Focus: CMH Early Stage and Startups - Young & Healthy Groups Finally Rewarded

Who: Early Stage & Startup Businesses, Ohio Based / Columbus

What: Startup Benefit Plan - Much needed relief from the expensive Affordable Care Act Health Insurance Rates.  As a community of young millennials who care, are driven, and focus on creating ideas to change the world, we have been punished excessively by the changes made in 2014 to the Health Insurance Industry. Benefits do not provide much, if anything.  Deductibles far to high to reach.  Most importantly, monthly premiums hinder our business development and lifestyle.

Where: Mosaic Employee Benefits - 22. E Gay Street, Floor 600, Columbus, Ohio 43215 Twitter: @mosaicbenefits Contact: 614.323.4494 Email: eric@hopewell.works

When:  Effective not long ago,  May 1st, 2016.  Underwriting is back! Mosaic Benefits and Hopewell Works (exciting new announcements to come) have found a rewarding solution for our young and healthy's.  Target Market:
1. Early stage employers with 2-50 employees
2. Average age under 45
3. Healthy lifestyles

Our healthy and active employers in Columbus have the opportunity to reduce health insurance costs immediately with savings in the 20-30% range.  A win win for the employer and employee.  How can you achieve this for your group? Each employee must complete a short 10 minute online form with us, asking limited and confidential health questions. Simple and easy.  Take the paper process out of insurance.  No cost to the employer besides the reduced health insurance premiums going forward.

Why: Startups need start up costs.  Millions of premium dollars are wasted in today's Community Rated Health Insurance Plans.  Reduce your bottom line health insurance cost, retain, and vest into the product and the success of Columbus' future businesses.      

Press: Metroprenuer - Columbus, Ohio May 27th, 2016

http://www.themetropreneur.com/columbus/small-businesses-startups-could-see-savings-on-health-insurance-costs/

Small Businesses & Startups Could See Savings on Health Insurance Costs

By Susan Post -

 

May 27, 2016

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There’s some potentially good news and much-needed relief in sight when it comes to health insurance premiums for startups and small businesses in Ohio.

Eric O’Brien of Mosaic Employee Benefits explains that with the Advent of the Affordable Care Act, set rates were introduced because insurers can’t deny risk.

“That’s why everything has been expensive the last three years,” he says. 

As of May 1, 2016 underwriting is back. Underwriting considers a policyholder’s health – which is good news for younger, healthy workers.

Small businesses with two to 50 employees are eligible for the underwritten plans that often see a 20 – 30 percent cost savings. O’Brien explains that while the percentage may not look like a lot, it shows significant cost savings in the long run. For example, a policy that was $300/month would be down to $210 – $240/month. Even at a 20 percent lower rate, over 12 months that adds up to a cost savings of $720 per employee.

“If your group qualifies, you’re going to pay a lot less and everyone is going to save a lot of money together,” O’Brien says.

He adds that there is one caveat to accessing the underwritten rates.

“To qualify for the underwritten rates you have to have a Chamber relationship,” he says. 

And one that’s in good standing, meaning a business is paid up on its membership.

To begin the process and access the rates, each of a business’ employees must fill out an online form with about 15 questions that ask about an individual’s health over the last seven years. Confidential, neither the employer nor the broker have access to the health information, but it is instead sent directly to an insurer who determines rates for the group.

“It’s a streamlined online enrollment process,” O’Brien says. 

Employees age 21-64 are eligible, but O’Brien says that since the plans have rates determined by health, they are better for healthy, younger groups with the average age under about 40. Too many health issues within a group and an employer can get priced out – meaning rates similar to what is already available on the exchange.

That young, healthy company profile – that’s many of Columbus’ startups.

“Essentially this is just a perfect world for our early-stage startup community,” O’Brien says. 

Because of costs, many small employers have struggled with benefits, both for their employees and as a retention tool, but O’Brien believes these rates will make health insurance more accessible again.

Even if a small business or startup is in a financial position to offer benefits, these unwritten plans could help individuals access better insurance. O’Brien says many employees have gotten used to a high-deductible plan and will likely move forward with a similar option and take the cost savings. But, it also opens the door for individuals to pay the same premium but access better insurance – something that could be especially helpful for young families.

To learn more contact Mosaic Employee benefits, or call them at (614) 323-4494.

Don't offer insurance to employees? Add value with FREE on-site Individual Enrollment

________ Team,

We are very excited to have the opportunity to be on site this upcoming Tuesday, November 3 from 11-3 pm to offer you free assistance with signing up for a 2016 health insurance plan (individual or family) via the carriers and healthcare.gov. We can help you pick the plan that provides the most value to your and your family based on your individual needs and budget, without the confusion of websites and sorting through information on your own.

Additionally, we'll be offering Ardina healthcare benefit plans for $10 or $20/month for the whole family. These plans work great as a supplement to save you time and money on your family's healthcare. Ardina plans are available whether or not you decide to buy an insurance plan, and provide a cost effective / innovative way of getting healthcare from your phone or computer, 24/7/365.

If you need advice or are interested in signing up for a health insurance and/or Ardina plan on Tuesday,  please be sure to have the following information available with you: 

• Information for everyone in your household who needs to be covered including their DOBs, mailing addresses & social security numbers

• Current insurance policy information (Plan numbers, coverage amounts, monthly premium costs), if you currently have a plan

• Estimated annual household income for upcoming year 

Please let me know if you have any questions before Tuesday and we look forward to meeting each of you then. We as Ardina & Mosaic Benefits are very excited to partner with ______ this year to help save you money and hassle on your healthcare in 2016!

Warm Regards,

Stephanie & Eric 

​Eric M. O'Brien 
Chief Insurance Officer                          

614.​323.4494

​www.myA​rdina.com​ / www.mosaicemployeebenefits.com

Stephanie Murnen 

​​Chief Customer Officer                

​www.myArdina.com

419.346.6650

Pt 2- Metroprenuer Feature: Mosaic Employee Benefits & InHealth Mutual

A Small Business Owner & Entrepreneur’s Guide to Healthcare Part 2

HOW-TO GUIDES — BY SUSAN POST ON SEPTEMBER 11, 2015 AT 12:00 PM 

In part one of a small business owner and entrepreneur’s guide to healthcare, we discussed the legal obligations of providing insurance, and what to do if you are an individual seeking coverage. In part two, we’ll discuss what providing benefits looks like for small business owners today, and trends that will continue to change the industry.

Small Businesses: Traditional Policies vs. Allowances 

There’s generally one of three ways insurance can go when talking small business – no insurance, a traditional small group policy, or defined contributions and allowances. As healthcare costs rise, more businesses are moving away from group policies and into allowances. Benefits are a powerful tool for attracting and retaining employees, and employers are doing what they can to ensure insurance options remain. However, there is one important caveat to simply offering employees help paying for their own policies.

“If I were your employer I could not allow you to go to the individual health insurance market and reimburse you or pay for those premiums directly, on or off exchange,” O’Brien says. “You see some small employers not offering group insurance paying FICA/payroll taxes giving them extra salary per year based on the cost of their insurance. Just like a raise. They want to give them something instead of nothing.” 

Thomas says an increasing number of employers have adopted the allowance or defined contribution mindset. This comes with some interesting potential benefits for business owners and employees alike.

With premiums constantly on the rise, it’s a way to control costs. As O’Brien points out, if a premium rises 25 percent at renewal across their entire workforce, where is the room for that in the budget? Allowances help a business know exactly what their expenses will be.

Allowances also eliminate the need for an HR department to get involved or be benefits experts. HR, in general, is often at a luxury for small employers.

Seeking individual insurance does have some benefits to employees as well. First, they are able to find a policy that better fits their needs, as most group policy plans offer a limited number of options. Insurance plans are not one size fits all. Should an employee choose to leave, while they would no longer have help covering premium costs, their policy would also travel with them.

Takeaway: Many employers are turning to allowances or defined contributions towards health insurance to maintain attractive benefits, but make sure you are doing so legally.

Trends

With the cost of healthcare on the rise, the industry is responding with a number of trends that help consumers stretch their dollar.

O’Brien recommends the AAA-like coverage of Columbus healthcare startup Ardina.

“Ardina is a great retention tool,” he says. “Ardina pairs so well with where the market is going.” 

About 60 percent of his younger-generation clients are using the tool as an insurance supplement. Whether offered by the employer or sought out by an individual, for an extra $10 or $20 per month depending on the plan, Ardina gives members access to telemedicine services as well as dental and vision discounts.

Telemedicine is emerging as a solution to high premiums on individual policies when it comes to common health issues. The quick and more convenient way to chat with a doctor saves patients time and money. Although it may be more cost-effective, telemedicine services generally don’t credit a deductible.

O’Brien says that for the first time in history, telehealth doctor visits matched primary care visits last year.

“You see a lot of retail shift,” he says.

He’s also seeing a rise of delivery doctors who come to a patient’s house for a predetermined amount of money. However, again, the service doesn’t credit a deductible.

These pieces paint an introduction to the complex world that is healthcare. By working with a broker, many individuals can find plans and options that are better-suited to their needs and budgets rather than just settling for what’s on the exchange.

For more information on InHealth Ohio, visit inhealthohio.org. For more information on Mosaic Employee Benefits, visit mosaicemployeebenefits.com.

Metroprenuer Feature: Mosaic Employee Benefits & InHealth Mutual

A Small Business Owner & Entrepreneur’s Guide to Healthcare Part 1

HOW-TO GUIDES — BY SUSAN POST ON SEPTEMBER 11, 2015 AT 8:00 AM 

How a business owner should approach health insurance is one loaded question. An issue of increasing complexity, it’s not something a business owner or entrepreneur should tackle on their own.

To help demystify the process (at least somewhat), The Metropreneur spoke with insurance provider InHealth Ohio and Eric O’Brien, a broker with Mosaic Employee Benefits, who specializes in individual and small group health insurance.

Both vehemently encouraged small business owners, entrepreneurs and individuals to reach out to either of their organizations or someone with experience in the industry when trying to get health coverage. Understand what exactly your policy says, and your options and legal obligations. This advice – it’s often free. Brokers are paid commission by insurance companies, not by you.

In part one of our healthcare guide, we’ll outline what the requirements are for offering insurance, and what to do if you’re an individual looking for coverage (or a business owner who wants to steer your employees int he right direction).

Do I need to offer insurance to my employees?

First things first. Is your business legally obligated to offer insurance?

“If you meet the full-time equivalent of 50, you have to provide insurance,” O’Brien says. Many people think full-time equals 40 hours/week, but employees are considered full-time at 30. 

If you have under 50 full-time equivalent employees, you are not legally obligated to offer health insurance, however many businesses choose to as an attraction and retention tool. That opens a small business and its employees up to a number of options (more details on that in part 2).

If an employer doesn’t offer benefits, an employee still needs insurance. While most plans have entered catastrophic territory (aka generally only beneficial if something really bad happens), in that one instance something serious does occur, it’s better to be insured. Not to mention, it’s the law. Each year a penalty is imposed on uninsured individuals. The fee was only $95 in 2014, but will triple in 2015 to around $300 and again in 2016 to around $1,000.

Takeaway: If your business has under 50 full-time equivalent employees, you’re not legally obligated to offer insurance, over 50 and you’re legally obligated. And yes, you still need insurance even if your employer doesn’t offer it.

Options, Options, Options

Individuals

Again, individual needing insurance should seek advice from a trusted and knowledgeable source, not just rely on the healthcare.gov exchange.

Among the insurance changes that the Affordable Care Act implemented, it also created health insurance co-ops like InHealth Ohio to provide access, innovation and competition in the marketplace.

“InHealth Mutual is a non-profit insurer, we’re built for members by members,” says CEO Jesse Thomas. The provider offers quality, affordable insurance that’s responsive to the needs of is members. Instead of stockholders expecting a return on investment, InHealth funnels all of its surpluses back to members by either lowering premiums or adding additional benefits. 

Policies through InHealth Ohio cover the 10 essential health benefits outlined by the ACA, but also focus on wellness, offering services like acupuncture because its members expressed interest.

Being a co-op, InHealth Ohio can develop policies based on member feedback. It’s how they arrived at their 2+2 plan. Each policy holder gets two free visits to primary care and two free visits to a behavioral health specialist. 

“The target audience for us is individuals under the age of 65…and those who are 138 percent of the federal poverty level and above,” Thomas says. 

In the year and a half since its inception, InHealth Ohio is providing insurance to about 22,000 – 23,000 individuals, of which about 11,500 are families and individuals, and the additional 11,000 from small businesses.

InHealth also offers a wide ranging network that’s broad enough to be easily accessible to 95 percent of the people in the sate. O’Brien points out that skinny networks have emerged as a way to make plans more competitively priced. While perhaps a better price, skinny networks make exclusive deals with a much smaller network of providers, meaning if you need to go to the doctor or hospital, you’ll probably have a more difficult time finding someone in-network.

Much of O’Brien’s work at Mosaic goes towards matching individuals and families with the right insurance, whether they are approaching him as an individual or at the referral of a small business. Not all policies are created equal, and he takes the time to educate them on what a policy really means and explore different options. Sometimes just $20 more a month can really make a break a year in terms of benefits.

O’Brien says InHealth Ohio is one of the best insurance providers in the state because of its broad network. They are also slightly more affordable. Thomas says their average premium is five to seven percent lower than its competitors, and in sates with co-ops (there are 22 across the nation), premiums come down by an average of nine percent.

Takeaway: The marketplace is hard to navigate, get help finding the best policy for your needs. Co-ops like InHealth Ohio are bringing a new and seemingly appealing option to the market.

Stay tuned for part 2 of how to approach health benefits as a small business owner. We’ll actually get to that whole small business offering benefits part…

Updated Income Threshold - Tax Credit Eligible on Health Premiums

2015 Federal Poverty Level Chart*

The Department of Health & Human Services (HHS) issues poverty guidelines that are often referred to as the “federal poverty level” (FPL). The Federally-facilitated Marketplace will use the 2015 guidelines when making calculations for the insurance affordability programs starting November 1, 2015.  Fall UNDER the 400% level at your household size and you may be eligible for upfront discounts on your premiums. Contact us www.mosaicemployeebenefits.com for assistance with your application, discount, and plan options. 

Household Size	100%	138%**	150%**	200%**	250%**	300%**	400%**
1	$11,770	$16,243	$17,655	$23,540	$29,425	$35,310	$47,080
2	15,930	21,983	23,895	31,860	39,825	47,790	63,720
3	20,090	27,724	30,135	40,180	50,255	60,270	80,360
4	24,250	33,465	36,375	48,500	60,625	72,750	97,000
5	28,410	39,206	42,615	56,820	71,025	85,230	113,640
6	32,570	44,947	48,855	65,140	81,425	97,710	130,280
7	36,730	50,687	55,095	73,460	91,825	110,190	146,920
8	40,890	56,428	61,335	81,780	102,225	122,670	163,560

Millennial Individual Health Insurance Alternative

If you are healthy and without access to Employer Coverage, weigh your options before purchasing individual health insurance.

Example:

30 years of age
Female
Income $55,000 annually
Non Smoker
Columbus, Ohio Zip Code

Cost of ACA Compliant Gold Health Policy: $322/month or $3,864/annually.  That's a new BMW 3 series.

She could reduce coverage to a Bronze level plan for $222/month,  a true catastrophic policy that covers nothing but risk to bills larger than $6,000.  Preventive care, included.

How to avoid these costs? Penalties, Short Term Insurance, Discounts.

$77.25/month Penalties
$117/month Short Term Insruance
$20/month Telehealth, Dental, Vision, Prescription, Chrio Discounts

Considering the same Female above, for similar  Gold level benefits, her monthly premium is reduced to $214/month. An annual savings of $1,296 by taking the penalty & covering herself with Short Term Insurance & Discounts.

The downside to Short Term Health Insurance - *Pre-existing conditions are NOT covered, Policy maximum $1million.  

-Costs pulled from live carrier quoting tools.
-Penalty estimates pulled from http://taxpolicycenter.org/taxfacts/acacalculator.cfm

obama-"CARE"....Staff Don't CARE!

5 months, 21 logged phone hours, 6 so called "escalations" with HEALTHCARE.GOV.....outcome - Uninsured.

This is not another rant on Obamacare laws.  It is a flawed system needing fixed.  One of the many fixes, Service.  A firsthand story below:

 - Every Individual is guaranteed Health Insurance.....WONDERFUL!
 - Tax Credit assistance in the Public Marketplace for individuals & families who need it....TREMENDOUS!

I rarely mess with the public marketplace.  I if do, I am helping very close friends who may need assistance applying for a subsidy.  Healthcare.gov with its tracking, verification, and service is too messy of a system to deal with and can be very risky at times. If you are perfectly healthy, you are better off with a 12 month Short term policy.

LET THE STORY BEGIN
A friend needed help and I wanted to assist!  She was directed to a policy through the public exchange in December of 2014, by a Navigator; they apparently play "vital role" with Obamacare.  *** (CMS.gov) NAVIGATOR - Navigators are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training.

NAVIGATORS - THE FIRST OF THE POOR SERVICE
This Navigator, with comprehensive training, directed my friend to a policy with Anthem through the public exchange, stating her preferred Primary Care Physician was In-Network. January comes along, her first appointment scheduled, she pays Out-of-Pocket, Doctor was not in network. Many things wrong with this -  1. ANTHEM is priced out of the individual market in 2015, expensive   2. they have a SKINNY Network (limited doctors & hospitals)   3. There are cheaper carriers with broader networks and similar coverage this Navigator over looked.  Poorly trained, they do not know how to recommend and provide the right health policies to Individuals & Families.  They are only good at navigating through the application.

WHERE THE MESS BEGINS, PHONE STAFF -  POOR SERVICE CONTINUED
I clean up the mess of the Navigator in late January.  Calling Healthcare.gov, I was instructed to submit a new application issuing the new policy my friend needed to include her doctor in-network. Still in the open enrollment period, by switching, we saved her an additional $140/month included her doctor in network, and she acquired stronger benefits.

After we completed her new application, we were instructed to cancel the old application over the phone with Healthcare.gov.  We reported the proper numbers, confirmed cancellation over the phone, all was good!??????......The rep was not able to give us a tracking ID# for the phone call, .GOV apparently doesn't do this, it is based on trust I guess.....! The Healthcare.gov rep, little did we know after we got off the phone, proceeded to cancel an application, but canceled the wrong (new) application.  This process takes Healthcare.gov 30+days to communicate to the insurance carrier. My friend  received her invoice and ID card, 30 days later receives cancellation on the same policy. Anthem had also sent an invoice we thought in error, so we called them direct to tell them them policy had been replaced.

WHERE HEALTHCARE.GOV IS USELESS, ESCALATION MANAGERS? - AWFUL SERVICE LEVEL 3
5 months, 21 logged phone hours, 6 so called "escalations" later with HEALTHCARE.GOV.  Rushing to get hold of Healthcare.gov, we had an emergency.  A preventive cancer drug is needed every 30 days and my friend stood there uninsured.  After a 45 minute hold we speak to a rep and are told to "escalate the issue with a manager." BUT AN ESCALATION COULD TAKE UP TO 60 DAYS! If its between life and death, they tell you to call 911 and continue care without insurance.

These policies run through healthcare.gov and .gov in turn communicates to the carriers.  Most carriers will tell you there is nothing they can do on a subsidized policy without it coming direct from .gov staff.  My friend, who needs urgent medication to prevent a relapse with cancer, might not be able to get it for 60 days because .gov staff will twiddle their thumbs taking their time to fix a mistake made they made?? FYI, this is apparently the highest level of escalation you can get through the system.

5 months, 21 logged phone hours, 6 so called "escalations" & the carrier finally felt so bad they kicked in their services and began to argue with .gov.  Throughout this time the client paid hefty out of pocket costs to maintain her prescription.

As we approach the halfway mark of 2015, a policy has apparently been issued for a 7.1.2015 effective date.

If obama-CARE CARES, create a process that CARES. 
If a mistake is made own up to it and have a system in place to take care of this matter SAME DAY. This is the insurance world, mistakes are very common, they are going to happen.

1. Have individuals hold 3 way calls with the carrier they choose and healthcare.gov.  Utilize this as tracking so each party remains on the same page

2. Hire account managers for large participating cities so services requests requiring multiple calls are communicated through 1 person.

3. I had service reps tell me there was no tracking of calls, tracking of calls but no confirmation number could be passed, and also received activity ID #'s on certain calls.  Your staff is not educated, know the rules and fix it.

4. PEOPLE CANT WAIT AROUND WITHOUT INSURANCE FOR 60+DAYS

#CAREobamaCARE