Virtual Second Opinions
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
There may be a time in employees’ lives when they receive a medical diagnosis or feedback they feel uncertain about. Second opinions allow patients facing medical challenges to seek additional medical information on their condition, which can provide clarity and other treatment options available. With the increase in the popularity of telehealth, there is even the option of virtual second opinions, which can provide convenience by saving employees time and travel.
A virtual second opinion can help ease some of an employee’s stress after a serious diagnosis or when looking for a diagnosis for ongoing symptomatic issues. It can be difficult for a patient to find an appointment, especially if they need specialty care. Therefore, offering health coverage that includes virtual care gives a more accessible and efficient option for care. This article explains the additional benefits of receiving second opinions virtually.
Benefits of Virtual Second Opinions
Access to a second opinion can help relieve worry about diagnosis or treatment uncertainty. A virtual second opinion can provide easier access to different opinions, creating peace of mind for a patient. Additional benefits to this virtual care option can include:
- Improved patient care—The most significant benefit patients find from seeking a virtual second opinion is an improvement in overall care. This is due to having access to a large library of doctors nationwide. No matter where a patient is located, they may potentially receive access to any specialist they need.
- Increased timeliness—Receiving a virtual second opinion is often more efficient than going in person to receive one. The virtual process may allow patients to receive in-depth care and a treatment plan from a physician in about two weeks; in contrast, in-person visits are booked months out in most cases.
- Individualized care—It’s easier to make informed health decisions when all the facts are present. With a virtual second opinion, doctors can take the facts and ease patient anxiety by answering questions and creating a clear plan.
- Expanded care—Offering the benefit of virtual second opinions to employees helps those who live in areas of the country that do not have adequate access to health care.
- Eased anxiety—Virtual second opinions can ease the anxiety and stress of employees that may have received a diagnosis or care option they’d like analyzed in-depth. It can also empower an individual to take charge of their health and increase overall health literacy.
It’s important to note that there are different virtual second opinion program levels available. For example, these programs can include quality care for cancer and musculoskeletal disorders. Other programs offer care from specialists and subspecialists, such as surgeons and oncologists, that may be required for a patient’s care.
Summary
The level of care offering needed at each organization will vary, so it’s important to survey the needs of employees to find out which coverage options will receive the most use. Providing the option of virtual second opinions can give employees comfort in knowing they have access to additional care when they need it most. For more information on virtual second opinions, contact RISQ Consulting today.
- Published in Blog
A Primer on Medical Stop-loss Insurance
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
Catastrophic and unexpected health care claims are on the rise. This increase in catastrophic claims is, in part, the result of medical and pharmaceutical advances, such as specialty drugs and cell and gene therapies, as well as medical price inflation. As a result, many employers with self-funded health plans are actively looking for ways to minimize their financial exposures to potentially catastrophic claims. A common strategy these employers have leveraged is purchasing stop-loss insurance.
This article provides a general overview of stop-loss insurance and outlines some considerations for employers to keep in mind when deciding whether to purchase this coverage.
What Is Stop-loss Insurance?
Generally speaking, stop-loss insurance helps self-funded employers protect themselves from higher-than-anticipated health claim payouts by limiting their exposure to employee medical claims that exceed a predetermined amount. In other words, such coverage can prevent abnormal claim frequency and severity from draining employers’ financial reserves.
Stop-loss insurance plays an important role in helping employers manage their health care costs and protecting against unexpected or catastrophic claims, as it sets a ceiling for the amount they pay in health claims. This coverage is not a form of medical insurance, but rather a policy employers can purchase to manage their financial risks.
How Does Stop-loss Insurance Work?
Under a stop-loss insurance policy, an employer’s claims liability is limited to a certain amount (also called an attachment point), therefore ensuring abnormal employee health claims do not drain the employer’s financial reserves. An employer can add stop-loss insurance to an existing plan or purchase it independently.
If an employer’s health claims exceed a predetermined amount, their insurer will usually reimburse them for all additional claims. For example, if an employer has a stop-loss insurance policy with an attachment point of $500,000, their insurer will typically begin providing reimbursement after the plan’s claims exceed $500,000. It’s worth noting that since stop-loss coverage only reimburses an employer for claims that exceed their policy’s attachment point, the employer is initially responsible for paying employee claims before they reach the established cost ceiling.
Types of Stop-loss Insurance
There are two types of stop-loss insurance: individual (or specific) and aggregate (or total claims). Understanding the difference between individual and aggregate stop-loss insurance can help self-funded employers evaluate and determine which coverage best meets their needs and reduces their financial exposures. Because health plan usage can be unpredictable, some employers choose to purchase both individual and aggregate stop-loss insurance to provide their organizations with maximum financial protection.
Individual Stop-loss Insurance
Individual stop-loss insurance limits an employer’s liability when an individual employee’s medical claims exceed the attachment point. As such, this coverage can protect employers against unexpectedly high claims from individual employees.
Aggregate Stop-loss Insurance
Aggregate stop-loss insurance can help safeguard employers from the total sum of health claims for an entire group of employees rather than any one individual. Under this coverage, an employer is usually reimbursed when their expenses for all employees’ medical claims exceed the attachment point for the plan year.
Stop-loss Insurance Considerations
Each organization is unique. Deciding whether stop-loss insurance is necessary depends on an organization’s specific needs, workforce characteristics and risk tolerance. Reviewing all relevant factors (e.g., rates, policy terms and potential exposures) can help employers decide whether purchasing this coverage makes sense. Employers can consider the following factors when evaluating whether to purchase stop-loss insurance.
Understanding the Attachment Point
The attachment points for individual and aggregate stop-loss insurance differ. Generally, the attachment point for an individual stop-loss policy is a specific dollar amount. As a result, an employer is only responsible for an individual employee’s claims up to that amount.
For aggregate stop-loss insurance, the attachment point is usually a percentage of expected claims. The typical attachment point for aggregate stop-loss insurance tends to be between 120% and 125% of expected health claims. In any case, a stop-loss insurance policy’s attachment point can vary depending on factors such as the employer’s size, employee demographics and overall risk profile.
Evaluating Coverage Limitations
Stop-loss insurance plans are medically underwritten; therefore, an insurer may refuse to cover certain conditions or require higher claim thresholds for those conditions. For example, if a plan enrollee consistently has high-cost claims, a stop-loss insurer may refuse to continue to cover that enrollee or require a higher claim threshold for the enrollee. This practice is known as lasering.
Additionally, since stop-loss contracts typically last for one year, an employer’s high-cost claimants may only be covered for a few months before the insurer excludes them from the policy upon renewal. Thus, the employer will likely be financially exposed to those claims the following year.
Monitoring Increasing Costs
While stop-loss insurance can help employers reduce their financial exposures when health claims are higher than anticipated in a given year, the cost of such coverage can increase annually. Rising claims can also make it more difficult to obtain rates from other providers.
Ensuring Stop-loss Coverage Aligns With Health Plan Provisions
Some stop-loss policies may exclude certain medical treatments or classes of individuals covered by employers’ health plans. Consequently, employers may be on the hook for expensive claims that aren’t covered under their stop-loss policies. Therefore, employers should consider reviewing their stop-loss policies and health plan provisions to ensure they align to limit their potential financial exposures.
Summary
Selecting the right insurance policies can have major financial repercussions for employers. Having sufficient coverage can lower employers’ insurance costs, reduce their risks and keep their workers healthy. Stop-loss insurance can make all the difference in helping employers mitigate their financial risks, especially as catastrophic health claims are increasing. Understanding stop-loss insurance will allow employers to make the best policy decisions for their respective organizations.
For more health care resources, contact RISQ Consulting today.
- Published in Blog
High Deductible Health Plans
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
Enrolling in a high deductible health plan (HDHP) allows you to place pre-tax earnings in a health savings account (HSA). Then, you can use these saved funds to pay for medical, dental and vision care, and most medications.
The Basics of HDHPs
Many people enroll in an HDHP, a health insurance option that does not cover your first dollar of medical expenses. Instead, these plans have a high deductible that must be met before most services are covered at 100 percent. In general, the deductible must apply to all medical expenses (including prescriptions) covered by the plan. However, plans can pay for “preventive care” services on a first-dollar basis (with or without a copay), including routine prenatal and well-child care, child and adult immunizations, annual physicals, mammograms, pap smears, etc.
HDHPs and HSAs: Their Connection
An HSA is an account that can be funded with your tax-exempt dollars, by your employer, or by both, to help pay for eligible medical expenses not covered by your insurance plan.
Anyone who meets the following criteria is eligible for an HSA:
- Covered by an HDHP, and not covered by any other plan that is not an HDHP
- Not entitled to Medicare benefits
- Not eligible to be claimed on another person’s tax return
After visiting your physician, health care facility or pharmacy, your medical claim will be submitted to your HDHP for payment. Then, you can use your HSA to pay for out-of-pocket expenses that were not covered by your plan. Or, you can simply save your money in your HSA for future medical costs.
For more information on HSAs, ask RISQ Consulting about their HSA flyer!
Why Enroll in a HDHP and Open an HSA?
- Once your deductible is met, most medical costs are covered at 100 percent.
- Contributions to and withdrawals from HSAs for qualified expenses are tax-exempt
- Ability to save for future medical expenses
- Funds roll over from year to year
- If the account is through your employer and you leave, you take it with you.
- You control and manage your health care expenses.
Contributions Are Easy!
Once enrolled in an HDHP, you (and your employer if the account is through your job) can make contributions to your HSA. Remember though, your total contributions are limited annually.
If you make contributions, you can deduct them (even if you do not itemize your deductions) when filling out your income tax return.
- Published in Blog
The Grinch Had the Right Idea
By Jennifer Outcelt, Creative Content Architect
My husband has an extreme aversion to the gift giving gambit of the holiday season. He’s by no means a Grinch when it comes to the decorations, feasts, time with loved ones, magic of Santa for our daughter, or general joy that the holidays can bring. Yet the capitalist consumer driven aspects of rearranging money into stacks of useless stuff to shove under a tree leaves him wanting… well, less.
To him, finding presents for the people he loves (and some he just likes) is the same feeling as John Travolta trying to find the intercom system in Pulp Fiction. Confusing, awkward, and unnecessary.
A few years back he requested a gift-less year. My poor indoctrinated brain could barely comprehend the concept, so I put up a bit of a fight. Eventually, we compromised and decided to condense our Christmas gifting to a singular special gift for each of us. At the time, our daughter was too young to understand Christmas and so we only got her a few essentials as well.
Much to my surprise, it felt better to get the one gift than it had in previous years getting a bunch of smaller gifts. Even more to my surprise, was how exciting if felt knowing that I had found just one awesome gift for my husband that he would love. In fact, that one gift is now considered the best gift he ever received and is talked about (and used) daily. Oddly, I don’t actually remember what gift I received… but I do remember having a wonderful, joyful, and playful Christmas. And I think those memories are more important.
Ever since, I have been looking at Christmas through a newly defrosted lens. We have continued the one gift rule between us and it has saved us stress, money, and time. We are now focused on the decorations, the food, the games, and the merriment of the family. After all, I’m an adult with a big girl job, and if I really want something, I can go buy it.
This attitude has even trickled down to other gift giving events. We have asked for experiences in lieu of toys at our daughter’s birthday. Now we have an amazing membership to the Anchorage Museum and can visit anytime we want to have a fun and active day out of the house. WAY better than a voice changing, battery operated, megaphone. Well… at least in my opinion.
The point is, that once we decided that material gifts should be limited or absent, the time we spent together became the goal and the reward. I found a cool article that dives into the money side of the holiday spending. I thought it complemented our recent gifting changes nicely and might offer you a new perspective on how to allocate your holiday funds.
https://moneywise.com/managing-money/budgeting/heres-why-you-should-stop-buying-christmas-presents
- Published in Blog
Quick Tips: Save Money on Energy in Your Household
This article is from RISQ Consulting’s Zywave client portal, a resource available to all RISQ Consulting clients. Please contact your Benefits Consultant or Account Executive for more information or for help setting up your own login.
According to the National Energy Assistance Directors Association, energy costs will reach a decade-long high this winter. Heating costs are predicted to rise 28% for U.S. households relying on natural gas and 27% for those using heating oil. Electricity costs are also anticipated to increase 10% per the U.S. Energy Department. Read on for tips on how you can lower the energy bills for your home.
Why Are Heating Costs Rising?
Many factors have contributed to the rapidly increasing energy costs this year including the following:
- A predicted colder-than-average winter
- Rising wholesale gas prices
- Depleted energy stores from increased demand during the 2020 and 2021 lockdowns
- Lowered supply stemming from financial sanctions put on Russian oil after the invasion of Ukraine
How Can I Reduce Energy Costs in My Household?
With skyrocketing prices, you may be wondering how you can reduce or control your winter utility bills. Many may be tempted to simply turn down the thermostat. Fortunately, there are ways you can lower your energy bills while staying warm this winter.
Here are some tips to help you lower your energy bills:
- Use a programmable thermostat to automatically lower your temperature when you’re not home.
- Seal areas where heat could escape from your windows and doors.
- Ensure radiators and vents are unobstructed.
- Open curtains and windows during the day and close them at night.
- Replace your furnace filter if it’s dirty.
- Have a professional inspect your HVAC systems for leaks.
- Close the vents and shut the doors to rooms you’re not using.
- Consider other sources of energy waste (e.g., leaky faucets, inefficient light bulbs).
Cold weather may make some increased energy costs inevitable. By using the above tips, and consulting the Department of Energy’s Energy Saver Guide, you can be well on your way to managing your winter utility bill.
For additional winter home safety tips, contact us today.
- Published in Blog
More Drugs, Less Money
By Alison Nelson, Account Manager
You may know him from Shark Tank or as the owner of the Mavericks, but you may soon know Mark Cuban as the man disrupting the pharmaceutical industry. It was recently announced that, billionaire Mark Cuban, has launched an online pharmacy boasting significant savings when compared to some traditional pharmacies. What makes this online pharmacy, Cost Plus Drug Company, stand out is their commitment to pricing transparency.
Cost Plus Drug Company is basing their prices on a 15% markup from the manufacturer cost and a $3 labor charge. This results in candid transparency on how much prescriptions costs to make. One of the medications listed on their website, estimates a $6,112.28 savings. The pharmaceutical industry is often associated with price gouging, prompting anticipation to see how other pharmacies respond.
To read more about Cost Plus Drug Company, read this NPR article or visit their website here.
- Published in Blog
