Greeting and Salutations from Ben

Posted on August 5, 2011 by Ben Surwill

Are you ready for another frequently asked question answered by Ben Surwill of Surwill & Company Insurance Services?

It has been awhile since my last writing, but the question concerning things to be cautious about when purchasing health insurance online has had me thinking this past week. So here are my thoughts.

Let’s start with acknowledging that there are now many options for purchasing health policies. We also know that many people ponder where to purchase the best health insurance. People can buy health plans offered by reputable insurance companies in a number of ways. First and foremost by contacting any local insurance agent; and secondly by using the internet in today’s tech savvy world. Despite the popularity of Internet shopping, you should be cautious. Look carefully at the pros and cons of online health insurance purchasing found below and figure out whether it is advantageous for you.

Pros:

1. You can browse at any one time without the need to leave home.

2. Helps to save up lots of precious time as you can get all your required information now by your own without the need for appointment arrangement with the insurance agents for face to face sharing.

3. You can compare the rates and terms from as many Insurance companies as you wish with no required obligations to purchase the policy.

Now let us look at the con side of things:

4. You need to be cautious and aware on all the terms and condition of the insurance quotes by buying online. There is no insurance agent whom you can ring up or you can meet in person if you need certain insurance advice or anyone who will remind you on the terms and condition of the online insurance policy.

5. When you purchase online, you will need to take the word of the product description posted on the web as that’s the only reference you can get. However, online buyers cannot really validate for their product/service integrity until you purchase and “get” them.

6. You will not be able to tell if the online company is really legitimate and if it is a safe site to shop.

To recap, do the necessary homework of online Insurance and its company before you go ahead to buy any policy online. Buy them if you are 100% confident on the genuine of the online Insurance Company with its products. Protect yourself with knowledge and information as of what to avoid and be aware of all if online purchase is what you are looking for.

Remember “Live Well, Be Well, with Surwill”. If you are wanting the help of an insurance agent, be sure to give me a call.

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What is your out-of-pocket maximum amount?

Posted on November 11, 2010 by Ben Surwill

Hard to believe it is November 9, 2010.  The weather has been great and the leaves are finally coming down, now the pickup part. My days of continual lawn work and car washing are ending with Daylight Savings Time.  I am hoping you are visiting the Surwill blog yet again.  That would mean that you are finding my comments “return worthy”.  This week’s I want to concentrate on “What is your out-of-pocket maximum amount?” This is perhaps the most important question you need to be able to answer when it come to your health insurance policy.

What is out-of-pocket maximum?  It is the most important part of your health insurance policy.

The yearly out-of-pocket maximum is the highest or total amount your health insurance company requires you to pay towards the cost of your health care.

Out-of-pocket expenses are what you pay for health-related services above and beyond your monthly premium.  Depending on you health plan, these expenses may include an annual deductable, coinsurance, and copayments for doctor visits and prescription drugs.

The out-of-pocket maximum helps protect you from very high additional costs. In most cases, once you reach your health plan’s out-of-pocket maximum, your insurance company will cover 100% of the costs they consider to be medically necessary.

What does this mean for you?  Make a simple phone call and I will answer your questions.  As an independent agent, I will compare all of our companies for you. For service before the sale, I want to help you understand what your policy will do. Afterward, I want to make your insurance experience as pain free as possible.

Remember “Live Well, Be Well, with Surwill”.  Give me a call at your convenience.

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Greetings and Salutations from Ben

Posted on October 26, 2010 by Ben Surwill

Are you ready for a few more frequently asked questions answered by Ben Surwill of Surwill & Company Insurance Services?  It is another Sunday night and I know that we are in the midst of health care reform, but in reality most of us just want to know the basics about health care.

Let’s start with how health care reform will extend and strengthen coverage:

  • Children under the age of 19, with pre-existing medical conditions can no longer be denied health insurance
  • health insurance plans will allow young adults to remain on their parents’ insurance coverage up until their 26th birthday
  • adults who are uninsured because of pre-existing medical conditions will have access to affordable insurance through a temporary subsidized high-risk pool

Why do you need health insurance?

As medical care advances and treatments increase, health care costs also increase. The purpose of health insurance is to help you pay for care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. In addition, you are more likely to get routine and preventive care if you have health insurance.

You need health insurance because you cannot predict what your medical bills will be. In some years, your costs may be low. In other years, you may have very high medical expenses. If you have health insurance, you will have peace of mind in knowing that you are protected from most of these costs. You should not wait until you or a family member becomes seriously ill to try to purchase health insurance.

We also know that there is a link between having health insurance and getting better health care. Research shows that people with health insurance are more likely to have a regular doctor and to get care when they need it.

What is a deductible?

It is a specific dollar amount that an individual must pay (or “satisfy”) before reimbursement for expenses begins. The higher the deductible, the lower the cost of the health insurance plan.

What is coinsurance?

Coinsurance is a feature found in most group health insurance plans. It sets forth the percentage of covered expenses that the employees and the health insurance plan will pay, usually after the deductible has been met. The most common coinsurance level is one in which the employee pays 30 percent of the expenses and the insurer pays 70 percent. This is called 70 percent coinsurance.

What is a covered expense and are there limits?

A covered expense is an eligible expense under a group health insurance plan. A covered expense is an expense incurred by a covered individual that will be reimbursed in whole or in part under the group health insurance plan. For example, under most health insurance plans, doctors’ visits are a covered expense. That is, a doctor’s fee up to the amount provided by the plan will be reimbursed by the insurer Just because an expense is covered does not mean that the coverage is unlimited. Both base plus and comprehensive plans have limits on the expenses for which they will reimburse. In addition, some form of deductible and coinsurance is often applicable. Insurers limit covered expenses in a variety of ways. One way is to cap allowable payments for a certain procedure or service. A common example of this type of limit would be a surgical schedule. Insurers also restrict covered expenses by limiting the number of visits or days for home health care or skilled nursing care, or by establishing a reasonable and customary charge.

What does this mean for you?  Do any of these statements resonate with you?  Are you wanting to know if you are where you need to be in regards to insurance?  The reason you have an insurance agent is to have them be the go to person.  Make a simple phone call and I will answer your questions.  We are here to provide the most coverage for the best price. As an independent agent, we will compare all of our companies for you. For service before the sale, we want to help you understand what your policy will do. Afterward, we want to make your insurance experience as pain free as possible.

I live with the saying “Live Well, Be Well, with Surwill”.  Give me a call at your convenience.

Posted in Health Care Reform, Health Insurance, Health Insurance FAQ | Tagged , , , | 2 Comments

Health Care Reform Starts Now!

Posted on October 18, 2010 by Ben Surwill

Health Care Reform Starts Now!
Impacts to Montana Small Business

As individuals and businesses embrace Health Care Reform, they have many questions.  Surwill & Company Insurance Services located in Billings, MT is here to help you understand and navigate the changes.  There are many points worth thinking about, but 3 key points stand out:

1st:  Health Insurance is becoming a mandatory purchase for individuals in 2014
2nd:  Some changes start NOW
3rd:  While much is changing, much is staying the same

Are small businesses eligible for Health Care Tax Credits?

Under the recently enacted health care reform law, many small businesses and tax-exempt organizations that provide health insurance coverage to their employees now qualify for a special tax credit.  The credit is:

  • Designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have,
  • In general, available to small employers that pay at least half the cost of single coverage for their employees, and
  • Available for tax years beginnings 2010 (an enhanced version of the credit will be effective beginning in 2014).

One positive change for some small employers is a Federal income tax credit for health insurance premiums they pay for certain employees.  The credit is available for tax years beginning in 2010.

What makes an employer eligible?

The credit is specifically targeted to help small businesses and tax-exempt organizations that primarily employ low and moderate income workers.  It is generally available to employers that have fewer than 25 full-time equivalent (FTE) employees paying wages averaging less than $50,000 per employee per year.

Because the eligibility formula is based in part on the number of FTEs, not the number of employees, many businesses will qualify even if they employ more than 25 individual workers.  The number of an employer’s FTE is determined by dividing (1) the total hours for which the employer pays wages to employees during the year (but not more than 2,080 hours for any employee) by (2) 2,080.

The following employees are not considered in counting an employer’s FTEs:

  • Seasonal workers
  • Business owners (including a sole proprietor, a partner in a partnership, a shareholder owning more than two percent of an D corporation, and any owner of more than five percent of other businesses), and
  • Members of a business owner’s family or household.

The amount of average annual wages is determined by first dividing (1) the total wages paid by the employer to employees during the employer’s tax year by (2) the number of the employer’s FTEs for the year, then rounding down to the nearest $1000.

What will be the credit amount?

The maximum credit is 35 percent of premiums paid in 2010 by eligible small business employers and 25 percent of premiums paid by eligible employers that are tax-exempt organizations.  In 2014, this maximum credit increases to 50 percent of premiums paid eligible small business employers and 35 percent of premiums paid by eligible employers that are tax-exempt organizations.

The maximum credit goes to smaller employers – those with 10 or fewer FTEs – paying annual average wages of $25,000 or less.  The credit is reduced if the number of FTEs exceeds 10 or if average annual wages exceed $25,000.

Only premiums paid by the employer under an arrangement meeting certain requirements (a “qualifying arrangement”) are counted in calculating the credit.  In computing the credit for a tax year beginning in 2010, employers may count all eligible premiums described for that tax year, including those paid before the health care reform law was enacted.

A qualifying arrangement is on where:

  • the employer pays premiums for each employee enrolled health care coverage offered by the employer,
  • in an amount equal to a uniform percentage (not less than 50 pe4rcent) of the premium cost of the coverage.

If an employer pays only a portion of the premiums for the coverage provided to employees under the arrangement (with employees paying the rest), the amount of premiums counted in calculating the credit is only the portion paid by the employer.

For purpose of the credit (including the 50-percent requirement), any premium paid pursuant to a salary reduction arrangement under a section 125 cafeteria plan is not treated as paid by the employer.  Also, the amount of an employer’s premium payments that counts for purposes of the credit is capped by the average premium for the small group market in the employer’s geographic location, as determined by the Department of Health and Human Services.

Example For the 2010 tax year, a qualified employer has 9 FTEs with average annual wages of $23,000 per FTE.  The employer pays $72,000 in health care premiums for those employees (which does not exceed the average premium for the small group market in the employer’s state) and otherwise meets the requirements for the credit.  The credit for 2010 equals $25,200 (35 percent x $72,000).

Content compliments of a legislative brief

If you have questions related to your health care obligations leave them as comments below, or feel free to contact us.


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