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Are You Starting To Plan For Your Employee Benefits In 2025?

October 18, 2022

If you need new ideas, this post is for you. I’ll be sharing more about Budget, Benefits, & Value

We know we need to address all of the aspects of employee well-being. That would include physical, mental, emotional, financial and purpose. It has to be balanced with your budget and your employee’s ability to pay their share if applicable.

Budget

Most employers have a budget for employee benefits. We usually tell our employers to budget for a 12% renewal cost and 1% for each month for renewal increases. For January 2021, we didn’t see many that were that high. And it is too early to predict trends for mid-year 2022 or 2023.

Benefits

At Benefits by Design, we know one size does not fit all. Healthcare is human-centric. What works for a super-healthy employee does not necessarily work for an employee with health issues. We will help you put together an offering that will work for all of your employee population.

Offering a choice of Benefits

Whether you are a large employer or a small one, there are lots of options available for employee benefits. Offering a choice doesn’t mean it will be more expensive. At Benefits by Design, we work with all of the Health Insurance Companies in California. We offer Creative Benefits. There are ways to establish a budget and allow employees to buy up if they want more as a payroll deduction.

What we are seeing is that most employers are offering Kaiser and then at least one additional medical insurance company.

For employers under 100 employees, California Choice or Covered CA small business plans are popular because they provide multiple carrier options at different price points.

California Choice is a small group exchange and I have seen as many as 5 different health insurance companies offered, depending on where the employee lives.

Covered CA small businesses can work well for employers with low-wage-earning employees because if employee-only coverage is offered, the employee can enroll their dependents on Covered CA and get a subsidy if they qualify.

H.S.A, H.R,A and F.S.A

Many employers are saving cost on their benefits using High Deductible Health plans with Health Savings Accounts (H.S.A), Health Reimbursement Accounts (HRA)to lower an employee’s overall out-of-pocket costs and Flexible Spending Accounts (FSA) to allow employees to pay for uncovered benefits expenses with pre-tax dollars.

Specialty benefits

Some specialty benefits can be voluntary, which means the employer pays the monthly bill, but the employee pays for them through payroll deduction. If payroll is reduced because the employee is getting benefits instead of salary, that reduces employer taxes and employee costs. You can set up a Section 125 plan, Premium Only Plan, that allows employees to pay their portion with pre-tax dollars.

Depending on how competitive employee benefits are in your industry, employees may expect to have dental, vision, employee assistance programs, disability, and life insurance to be employer paid. At Benefits by Design, we have a lot of ideas we can propose to help meet your needs in this category.

Some of the other things that can be part of the package are Pet insurance, student loan pay-off benefits, adoption assistance, fitness class passes, and commuter benefits.

Value for the organization and your employees

If you are not sure what will interest your employees and motivate them the most, consider doing a focus group or an employee survey.

At Benefits by Design, we can offer the best health insurance benefits in California. Contact us for more information.

Pam Morton
Benefits by Design Insurance Services
415-524-8959 Larkspur, CA office
760-696-3573 Carlsbad, CA office
PamM@benefitsbydesignca.com
www.benefitsbydesignca.com
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Pros and Cons of Purchasing Individual Dental Insurance

September 9, 2021

When is it cost effective to buy Individual dental insurance?

People ask me all the time what dental insurance I recommend. My answer is, it depends. There are pros and cons of purchasing individual dental insurance.

To get a good value out of your individual dental insurance, consider these 2 things:

  1. Does my current dentist participate in any dental insurance networks?
  2. If they don’t, will they accept any PPO dental insurance?

Most dentists don’t participate in dental insurance networks because they have to accept reduced fees for their services. When a dentist participates in a dental network, they have to agree to not charge the member more than the reimbursement fee schedule of the dental insurance company. That is an advantage for you as a member because you can get more coverage for your dental work for less.

 

Dental HMO

In some cases, such as with a dental HMO network, the fee schedule is greatly reduced from what the dentist would normally charge. Reasons why a dental office would participate could be 1) The dentist or the dental office is new and trying to build a client base 2) The dental office wants to build volume for their practice and offering reduced fees will bring in more clients 3) The dental office is well established and they have found that over time serving everyone, regardless of their profit is good business.

If your dentist participates in a dental HMO provider network, you can get the most out of your dental insurance at the lowest cost. If you are willing to change dentists or you need to pick a new dentist anyway, a dental HMO plan would have the most value from both a benefits and a cost perspective.

Here are the pros and cons of Dental HMO:

Pros Cons

Costs less Not very many dental offices to choose from

Better coverage Dentist office may try to upsell other procedures to make up for less profit

Dental PPO

If your dentist only takes PPO dental plans, go to their website or call them to find out if they participate in any dental networks and ask if they are DHMO or dental PPO (DPPO) networks and which ones. Let us know the names of the dental networks and we’ll include those in your quote.

If your dentist participates in a dental PPO network, you will get the most value out of the plan because the dentist can only charge you the maximum allowed amount and your out of pocket maximum for the year will go a lot farther.

Here are the pros and cons of Dental PPO:

Pros Cons

Go to any dentist Pay more out of pocket for an out of network dentist

Preventive care usually covered at 100% Watch out for balance billing I the dentist is not in

Higher max out of pocket covered the dental PPO network

What if your dentist doesn’t participate in any dental networks but they will bill any dental PPO plan? Then you will want to pick a dental plan that offers the most reimbursement for your dental claims. Some dental companies use their own dental claims data to determine the maximum they will pay (using their participating dentists fees which are reduced) and others will base their reimbursement on Usual and Customary.  Usual and Customary is the best reimbursement schedule for you because it is usually based on an industry average of what dentist charge in your area.  If they pay at the 80th or 90th percentile, then it means that your claims will be paid at 80% or 90% of what most dentists charge.

Now that you have taken the time to figure out if your dentist participates in any DHMO or DPPO networks, here are some guiding questions?

What are the most important things to look for in the dental plan you are considering?

  1. Is my dentist in the network?
  2. With a dental PPO plan, what is the out of network reimbursement schedule based on?
  3. What is the maximum the plan will pay out for the year?
  4. Does the plan have a deductible and what is subject to the deductible?
  5. Is preventive care covered at 100%?
  6. Is there a waiting period for any services?
  7. What are the exclusions of the plan?
  8. Does the plan cover major services such as crowns and root canals?

Tip: If you need to have any dental work done that will cost more than $100, ask your dentist’s office for a predetermination of benefits. A predetermination of benefits will be an itemized cost your dentist office will get from your dental insurance company to find out what your final cost will be after the insurance pays their part.

For more information on dental insurance or to get a quote for dental insurance, please contact Benefits by Design Insurance Services at 760-696-3573 or admin@benefitsbydesignca.com.

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Should you do an Employee Survey about Employee Benefits?

April 16, 2019

The answer is yes.  If you haven’t done one in a while, it is time.[1]

How do you think your workforce has changed in the last decade? Is your workforce younger and paying off student loan debt or struggling with mortgages? Are those responsibilities keeping them from contributing to their retirement accounts?  Is that a concern in your organization?

Employee Benefits are an important part of an employee’s compensation.  In this tight job market, it is important to understand where your employees are in their satisfaction of what they are being offered as well as what you are competing against if they are thinking about other opportunities.

Sometimes small changes to the benefit package can make a big difference without being a big impact in cost.  As an example, not all employers offer vision coverage and yet glasses can cost employees a lot of money by the time they pay for scratch resistant coating, progressive lens, and other upgrades. The cost of vision coverage is small when compared to medical or dental benefits.  One of our clients conducted an employee benefits survey and found out that a majority of the employees would rather have a vision benefit than long term care.

Employers are also getting creative when adding voluntary benefits.  The word “voluntary” means the employee pays for a portion or even all of the benefit but the employer is making it on a payroll deduction basis for ease of budgeting.  This can include options such as accident policies, life insurance for employee and/or dependents, cancer policies or even pet insurance.

These are just some examples of things you might want to include in your survey. You probably won’t know what you are missing unless you do a survey to ask your employees what they really want.  Online surveys can be quick, easy to do and sometimes free.

We’d be happy to help you put together an employee survey.  You can contact me at pamm@benefitsbydesignca.com or visit our website at www.benefitsbydesignca.com.

 

[1] Source: SHRM OCT 2017 – How to design an Employee Benefits program. Common market research techniques include employee inquiries in the form of personal interviews, simplified questionnaires or sophisticated research methods.

 

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