Employee Benefits - Gilroy Kernan & Gilroy Insurance

Competitive employee benefits packages and options, and leading-edge executive compensation products are two of the most sought-after programs today. Both help an employer compete in the job market by attracting, rewarding and keeping top employees. Gilroy Kernan & Gilroy's Employee Benefits Department designs benefits programs tailored to meet the needs of your business.

Consumer Driven Healthcare
Consumer-driven healthcare plans are an innovative approach to healthcare benefits and consist of three key components:

Personal Care Account (PCA) — Offered on a pre-tax basis, the employer funds the Personal Care Account. When paying for medical and health-related services, employees access this account first. Benefit dollars remaining in the account at year-end roll over and may be used by employees to cover future medical costs.

Health Coverage — Employees tap health coverage if their annual healthcare expenses exceed the amount in their Personal Care Account and if they have met an annual deductible. (Most services covered by the Personal Care Account apply toward the annual deductible.) Preventive care services are also paid for by health coverage. These expenses are not deducted from an employee's Personal Care Account.

Tools, Resources & Support — Through a consumer-driven healthcare plan, Gilroy Kernan & Gilroy can connect you to a comprehensive suite of resources to help you make health and wellness decisions. Plan members can research providers across a broad range of criteria; review pricing for medical services or conditions; view quality ratings for facilities; interact with experienced nurse health coaches; benchmark care received against industry standards for key conditions; search for health information; and easily track all account activity online. Members also benefit from a number of technology-enabled programs that evaluate medical claims to spot possible omissions and mistakes in medical care.

Dental Plans
Dental plans are one of the nation's most popular employee benefits. Services are generally placed in groupings for purposes of plan design, such as Preventative, Basic and Major Dental and/or Orthodontic Services. Plan options are available to address the needs of the employer.

Exclusive Provider Organizations (EPO)
The latest Managed Care option available to employers, an Exclusive Provider Organization (EPO) can be more affordable than other Managed Care options. EPOs typically look like an HMO plan, using a combination of co-payments, deductible and coinsurance with participating providers. There is no "gatekeeper" feature, so employees are permitted to "self-refer" for specialty care. Many co-payment design options, with and without deductible and co-insurance features, are available.

Flexible Spending Accounts (FSA)
Commonly referred to as reimbursement accounts, through a Flexible Spending Account (FSA) employees can pay for benefits, daycare services and unreimbursed medical expenses, including many over-the-counter items, with pre-tax dollars by using a salary reduction program.

Health Maintenance Organization (HMO)
Health Maintenance Organizations (HMOs) were introduced as an alternative benefit to traditional healthcare coverage, making benefits more affordable. With an HMO you are required to use the physicians, hospitals and laboratory facilities that contract with the carrier. Referrals are required for specialty care. Many benefit riders are available for HMO plans, so each employer group can somewhat customize their benefit plans. HMOs can still be offered alongside traditional medical plans to provide a cost-effective alternative.

Life Insurance
Almost all employers, regardless of size, provide death benefits for their employees as an integral part of their employee benefits program. Forms of death benefits include:

A group life insurance employee program may be offered on a contributory and a non-contributory basis. There are a number of advantages for offering group Life and group Buy-Up (voluntary) life benefits:

Long-Term Disability
Also known as Loss-of-Income Protection, Long-Term Disability plans typically provide income replacement after 26 weeks, under a two-part definition of disability.

Part one usually applies to the initial two years that LTD benefits can be paid. Employees must be disabled to an extent that they cannot perform the duties of their own occupation.

Part two usually applies to the timeframe after the initial two years of LTD benefits. Benefits will continue to be paid if the person is unable to engage in any work or occupation for which he/she is reasonably fitted by education, training or experience.

Long-term disability can be offered as an executive compensation benefit (paid by the employer) or can be purchased by a worker as a voluntary benefit.

Point of Service Plans (POS)
A Point of Service Plan is known as a "new form" of managed care, developed to respond to consumers wanting the controlled costs and incentives of a managed care plan — but also the freedom and flexibility of a traditional indemnity plan. A POS offers fixed co-payments with required referrals to network providers. This is known as "in-system benefits." Members of a POS also have the option of seeing a provider of their choice, subject to deductible and coinsurance. This is called "out-of-system" coverage. POS plans typically have participation requirements, may be offered alongside another healthcare plan and can use a combination of approaches to a plan design.

Preferred Provider Organization (PPO)
A Preferred Provider Organization (PPO) is similar to a Point of Service Plan. PPOs offer both "in-system" (Managed-Care Benefits) and "out-of-system" benefits that include deductible and coinsurance options. The "in-network" Managed Care feature provides physician, hospital and other medical services with various co-payment options. However, there is not a "gatekeeper" requirement to see specialty providers. With a PPO, a member may "self-refer" to any participating provider within the carrier’s covered service area with the "in-system" or Managed Care feature.

Self Insurance
Self-insurance is a funding arrangement that provides responsibility to an employer for providing plan benefits to employees.

Rewards for an employer include the ability to: capture and benefit from favorable claims experience; reduce administrative expenses; avoid New York State mandated benefits coverage; and have greater flexibility and control over their own plan design.

The risks include little experience that would be required in underwriting, legal (including lawsuits) and administrative services compared to an insured arrangement with a carrier. Self-funded benefit plans can be extremely advantageous for an employer. However, not all employer groups would be eligible to self-insure their medical coverage.

Gilroy Kernan & Gilroy can help you determine what you need to do when considering self-insurance.

Short-Term Disability (Voluntary)
Voluntary short-term disability is, as its name indicates, offered as a group benefit on a voluntary basis. Coverage is provided for an accident and/or an illness and different benefits can be chosen for each employee through group coverage. Waiting periods vary, based on whether the disability results from an accident or illness, as does the duration period of benefits.

However, New York State mandates that employers must provide short-term disability to workers, with only a few exclusions (such as municipalities). Voluntary short-term disability can be purchased to supplement this mandatory coverage.

Traditional Coverage
Traditional coverage is also known as "group health insurance." Indemnity plans provide the freedom of using any physician and hospital in each carrier's service areas, typically throughout the United States and outside the country.

Vision
Supplemental vision plans cover services such as routine examinations and hardware products like lenses, frames and contact lenses. Some plans offer discounts with Lasix surgery. Vision plans may be offered with a group benefits program as a voluntary benefit.

Copyright 1998-2005 Gilroy Kernan & Gilroy Insurance. All Rights Reserved.
The information presented on this site addresses certain aspects of selected insurance topics, issues and coverages. It is not intended to be a complete or conclusive definition of coverage. You should always consult an Account Manager at Gilroy Kernan & Gilroy for an explanation of a policy's provisions with respect to specific applications.

Developed, maintained and hosted for Gilroy Kernan & Gilroy Insurance by

... when it's time to establish an Internet presence.