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Health Self Insured 
Alternatives to Funding Your New Jersey Health Insurance 

We help our client's to decide if their New Jersey Health Insurance should be Insured, Self-Funded or Minimum Premium Funded. Criteria in Deciding Whether to Self-Insure:

• Is the group large enough to spread the risk and have a credible experience?
• The level of risk a client is willing to take
• Can the client cope with fluctuations in claim payments

1. Employer Self Administration
2. Administrative Services Only Contract - The insurance company administers the plan (no financial risk is assumed by the insurance company).
3. Third Party Administrators - Outside firms offering computerized claims payments and database services.

1. No state premium tax
2. No insurance company margin or risk charges
3. State-mandates benefits do not have to be met
   

Group Health Insurance
Group Health Insurance Review

We look for ways to help our clients. It's a process of finding answers to theirquestions and helping to analyze their present employee benefits direction. Our "Client First" commitment guarantees increased efficiency and maximized results.

An important part of a benefit review is formalizing a written comparison of New Jersey health care insurance benefits and plan designs. The comparison sets the benchmarks and criteria for designing a group health insurance package to insure a valuable enhancement in recruiting and retaining employees. The main function is to assist in the following areas: 

• Development of a written benefit comparison
• Compare plan designs - managed care, indemnity, self-insured options, etc.
• Selection of benefit programs
• Tailoring benefit plans to meet requirements
• Organize enrollment meetings and presentations to employees 

We Answer your Disability Questions

The definitions of disability, residual coverage, loss of income and occupational skills are inherently complicated. Social security, federal and state mandated benefits, add to the complexity of disability coverage.

The key element of any disability management strategy is plan integration. As independent professionals, The Spiro Group has the freedom to offer disability features that fit.

If you want answers to the questions below, Contact Spiro.

Questions

How do you apply partially worked days to the disability elimination period?

How many days may an employee return to work during the elimination period and still qualify?

What happens when an employee returns to work on a part time basis?

Is securing Social Security Disability income for the employee important? This benefit provides cost of living increases and Social Security retirement credits.

Have you coordinated with LTD and enhanced TDB to eliminate duplicate coverage and highly compensated reverse discrimination?

How does paying premium with after-tax dollars affect benefits?

How do you minimize the impact of disability on both the employee and employer?

Group Life Insurance

Not all NJ group life insurance plans are alike. The Spiro Group looks for ways to maximize your benefits and reduce your cost.

Do you have the following benefits in your present group life plan? Before you choose a group life plan contact Spiro to compare.

• Financial counseling at no additional cost

• Available on base plan and buy up
• Retiree eligibility
• No age limit
• Increased protection optional

3. Accelerated Death Benefit

4. Waiver of Premium

5. Security Account

6. Plan Packaged Discount

7. Accidental Death & Dismemberment (AD&D)

8. Turnkey Enrollment Support

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Dental  

A Dental Program can complete the health benefits package you offer your employees, even if your firm is as small as 2 or as larger. The plan design below covers the most frequently used dental services, such as simple extractions, fillings, X-rays, and periodic exams.

PREVENTIVE/DIAGNOSTIC SERVICES 

• Oral exams‑initial and periodic 
• Prophylaxis, including cleaning and polishing 
• Fluoride treatments for covered persons under age 19
• Sealants to age 14 only

BASIC SERVICES

• Simple extractions                                  
• Synthetic restorations                             
• Silver amalgam fillings                           
• Palliative emergency dental services      
• General anesthesia
• Simple repair of dentures
• Surgical extractions
• Periodontic examinations
• Root canal

MAJOR SERVICES

NOTE: Coverage must be in effect for at least six months before the plan pays benefits for these services unless waived by the home office.

• Inlays and crowns
• Partial or complete dentures
• Fixed bridges

ANNUAL MAXIMUMS

The Dental program has an annual maximum up to  $2,000 in benefits for each covered person.

CHOICE OF BENEFIT LEVELS

The Dental Option Plan program pays 100 percent Preventive and Diagnostic Services, 80 percent for Basic Services, and 50 percent for Major Services.

DEDUCTIBLE

The Dental program includes a deductible. The deductible is $50 per individual for Basic and Major Services to a maximum of $150 per family.

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Standalone Perscription Drug Plans  

The historical approach to providing coverage for prescription drugs was to include them as an eligible expense under major medical.  The plan then paid its applicable coinsurance percentage of the actual cost of the prescription to the participant.  There were no restrictions on where the participant could have his or her prescription filled or on the purchase of brand name drugs versus generic alternatives.  As a result, since the pharmacy's profit margin is greatest on brand name drugs, the great majority of prescriptions were filled brand.  Additionally, since there were no limitations on pharmacies, the cost of a given prescription varied with those purchased as smaller, single store pharmacies often cost more than the same prescription purchased elsewhere.

The net result of this historical approach has been that the cost of prescription drugs was uncontrolled and very high. This was further and substantially exacerbated by the significant increase in utilization and by the dramatic increase in the cost of drugs over the past few years.

The stand-alone prescription drug program was developed as a way of managing these costs. The service is purchased from a company typically established to provide this singular service. It will have entered into contractual agreements with both chains and with independent drug stores whereby they agree to discount the cost of both brand name and generic drugs purchased  by participants showing a card which identifies them as being covered by that company.  (Each prescription drug company issues ID cards to all of the participants covered by XYZ Company plan.) In addition to the discounted cost of drugs, these network pharmacies have also agreed to a discounted dispensing fee.

For still greater savings, almost all of these companies offer a mail-order program for maintenance drugs.  They buy drugs in mass directly from the manufacturers to fill all of their client needs.  Thus, their cost is much lower, and they therefore provide even greater discounts than are available at the retail level.  Too, since they work on a high volume basis, their dispensing for mail order is also lower.

Finally, many of these companies offer a Formulary rebate plan with their mail order program.  With respect to the more widely used drugs where alternative products are available, they negotiate with a single manufacturer for a volume rebate on that product. Each employer in the formulary plan shares in the rebate based upon the usage of the formulary drugs used by the participants.

The key is selecting the prescription Drug Company that offers the best network of pharmacies for the employees of a given employer while offering the greatest discounts. Combining this selection process with plan design which encourages the use of generic drugs can result in a significant and reduction in prescription drug costs.

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Group Long Term Care (LTC) 

 As the population ages, employees will be confronted with the needs of their elderly relative and their responsibilities to employers. Elder care is an issue that is growing and it will hit a pick in the year 2011. This when the first Baby Boomers turns 65. Most individuals and organizations can't wait to address elder care concerns.

We all value our independence. Have you ever thought what you would do if you couldn't bathe or dress yourself? If you needed help getting from place to place, who would be there to help you and how would you pay for it? Trauma victims, patients recovering from serious illness and surgery, people with terminal illness as well as the elderly may need help with day to day activities and may require long term care. But, long-term care can be expensive. The cost of long-term care could be an issue that all too many of us will have to face.

The Spiro Group offers a long-term care insurance program that is flexible, allowing you to purchase a plan that works for you. We are also pleased to offer this coverage to other family members. Each employee's eligible family members may purchase their own long-term care coverage.

What Is Long Term Care?

Long Term Care is defined as the type of care received either at home or in a facility when someone needs assistance with activities of daily living, or suffers severe cognitive impairment, due to an accident, an illness or advancing age. You can see by the definition that the need for long-term care is not limited to the elderly. Anyone who cannot function independently may need the protection of long-term care insurance. Accidents and unexpected illnesses can happen at any time, any age. The risk may be greater than you expect.

• Today, nearly 13 million Americans need assistance with everyday activities.
• 40% of those needing long-term care are between the ages of 18 and 64.
• About 60% of the U. S. population will need long term care at some point. 

If you needed long term care, who would provide that care? Where would you receive it? How would you pay for it? These are important questions to consider.

How Much Does Long Term Care Cost?

The national average cost for long-term care facility is $40,000 per year. Home‑based care costs vary depending on the type and frequency of care required. For most of us, this expense could have a significant impact on our financial security.

Who Pays For Care?

Many people believe that health insurance or a government program will pay for long-term care. Health insurance won't cover these costs, and government programs like Medicare and Medicaid fall short as well. Without insurance protection, your assets could disappear quickly, along with your ability to make choices and maintain control over your life. In fact, 72% of those entering nursing homes are impoverished within one year

Who Are The Care Givers?

You may be familiar with the term "sandwich generation". It describes a situation that has become quite common: adults caring for their parents at the same time they are raising their children. Traditionally the role of caregiver has fallen to wives and daughters. Whether you are the person receiving care or providing it, a long-term care situation can take its toll emotionally, physically, and financially.

How Would You Cope?

Balancing work and raising a family with care giving responsibilities is a challenge. The tradeoffs required might mean cutting back hours at work or hours with the family, both of which can be stressful.

Long Term Care insurance can't prevent you from ever-needing long term care, but it can help you protect yourself and your family from the financial impact. As you can see from the information we have presented, it is an issue that bears consideration. Please take the time to learn more about this coverage and the valuable protection it provides.

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Executive Compensation 
With Split Dollar Insurance

Employers often want to help themselves and their key employees obtain additional life insurance protection. Some key employees, however, don't want their taxable pay substantially increased.

Employers may also want to control part of the policy cash values and death benefits of that additional insurance. Plus, they may want to recover all or part of their costs in providing the coverage maybe not right now but later, when an employee retires or dies.

Split Dollar is a solution that lets employers assist employees in the purchase of their personal life insurance,

How It Works

In a Split Dollar program, you and your key employee agree to share the rights and premium payments of a permanent, cash value life insurance policy. The premium can be split in many different ways as can the cash values and death benefits. Split Dollar arrangements are very flexible.

Let's look at one popular type of Split Dollar program collateral assignment. With this type of program, the employee is the owner of the policy, and names a beneficiary of his or her choice, You, as the employer, receive a collateral assignment for the amount of the policy cash value and death benefits equal to the premiums you pay on the policy. If you and your employee decide to terminate the insurance policy while the employee is still alive, you are entitled to receive your interest in the policy from the cash value. The rest of the cash value belongs to your employee,

If the employee dies while the insurance policy is still in effect, you are entitled to receive your interest from the death proceeds. Your employee's beneficiary receives the remaining policy death proceeds income tax‑free.

Taxation

The premiums your business pays on the life insurance policy are not deductible. However, the program can be designed so that you recover your premium payments tax‑free when the insurance policy terminates, or if the employee dies while it is still in effect.

Your key employee reports as income the value of the pure insurance protection (also called economic benefit) received plus the value of any other benefits received under the policy (for example, policy dividends received in cash) less the employee's contribution to the program, if any.

Employer Advantages

A Split Dollar program allows the employer to provide supplemental life insurance benefits to key employees on a selective basis. You decide who is covered; it is easy to communicate and administer,

Your business may recover its entire premium contribution at death or insurance policy termination. In the meantime, you have control over the part of the death benefit and cash value that represents the premiums you have paid into the policy.

Employee Advantages

The Split Dollar program provides your key employee with permanent insurance protection. In addition, cash values over and above the employer's cumulative premium payments belong to the employee. And after retirement, policy cash values can be used to provide supplemental income.

Split Dollar arrangements are very flexible. They can be structured to meet many different employer objectives. Split Dollar programs, like Executive Bonus programs, can provide both pre- and post retirement death benefits.

Split Dollar Benefit For Key Employees

In today's competitive marketplace, executive benefits programs help attract top people. These programs provide additional benefits for business owners and key employees on a selective basis.

Executive benefits are appealing: the employee receives an added benefit. And with some concepts, including split dollar, the business may recoup all or part of its cost upon the employee's retirement or death.

With collateral assignment split dollar, the company pays all or part of the premium for a key employee's life insurance policy. The business is assigned a portion of the death benefit and policy cash values equal to premiums the employer pays. The employee's current cost is determined by the current economic benefit, which is based on the employee's part of the death benefit.

At a future date, usually when the employee retires, he or she uses policy cash values to repay the premiums the company paid. The split dollar agreement is terminated, and the policy and its benefits belong solely to the employee.

A split dollar program is a great way to provide valuable life insurance for yourself and key employees. It's also a great way to improve your key employee compensation package.

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