Health Insurance Tax Credit for Small Business

Small Business Owners may be able to claim a new credit on their 2010 tax returns if they pay employee insurance premiums in 2010.

The credit, available through the Patient Protection and Affordable Care Act, is intended to:

1.   Give small employers a tax break if they pay at least half the cost of single coverage for their employees on the group health plan.

2.   Encourage small employers to offer health insurance for the first time or maintain the coverage they currently have.

Who is eligible?

Employers with fewer than 25 full-time employees for the tax year and less than $50,000 in average annual wages per full-time employee, may be eligible for the tax credit if the employer pays at least 50 percent of the premium cost of health insurance coverage. Additional requirements and rules apply. Refer to the IRS website for more information. The IRS has also issued a “Three Simple Steps” guide to assist employers in determining their eligibility.

How much is the credit?

To achieve the maximum credit of 35 percent of employer-paid premiums paid in 2010 through 2013, an employer must have 10 or fewer full-time employees with an average annual full-time-equivalent wage of $25,000 or less. Those employers who employ between 11 and 25 full-time employees and/or with average wages in excess of $25,000 but less than $50,000 may still qualify for a lesser credit. Different credit amounts apply to tax-exempt small businesses.

How will the credit change in 2014?

Beginning in 2014, the tax credit increases to a maximum of 50 percent and is available for the two-consecutive-taxable year period beginning with the first taxable year in which the employer offers a qualified health plan to its employees through an exchange.

How are business owners (and their family members) who are employees counted?

Business owners and their family members are not counted when determining the number of full-time employees, the amount of average annual wages or premiums paid with respect to the credit. See the IRS website for further information including a description of a “business owner” and “family member.”

How does this affect payment of health insurance premiums?

It doesn’t. The credit is claimed on the employer’s tax return. The employer must pay the premiums during the year and claim the credit on his/her annual income tax return.


Health claim denied? Here’s what you need to know.

Health Insurance denials can happen for a number of reasons.  A simple cause can be a billing error from the provider’s office.  If the claim is submitted using the wrong treatment or diagnostic code, the claim can be denied.  More serious reasons can involve treatments considered “experimental” or “pre-existing”.  Both of these reasons can be appealed if you feel the insurance company’s decision is wrong.

If your healthcare claim is denied, you have the right to appeal.  Health Insurance carriers are required to provide an appeals process.  Typically there are a few levels of appeal, each moving more ‘independent’ by involving impartial medical professionals.  Washington State also provides the Patient’s Bill of Rights which provides an independent third-party review of your appeal, if the standard appeals process is unsuccessful.

Washington Health Insurance Agency provides assistance through the appeals process, by walking their health insurance clients through the steps, carefully tracking the appeal deadlines, recommending the best supporting documents, and even participating in the appeal discussion board via conference call on behalf of their clients.

The most important thing to remember is that if you feel the denial is wrong, you have to appeal.  Many people just assume there is nothing they can do.  The New York Times recently reported a story about this very point.

Remember, if you have the right Health Insurance Agent, you don’t have to go through the appeal process alone.


Small Business owners pay too much for health insurance

There’s a huge misconception out there that if you own a business, you get a better deal on health insurance.  The fact is, many “group” health insurance plans come with higher price tags than individual health policies.

For the small business owner with 5-7 employees or less, offering to reimburse employees for their individual health insurance policies through an HRA (Health Reimbursement Arrangement) can prove a significant cost savings to the business, while giving more freedom of health insurance plan choice to their employees.

In addition, the employees ‘own’ their individual plans, which means there’s no need for COBRA coverage if they leave their current employer.  Since businesses smaller than 20 employees do not offer COBRA coverage anyway, individual plans become even more attractive.

The biggest advantage of individual health plans over small group plans is price.  Individual health plans typically offer lower premiums than similar group plans.   The reason is risk.  Individual health insurance in Washington State requires a health risk questionnaire be completed as part of the application process.  The purpose of the health questionnaire is to ‘weed out’ the higher risk applicants with significant health risks.

Most people pass the questionnaire with ease.  When they do, they fall into the same group as everyone else who also passed the same questionnaire, which represents a lower ‘risk’ to the insurance company, thus lowering rates.  (Those who do not pass the health questionnaire are provided the opportunity to sign up on the Washington State Health Insurance Pool, a high-risk pool with significantly higher premiums)  If a business has an employee who does not pass the health questionnaire, then it can still prove less expensive to cover the high risk pool premium for that individual employee versus paying higher group rates for all employees.

Group plans in Washington do not have a health questionnaire, so the insurance company has no way of ‘weeding out’ the unhealthy employees.  The rates have a ‘built in’ risk factor, whether warranted or not, because the insurer has no way of  separating the high risk groups from the low risk.  Groups of 2-50 employees are ‘community rated’ meaning they are in the same risk pool whether their employees have low utilization or high.   Therefore, the small business with healthy employees ends up paying a higher rate because of other businesses who may have employees with expensive high risk chronic health problems.

Offering individual health plans to employees comes with more advantages than just lower price.   They also come with less administration.   Unlike ‘group” plans, there are no ‘renewals’ each year to go through, no minimum participation requirements imposed by insurance carriers, and no minimum employer contribution requirements, either.   Employers still have the ability to define eligibility, probation periods, and can design their health benefit package with more options and flexibility.

The Washington Health Insurance Agency has been providing creative solutions like this to small business owners for years.  Give us a call at 360-464-1622 to find out if you’re paying too much for your health insurance coverage or fill out our business quote form for a free cost comparison at http://www.washingtonhealthinsuranceagency.com/health-insurance-for-business


Is Pregnancy a Pre-Existing Condition?

It happens from time to time that I get a call from a woman who is pregnant, and she has no health insurance.  In Washington State, there are programs available through DSHS for pregnant mothers that will pay for costs associated with a pregnancy, including the delivery.  However, many times applicants do not meet the low income requirements to qualify for the State assistance. 

Health Insurance carriers in Washington have 9 month waiting periods for most pre-existing conditions.  This 9 month waiting period is waived if proof of prior credible insurance is provided, but when there’s been a lapse in coverage of more than 2 months, then the new insurance plan will have a 9 month waiting period on ‘pre-existing’ conditions (conditions treated or that should have been treated in the past 6 months) 

Pregnancy has a different set of rules when it comes to the standard pre-existing condtion clause.

Coverage offered by an Employer (also called ‘Group’ insurance) typically DOES NOT consider pregnancy a pre-existing condition.  Maternity and Diabetes are often exempt from the 9 month waiting period and covered without any issue.

Individual health insurance carriers do consider pregnancy a pre-existing condition.  However, they will cover everything except the charges associated with the actual delivery.  All prenatal doctor visits and ultrasound costs leading up to the delivery will be covered, even if there is a 9 month waiting period on the plan. Additionally, these plans will often pay for hospital and physician charges surrounding complications for the mother or newborn, as well as postpartum costs.   

The cost of having a baby can range from as little as $4000 to as much as $20,000 or more if there are complications, premature birth, or an emergency c-section.   Having the right health plan will make sure those costs are covered.  For more information on the best health insurance to have when pregnant, give us a call 360-464-1622 or visit us at www.wahealthagency.com


Tyson got a new truck

I received a call recently from a young couple, Tyson and Stacie, who had heard about me from their auto insurance agent.  They were wondering if I could save them some money off their health insurance.  Tyson had a great job working for an excavation company, and his employer paid 100% of his health insurance premiums.  Like many employers, however, they did not pay for his wife’s insurance.  In Tyson’s case, I  found out that $207 was being deducted from his paycheck for Stacie’s health insurance.  He’s paid twice a month, so that meant her health insurance was $414 a month!   After comparing a few plans, I was able to show them how she could buy her own individual health insurance plan for only $175/mo, AND we lowered her deductible by $500.  Tyson quickly figured the savings in his head and exclaimed “I can buy a new truck!” -which I found out later he did just that.  Many people assume the best place (or only place) they can get health insurance is through their employer.  If the employer is paying the premium, then they’re right.  If not, there’s a very good chance they’ll be paying more than they have to.  To find out how much you can save, call us at 360-464-1622 or visit us at www.wahealthagency.com


a great way to start the New Year – Donate Blood and save 3 lives!

January: National Blood Donor Month

National Blood Donor Month honors blood donors and stresses the importance of donating blood. And there is no better time to donate blood than during January.

Blood is traditionally in short supply during the winter months due to the holidays, travel schedules, inclement weather and illness. January, in particular, is a difficult month for blood centers to collect blood donations. That’s why all eligible blood donors are encouraged to schedule an appointment to donate blood during National Blood Donor Month.

Donate Blood, Save Three Lives

You can save up to three lives, according to the America’s Blood Centers (ABC) when you donate blood. Blood is needed for emergencies, surgeries and people who have cancer, blood disorders, sickle cell, anemia and other illnesses. Blood donors play a vital role in meeting the daily blood needs of their communities and hospitals, and maintaining an adequate blood supply in its blood centers. “It’s the blood on the shelf that saves lives,” says Don Doddridge, President of ABC.

Get more information

To find a local blood center or learn more about donating blood, visit AmericasBlood.org or call 1-888-USBLOOD.


How to avoid overpaying your doctor

For anyone who’s been to the hospital, you know the paperwork afterwards can be overwhelming.  Between the hospital bills, the surgeon, the anesthesiologist, the doctor you’ve never met before who must have come in while you were on the operating table…the bills start flying in.

Here’s a tip- WAIT to pay your provider bills until you’ve received confirmation from your insurance.

Since every claim must be submitted to your insurance first, you’ll receive a statement from your carrier for everything.  The statement is called an EOB (Explanation of Benefits)

One big problem is that some providers (not all) like to get paid right away, and don’t bother to wait for the insurance company.  So, they send the bill to you, the same time they send it to your insurance.  Since the billed amount is usually higher than the insurance company’s “allowed amount”, if you pay the bill, you will more than likely pay too much.

What’s worse, the provider may not refund you the overage, they may just give you a “credit” towards you next visit.

So, the solution?  Make a file that you drop every doctor invoice into.  As soon as your insurance company sends you an EOB, pull out the file and match the doctor’s invoice with the EOB.  If it matches, pay the doctor.  If it doesn’t, call the doctor’s office and request a corrected invoice.

This way, you can be sure to never over-pay for your patient responsibility costs.  *Note – be sure you don’t wait longer than 30 days to call your provider’s billing department, as some providers are quick to send you to collections.

For the best health insurance options in Washington State, visit us online at www.wahealthagency.com or give us a call for expert advice at 360-464-1622.


Pharmacy costs make our premiums higher

Have you ever compared the actual costs of your prescription drugs from one pharmacy to the next?  What you may find might shock you.  Unfortunately, those differences don’t matter to most of us who just pay a copay for our Rx.  We just simply go to the closest pharmacy to our work, or the one on the way home.

When we pay a copay for our Rx, then we really have no idea of what the actual costs are.  But we should, because those costs are being passed on to our insurance carrier which will ultimately affect our future premiums.

Many health insurance companies are changing their Rx coverage from co-pays, to co-insurance.  Instead of paying $20 for that brand name drug, the cost would be 30%.  The point is to give an incentive to policy holders to shop the local pharmacies, and talk to their doctor about lowering their prescription costs.

Prescription drug costs make up over 1/3rd of total claims costs.  To save the insurance company and yourself money, always talk to your physician about generic medications, as well as alternatives that may provide the same results, and provide you a lower copay.

Understanding and being aware of the actual cost of our prescriptions is something we can all do to help reduce the spiraling cost of health care.

Regence BlueShield has a helpful website for looking up drugs and their alternatives.  Another tip: switch to mail order if you have a chronic condition.  Many health plans have a mail order program that will give you 3 months supply for 2 months copay.

For help finding the best health coverage in Washington State, visit us at www.wahealthagency.com or call 360-464-1622


Individual Health plans in Washington will see a slight premium increase eff Jan 1st 2010

Legislation changes or rulings by The Washington State Office of the Insurance Commissioner will sometimes mean higher premium costs for Washington residents.  Usually because of a new mandate increasing the coverage your health insurance provides.  Whether you want the new coverage or not, the mandates increase the risk to the insurance carrier, thus increasing your costs. 

This go around, the increase is not much (not like the 3% increase a couple years ago).   For many clients of the Washington Health Insurance Agency, they’ll see only a slight $1 or $2 increase.  Some will not see any increase at all. 

The increase is due to a couple of changes to the Organ transplant coverage:

    •Organ Transplant Lifetime Maximum—SB 5725 requires health plans to limit transplants to a separate lifetime maximum of not less than $350,000. (up from $250,000)

    •Organ Transplant Waiting Periods—HB 1308 requires health plans to reduce organ transplant waiting periods by the amount of time a person had prior creditable coverage.

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