What You Need is a Knowledgeable Expert on your Team
A doctor who reigns in skyrocketing health insurance costs by personally taking care of your employees.
How? By putting an expert DPC doctor at the center of your self-funded health plan.
Everyone benefits when you choose a DPC doctor to:
- Protect your employees from needless frustration,
- Protect your health plan from financial harm.
- Protects your health plan from financial harm
We Now Offer Direct Primary Care Paired with 3 Different “MEC” Plans
DPC for St. Louis Employers: A Healthcare Revolution
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DPC and Employee Wellness
A) 5 Creative Options for Employers to Consider in order to Lower the Cost for their Employees' Medical Benefits
1. Explore direct primary care -
A growing number of primary-care physicians are partnering with employers to deliver affordable preventative and primary care on a fixed-monthly membership model, in what is known as direct primary care.
Instead of billing patients' insurance, direct primary care providers charge users a monthly fee for unrestricted access to their doctor. Unlike concierge practices, providers in direct primary care do not bill insurers or Medicare for medical visits.
The price point is significantly less than most concierge practices. Often, it costs less than $1,000 per year per person."
While large DPC offices on the East Coast often charge $79, $89, or more per person per month, DPC St. Louis charges $60 with group discounts to employers available.
Direct primary care -- coupled with a high-deductible health insurance plan for larger companies, or a health-sharing ministry for 50 employees or less (see below) -- can be an outstanding and affordable solution for entrepreneurs and small business, often saving 12-15% over what employers spend on traditional health insurance.
If you are looking for a direct primary care provider outside of St. Louis, the Direct Primary Care Frontier has published its directory of DPC physicians online.
2. Investigate healthcare sharing ministries
"Basically, small to midsize employers can offer employees health ministry benefits vs. health insurance benefits," said John Beidle, an enrolled agent in St. Louis, Missouri, who specializes in benefits planning for small-business owners. Employers can offer a health reimbursement arrangement to reimburse employees for the membership fees that these health ministries charge. IRS notice 2013-54 (IRS notice 2013-54) explains how to integrate an HRA into a company plan. "You need to have a good tax person on your side who understands this," said Beidle. "It's complicated."
Among the nonprofit health ministries that offer health care are Christian Healthcare Ministries and Samaritan Ministries. Membership ranges from $45 a month for a single person to $150 per month. For a two-parent family, it ranges from $135 to $450. In Samaritan Ministries in Peoria, Illinois, the monthly "share" is $160 for an individual and $405 for a family."
3. Negotiate harder
"In the 50- to 99-employee space, a lot of employers don't realize they can negotiate their health insurance premiums. They think, `My renewal is my renewal.' But you can negotiate in that marketplace," according to Jeffrey Ingalls, president of The Stratford Financial Group. A good broker can point out factors that the insurer should take into account. He'll ask clients, "Do you have any claimants that left the company? Is the health of the company getting better?" That typically gives Ingalls some leverage.
4. Try the SHOP Exchange
Under the ACA, small businesses with 50 or fewer "full-time equivalent employees" can turn to the Small Business Health Options (SHOP) exchange. "It is essentially a federal or state-run supermarket—or marketplace—where businesses can shop for small-business plans," said Sally Poblete, founder and CEO of Wellthie, a digital health firm. She says companies can enroll in SHOP in any month or time of the year.
5. Convert to individual plans
While discontinuing group health insurance can be a hard sell to employees, they may be better off if you do. "Some employees might be better off financially with an individual plan bought through the exchanges set up under the Affordable Care Act," said Michael Stahl, senior vice president at HealthMarkets Insurance Agency. "Every employer with under 50 employees should be offering money to buy individual plans vs. group plans," according to Paul Zane Pilzer, author of the book "The End of Employer-Provided Health Insurance: Why It's Good for You, Your Family, and Your Company."
The price point is significantly less than most concierge practices. Often, it costs less than $1,000 per year per person."
While large DPC offices on the East Coast often charge $79, $89, or more per person per month, DPC St. Louis charges $60 with group discounts to employers available.
Direct primary care -- coupled with a high-deductible health insurance plan for larger companies, or a health-sharing ministry for 50 employees or less (see below) -- can be an outstanding and affordable solution for entrepreneurs and small business, often saving 12-15% over what employers spend on traditional health insurance.
If you are looking for a direct primary care provider outside of St. Louis, the Direct Primary Care Frontier has published its directory of DPC physicians online.
2. Investigate healthcare sharing ministries
"Basically, small to midsize employers can offer employees health ministry benefits vs. health insurance benefits," said John Beidle, an enrolled agent in St. Louis, Missouri, who specializes in benefits planning for small-business owners. Employers can offer a health reimbursement arrangement to reimburse employees for the membership fees that these health ministries charge. IRS notice 2013-54 (IRS notice 2013-54) explains how to integrate an HRA into a company plan. "You need to have a good tax person on your side who understands this," said Beidle. "It's complicated."
Among the nonprofit health ministries that offer health care are Christian Healthcare Ministries and Samaritan Ministries. Membership ranges from $45 a month for a single person to $150 per month. For a two-parent family, it ranges from $135 to $450. In Samaritan Ministries in Peoria, Illinois, the monthly "share" is $160 for an individual and $405 for a family."
3. Negotiate harder
"In the 50- to 99-employee space, a lot of employers don't realize they can negotiate their health insurance premiums. They think, `My renewal is my renewal.' But you can negotiate in that marketplace," according to Jeffrey Ingalls, president of The Stratford Financial Group. A good broker can point out factors that the insurer should take into account. He'll ask clients, "Do you have any claimants that left the company? Is the health of the company getting better?" That typically gives Ingalls some leverage.
4. Try the SHOP Exchange
Under the ACA, small businesses with 50 or fewer "full-time equivalent employees" can turn to the Small Business Health Options (SHOP) exchange. "It is essentially a federal or state-run supermarket—or marketplace—where businesses can shop for small-business plans," said Sally Poblete, founder and CEO of Wellthie, a digital health firm. She says companies can enroll in SHOP in any month or time of the year.
5. Convert to individual plans
While discontinuing group health insurance can be a hard sell to employees, they may be better off if you do. "Some employees might be better off financially with an individual plan bought through the exchanges set up under the Affordable Care Act," said Michael Stahl, senior vice president at HealthMarkets Insurance Agency. "Every employer with under 50 employees should be offering money to buy individual plans vs. group plans," according to Paul Zane Pilzer, author of the book "The End of Employer-Provided Health Insurance: Why It's Good for You, Your Family, and Your Company."
B )How QSEHRA can make a difference with the Five Common Alternatives to Traditional Group Coverage
Reproduced in part from the People Keep blog article by Caitlin Bronson on February 28, 2018
1. A family member’s group health insurance
At any small business, a sizable number of employees will have health insurance coverage through their spouse or a parent. When offered a group health insurance policy through their company, these employees will compare coverage options. If the family member’s policy is preferable, they won’t enroll in their company’s policy.
QSEHRA: Employees covered under a family member’s policy can’t receive reimbursement for their portion of the premium. However, they can be reimbursed for any other eligible expenses under the company’s QSEHRA. These reimbursements will be free of both payroll and income taxes.
2. Health care sharing ministries
An increasingly popular alternative to health insurance is the health care sharing ministries, which are faith-based cost-sharing programs. Members who share religious beliefs contribute a fixed dollar amount each month to their own savings account. When a member needs help paying medical expenses, they submit a request for the amount and the organization decides whether to approve the request. If the request is approved, the amount is paid using funds from other members’ savings accounts.
While these organizations aren’t considered insurance, members are exempt from the Affordable Care Act’s individual mandate.
QSEHRA: Employees belonging to a health care sharing ministry can’t be reimbursed for their membership fees under the company’s QSEHRA, but they can be reimbursed for any other eligible expenses. These reimbursements will be free of a payroll tax, but because ministry membership doesn’t qualify as MEC, they’re subject to income tax.
3. Individual health insurance
Some employees may choose to forgo group coverage from their company in favor of an individual health insurance policy. In some cases, this makes financial sense. In other cases, the employee may not like the coverage available through their company. The employee with a Direct Primary Care membership, for example, may want a high-deductible health plan (HDHP) so they can contribute to a health savings account (HSA).
QSEHRA: Employees with individual coverage can be reimbursed for their premiums under the company’s QSEHRA, along with any other eligible expenses. These reimbursements will be free of both payroll and income taxes.
4. Short-term health insurance
For many reasons, employees may not want ongoing major medical coverage. One alternative is to purchase a short-term health insurance policy. With a short-term policy, employees can get coverage fast and drop coverage without penalty. They can also choose from a range of deductible amounts.
QSEHRA: Employees with a short-term health insurance policy can be reimbursed for their premiums under the company’s QSEHRA, along with any other eligible expenses. These reimbursements will be free of a payroll tax, but because short-term coverage doesn’t qualify as MEC, they’re subject to income tax.
5. Going uninsured
Some employees don’t want to deal with insurance or health care financing of any kind. In this case, they may choose to go uninsured. Although they face a steep IRS penalty for this choice, they’re free to make it.
QSEHRA: Employees without insurance can still be reimbursed for any eligible expense under the company’s QSEHRA. These reimbursements will be free of a payroll tax, but subject to income tax.
Conclusion
Whenever employees use an alternative to their company’s group health insurance policy, their company’s participation requirements are affected or they don’t receive value for the company’s benefit, or both.
In contrast, the QSEHRA provides value to all employees and is never negatively affected by eligible employees’ health care decisions.
An increasingly popular alternative to health insurance is the health care sharing ministries, which are faith-based cost-sharing programs. Members who share religious beliefs contribute a fixed dollar amount each month to their own savings account. When a member needs help paying medical expenses, they submit a request for the amount and the organization decides whether to approve the request. If the request is approved, the amount is paid using funds from other members’ savings accounts.
While these organizations aren’t considered insurance, members are exempt from the Affordable Care Act’s individual mandate.
QSEHRA: Employees belonging to a health care sharing ministry can’t be reimbursed for their membership fees under the company’s QSEHRA, but they can be reimbursed for any other eligible expenses. These reimbursements will be free of a payroll tax, but because ministry membership doesn’t qualify as MEC, they’re subject to income tax.
3. Individual health insurance
Some employees may choose to forgo group coverage from their company in favor of an individual health insurance policy. In some cases, this makes financial sense. In other cases, the employee may not like the coverage available through their company. The employee with a Direct Primary Care membership, for example, may want a high-deductible health plan (HDHP) so they can contribute to a health savings account (HSA).
QSEHRA: Employees with individual coverage can be reimbursed for their premiums under the company’s QSEHRA, along with any other eligible expenses. These reimbursements will be free of both payroll and income taxes.
4. Short-term health insurance
For many reasons, employees may not want ongoing major medical coverage. One alternative is to purchase a short-term health insurance policy. With a short-term policy, employees can get coverage fast and drop coverage without penalty. They can also choose from a range of deductible amounts.
QSEHRA: Employees with a short-term health insurance policy can be reimbursed for their premiums under the company’s QSEHRA, along with any other eligible expenses. These reimbursements will be free of a payroll tax, but because short-term coverage doesn’t qualify as MEC, they’re subject to income tax.
5. Going uninsured
Some employees don’t want to deal with insurance or health care financing of any kind. In this case, they may choose to go uninsured. Although they face a steep IRS penalty for this choice, they’re free to make it.
QSEHRA: Employees without insurance can still be reimbursed for any eligible expense under the company’s QSEHRA. These reimbursements will be free of a payroll tax, but subject to income tax.
Conclusion
Whenever employees use an alternative to their company’s group health insurance policy, their company’s participation requirements are affected or they don’t receive value for the company’s benefit, or both.
In contrast, the QSEHRA provides value to all employees and is never negatively affected by eligible employees’ health care decisions.