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  • My two older boys, ages 9 and 10, are playing ‘kid pitch’ baseball this year. Believe it or not, when I asked them what position they wanted to play, they both said “Dad, I want to be the pitcher”.

    Then we asked each player on the team what position they wanted to play and each and every player said “Pitcher”. On paper this is not strange, as this is the most glorified position in baseball. After all, they make the most money, get the most publicity (when they are good), and seem to have the biggest fan base.

    The other coaches and I talked to our 13-man roster about how important every position is on the team and how every position contributes to the overall goal. We teach them that they all have to play together to win.

    This conversation made me think of a business and all the “players” within a company. I bet if you asked most employees, “If I could give you a new position, what would it be?”, a popular responses would be, “I want to be the manager, the president, or the owner.”

    I am not downplaying the pitcher, the manager, the president, or the owner positions, as they are still important. But isn’t the baseball team just like a company, where that every position is important?

    • Without Risk Managers – workers gets hurt and worker’s comp rates go through the roof.
    • Without Payroll Employees – we have anarchy because no one gets paid.
    • Without Tax Administrators – the IRS is knocking at the door (actually they don’t even knock, they just enter.)
    • Without Sales People – there are no new customers.
    • Without Benefits Administrators – no one has healthcare, 401K’s, or vision and dental insurance.
    • Without Wellness Coordinators – people miss out on learning to improve their health choices.
    • Without Human Resource Employees – you have a disheveled mess.

    You get my point? Every business needs:

    • Right, center, and left fielders
    • Catchers and pitchers
    • First, second, and third basemen
    • Shortstops
    • Teammates on the bench ready to play
    • Fans
    • Beloved mascots
    • Coaches
    • Umpires

    No team is successful without all of these positions working together towards a unified goal. Isn’t the same true in business? Whenever everyone works together—bringing their special talents and experiences with them—games are won, and businesses grow.

    “Trend Following Little League Team,” © 2012 Michael Covel, used under Creative Commons Attribution-Share Alike 2.0 Generic License.

  • The news channels are flooded with updates on the trials and tribulations of the Affordable Care Act’s website and accompanying registration process. Politics aside, the implementation of this piece of legislation could mean big changes and larger financial challenges for your health benefits plan.

    Most small business owners today are able to provide some form of health insurance coverage for their employees through large commercial healthcare plans. However, with the Affordable Care Act, these plans will come at a cost for business owners. In fact, Ohio businesses are expected to see a 71% increase in these premiums. 

    These high increases may force you to reduce or eliminate the health benefits you are able to extend to your employees, forcing them to buy insurance from the government’s healthcare marketplace.

    An Alternative to Government Healthcare

    The appeal that the Affordable Care Act has for many Americans is also one of its biggest challenges for those looking to enroll. Long wait times, sparse customer service and other registration obstacles will make it difficult, not to mention aggravating, for your employees to secure health benefits which match their needs.  

    Fortunately, you have another option for your company’s health benefits. You can implement a self-insured plan. Self-insured companies are responsible for their own medical costs, eliminating the need to subsidize the healthcare expenses of other insurance groups.  

    How Self-Insured Policies Work

    Self-insured healthcare provides plan flexibility, control and the potential for premium reductions for your business. Companies are responsible for contributing to a claims fund each month and that money is used to cover all employee medical expenses beyond their out-of-pocket costs. With a self-insured plan, you can still provide quality care to your employees and protect them from having to navigate through miles of government red tape.

    An essential component for any self-insured policy is known as the TPA, or third-party administrator. TPAs ensure that your employees are getting all the benefits promised to them in their insurance policy.  

    Who Has the Time?

    Of course, if you’re a small-to-medium sized company, you are probably thinking “Sounds great, but we don’t have the time or resources to manage self-insured policies ourselves.” 

    That’s where GMS comes in. Our services:

    • Let you focus on growing your business. We cover everything from eligibility to claims management and even customer service.
    • We’ll worry about the policy details. You worry about growing your business.
    • Save you money. We underwrite a custom policy for your group so you won’t pay for extra insurance that you don’t really need.
    • Limit your risk. We offer stop-loss insurance, which minimizes your exposure in the event of an unforeseen and major health claim.

    Learn more on how a self-insured plan administered by GMS can drastically reduce your health care costs, increase the cash flow of your business and ultimately provide better coverage for your employees and their dependents. Contact us today. 

    Image credit: 

    Creative Commons Image: Images_of_Money

     

  • In 2014, small group health insurance premiums in Ohio are expected to increase by 71%. As a business owner, you know that healthcare is already a significant expense, and increases like this are likely keeping you awake at night, wondering how you can keep employees insured AND pay the bills.

    Fortunately, you can start sleeping better again, because Group Management Services has a completely unique and customizable solution that enables you to provide the coverage your group needs while limiting your expenses and business risks associated with healthcare coverage.

    To give you an idea about how GMS can do this, let’s first take a look at how small and medium-sized businesses are covered today: fully insured plans.

    Fully Insured Healthcare Plans

    Under fully insured healthcare plans, the insurance company will determine your business’s premiums based on projected claims, which are determined by the Experience Rating (soon to be Community Rating). In essence,  groups are rated on a scale. The closer to 1 the  group is, the healthier. The healthier the  group, the lower the premium.

    The problem with this scenario is that the insurance company determines how healthy a person is AND how much that person’s premium is going to be. As a business owner, they don’t provide any solutions or alternatives.  Self funding with GMS provides options.  

    A Healthcare Solution For Business Owners

    As a business owner, this can be pretty daunting.

    Enter our two-step solution, which not only limits your healthcare expenses, but keeps the quality of those benefits at the level your employees deserve.

    Step 1: Self-Insured Healthcare

    GMS is proud to announce the launch of Group Captive Management (GCM), a self-insured captive insurance company that benefits your business in many ways:

    1. Save money: We will underwrite a custom policy for your group so you won’t have to pay for insurance that your group doesn’t need.
    2. Increase cash flow
    3. Limit your risk: Stop-loss insurance will minimize your exposure
    4. Spend time growing the business: GMS covers everything, from  eligibility to claims to customer service. Don’t spend time buried in the details. Leave that to us.
    5. Keep employees happy: Instead of dropping insurance altogether, reducing employees’ to part-time hours, laying employees off, or going out of business, you can offer great health benefits  while competitors are struggling to cope with the healthcare changes.

    Step 2: Third-Party Administration

    We are also proud to announce today the acquisition of third-party administrators: Ogden Benefits Administration, Employee Benefit Concepts, and Variable Protection Administrators.

    This acquisition, in conjunction with our self-insured plans, provides even more benefits to small and medium-sized business owners:

    1. Further earn your trust: With our TPA services, we hold ourselves accountable for the policies we underwrite for your group. You will know that your employees are getting all the healthcare benefits promised.
    2. Lower your premiums: GMS now has access to tools that can keep your healthcare claims low, which keeps your premiums lower and your cash flow higher.
    3. Centralize points of contact: You no longer have to hire and pay a separate TPA. Now, you can work directly with GMS for all of your healthcare benefits needs.  

    Let’s Get in Touch

    Sure, there are a lot of healthcare changes coming your way. But you don’t have to navigate them on your own.

    Regardless of whether you’re a client or a prospect, the time is now to make your business simpler, safer and stronger. Give us a call at 330-659-0100 or contact us for more information about our self-insured and TPA services today.  

  • Since the Affordable Care Act (ACA) passed in 2010, many business people and consumers have felt that their insurance costs were going to be going up. I’m sure they have never regretted being so right.

    The deadline looms for Ohio to submit insurance plan options to the federal government for the healthcare exchanges. As the deadline approaches, there have been more and more articles both locally and nationally that talk about projected increases in healthcare premiums.

    ACA Impact in Ohio

    In Ohio, Lt. Governor and Director of Insurance Mary Taylor has talked about small businesses seeing an increase between 50-85%. Some companies may even see an increase as large as 150%, she says. Granted, under the ACA, companies with older or sicker populations may see their premiums shrink by as much as 40%. However, those with populations which were once more desirable will see a huge increase. This is due to the law’s provision that rates must be based on a large community (community rating) with premiums being more equally spread over that community.

    Many news stories are being written about the “unintended consequences” of this law. Some of the ACA’s biggest supporters, like unions and members of President Obama’s party, are beginning to voice serious concerns about the law.

    Understanding the ACA

    Of course, the ACA is now the law of the land thanks to the Supreme Court’s ruling in June of 2012. That means that employers will have to make pretty tough decisions in the next few months as more of the law’s features begin taking effect. Many employers have been taking advantage of what has become a cottage industry of late, the Obamacare seminars. However, those have left many employers even more confused.

    Large companies are also confused, but have more resources to guide them through these waters. Small business owners must learn to navigate them alone, or do what others have done and begin conversations with a Professional Employer Organization (PEO) like GMS. A PEO can provide small businesses the same resources and infrastructure that a large company has without all of the associated costs.

    PEOs Can Help

    For further information on how a PEO can help you deal with the ACA, contact Tim Austin at taustin@groupmgmt.com or 330-659-0101.

    “Stethoscope and Piggy Bank,” ©401(K) 2012, used under Creative Commons Attribution-ShareAlike 2.0 Generic license.

  • How healthy are your employees? If you are a small business owner looking to save money on your healthcare, let’s hope they are all vegetarian non-smokers training for a marathon, right? 

    While that would be great, for your small business what matters more for your bottom line is the type of healthcare plan you provide. You have two choices: a fully insured plan or a self-insured plan. 

    TPAs and self-insurd plans can save your small business money. Image is a piggy bank with a $100 bill. “Health Care Cost” by Tax Credits licensed by CC BY 2.0

    Type of health insurance coverage matters

    Many small business owners today provide some form of health coverage through fully insured healthcare plans. However, with the Affordable Care Act, the prices on those premiums are on the rise. 

    In the face of these increases, you might want to consider a self-funded group plan, which can:

    1. Increase cash flow
    2. Limit your risk
    3. Keep employees happy

    How it works: With a self-insured policy from GMS you pay a specific amount into a claims fund each month. This contribution is what covers your employees under your plan. With a self-insured plan from GMS you only pay for what you need, and you can further protect yourself with stop-loss insurance so you won’t have unexpected expenses in the event of a major claim. 

    “When companies are self-insured, they assume most of the financial risk of providing health benefits to employees. Instead of paying premiums to insurers, they pay claims filed by employees and health care providers. To avoid huge losses, they often sign up for a special kind of “stop loss” insurance that protects them against very large or unexpected claims, say $50,000 or $100,000 a person.”

    Step 2: Third Party Administration

    Further earn your trust
    With our TPA services, we hold ourselves accountable for the policies we underwrite for your group. You will know that your employees are getting all the healthcare benefits promised.

    Lower your premiums
    Proper management of healthcare can lead to lower claims, lower claims leads to lower premiums which will make your cash flow higher.

    Centralize points of contact
    You no longer have to hire and pay a separate TPA. Now, you can work directly with GMS for all of your healthcare benefit needs.

    What is the benefit of having a third-party administrator manage my plan?

    When you have a third-party administrator, like Group Management Services, manage your self-insured plan you ensure your employees receive everything promised to them, and limit you from spending more money than anticipated. Plus, you have the choice to pick coverage that your group actually needs.

    More Related Links:

    Learn more about TPAs and self-funded plans by reading our previous posts below:

     

    What do you think about the health insurance plan options for small businesses? Would you make any changes or suggestions? Let us know your thoughts in the comments below.

  • In the business world, everyone is always looking to maximize profitability. It’s not because business owners are greedy trying to grab every last dime. It’s because they are working their tail off to either make the business succeed or make it grow.

    In their efforts to do so, business owners look to control what they can, especially when it comes to costs. As a salesperson, I have often been the person who they tried to control costs through by either beating me up on price, extracting extra services or using what my company does to help make them more profitable. However, it often seems to come back to controlling costs.

    When a business owner thinks of controllable costs, they often think of material prices, employee hours or something else on the production end. What seldom comes into play is controlling workers comp, healthcare and unemployment costs.  But, how can you control those costs? Those things are completely out of a business owner’s control. Right?

    Wrong!  Large corporations, with large HR budgets, have long been able to control costs in those area by self-insuring or doing better documenting of employee issues that lead to terminations.  Small business owners general don’t have that same luxury, unless they work with a PEO.

    How PEOs Make Your Business Stronger

    According to a recent white paper put out by the National Association of PEOs, companies that use a PEO have 10-14% lower turnover of employees than comparable companies. With employee replacement costs equaling 150% of that employee’s wages according to the Society of Human Resource Managers (SHRM), that is a cost that is a potentially large cost that can be cut or altogether avoided. These numbers are even higher for companies in the white collar world.

    Companies that use a PEO that has a self-insured Worker’s Comp and/or Healthcare program automatically have mechanisms put in place through those programs that monitor and manage costs tied to those programs. By having specialists working exclusively in those areas, every conceivable way to manage those costs is reviewed for its viability and cost effectiveness.

    Additionally, companies that use a PEO are 50% less likely to fail compared to other similar companies in their industries.  According to that same white paper “Data broken down by specific industries  point to ‘Professional, Scientific, and Technical Services’, ‘Construction’ and ‘Finance and Insurance’ as being three industry categories that disproportionately benefit from PEO services in both lower employee turnover rates and lower business failure rates.”

    To see how a PEO like GMS can benefit your business, give us a call at 330-659-0100 or fill out our online form today.

  • Imagine you’re the CEO of a company with 49 employees. You’re currently covered through a fully insured health plan, but are considering switching to a self-insured group plan due to the potential premium increases resulting from the Affordable Care Act.  

    All of the companies you know with self-funded plans are larger companies (250+employees), so you aren’t sure if this is the right solution for you. You’re also concerned that since you would pay self-insurance claims directly, your company could be liable for a major claim if an employee has a serious health issue. 

    What do you think – what would you do in this situation? Before you make a decision, consider the following key points. 

    What happens when you have a major claim on a self-insured policy?

    The answer depends on the stop-loss insurance coverage.

    How Stop-Loss Protects you From Major Unforeseen Claims 

    • Stop-loss insurance protects you from higher-than expected claim totals. If your group’s claim amount exceeds the self-funded limit, the stop-loss insurance provider will  pays the difference.

    How Third Party Administrators (TPAs) Can Help

    • Reduce administrative tasks – TPAs administer the health plan by processing the claims, issuing ID cards,  and dealing with customer questions
    • Offer stop-loss with self-funded plans

    Benefits of TPA Self-Funded Health Plans with GMS 

    Creative, custom-tailored solutions for your employees 

    • Only pay for what you need – pay a specific amount into a claims fund each month
    • Stop-loss insurance included – you won’t have unexpected expenses in the event of a major claim 
    • One bill – streamline billing makes payments easy
    Ok, so go back to the beginning and imagine you are that business owner again. 
     
    Would you feel more comfortable making a decision with this information on TPAs and self-funded plans? Hopefully you’ll see that this option is not just for large companies—that this could be a time and money saving option for your company, too. 
     
    If you’re interested in learning more about how GMS can help save your real company time and money with TPA services, let us know. We’re always here!

  • When the Affordable Care Act passed in late 2010, one of the major tenets of the plan was the creation of healthcare exchanges in every state. These exchanges would be state-run with federal seed money used to create them. People who didn’t have coverage or had unaffordable coverage through their employers would be able to buy subsidized plans at a comparatively low cost.

    The exchanges began with the implementation of the ACA in 2014. Of the 50 states, 23 of them were run by the federal government. In late 2015, it was reported that 12 of the 23 federally-run state exchanges were shutting down due to unsustainable losses. In some areas, things have gotten worse.

    Image of healthcare exchanges. Learn about self-insured health care plans.

    Withdrawal from the Healthcare Exchanges

    Over the last couple of years, some insurance companies have begun announcing their intent to withdraw from the healthcare exchanges. In some counties, they were the last insurance company standing. According to a recent Washington Post article, dozens of counties across the country could be without any insurance companies in the exchanges. 

    According to that same article, “that leaves 35 thousand marketplace enrollees living in a county with no affordable way to purchase insurance (As it stands, people who receive subsidies can only use them to purchase coverage in the marketplace.), and 2.4 million would be left with just one insurer’s plan to choose from. That’s out of 12.2 million enrollees total.”

    What to Do Without the Healthcare Exchanges

    If you’re an employer who counted on those exchanges for your employees to get coverage, what are you to do? If you’d like to take care of your employees and offer them coverage, you can begin shopping for a group plan, but you’ve probably heard about the extremely high costs of even the most basic coverage. You can wait for Congress to step in, but partisanship appears to be at an all-time high and the prospects of a quick resolution seem remote.

    Another option is to look at self-insuring your healthcare through a level-funded plan, like the kind offered by GMS. To find out if this is something that could work for an organization of your size contact us today to talk to one of our healthcare experts about a self-insured health plan.

  • When it comes to finding the right health plan for your business, the key is to find an option that makes sense for your business. One route that a business can go is to invest in TPA services for a self-funded health plan, which offers several benefits that can help owners save money and mitigate their risk with proper planning and support. Self-funded insurance also allows businesses to avoid some of the increased regulations on healthcare, which is a big reason why more small and midsize employers are choosing to self-insure, according to the Society for Human Resource Management.

    With all that in mind, self-funding sounds like an intriguing option, right? However, there are a pair of misconceptions about self-funding that either dwell in the past or are not that relevant to business owners. Here are two reasons why owners avoid self-funding, and how a TPA can dispel those arguments.

    Image of a business owner considering self-funded health insurance through TPA services.

    Myth No. 1: Self-Funding Will Sink Small Businesses

    Some business owners remember stories about a company sinking because they went self-funded. What essentially would happen is that a business with self-funded insurance would run into a large number of costly claims after one or several employees got really sick. Because they were self-funded, the business would theoretically be stuck paying all of those claims without any help from a provider, which would force them to shut down since they wouldn’t have the cash flow to actually run their business and pay their other bills.

    While businesses back in the ‘70s and ‘80s did run into this problem, times have changed. Businesses can now invest in something called stop-loss insurance to manage their risk and set a maximum liability number for their yearly claims. 

    Stop-loss insurance allows a business to mitigate its liability so that it can self-fund its insurance without having to fear a year with an unexpected number of claims. Let’s just say that your business is given a $10,000 monthly maximum through stop-loss insurance. At the end of the year, that’s $120,000 max. If your business exceeds $120,000 in claims in a year, you’re reimbursed the overage by the reinsurer.

    This policy also works in your favor if you have fewer claims than expected. If you don’t reach your maximum claims liability number, you simply get to keep the difference, or you can take advantage of a “premium holiday.” This allows you to use the refund to pay for one or several insurance premiums in advance. Since the refund could affect your tax filings, this option can help you avoid having to do a tax adjustment on your healthcare fees since we’ll just deduct your refund from the premiums for the following year.

    Myth No. 2: Self-Funding Makes Owners Deal with Several Moving Parts

    As we’ve mentioned before about self-funding, “normal businesses with fewer than 5,000 employees won’t have the infrastructure to comply with all the regulations and make it financially feasible.” Managing a self-funded plan can mean carefully overseeing several important moving parts. This means that you’re going to need some help because self-funding can be a lot of work for whomever oversees their HR.

    While some owners may be scared off by self-funding, there’s a simple solution to these moving parts: a TPA. What we can do as a PEO with TPA services is manage everything in house so that you can benefit from self-funding without having to deal with all the regulations and administration needs, which can include: 

    • Electronically sending out a file on health plan eligibility every day
    • Having an in-house programmer who can receive necessary data files
    • Access to a pharmacy benefits manager, who works with pharmacies on plan eligibility and drug costs

    Those are just a few of 30 moving pieces that are necessary for self-funding. When you work with a TPA, we can be as transparent about this process as you’d like so that you can see how everything works, or you can let us take care of the work while you focus on other important matters. Regardless of how much or how little you want to know about the process, a TPA enables you to take the HR work out of your hands. This way they can sign up for self-funding, pay their premiums, and know that the work is being done for them.

    Using TPA Services to Self-Fund Your Business

    The key to a good self-funded plan is a TPA that can take care of all the moving parts for your business. As a Professional Employer Organization that offers TPA services, Group Management Services can allow you to enjoy the benefits of self-funding while managing your plan. Contact GMS today to talk one of our experts to learn more about self-funding and to get a quote for your business.

  • Escalating costs of healthcare and benefits have led business owners across the country to seek out a solution that makes the most sense for their company. Of the many options out there, self-funded health insurance has become a realistic opportunity for many small businesses thanks to third-party administrators.

    These organizations, also known as TPAs, allow business owners to take advantage of self-funding, which can provide a “greater level of flexibility that comes with being able to tailor the plan to their needs,” according to the Society for Human Resource Management. The self-funding process can be complicated, but a good TPA can simplify the process so that employers can reap the benefits of self-funded insurance without having to deal with the risks of managing it themselves.

    Image of a third-party administrator for a small business.

    How Does the TPA Process Work?

    While some people refer to TPAs as “claims payers,” the role a TPA plays is much more intricate than that. Let’s start by imagining that your business is going from a fully-insured carrier to become self-funded. In this instance, the business owner is  now the plan fiduciary, which just means that they are financially responsible for the plan.

    Since you’re now self-funded, there’s no insurance company anymore, and you rent what is called a PPO network. For example, GMS primarily works with Cigna. These networks have a long list of providers and hospitals in their network and negotiate discounts with each of these groups. You then pay your network a set cost per employee, per month so that they have access to these discounts.

    This is where the “claims payer” name comes into play. When members of your plan go out and generate insurance claims, those claims go directly to your TPA. The TPA then administers these claims to tell providers who’s eligible on the plan, processes them, and bills the client for monthly fees and the amount of money that needs to be paid to these providers.

    Do I Need a TPA if I want Self-Funded Insurance?

    Absolutely. While a Google-sized company can afford to have an in-house TPA, normal businesses with fewer than 5,000 employees won’t have the infrastructure to comply with all the regulations and make it financially feasible. A TPA gives you access to a team of people who can handle the day-in, day-out needs of self-funding, which can range from daily electronic filings of plan eligibility to a pharmacy benefits manager who deals with every prescription one of your members has filled.

    There are also the potential financial ramifications of managing self-funded insurance in-house. The right TPA can offer you stop loss insurance to mitigate your liability. As GMS’ Costas Reamensnyder points out, a self-funded health insurance plan allows you to “pay only for actual claims; not the total expected claim level from a fully insured carrier.” This means your plan can save a substantial amount of money each year. . A TPA can help you set a cap for maximum liability, which means that you can properly budget for your plan and cover yourself from unforeseeable circumstances.  This maximum liability is provided by adding a stop loss insurance policy. It essentially mitigates your financial liability by limiting the plan’s maximum exposure.

    The PEO TPA Connection

    If interested in self-funding your health insurance, GMS can help. As a Professional Employer Organization, we can help business owners in a variety of ways, including our TPA services. Contact GMS today to talk to one of our experts about self-funded health insurance for your business.