The Pay or Play Decision:

payorplayindividualmandateThis The Pay or Play Decision flowchart discusses the advantages and disadvantages of three of the options available to employers as they determine if they will offer health coverage to employees in 2015.

© 2013 Zywave, Inc.All rights reserved.

Reinsurance Program Changes for 2015

Health Care Reform bulletinOn Nov. 24, 2013, HHS published its 2015 Notice of Benefit and Payment Parameters Proposed Rule, which addresses key changes to the transitional reinsurance program for 2015. This Reinsurance Program Changes for 2015 document provides an overview of the changes.

© 2013 Zywave, Inc.All rights reserved.

Half of Americans Would Fail Health Insurance 101

person sitting on question markSurvey results from the American Institute of CPAs shows a majority of U.S. adults cannot accurately identify basic health insurance terms.  51% of 1000 respondents, could not accurately identify at least one of the following terms: premium, deductible and copay.

“Alfac WorkForces Report” revealed that 89% of workers choose the same benefits year after year, because they don’t understand the options provided.  Americans need to take time to familiarize themselves with key terms and assess their needs so they make the best decisions during annual open enrollment.

According to Colonial Life, the top mistakes employees make when enrolling in benefits:

  1. Not reading the benefits information before enrollment
  2. Not knowing what benefits they currently have and what they cost
  3. Forgetting to talk with their spouse about their family’s needs before enrollment
  4. Assuming the cost of a new benefit is unaffordable without seeing any prices
  5. Not attending the group informational meeting
  6. Not taking time to understand the upcoming changes in their benefit plans

Help your employees be informed, so they make wiser less expensive choices.  There are some excellent and free resources out there to help.

Choosing Wisely (–physician groups have joined with Consumer Reports to help promote the more effective use of health care resources

The artistic community. Good ( on online community that aims to drive local collaboration and grass-roots progress–hosted a “transparency contest” that challenged graphic designers to create an easy-to-digest infographic that illustrates Affordable Care Act.

YouTube. Enter key words “health insurance 101” and your results will yield a free video library that breaks down health insurance words and then some.

When employees are informed, they make wiser, less expensive choices. And that benefits everyone.


Reference: Butler, K (2013, November) The ‘Sight Words” of Health Benefits.


Defined Benefit vs. Defined Contribution Healthcare – What’s the Difference?

questions and answers2The health insurance industry is transitioning away from defined benefit healthcare and towards defined contribution healthcare. Many experts even say we’re approaching the tipping year for defined contribution healthcare. But what do these terms mean and how are they different?

The simplest way to think about it is what the employer is controlling.

  • With defined benefit healthcare the employer sets the specific health benefit.
  • With defined contribution healthcare the employer sets the specific amount contributed (but doesn’t dictate the exact heath benefit).

Let’s look at these definitions closer.

Defined Benefit Healthcare

Defined benefit healthcare is the traditional way we think about employer health insurance. A company provides its employees with a defined healthcare benefit — doctor visits, hospitalization, pharmacy and so on — often at uncertain annual cost.

The benefit is administered through an employer-sponsored group health benefits plan.

Defined benefit and defined contribution healthcare are often compared to retirement benefits. Using this reference, a defined benefit would be a pension-style retirement plan.

Defined Contribution Healthcare

Defined contribution healthcare is a new way to think about employer health insurance. In it’s purest form, a company provides its employees with a health insurance allowance or “contribution” to spend on their own healthcare — at an annual cost that the company controls. Think of defined contribution like a stipend, or a gift card, to use for health insurance.

The benefit is administered through a defined contribution software provider and may or may not include a private exchange.

Using the same comparison to retirement benefits, defined contribution healthcare would be the 401(k)-style retirement plan.

Just as there are many variations of defined benefit healthcare (various ways to structure the group health benefits plan), many variations of defined contribution healthcare are popping up because they are an effective way to control cost.