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Group Health Insurance May Be Best for Your Business … Even If You’re an Individual

Even if you’re an individual, group health insurance may be best for your business.

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RECENTLY, I HEARD A business owner tell a frustrating story about how she was forced to spend a surprisingly large sum for the treatment of a health condition. She was angry because her individual health insurance plan, bought through the Marketplace in 2014, had just increased in premium for the fourth time. She expected more from her insurance!

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Podcast: What Exactly Does it Take to Become America’s Finest Optical Retailer?

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There has been a growing rift between group and individual insurance since 2015 — most owners have not been able to keep up with all of the details. I have heard, erroneously, from many business owners that they believe:

  • They couldn’t do group insurance.
  • They would have to pay for all of their employees.
  • Individual insurance would be cheaper.

Not true.

Individual insurance contracts (aka Obamacare plans) are no longer the same as group plans. Differences include deductibles, max out-of-pocket financial exposures, and pricing. In most cases, individual insurance is less advantageous for the consumer.

Many small business owners are not aware of the increased availability of group insurance.

In 2014, the Affordable Care Act changed many of the regulations affecting small businesses and insurance. States have also been tweaking rules applicable to groups employing between two and 50 people (small groups). It is very possible that a small business would be better off with group insurance — and the employees as well.

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Here is the basic situation: In most states businesses with two or more people are eligible to purchase group insurance. Why is this important?

Because, in many states, group insurance may be less expensive per person, have lower financial exposures and have access to larger PPO networks.

How does it work? There is a little-known aspect of the Affordable Care Act that makes group insurance very accessible for small businesses. If you have an inception/renewal date of Jan. 1, then the business is not required to contribute to the employees’ premiums. Further, there are no participation requirements (i.e. how many people must participate of the employed population), so the business owner could be the only one participating — a “group” of one. Some states do not allow groups of one. In these states, you must have two participants. And note that husband-wife groups are treated differently and may not be eligible.

If the group insurance plan renews on any other date of the year, then the group is subject to contribution and participation requirements. These requirements are set by the insurance companies and are typically less stringent than most business owners believe.

Typical participation requirement: 70 percent of eligible full-time staff after qualified waivers. A qualified waiver is someone who has an insurance plan from a spouse, the government or an individual plan. Let’s say we have a group of 10 full time employees, four of whom have coverage through their spouse and one who is on Medicare. Here is how we determine the participation requirement: 10 eligible – 5 qualified waivers = 5 employees. In this case, to attain 70 percent participation, only four people must participate!

In regard to employer cost for groups that do not start/renew on Jan. 1, requirements may not be as high you think. In most cases, the employer is asked to contribute 25 percent of the cost of individual coverage on the lowest cost plan.

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Here’s how this plays out in the real world: Most small businesses offer two or three plans for the employees to choose from, one of which will be the “lowest cost.” The employer then calculates 25 percent of what it costs for that single person and the employee is responsible for the remaining premium. How much money are we talking about? Typically an employer is asked to contribute $75 to $225 per month per person depending on the age of the employee — only for those who choose to contribute.

Marcus Newman is Vice President — Small Business Sales with GCG, a full-service financial, employee benefits and risk management firm. A regular public speaker and educator, he can be contacted at marcus.newman@gcgfinancial.com

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Editor's Note

Size Matters… The Bigger the Better

And addressing some other sensitive subjects you might encounter in the workplace.

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AND THE BIGGER the better as far as I’m concerned. I have no problem admitting I am a size queen. I love a BIIIIIG … survey. The more data the happier I am. So, I got a lot of pleasure out of seeing the results of our first Big Survey and wow did it provide some insight. There is a lot to unpack there and you can see everything we found starting on page 34. This is the first of many to come and I’m excited to see how this survey evolves from year to year.

The answers were of course anonymous but there is one more thing I need to say: breastfeeding or having a pregnant employee’s water break at work are not weird things employees have done. Those are natural and unavoidable. If you answered something in this vein to the question “What is the weirdest thing an employee has done at work?” perhaps you need some sensitivity training and to take a very close look at yourself. Ok, rant over.

You know what amused me in this issue? The number of people cutting their nails at work — for the record, that is weird and gross (page 70) — and that so many of you consider your best and worst habit one in the same!

Also, rarely does a Real Deal generate the sort of response this issue’s did – The Case of the Concealed Concern on page 72. I know the gun debate is a hot topic and in a magazine with as broad an audience as INVISION’s there is no way we are all going to come down on the same side of an issue, but except for one slightly over the top (and poorly written) response, all the points of view we received were measured, well-executed and logical. This one really got you thinking, so if you haven’t read it or addressed this issue in your business, I encourage you to review it and discuss.

Best wishes for your business,

Dee Carroll

EDITOR-IN-CHIEF

dee@invisionmag.com

Five Smart Tips From This Issue

1. Start a movement. Resurrect a one-off holiday celebrating opticians. (Calendar, page 20)
2. According to our Pop Quiz, 58% of you are anti-flu shot (page 71). So, be flu ready with an in-office flu kit. (Tip Sheet, page 58)
3. Want to know how to get to the root of a candidate’s strengths and weaknesses in the interview? We’ve got some ideas. (Ask INVISION, page 62)
4. Everyone loves a party… that’s how you “get to show them up” to your in-store events. (Line Time, page 66)
5. The perfect way to harness the power of the modern consumer’s self-absorption to benefit your business. (Benchmarks, page 68)

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Danielle Richardson

A Case for Yoga

Let go of any preconceived notions… yoga is for everyone.

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I KNOW, I KNOW — yoga is not for you… but let me stop you right there. Yoga is truly for everyone! Yoga is finding its place in the mainstream as 1 in 7 American adults reported practicing yoga according to a 2017 survey.

However, as the number or practitioners continues to rise, so too does the number of people who feel alienated by yoga. Social media has warped the perception of this ancient practice into something that more closely resembles gymnastics or acrobatics. This shift distances many would be practitioners because of feelings of not being “flexible” or “fit” enough. I’m here to tell you that’s BS! This article is to make the case for yoga and its inclusion in your wellness routine.

Podcast: What Exactly Does it Take to Become America’s Finest Optical Retailer?
INVISION Podcast

Podcast: What Exactly Does it Take to Become America’s Finest Optical Retailer?

Podcast: Why Optical (and Especially Optical Retail) Is Lagging Behind Other Industries
INVISION Podcast

Podcast: Why Optical (and Especially Optical Retail) Is Lagging Behind Other Industries

Podcast: What the Heck is Marketing? And What Should ECPs Focus on to Attract New Clients?
INVISION Podcast

Podcast: What the Heck is Marketing? And What Should ECPs Focus on to Attract New Clients?

The true origin of yoga can be disputed, but the most popular types of yoga in the West are derived from a 5000-year old Indian philosophy system and body of knowledge. Yoga takes a holistic view of the human experience and consists of practices to unite the mind, body, and soul. Yoga extends beyond physical movement to combine meditation, self-discipline, and breathing practices to achieve optimal health and wellbeing. Below are a few things to remember about yoga:

Yoga is for everyone. Contrary to popular belief, yoga does not require fancy tights or expensive studio memberships. Additionally, you don’t have to overhaul your life or become a Himalayan monk to practice. The only requirements for yoga are your body and your breath. Yoga is most often practiced on hard wood with a mat or blanket, but carpet is suitable as well. Yoga can also be made accessible to those with disabilities using chairs and props for modifications. There truly is something for everyone.

Beginners are always welcome. There are plenty of resources available for new yogis. You can go the in-person route and sign up for a new student special at a local studio. Local yoga studios often have classes designed for beginners where you can receive in-person guidance and personalized tips to make the practice more comfortable. Additionally, you can use online beginner yoga videos on YouTube via my channel “FierceClarity” or another excellent source like “YogaWithAdrienne.” My recommendation is to begin once per week and gradually increase frequency. There is no right or wrong amount of yoga to do, but the longer you stick with the practice the more benefits you will see.

Yoga has real benefits. According to The National Center for Complementary and Alternative Medicine, an NIH affiliate, research shows yoga may help relieve stress and chronic pain, manage chronic disease symptoms, and even aid in smoking cessation. Other studies have found yoga to successfully decrease inflammation, improve heart health, and improve some symptoms related to anxiety and depression. Additionally, yoga aids in weight loss and can help maintain a healthy weight when practiced regularly.

I started practicing yoga at the end of optometry school when I was burned out and sick from an unhealthy lifestyle. This simple practice has changed my life for the better. I became so passionate about it that I now teach yoga to others. I hope you will let go of any preconceived notions and give yoga a try. It is a rich tradition with several different styles and teachers. Be like Goldilocks and experiment a bit until you find the yoga that is just right for you.

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Columns

Don’t Do Do-It-Yourself Optometry … Do This Instead

Even the most successful DIYers know when to call in a pro — and doing so can free up their time for bigger and better things.

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I CONSIDER MYSELF A competent Do it Yourselfer, and during a recent house remodel I was determined to handle as many tasks myself as possible. My father is a retired master carpenter, and I spent countless childhood hours watching him craft pristine custom cabinetry.

Clearly, I had no reason to doubt my ability to handle some basic trim work. This was going to be easy, right? Wrong!

Similarly, while a wealth of DIY-style info is available, DIY optometry practice management is no piece of cake. The goal of running an efficient, profitable practice is not as easy as it sounds.

Perhaps the most important sign of a competent DIYer is knowing when to hire a professional. Honestly, I knew I couldn’t manage my own plumbing or wiring.

Hiring specialists to manage certain aspects of your practice can outweigh the self-satisfaction of DIYing. More often than not, the main benefit is prioritization. Here’s why:

Ten years ago, the optical dispensary comprised at least 70 percent of the overall practice revenue, while exams and services made up the remaining 30 percent. Today, with the increase in medical-model eyecare, exams and services can match or exceed dispensary revenue.

Most ODs once dedicated significant time to dispensary operation, but more time is now spent learning new equipment, interpreting test results and filling schedules with more non-optical patients. Managing inventory and lens purchasing now takes a backseat to offering other specialty medical services. Such profitable specialties are where you should be focusing your energy, rather than overseeing day-to-day dispensary management. To compound the problem, optical dispensing is becoming increasingly complicated. Patients have vision plans with specific criteria, lab networks and products, mandating that optometrists be masters in maximizing profitability and understanding plan contracts.

Delegating allows you to focus attention on next-level eyecare and promotes overall practice development. Let’s discuss a few aspects of optometry dispensary operation that benefit from less DIY and more professional management.

  • Staff training. Optical dispensary management services provide staff with professional education sessions. Performance standards are established and regular meetings held to discuss products and technologies. Incentives programs entice staff to meet sales goals.
  • Revenue cycle management. The capture, management, and collection of patient and insurance revenue as well as cash flow, audit risk and ultimately profit can be outsourced to professional firms.
  • Marketing materials and initiatives. Demographic-specific marketing programs tailored to a practice’s patients can boost sales. Collateral may include educational patient information or professional courtesy programs.
  • Third-party billing. Staff are trained to maximize plan benefits, and ODM services process all optical claims on the practice’s behalf.
  • Dispensary inventory management. DMs purchase existing inventory while transitioning to new inventory targeted to a practice’s specific patient demographics. This includes an analysis of the practice’s market showcasing competitive price structures and consumer preferences.

Enlisting professional help isn’t an admission of lack of skill, it’s the practical awareness that not everything can be accomplished on your own. So, while you may choose to keep your home remodeling efforts DIY, let experts take your optical practice to the next level. A little help never hurt anybody.

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