, all medical claims are processed by ClaimLinx as a third party administrator and are paid with funds directly from the company.

Using an employer-sponsored plan allows companies to continue to provide benefits at a lower cost because they are no longer prepaying for services to an insurance company in the form of premiums. Insurance carriers charge for a plan under the assumption that every employee will be using large amounts of services. In most cases, that just is not true.

Instead employers can purchase a high deductible plan and pair that with a MERP. That way they are only paying for services actually rendered to employees.

In addition, because ClaimLinx provides a full customized schedule of benefits with a member ID card, members should not be required to pay up front for services and wait for a reimbursement (excepting special circumstances). Claims are processed and payment is sent at a later date directly to providers. This means members should experience the same conveniences as with a traditional insurance plan.

In its simplest terms employer-sponsored, or self-funded, plans are those in which qualifying medical services are paid by the company.

All of this is made possible using a 60-year-old tax code that allows companies to deduct medical expenses for its employees. What it means for employees, though is that their employer can provide the benefits they need at a cost the business can afford.