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Employee Benefits Solutions
At Paul Donas, LLC we are committed to providing the appropriate health and wellness solutions for your small, mid-sized to large company’s employees for your business with benefits that attract and retain the best employees in the market. We know that there is a wide variety of insurance providers out there and we’re here to help you make the best and most informed decision. Since there is an enormous amount of information directly related to plan style, company size, benefits and budgets, we can provide the clarity and direction to choose the most complete plans for groups of any size. Below are just some of the considerations for your health care benefit plan.
PREFERRED PROVIDER ORGANIZATION (PPO) PLANS
PPO plans offer a large network of participating providers so your employees have a maximum range of doctors and hospitals to choose from. With PPO plans, employees do not have to choose a Primary Care Physician (PCP) and do not need a referral to see a specialist. Additionally, PPO plans afford members the opportunity to utilize out-of-network providers.
When considering a PPO plan, you will be evaluating the following factors for benefit solutions:
- Size of the network – primary doctors, specialists, labs, hospitals, pharmacies
- In-network copays
- Deductibles – in and out of network
- Co-insurance – in and out of network
- Pharmacy benefits including deductibles and copays
- Maximum out-of-pocket
For more information about a PPO solution for your company, please contact us.
POINT-OF-SERVICE (POS) PLANS
Similar to PPO Plans, Point-of-Service (POS) plans offer subscribers the choice of participating providers as well as the ability to see non-network providers. Plans may require members to choose a primary care physician and some may require referrals to see an in-network specialist. This all depends upon the specifics of the chosen plan.
When considering a POS plan, you will be evaluating the following factors for benefit solutions:
- Size of the network – primary doctors, specialists, labs, hospitals, pharmacies
- In-network copays
- Deductibles – in and out of network
- Co-insurance – in and out of network
- Pharmacy benefits including deductibles and copays
- Maximum out-of-pocket
To distinguish which POS plan works for your company, please contact us.
EXCLUSIVE PROVIDER ORGANIZATION (EPO) PLANS
An Exclusive Provider Organization plan is a health plan that offers access to in network providers only; you must use the designated network of physicians, pharmacies, specialists and hospitals. Apart from emergencies, out-of- network benefits are not covered.
When considering an EPO plan, you will be evaluating the following factors for benefit solutions:
- Size of the network – primary doctors, specialists, labs, hospitals, pharmacies
- Copays
- Deductibles
- Co-insurance
- Pharmacy benefits including deductibles and copays
- Maximum out-of-pocket
For more information about EPOs, please contact us.
Health Maintenance Organization (HMO) Plans
Like EPOs, the HMOs offer benefits in-network only. Referrals to specialists are typically required and some plans even require members to choose a primary care physician. An HMO generally keeps premiums lower because it covers in-network physicians and facilities and typically requires a referral from the member’s primary care provider.
Since Health Maintenance Organization plans limit the provider access, the monthly premiums are more affordable. These types of plans are attractive to members who have lower medical utilization needs. Some HMO plans offer low prescription drug costs for both generic and brand name medications with a small co-payment. However, other HMOs may have varying prescription plan pricing for generic and tiered drugs.
To learn more about which HMOs work for your company, connect with us.
HSA PLANS / HIGH-DEDUCTIBLE HEALTH PLAN
A High Deductible Health Plan offers substantially lower premiums than traditional plans. The trade-off is that all medical utilization is subject to a high deductible except for annual wellness visits. Members enrolled in a High Deductible Health plan will spend more per visit on their doctor, prescription and hospital visits than on a traditional plan but the savings in annual premium may offset those higher utilization costs. High Deductible plans can be built using the various platforms detailed above HMO, PPO, EPO, etc. to shift the burden of medical expenses to the member.
The member can see a savings on monthly premiums because of the self-funding requirements of the HSA. Members contribute to their Savings plans on a pre-tax basis over the course of the plan year. Medical expenses such as doctor visits, prescriptions, specialists and hospitalizations are paid with pre-tax dollars by the member and can also be used towards dental and vision care.
Clients may contribute to their HSA up to an annual limit set by the IRS. The amount contributed is tax deductible up to the elected amount and is deducted on a pretax basis from paychecks or can be deposited ad hoc over the course of the year. The Health Savings Account earns tax-free interest and withdrawals for eligible expenses determined by the IRS rules are non-taxable. Employers may also contribute to the HSA and employees will not be taxed on these contributions.
HSA funds may be used for qualified health expenses such as medical, dental and vision expenses. Clients are responsible to make sure HSA funds are being used for qualified healthcare expenses. Any HSA funds used on ineligible expenses will be subject to federal income tax, with an additional 20% tax penalty if under the age of 65.
For more information on HSAs, please contact us.
Ancillary Benefit Plans
Enhance your company’s employee benefits package by adding a variety of plans that provide additional benefits. There are three levels of Ancillary Benefits. Non-contributory, Contributory and Voluntary. In consideration of which plan works best for your company-based budgets and goals, the simple definitions are detailed below:
Non-contributory – the premiums are completely paid by the employer. There is no outlay due by the employee. These plans must cover all eligible employees.
Contributory – premiums are split (not necessarily equally) between the employer and eligible employees who choose to enroll in the coverage
Voluntary – premiums are typically paid 100% by the employee but the employer may elect to pay a de minimis portion of the premium.
To create an attractive ancillary benefits program, you will need to understand what your employees want and need. You also must choose what fits with your business objectives. We make this easy for you by:
- Giving you access to a selection of benefit carriers, resulting in competitive pricing and favorable underwriting concessions.
- Identifying the best options in your industry to see what your plan may be missing.
- Determining future trends to ensure the plan you offer is competitive now and down the line.
Contact us for a no-cost review of your current benefits plan.
Ancillary benefits include:
DENTAL INSURANCE
Among the most sought-after types of these benefits is Dental Coverage. We will help you navigate the various plan options including Dental HMO (DHMO) and Dental PPOs to secure coverage that meets the company budget and employee needs.
SHORT-TERM DISABILITY (STD)
Bills do not stop coming in just because someone can no longer work. Accidents or sudden illness impact an individual’s ability to earn a living. Short-Term Disability plans pay benefits when sickness or injury prevents you from working. We will help find you a plan that has affordable premiums and comprehensive benefits.
LONG TERM DISABILITY (LTD)
Having a steady income keeps families financially stable. Sometimes disabilities can be short-term and sometimes they can be long term. Long-Term Disability allows you to continue to pay your family’s bills if you are hurt and out of work for an extended period due to injury or illness.
While premiums are important considerations, the carrier’s definition of disability needs to be understood. Plans have differing definitions of when someone is disabled. It is important to know the plan’s definition of disabled as benefit payments hinge on the distinction.
GROUP LIFE/AD&D
We cannot predict the future, but we can plan for it. The reality is that sometimes employees die. Group Life Insurance is a low-cost way to supplement your current benefits package. Paul Donas, LLC will assist you in structuring a Group Life insurance plan for your company. Employers can choose to offer coverage for all employees as a flat dollar amount or multiple of pay. Employees may be given the opportunity to buy up or add to their coverage on a voluntary basis. In addition, voluntary coverage may be extended to spouses and dependent children.
VISION INSURANCE
Vision care is a moderately priced complement to any comprehensive healthcare package. Vision coverage is often combined with dental insurance plans. Typical vision plans provide benefits like routine eye exams, allowances for prescription glasses and contacts and discounts on other vision services.
CONSULTING and EMPLOYEE EDUCATION
Unbiased professional and carrier agnostic.
At Paul Donas, LLC, we work with you to create a comprehensive employee benefits package that lays the foundation for an organization-wide culture of health that attracts and retains talent.
Paul Donas, LLC will research your options thoroughly, provide education on insurance coverages and costs. More importantly, we represent your business—not the insurance company. We are unbiased professionals and carrier agnostic.
We are available for annual open enrollment, employee education seminars, consultative discussions and individual communications with your employees throughout the plan year as needed.
As your insurance broker, we are your advocate in the medical and wellness arena on the phone, by virtual meeting or in-person.
Paul Donas, LLC will help you choose the right plan for your company—whether you are working with small groups of under 50 employees or large groups of 50+. We will help you pick plans from our many carriers to ensure the best policy based on budgets, employees and benefits.
