Send me a Text Message. I'd love to hear from you.
This is how restaurant owners offer affordable health insurance to their employees without emptying their wallets.
In this episode, we promise you'll uncover actionable strategies by diving into a conversation with James Douglas, the owner of Soul to Sole Benefits. James shares his expertise on partnering with Connect for Health Colorado to unlock quality healthcare options, including individual coverage, health reimbursement arrangements, and small group plans. You'll also learn how employees can leverage tax credits to reduce costs, ensuring restaurant owners provide valuable benefits without financial strain.
Chapters:
00:00:08 - Affordable Health Insurance Solutions for Restaurants
00:05:09 - Navigating Health Insurance for Restaurants
00:10:40 - Strategizing Affordable Healthcare Coverage Options
00:16:50 - Health Insurance Enrollment Support for Restaurants
00:31:33 - Navigating Health Insurance Options for Restaurants
James and I dive into the unique challenges that both large corporate chains and small independent restaurants face in offering health care benefits. We highlight how Connect for Health Colorado serves as a marketplace for tailored insurance plans, offering financial assistance and customized options to meet diverse needs. James' inspiring journey from professional long jumper to health insurance advocate adds a personal touch, illustrating the importance of working with a licensed agent or broker. This episode is a goldmine of insights for those looking to navigate the complex world of health insurance effectively.
We'll also walk you through a real-life case study of a small Ethiopian restaurant, showing how to stretch a tight budget of $1,000 to cover comprehensive benefits by leveraging tax credits. Learn the differences between non-compliant and ACA-compliant plans, and understand the crucial role of a trusted insurance advisor. Whether you're managing a large chain or a small eatery, this episode will equip you with the knowledge to offer affordable, quality healthcare to your employees. Tune in to gain essential guidance and ensure your team has access to the best health insurance solutions available.
Resources:
Soul to Sole Benefits
James Douglas
Connect for Health Colorado
Outside of Colorado-HealthCare.Gov
P.S. Ready to take your restaurant to the next level? Here are 3 ways I can support you:
- One-on-One Coaching - Work directly with me to tackle your biggest leadership challenges and scale your operations with confidence. Learn more at christinmarvin.com
- Multi-Unit Mastery Book - Get the complete Independent Restaurant Framework that's helped countless owners build thriving multi-location brands. Grab your copy at https://www.IRFbook.com
- Group Coaching & Leadership Workshops - Join other passionate restaurant leaders in transformative group sessions designed to elevate your entire team. Details at christinmarvin.com
Podcast Production: https://www.lconnorvoice.com/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Christin Marvin (00:08):
If you're a restaurant owner who wants to
offer health insurance benefitsto your employees but finds it
too expensive due to the size ofyour staff or simply doesn't
know where to start, thisepisode is for you.
Join us as we share a real lifeexample of a restaurant that
provides benefits to a team ofjust eight people.
Today I'm speaking with JamesDouglas, owner of Soul to Sole
(00:32):
Benefits, about how he partnerswith Connect for Health Colorado
to provide affordable andquality health care to employees
in the restaurant industry atany budget.
James started Soul to SoleBenefit Solutions with a
person-to-person connection inmind.
Having been both in the healthinsurance and hospitality
(00:53):
industries for 10 plus years, hebelieves that the individuals
on the other side of the healthinsurance solutions should know
what their coverage options areand should have an advocate to
help them navigate those options.
His love for people andknowledge of the industry gave
life to this opportunity toserve his community, build
(01:14):
relationships and use his skillset to support a better health
coverage experience.
In this episode, james and Idiscuss how his company helps
restaurant owners provideaffordable and quality health
insurance to their employees.
He explains the step-by-stepprocess of offering health
insurance through individualcoverage, health reimbursement
(01:37):
arrangements or small groupplans, and how employees can
qualify for tax credits to maketheir plans more affordable.
James emphasizes the importanceof understanding the different
health insurance optionsavailable and tailoring them to
the specific needs of therestaurant and its employees.
He also highlights the role andvalue of working with a
(02:01):
licensed agent and broker.
Welcome to the no Hesitationspodcast, the show where
restaurant leaders learn tools,tactics and habits from the
world's greatest operators.
I'm your host, Christin Marvin,with Solutions by Christin.
I've spent the last two decadesin the restaurant industry and
now partner with restaurantowners to develop their leaders
(02:23):
and scale their businesseswithout wasting time and energy,
so they can achieve work-lifebalance and make more money.
You can now engage with me onthe show and share topics you'd
like to hear about, leadershiplessons you want to learn and
any feedback that you have.
Simply click the link at thetop of the show notes and I'll
(02:46):
give you a shout out on a futureepisode.
Thanks so much for listeningand I look forward to connecting
.
Hi, james, how are you?
Welcome to the show.
James Douglas (03:00):
Awesome, I'm doing incredibly well and thank
you for having me.
I'm happy to be here.
Christin Marvin (03:05):
Absolutely.
This is just an incredible.
It's going to be an incredibleconversation.
You and I have a little bit ofhistory and background and had
lost contact with each other.
I think we had stayed connectedon social media channels over
the years, but we werereconnected a couple of weeks
ago, surprisingly, and I waselated to see your name on the
email and I immediately reachedout and said is this James?
(03:27):
Is this James Douglas?
Is this the guy who I think itis so really excited to have
this conversation and learn moreabout what you're doing to
support the hospitality industry.
So thank you so much for takingthe time today.
James Douglas (03:40):
Absolutely.
Christin Marvin (03:42):
We are going to talk about how you provide
affordable and quality healthinsurance to independent
restaurants, to restaurantowners, to managers and really
restaurants of any size in theindependent space and on any
budget.
Which is just really excitingbecause a lot of the times I
hear from restaurant owners thatI work with or have
(04:04):
conversations with they reallywant to provide benefits but
they don't know where to go,they don't know the process of
getting started and they thinkit's too expensive or it has
been too expensive.
So really excited today to showand go through some real life
examples of restaurant clientsthat you work with and really
walk the listeners through astep-by-step process of what
(04:26):
this looks like, the type ofsupport that you provide to them
after the policy goes live andhow you really work with their
budgets to get creative.
So let's start with a littlebit of your background in the
restaurant industry.
James Douglas (04:43):
Yeah, well, it spans, I don don't know,
somewhere around probably 10years in the industry, on or on
and off, uh, everything from,you know, being a server to a
manager, uh, a mom and popitalian shop when I was in
college, uh, steakhouse, uh, Iended up obviously connecting
with uh you at snooze and thatwas a completely different
(05:07):
experience than anything I'dever been a part of.
But I think as we start tocontinue for sure, as we
continue the conversation today,I think a lot of it's going to
kind of dial back to theexperience the experience of a
restaurant or the experience ofa healthcare solution, or the
experience of really everythingin life.
(05:28):
And I mean, I've been in bigcorporate Darden restaurants and
the culture is very differentthan, say, a mom and pop, and so
the needs are very different.
But each arena needs a caresolution and so my handful of
years in service in therestaurant industry is has
(05:50):
really allowed me to relate withbusiness owners on a level
where I'm able to speak theirlanguage Right.
I understand their stressesRight.
If there are slips and cuts andfalls like what's proper
procedure, what's properprocedure?
And typically when a restaurantowner wants to know, okay, well
, what's the proper procedurefor healthcare.
(06:12):
It sometimes is a struggle tofind and identify what that
answer is, and wanting toprovide those benefits to the
employees is it's a piece of thegame.
Christin Marvin (06:17):
Yeah, absolutely.
Would you talk about just kindof a big picture perspective?
What you do at Soul to SoulBenefits, what you offer and
what type of restaurants youwork with.
James Douglas (06:32):
Yeah, so there's a famous billionaire I'll leave
his name out of it, but he goes.
You know, if you can't explainit in less than 30 seconds and
you don't understand what you'redoing.
And so the nutshell and thehigh level overview of what I do
and what we do at Soul to SoleBenefits is that we help
employers provide healthinsurance to their employees in
(06:55):
an affordable manner.
Right, there's obviously alittle bit of strategy.
The employer is going to set adollar amount per month, based
on their budget, that theemployee can then take and use
to go get their own individualhealth insurance plan, and so
the employer subsidizes thatplan.
The employee gets choices andoptions.
Many times Actually, I wouldn'tdo it if the employer didn't
(07:18):
save money and so ultimatelyit's a win-win across the board
for people, and a lot of thebarrier is just understanding
health care, and that's where weadvocate for the employer and
the employee.
Christin Marvin (07:32):
Yeah, absolutely.
I set up a health care planback in the day and we had four
or five restaurants, I think, inthe company at the time.
It was just so over my head andI wasn't an expert in it.
I know a lot of restaurantowners aren't experts in it
either.
It's a very complicatedindustry and kudos to you for
(07:54):
being in it.
Would you talk a little bitabout why you chose to go the
health insurance route, comingout of the restaurant industry?
James Douglas (08:02):
Yeah, honestly, I kind of just fell in it.
Um, I was training as aprofessional long jumper.
Uh, up in fort collins I had anolympic coach, my training
partner.
She won the the bronze medal inthe london olympics and the
women's long jump, and, uh, thatwas my, my dream and my goal.
Uh, long story short, I got hitby a car while riding a bicycle
, ended up moving back toAlamosa, colorado, and my track
(08:27):
coach was married to the CEO ofthe hospital and there was a
position that I applied for.
It was actually a position withConnect for Health Colorado,
and so I was a health coverageguide for them in the first year
of the ACA, the Affordable CareAct, and so that was kind of
where I cut my teeth in thehealthcare world.
And a year later I ended upbeing stolen by a health
(08:50):
insurance company and I workedthere for the next four years,
and so that's how I kind of gotstarted.
Christin Marvin (08:57):
I love it.
So you've got 10 years in therestaurant business, 10 years in
the health insurance space.
You're an expert in both.
I love that.
Sorry about the long jumping.
James Douglas (09:07):
Yeah, me too.
Christin Marvin (09:08):
Yeah, talk a little bit about your connection
today with Connect for HealthColorado and what they do.
James Douglas (09:17):
Yeah, so today Connect for Health Colorado is
the only place in our state thatyou can go and get assistance,
financial assistance to makehealth insurance affordable, and
so when you look at all theother states in the country,
many of them have somethingcalled healthcare.
gov.
Well, in Colorado we don't havehealthcaregov because we have
(09:37):
Connect for Health Colorado, andthe easiest way to describe
kind of what they are is kind oflike a price line for all
health insurance carriers, andso you're able to go to Connect
for Health Colorado.
Based on your zip code, you'reable to see all of the different
health insurance options thatare offered to you and then,
based on age, income, householdsize and zip code, you're able
(10:01):
to find a plan that's going tobest fit your needs, because you
won't pick a plan that doesn'thave your doctor and you won't
pick a plan that doesn't coveryour prescription.
So you're going to find thebest solution, based on your
current situation, to identifywhat's going to be, uh right,
advantageous for you to pick,and so identifying that connect
(10:23):
for health colorado is a placewhere you go and get those tax
credits is incredibly important,especially as we dive into
really, how does that play inthe role of a restaurant owner
wanting to help provide coverageto their employees.
Christin Marvin (10:38):
Okay, awesome.
And then will you speak aboutall the products that you offer.
Is it just health insurance?
James Douglas (10:47):
Yeah, so I think initially it started out as just
health insurance, and then youstart to understand like the
employer wants to offer a fullbenefit set because the
competitors down the road areoffering a full benefit set, and
so that has upgraded to dentalvision, ancillary life,
accidental.
All of that can be packagedtogether based on the employer's
(11:09):
budget, and so the strategiesthat we can dive into is right.
The restaurant owner has abudget and we have to work
around that budget, around thatbudget, and so that strategy in
utilizing and leverage Connectfor Health Colorado and
obviously taking whatever it isthat you are wanting to
(11:30):
contribute the employers wantingto contribute to their
employees, is ultimately thefoundation for how you're going
to provide coverage in anaffordable way that makes sense
for everyone.
Christin Marvin (11:41):
Okay and I love you work with.
You know you've got someexamples here of a restaurant
that's really small one location, eight people on the plan up to
a company that's got fourlocations, 200 people right With
around 25 people on the plan.
Walk us through the example.
Let's use the single locationwith eight employees.
Walk us through that processfrom start to finish and if you
(12:03):
can speak to kind of what theirbudget was and then what you
were able to find for them,coverage wise, tax credits came
into play there.
Walk us through that scenarioif you would.
James Douglas (12:14):
Yeah, so the single location for that
Ethiopian restaurant.
They have eight employees andwhen they came to me they said
you know I have a really tightbudget.
I said you know how tight is it?
They go, you know we have$1,000 to contribute to the
employees.
And so when you, when you'reworking with that $1,000 budget,
(12:37):
you have to understand thatthat $1,000 is only going to go
so far, especially in the worldof inflation today.
Going to go so far, especiallyin the world of inflation today.
And so if the business ownerwere to give, let's just say,
the $1,000 split up by eight,then we know that that's only
$125 a month.
But based on the salaries ofthe employees at this one
(13:00):
location, they were actuallyeligible for $500, $600, $800 in
tax credits per month.
And so by the employer offeringthat $125, it is actually
affordable because they're notthe highest paid employees, the
hourly workers are not thehighest paid employees, and so
(13:22):
by them offering that $125, itis actually a disservice to the
six hourly employees who workthere.
And so what we did was westrategized in a way to let them
go to Connect for HealthColorado.
They then were able to gettheir $400, $500, $600, $800 a
month in tax credits and theemployer now no longer has to
(13:43):
contribute that $125 to thosesix employees.
And so now there's a thousanddollar budget for the two
remaining salaried employees.
And so I want to be very clearhere you cannot carve out by
management.
You can't say my managers getto split a thousand and the
employees right, they get what'sleft.
(14:04):
Get to split a thousand and theemployees right, they get
what's left.
But when you start to structureand strategize, right, that
saves the employer money and itallows for them to provide a
better benefit for the salariedemployees, right.
Those people typically workmore hours than the hourly.
And then the hourly employeesare now able to go and get these
tax credits that they'reeligible for.
They're leveraging Connect forHealth Colorado.
(14:24):
They're leveraging all of thoseresources and tools to identify
if they're doctors in network,are their prescriptions covered,
right?
All of that gets put togetherin kind of one solution for the
business owner, for theemployees and for the employees'
families.
And so that's just kind of thefirst example, at a very high
(14:45):
level, of how they were able toput a healthcare solution in
place.
And then they actuallycontribute 100% of the dental
and vision as well.
Christin Marvin (14:54):
Okay, great.
Sorry to interrupt you.
I'm curious, would you circleback to, and maybe I missed it
how does a restaurant or therestaurant's employees qualify
for the tax credit?
James Douglas (15:06):
Yeah, so tax credits are based on age, income
, household size and zip code,and so when you are looking at
tax credits in general, the onlyway that you can qualify for a
tax credit is if you one do notreceive an affordable offer from
your employer.
You are not on Medicaid and youare not on Medicare.
(15:29):
So those are kind of the threedifferent chunks that you have.
Right, you have Medicaid forpeople who household a one
making less than about $18,000to $20,000 a year, and then
Medicare is for the individualswho are 65 and older, who have
worked their 40 quarters right.
That is, their part A and theirpart B benefits right, c and D
as well.
But then there's everyone elsein between who doesn't get
(15:54):
offered from their employer orwho doesn't get coverage through
their spouse.
And so this hole in therestaurant world where a lot of
the workers fall into is anopportunity for the employer to
say, hey, I've structured ahealth insurance solution so
that you can go and get thesetax credits in such a way that
(16:15):
you're going to make it's goingto make their plans way more
affordable and it's going tohelp the employer save money in
the process.
The employee is going to getchoices and options money.
In the process.
The employee is going to getchoices and options.
The employer is going to beable to now take the budget that
they do have and now provide itto the employees who are
salaried or who are in adifferent geographic location.
There are many differentclasses that we can kind of
(16:37):
break out, but that's kind ofhow it works.
Christin Marvin (16:50):
Hey there, podcast friends.
I hope you're enjoying theseimpactful conversations and
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Christin Marvin (18:38):
And then do you find that we'll get back to the
rest of the example here in asecond.
But I'm curious are employerswanting to?
Are they finding successoffering full health insurance
benefits to employees, or is itmore accidental?
When it comes to the restaurantbusiness, what, what do you
find is the most popular?
James Douglas (18:56):
and and just yeah , I mean, it's a great question
and I truly dislike answers thatare like it depends.
Right, every situation isunique, but when it comes to the
restaurant world, everyrestaurant is unique in the
sense that their budget isdifferent, their personnel is
(19:18):
different, their culture isdifferent.
Right, when you start to lookat the market in the state, in
the cities, in the counties thatthey operate in, are very
different.
And so here in Colorado, theindividual market is very strong
.
In Colorado, the small groupmarket is incredibly expensive.
Right, for the last three years, I've seen 17% increases on
(19:41):
what they were already paying.
Last year were 31 percentincreases.
This is a trend that is notsustainable for any employer,
let alone a restaurant.
Right, cost of cost of goodshas gone up like crazy.
We don't need to dive into that.
But understanding that inColorado specifically, the
(20:01):
individual market is great.
When you look at Arizona, thesmall group market is phenomenal
.
And so when you start to quoteout different options or
different paths that thebusiness owner can take, we
compare both, because if wedon't know what apples to apples
actually is, then that's adisservice to the employer, but
(20:23):
it also doesn't allow for themto be educated to make the best
decision and so based on thecounty, based on the state and
the zip code.
If an ICRA it's an acronymI-C-H-R-A stands for Individual
Coverage, health ReimbursementArrangement kind of a tongue
twister right.
If that is a better solutionfor the business owner, then
(20:44):
that is saying that the marketthat they operate in, the
individual market, is stronger.
An individual market is lessexpensive.
If it's, say, arizona and we'recomparing an ICRA to a small
group plan, small group's goingto win because small group rates
are better, they're lessexpensive than the individual
market and they're also smallbusiness owner tax credits if
(21:06):
they want to provide a smallgroup health insurance plan and
so small group individual.
It depends on where the owneris.
Christin Marvin (21:14):
Okay, got it.
So let's go back to yourEthiopian restaurant that has
eight employees.
So once they've determined ifthey qualify for tax credit,
once they've chosen the planthat they want to sign up for,
what's the process look likethen?
James Douglas (21:28):
Yeah, so typically open enrollment for
health insurance is November 1stthrough January 15th, that's
countrywide, it doesn't matterwhere you are.
And so if you do not get healthinsurance in that window of
time, then you technicallycannot buy it without something
called a qualifying life changeevent.
And so when the business owneroffers an ICRA or offers a small
(21:51):
group plan to their employees,it opens up what's called a
special enrollment period foreveryone.
That is offered every employeewho is benefit eligible to then
go shop and get health insurance.
And so once that process is putin place, they offer the
employees pick their plans.
Then there's a paymentstructure put in place,
(22:13):
depending on how, which path yougo, and once the premiums are
paid monthly, then the cards aresent, the welcome kits are sent
out by the carrier.
Every year the employee is goingto have to pick a new plan.
If it's small group, right,there's an annual renewal that
comes up.
If it's an individual coverageHRA then the individual plans
(22:37):
change year to year.
And so they're going to say,hey, I liked this plan that I
was on, right.
When open enrollment is comingup, they're going to say, hey,
james, right, that's a servicethat I provide to the business
owner is.
I assume the I don't want tocall it an HR position, but I
assume the admin support andhelping their employees make
(22:59):
their choices on their healthinsurance, dental vision
ancillary through software andtechnology that they can
literally go into the portal,software and technology.
That they can literally go intothe portal, make a few clicks
and say, hey, I want it to staythe same or I want to make some
slight adjustments to thisbenefit this year, and so that
(23:22):
is the support that comes on theback end.
But understanding that youdon't really want to be on the
same plan for forever becauseyour needs are going to change,
family size and household sizesare going to change, and so
understanding taking a look atit each and every year allows
for me to educate the employee,the employer, on what's going to
be the best fit moving forwardin the next year.
Christin Marvin (23:41):
Okay, and then will you refresh my memory on
what constitutes a qualifyingevent.
James Douglas (23:50):
Yeah, you can get married, you can get divorced.
You can have a child, you canadopt.
Right, you can change states.
Moving from state to state isconsidered a qualifying life
change event.
You can gain citizenship.
You can be released fromincarceration.
There's a laundry list ofqualifying life change events.
(24:14):
And, yeah, I mean, as therestaurant owner, just know that
when you choose to offer eithersmall group or an ICRA right,
that is going to open up thequalifying life change event for
your employees, which is goingto allow for them to shop, which
is great.
Christin Marvin (24:35):
Okay, so if I'm a restaurant owner and you
talked about your support thatyou offer during open enrollment
, but if I'm a restaurant ownerand I am HR which is a lot of
the case, right if I have healthinsurance offered and I hire a
new employer, a new manager,what does support look like from
you?
James Douglas (24:54):
from there, yeah, so I would be an extension and
an assistant to the HR, right?
Our team would.
So, mapping out the process,let's say, an ICRA was put in
place, right?
The employer set 300 bucks amonth they want to give to their
salaried employees and that'stheir solution.
(25:15):
So the employees would then gopick their plan.
If they picked a $200 a monthplan, then they don't pay
anything per month.
But if they pick a $400 a monthplan, then there's still $100
that is out there that theemployee is responsible for.
And so what's going to happen isthe employer is going to pay
the full $400 for that employeeand then they're going to
(25:37):
payroll, deduct the $100 fromthe employee's paycheck on a
pre-tax basis, and it's going tolook and act very similar to
group.
And it's going to look and actvery similar to group.
And so what will happen is HRthen is going to want to know
hey, you know how much do I needto pull from James's paycheck
each week?
And so, right, we would come in.
(25:58):
We would say, hey, james pickeda $400 plan, you guys are
contributing $300.
Right, each paycheck you needto take out $50.
And so, if you got paid twice amonth, and so that calculation
and those reports are all runthrough the tech platforms that
we use and it's all kind of likewrapped up in a nice little bow
for HR to say, hey, this iswhat we need to deduct each and
(26:20):
every year.
Christin Marvin (26:22):
Perfect.
So you're offering the hands-onsupport for the restaurant
owner to make sure that thatemployee gets set up with a plan
of their choice.
They fully understand the insand outs of the plans and the
cost, and then you're providingthe information to the
restaurant owner that needs tobe sent over to payroll.
If there is an additionaldeduction per paycheck, that
needs to happen.
James Douglas (26:44):
Absolutely.
And so when you start to lookat right and a restaurant owner
can only wear so many hats,right, and they always find a
new hat to wear because it's thehat is needed to be worn their
(27:09):
plate or if this is one hat thatwe can assist in implementation
and administration and ongoingsupport, then having a licensed
agent and broker on deck isincredibly helpful, because it's
not the employer's job to sithere and say, like you should be
on this plan, like no, theemployee should pick what plan
they want to be on.
But that's essentially what wedo in the small group model is
say like, hey, we go to acarrier and then we say we're
going to offer Blue Cross, blueShield, we're going to offer a
(27:33):
Cigna plan.
And OK, well, if we're offeringCigna plans, only, how many
plans of Cigna do we get tochoose?
Well, now, right, we might givetwo, maybe three options, and
that's going to cost thebusiness owner right, money to
do that.
And so when we say, okay, weoffer health insurance, here are
your choices one, two, maybethree.
(27:53):
Well, if you only have twochoices, that's a dilemma, and
if you have three, you're justlike, okay, well, I guess this
is the the the best for me basedon what I have and right, we
all have to play the cards thatwere dealt, but understanding
that your employees truly aregoing to have choices and
options once they go to theindividual market and look at
(28:17):
what's available.
So, just for context, there aresix health insurance carriers
here on the front range inDenver carriers here on the
front range in Denver.
So, like where I live personally, there are 87 plans that I can
choose from.
So if you put a small groupoption in place and there are
three plans to choose from andpeople still can't pick those
(28:38):
three plans and I come on boardand say, hey, here's 87, that's
incredibly confusing.
But there are filters andvalues that you can put in place
, like just a little practicethat I have everyone literally
anyone that I help I have themprioritize these five things
your doctor premium, deductible,office visit co-pays and
(29:00):
prescription co-pays.
And so I don't care what theorder is, but I have them
identify what is the mostimportant thing of those five
variables.
And if they say premium is thenumber one thing that we need to
pay attention to, I go find thecheapest plan that's available.
But if they say, james, mynumber two focus is deductible.
I have to have a low deductible.
(29:22):
Well then I can't just go findthe cheapest plan because that's
probably going to have a higherdeductible.
I now have a second filter ofsaying okay, well, what is the
most bang for your buck, right?
And then I need to have mydoctor in network.
I need to have prescriptionoffice visit co-pays at this
threshold because I go this manytimes.
So many times people will sithere and say like, oh, I need
(29:43):
the best, I need a gold plan,but I only go to the doctor once
a year.
Well, it's really hard torecommend that you fork out $400
a month for a gold level planif you only go one time and
every single ACA compliant planis going to give you an annual
wellness exam paid for at ahundred percent, one time per
year right and so if I can savethe employee money on the back
(30:06):
end, then they are incrediblyexcited.
If I can save the employee moneyon the back end, then they are
incredibly excited.
If I can save the employer onthe back end money that they
don't have to give to a carrier,right then they now have
additional funds that they canput into like an end of the year
party salary or compensationraises, party salary or
(30:33):
compensation raises Right youwould be.
You would be shocked at thethings that employers can can
provide if they have theresources and bandwidth to do it
.
They're very generous.
Christin Marvin (30:42):
I love it.
I'm I'm not surprised by you,because you've always just been
professional and caring andhospitable, but I love what you
just said about looking out forthe employee and the employer.
That's awesome.
James Douglas (30:54):
Cause.
I know you mean it?
Christin Marvin (30:56):
I know you which is great so what
absolutely?
What have we not talked about?
What else do listeners need toknow about?
About you, about the company,about what you offer?
James Douglas (31:11):
need to know about you, about the company,
about what you offer.
Yeah, I mean, I think it's ajourney right Like you didn't
start your restaurant to becomea healthcare expert and so
understanding that trust doesabsolutely need to be built, and
putting trust in a person whois licensed to understand that
there are affordable Care Actcompliant plans.
(31:32):
And then there are companiesout there who parade around
acting like health insurancecompanies and they say things
like we have PPO networks, whenthey really don't.
They just rent a piece of acarrier's network because
carriers do do that.
And so now they put outmarketing material saying we
offer a PPO and this is really,and they don't have to charge
(31:54):
the prices that an ACA compliantplan includes because they're
not including all of thebenefits.
And so when you're looking atsome of these off, we'll just
call them non-compliant plans.
The pricing is very low andthey tell you this low co-pays,
low deductible but what theydon't tell you is that they stop
(32:17):
paying after a certainthreshold.
And so if you find yourself ina very bad place medically and
you have a $100,000 claim, well,it turns out that this
non-compliant plan might stoppaying after 10 grand and you
still get stuck with 90,000,right.
(32:38):
And then, when you look at anAffordable Care Act compliant
plan ACA compliance there are 10essential health benefits that
are included in each and everyplan, Whether you agree with
them or not.
They are all included in anannual wellness exam.
One time per year is oneambulatory and emergency care is
one.
So no matter where you go inthe world right now, right
(33:02):
Carriers do not like paying forcare outside of the U S, let
alone, uh, outside of theirnetwork.
And so, understanding that,there's verbiage in a document
called an explanation ofcoverage that is 100 pages plus
deep, and in that evidence ofcoverage it states things like
you have urgent and emergentcare wherever you are.
(33:23):
So if you were to fly out ofstate or out of the network or
out of the country, then there'sa word, one word that kind of
revolves around how much yourhealth insurance company is
going to pay, and the word isstable.
And so if you get hurt out ofnetwork, it is that facility's
job to get you stable, and onceyou are stable, it is your
(33:46):
responsibility to get back innetwork as quickly as possible,
Otherwise you will start toincur.
So urgent and emergent care isincluded in all ACA compliant
plans, Right.
All of this information is stuffthat the restaurant owner does
not have to know, because weknow it and understanding that
(34:08):
it is going to take time totrust and understand.
Like, okay, these are thethings that are important to me
and it's the restaurant, thebusiness owner's job to
communicate that to me.
And then it's my job to makesure that I service and make
sure that you are not onlygetting those things hopefully
I'm exceeding those expectationsbut also you have enough wit
(34:29):
around it where you're not justblind and just blind trusting
that I'm going to take care ofeverything.
I am, but it's also veryhelpful to know that there's a
trusted relationship in placeand you don't have to right.
I'm going to tell you what youneed to pay attention to.
Christin Marvin (34:44):
Kind, of thing.
Yeah, I wish you were aroundback in the day when I was
choosing plans, because I willsay I've unfortunately been
surprised by a couple of ourhealth insurance plans of
covering not covering thingslike ambulance rides and then
getting, you know, some $3,000bills in the mail going oh this
is great, right?
Um.
So it makes so much sense,obviously, to tailor it to your
(35:06):
lifestyle, right?
Whether you, like you said, ifyou're traveling, or what you do
for physical fitness, or howyou spend your time or hobbies
or whatever.
But yeah good, you know we'realways learning, aren't we Down
the road?
James Douglas (35:19):
Oh yeah.
Christin Marvin (35:21):
Are you licensed only in Colorado?
James Douglas (35:25):
I am licensed in Montana and Colorado and then I
have business in California,Texas, and actually I might be
coming to Arizona pretty quick.
Christin Marvin (35:37):
How can people get a hold of you?
James Douglas (35:40):
They can find me on my website
soul2soulbenefitscom.
That's S-O-U-L to S-O-L-E.
Benefitscom, that's S O U L twoS O L E, and so, just so people
have context, that is, takingthe person and physically
getting them to where they wantto go.
Um, that's kind of how we cameup with the name soul to sole
benefits.
com.
Christin Marvin (36:02):
Um, or uh, I mean, obviously you're connected
with you and um, yeah, that'syeah that's really cool, you
know, for anybody that'slistening here, if you want to
connect with me or have meconnect you with James, there's
an option Now.
If you just go to the top ofthe show notes, you can simply
click click the link and send mea text message with your email
(36:23):
address and I'd be happy toconnect you guys, James, for
anybody that's listening, that'soutside of where you're
licensed.
What would you recommend?
Where can they go to startlearning more about tax credits
and find a health insuranceprovider?
James Douglas (36:37):
Yeah, so just a small piece of what I was doing
prior to opening the agency.
I was a regional sales directorfor a fintech company for the
22 most Western states in thecountry, and so I actually know
many of the markets across thecountry, and if you have
(36:58):
questions you can still reachout to me, and then I have
partners all across the country.
I'll make sure that you end upin excellent hands.
Christin Marvin (37:06):
I love it.
You are a wealth of knowledge,my friend.
Thank you so much.
Thanks for the work that you'redoing to supporting the
industry.
You know it.
I know we both love it and itmeans a lot to us, but it means
a lot to me for sure.
So thank you so much for beinghere.
Really appreciate your time.
Thank you for breaking thisdown and making it a little bit
more digestible.
For sure it's very important.
(37:26):
This is a very complicatedsubject.
A little bit more digestible,for sure it's very important.
This is a very complicatedsubject and, again, just excited
about the customization here,the creativity, your passion
behind this and knowledge ofboth the restaurant industry and
the health insurance industryyou know, spending 10 years in
both.
You are the expert, soeverybody's in good hands and,
yeah, just can't.
Can't.
Thank you enough.
(37:47):
Really appreciate your time.
James Douglas (37:48):
It was a pleasure being here.
Thank you for having me.
Christin Marvin (37:51):
Absolutely, we'll stay connected.
All right, everybody.
Thanks so much for listening.
If you know anybody in therestaurant industry who could
benefit from listening to thispodcast, please feel free to
share it with them.
You can listen in anywhere youlisten to your shows.
Thanks so much.
We'll talk to you next week.
If you're a restaurant owner who wants to
offer health insurance benefitsto your employees but finds it
too expensive due to the size ofyour staff or simply doesn't
know where to start, thisepisode is for you.
Join us as we share a real lifeexample of a restaurant that
provides benefits to a team ofjust eight people.
Today I'm speaking with JamesDouglas, owner of Soul to Sole
(00:32):
Benefits, about how he partnerswith Connect for Health Colorado
to provide affordable andquality health care to employees
in the restaurant industry atany budget.
James started Soul to SoleBenefit Solutions with a
person-to-person connection inmind.
Having been both in the healthinsurance and hospitality
(00:53):
industries for 10 plus years, hebelieves that the individuals
on the other side of the healthinsurance solutions should know
what their coverage options areand should have an advocate to
help them navigate those options.
His love for people andknowledge of the industry gave
life to this opportunity toserve his community, build
(01:14):
relationships and use his skillset to support a better health
coverage experience.
In this episode, james and Idiscuss how his company helps
restaurant owners provideaffordable and quality health
insurance to their employees.
He explains the step-by-stepprocess of offering health
insurance through individualcoverage, health reimbursement
(01:37):
arrangements or small groupplans, and how employees can
qualify for tax credits to maketheir plans more affordable.
James emphasizes the importanceof understanding the different
health insurance optionsavailable and tailoring them to
the specific needs of therestaurant and its employees.
He also highlights the role andvalue of working with a
(02:01):
licensed agent and broker.
Welcome to the no Hesitationspodcast, the show where
restaurant leaders learn tools,tactics and habits from the
world's greatest operators.
I'm your host, Christin Marvin,with Solutions by Christin.
I've spent the last two decadesin the restaurant industry and
now partner with restaurantowners to develop their leaders
(02:23):
and scale their businesseswithout wasting time and energy,
so they can achieve work-lifebalance and make more money.
You can now engage with me onthe show and share topics you'd
like to hear about, leadershiplessons you want to learn and
any feedback that you have.
Simply click the link at thetop of the show notes and I'll
(02:46):
give you a shout out on a futureepisode.
Thanks so much for listeningand I look forward to connecting
.
Hi, james, how are you?
Welcome to the show.
James Douglas (03:00):
Awesome, I'm doing incredibly well and thank
you for having me.
I'm happy to be here.
Christin Marvin (03:05):
Absolutely.
This is just an incredible.
It's going to be an incredibleconversation.
You and I have a little bit ofhistory and background and had
lost contact with each other.
I think we had stayed connectedon social media channels over
the years, but we werereconnected a couple of weeks
ago, surprisingly, and I waselated to see your name on the
email and I immediately reachedout and said is this James?
(03:27):
Is this James Douglas?
Is this the guy who I think itis so really excited to have
this conversation and learn moreabout what you're doing to
support the hospitality industry.
So thank you so much for takingthe time today.
James Douglas (03:40):
Absolutely.
Christin Marvin (03:42):
We are going to talk about how you provide
affordable and quality healthinsurance to independent
restaurants, to restaurantowners, to managers and really
restaurants of any size in theindependent space and on any
budget.
Which is just really excitingbecause a lot of the times I
hear from restaurant owners thatI work with or have
(04:04):
conversations with they reallywant to provide benefits but
they don't know where to go,they don't know the process of
getting started and they thinkit's too expensive or it has
been too expensive.
So really excited today to showand go through some real life
examples of restaurant clientsthat you work with and really
walk the listeners through astep-by-step process of what
(04:26):
this looks like, the type ofsupport that you provide to them
after the policy goes live andhow you really work with their
budgets to get creative.
So let's start with a littlebit of your background in the
restaurant industry.
James Douglas (04:43):
Yeah, well, it spans, I don don't know,
somewhere around probably 10years in the industry, on or on
and off, uh, everything from,you know, being a server to a
manager, uh, a mom and popitalian shop when I was in
college, uh, steakhouse, uh, Iended up obviously connecting
with uh you at snooze and thatwas a completely different
(05:07):
experience than anything I'dever been a part of.
But I think as we start tocontinue for sure, as we
continue the conversation today,I think a lot of it's going to
kind of dial back to theexperience the experience of a
restaurant or the experience ofa healthcare solution, or the
experience of really everythingin life.
(05:28):
And I mean, I've been in bigcorporate Darden restaurants and
the culture is very differentthan, say, a mom and pop, and so
the needs are very different.
But each arena needs a caresolution and so my handful of
years in service in therestaurant industry is has
(05:50):
really allowed me to relate withbusiness owners on a level
where I'm able to speak theirlanguage Right.
I understand their stressesRight.
If there are slips and cuts andfalls like what's proper
procedure, what's properprocedure?
And typically when a restaurantowner wants to know, okay, well
, what's the proper procedurefor healthcare.
(06:12):
It sometimes is a struggle tofind and identify what that
answer is, and wanting toprovide those benefits to the
employees is it's a piece of thegame.
Christin Marvin (06:17):
Yeah, absolutely.
Would you talk about just kindof a big picture perspective?
What you do at Soul to SoulBenefits, what you offer and
what type of restaurants youwork with.
James Douglas (06:32):
Yeah, so there's a famous billionaire I'll leave
his name out of it, but he goes.
You know, if you can't explainit in less than 30 seconds and
you don't understand what you'redoing.
And so the nutshell and thehigh level overview of what I do
and what we do at Soul to SoleBenefits is that we help
employers provide healthinsurance to their employees in
(06:55):
an affordable manner.
Right, there's obviously alittle bit of strategy.
The employer is going to set adollar amount per month, based
on their budget, that theemployee can then take and use
to go get their own individualhealth insurance plan, and so
the employer subsidizes thatplan.
The employee gets choices andoptions.
Many times Actually, I wouldn'tdo it if the employer didn't
(07:18):
save money and so ultimatelyit's a win-win across the board
for people, and a lot of thebarrier is just understanding
health care, and that's where weadvocate for the employer and
the employee.
Christin Marvin (07:32):
Yeah, absolutely.
I set up a health care planback in the day and we had four
or five restaurants, I think, inthe company at the time.
It was just so over my head andI wasn't an expert in it.
I know a lot of restaurantowners aren't experts in it
either.
It's a very complicatedindustry and kudos to you for
(07:54):
being in it.
Would you talk a little bitabout why you chose to go the
health insurance route, comingout of the restaurant industry?
James Douglas (08:02):
Yeah, honestly, I kind of just fell in it.
Um, I was training as aprofessional long jumper.
Uh, up in fort collins I had anolympic coach, my training
partner.
She won the the bronze medal inthe london olympics and the
women's long jump, and, uh, thatwas my, my dream and my goal.
Uh, long story short, I got hitby a car while riding a bicycle
, ended up moving back toAlamosa, colorado, and my track
(08:27):
coach was married to the CEO ofthe hospital and there was a
position that I applied for.
It was actually a position withConnect for Health Colorado,
and so I was a health coverageguide for them in the first year
of the ACA, the Affordable CareAct, and so that was kind of
where I cut my teeth in thehealthcare world.
And a year later I ended upbeing stolen by a health
(08:50):
insurance company and I workedthere for the next four years,
and so that's how I kind of gotstarted.
Christin Marvin (08:57):
I love it.
So you've got 10 years in therestaurant business, 10 years in
the health insurance space.
You're an expert in both.
I love that.
Sorry about the long jumping.
James Douglas (09:07):
Yeah, me too.
Christin Marvin (09:08):
Yeah, talk a little bit about your connection
today with Connect for HealthColorado and what they do.
James Douglas (09:17):
Yeah, so today Connect for Health Colorado is
the only place in our state thatyou can go and get assistance,
financial assistance to makehealth insurance affordable, and
so when you look at all theother states in the country,
many of them have somethingcalled healthcare.
gov.
Well, in Colorado we don't havehealthcaregov because we have
(09:37):
Connect for Health Colorado, andthe easiest way to describe
kind of what they are is kind oflike a price line for all
health insurance carriers, andso you're able to go to Connect
for Health Colorado.
Based on your zip code, you'reable to see all of the different
health insurance options thatare offered to you and then,
based on age, income, householdsize and zip code, you're able
(10:01):
to find a plan that's going tobest fit your needs, because you
won't pick a plan that doesn'thave your doctor and you won't
pick a plan that doesn't coveryour prescription.
So you're going to find thebest solution, based on your
current situation, to identifywhat's going to be, uh right,
advantageous for you to pick,and so identifying that connect
(10:23):
for health colorado is a placewhere you go and get those tax
credits is incredibly important,especially as we dive into
really, how does that play inthe role of a restaurant owner
wanting to help provide coverageto their employees.
Christin Marvin (10:38):
Okay, awesome.
And then will you speak aboutall the products that you offer.
Is it just health insurance?
James Douglas (10:47):
Yeah, so I think initially it started out as just
health insurance, and then youstart to understand like the
employer wants to offer a fullbenefit set because the
competitors down the road areoffering a full benefit set, and
so that has upgraded to dentalvision, ancillary life,
accidental.
All of that can be packagedtogether based on the employer's
(11:09):
budget, and so the strategiesthat we can dive into is right.
The restaurant owner has abudget and we have to work
around that budget, around thatbudget, and so that strategy in
utilizing and leverage Connectfor Health Colorado and
obviously taking whatever it isthat you are wanting to
(11:30):
contribute the employers wantingto contribute to their
employees, is ultimately thefoundation for how you're going
to provide coverage in anaffordable way that makes sense
for everyone.
Christin Marvin (11:41):
Okay and I love you work with.
You know you've got someexamples here of a restaurant
that's really small one location, eight people on the plan up to
a company that's got fourlocations, 200 people right With
around 25 people on the plan.
Walk us through the example.
Let's use the single locationwith eight employees.
Walk us through that processfrom start to finish and if you
(12:03):
can speak to kind of what theirbudget was and then what you
were able to find for them,coverage wise, tax credits came
into play there.
Walk us through that scenarioif you would.
James Douglas (12:14):
Yeah, so the single location for that
Ethiopian restaurant.
They have eight employees andwhen they came to me they said
you know I have a really tightbudget.
I said you know how tight is it?
They go, you know we have$1,000 to contribute to the
employees.
And so when you, when you'reworking with that $1,000 budget,
(12:37):
you have to understand thatthat $1,000 is only going to go
so far, especially in the worldof inflation today.
Going to go so far, especiallyin the world of inflation today.
And so if the business ownerwere to give, let's just say,
the $1,000 split up by eight,then we know that that's only
$125 a month.
But based on the salaries ofthe employees at this one
(13:00):
location, they were actuallyeligible for $500, $600, $800 in
tax credits per month.
And so by the employer offeringthat $125, it is actually
affordable because they're notthe highest paid employees, the
hourly workers are not thehighest paid employees, and so
(13:22):
by them offering that $125, itis actually a disservice to the
six hourly employees who workthere.
And so what we did was westrategized in a way to let them
go to Connect for HealthColorado.
They then were able to gettheir $400, $500, $600, $800 a
month in tax credits and theemployer now no longer has to
(13:43):
contribute that $125 to thosesix employees.
And so now there's a thousanddollar budget for the two
remaining salaried employees.
And so I want to be very clearhere you cannot carve out by
management.
You can't say my managers getto split a thousand and the
employees right, they get what'sleft.
(14:04):
Get to split a thousand and theemployees right, they get
what's left.
But when you start to structureand strategize, right, that
saves the employer money and itallows for them to provide a
better benefit for the salariedemployees, right.
Those people typically workmore hours than the hourly.
And then the hourly employeesare now able to go and get these
tax credits that they'reeligible for.
They're leveraging Connect forHealth Colorado.
(14:24):
They're leveraging all of thoseresources and tools to identify
if they're doctors in network,are their prescriptions covered,
right?
All of that gets put togetherin kind of one solution for the
business owner, for theemployees and for the employees'
families.
And so that's just kind of thefirst example, at a very high
(14:45):
level, of how they were able toput a healthcare solution in
place.
And then they actuallycontribute 100% of the dental
and vision as well.
Christin Marvin (14:54):
Okay, great.
Sorry to interrupt you.
I'm curious, would you circleback to, and maybe I missed it
how does a restaurant or therestaurant's employees qualify
for the tax credit?
James Douglas (15:06):
Yeah, so tax credits are based on age, income
, household size and zip code,and so when you are looking at
tax credits in general, the onlyway that you can qualify for a
tax credit is if you one do notreceive an affordable offer from
your employer.
You are not on Medicaid and youare not on Medicare.
(15:29):
So those are kind of the threedifferent chunks that you have.
Right, you have Medicaid forpeople who household a one
making less than about $18,000to $20,000 a year, and then
Medicare is for the individualswho are 65 and older, who have
worked their 40 quarters right.
That is, their part A and theirpart B benefits right, c and D
as well.
But then there's everyone elsein between who doesn't get
(15:54):
offered from their employer orwho doesn't get coverage through
their spouse.
And so this hole in therestaurant world where a lot of
the workers fall into is anopportunity for the employer to
say, hey, I've structured ahealth insurance solution so
that you can go and get thesetax credits in such a way that
(16:15):
you're going to make it's goingto make their plans way more
affordable and it's going tohelp the employer save money in
the process.
The employee is going to getchoices and options money.
In the process.
The employee is going to getchoices and options.
The employer is going to beable to now take the budget that
they do have and now provide itto the employees who are
salaried or who are in adifferent geographic location.
There are many differentclasses that we can kind of
(16:37):
break out, but that's kind ofhow it works.
Christin Marvin (16:50):
Hey there, podcast friends.
I hope you're enjoying theseimpactful conversations and
leadership insights I'm bringingyou each week.
Before we dive back intotoday's episode, I want to take
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That would go a long way insupporting the show.
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(17:10):
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Christin Marvin (18:38):
And then do you find that we'll get back to the
rest of the example here in asecond.
But I'm curious are employerswanting to?
Are they finding successoffering full health insurance
benefits to employees, or is itmore accidental?
When it comes to the restaurantbusiness, what, what do you
find is the most popular?
James Douglas (18:56):
and and just yeah , I mean, it's a great question
and I truly dislike answers thatare like it depends.
Right, every situation isunique, but when it comes to the
restaurant world, everyrestaurant is unique in the
sense that their budget isdifferent, their personnel is
(19:18):
different, their culture isdifferent.
Right, when you start to lookat the market in the state, in
the cities, in the counties thatthey operate in, are very
different.
And so here in Colorado, theindividual market is very strong
.
In Colorado, the small groupmarket is incredibly expensive.
Right, for the last three years, I've seen 17% increases on
(19:41):
what they were already paying.
Last year were 31 percentincreases.
This is a trend that is notsustainable for any employer,
let alone a restaurant.
Right, cost of cost of goodshas gone up like crazy.
We don't need to dive into that.
But understanding that inColorado specifically, the
(20:01):
individual market is great.
When you look at Arizona, thesmall group market is phenomenal
.
And so when you start to quoteout different options or
different paths that thebusiness owner can take, we
compare both, because if wedon't know what apples to apples
actually is, then that's adisservice to the employer, but
(20:23):
it also doesn't allow for themto be educated to make the best
decision and so based on thecounty, based on the state and
the zip code.
If an ICRA it's an acronymI-C-H-R-A stands for Individual
Coverage, health ReimbursementArrangement kind of a tongue
twister right.
If that is a better solutionfor the business owner, then
(20:44):
that is saying that the marketthat they operate in, the
individual market, is stronger.
An individual market is lessexpensive.
If it's, say, arizona and we'recomparing an ICRA to a small
group plan, small group's goingto win because small group rates
are better, they're lessexpensive than the individual
market and they're also smallbusiness owner tax credits if
(21:06):
they want to provide a smallgroup health insurance plan and
so small group individual.
It depends on where the owneris.
Christin Marvin (21:14):
Okay, got it.
So let's go back to yourEthiopian restaurant that has
eight employees.
So once they've determined ifthey qualify for tax credit,
once they've chosen the planthat they want to sign up for,
what's the process look likethen?
James Douglas (21:28):
Yeah, so typically open enrollment for
health insurance is November 1stthrough January 15th, that's
countrywide, it doesn't matterwhere you are.
And so if you do not get healthinsurance in that window of
time, then you technicallycannot buy it without something
called a qualifying life changeevent.
And so when the business owneroffers an ICRA or offers a small
(21:51):
group plan to their employees,it opens up what's called a
special enrollment period foreveryone.
That is offered every employeewho is benefit eligible to then
go shop and get health insurance.
And so once that process is putin place, they offer the
employees pick their plans.
Then there's a paymentstructure put in place,
(22:13):
depending on how, which path yougo, and once the premiums are
paid monthly, then the cards aresent, the welcome kits are sent
out by the carrier.
Every year the employee is goingto have to pick a new plan.
If it's small group, right,there's an annual renewal that
comes up.
If it's an individual coverageHRA then the individual plans
(22:37):
change year to year.
And so they're going to say,hey, I liked this plan that I
was on, right.
When open enrollment is comingup, they're going to say, hey,
james, right, that's a servicethat I provide to the business
owner is.
I assume the I don't want tocall it an HR position, but I
assume the admin support andhelping their employees make
(22:59):
their choices on their healthinsurance, dental vision
ancillary through software andtechnology that they can
literally go into the portal,software and technology.
That they can literally go intothe portal, make a few clicks
and say, hey, I want it to staythe same or I want to make some
slight adjustments to thisbenefit this year, and so that
(23:22):
is the support that comes on theback end.
But understanding that youdon't really want to be on the
same plan for forever becauseyour needs are going to change,
family size and household sizesare going to change, and so
understanding taking a look atit each and every year allows
for me to educate the employee,the employer, on what's going to
be the best fit moving forwardin the next year.
Christin Marvin (23:41):
Okay, and then will you refresh my memory on
what constitutes a qualifyingevent.
James Douglas (23:50):
Yeah, you can get married, you can get divorced.
You can have a child, you canadopt.
Right, you can change states.
Moving from state to state isconsidered a qualifying life
change event.
You can gain citizenship.
You can be released fromincarceration.
There's a laundry list ofqualifying life change events.
(24:14):
And, yeah, I mean, as therestaurant owner, just know that
when you choose to offer eithersmall group or an ICRA right,
that is going to open up thequalifying life change event for
your employees, which is goingto allow for them to shop, which
is great.
Christin Marvin (24:35):
Okay, so if I'm a restaurant owner and you
talked about your support thatyou offer during open enrollment
, but if I'm a restaurant ownerand I am HR which is a lot of
the case, right if I have healthinsurance offered and I hire a
new employer, a new manager,what does support look like from
you?
James Douglas (24:54):
from there, yeah, so I would be an extension and
an assistant to the HR, right?
Our team would.
So, mapping out the process,let's say, an ICRA was put in
place, right?
The employer set 300 bucks amonth they want to give to their
salaried employees and that'stheir solution.
(25:15):
So the employees would then gopick their plan.
If they picked a $200 a monthplan, then they don't pay
anything per month.
But if they pick a $400 a monthplan, then there's still $100
that is out there that theemployee is responsible for.
And so what's going to happen isthe employer is going to pay
the full $400 for that employeeand then they're going to
(25:37):
payroll, deduct the $100 fromthe employee's paycheck on a
pre-tax basis, and it's going tolook and act very similar to
group.
And it's going to look and actvery similar to group.
And so what will happen is HRthen is going to want to know
hey, you know how much do I needto pull from James's paycheck
each week?
And so, right, we would come in.
(25:58):
We would say, hey, james pickeda $400 plan, you guys are
contributing $300.
Right, each paycheck you needto take out $50.
And so, if you got paid twice amonth, and so that calculation
and those reports are all runthrough the tech platforms that
we use and it's all kind of likewrapped up in a nice little bow
for HR to say, hey, this iswhat we need to deduct each and
(26:20):
every year.
Christin Marvin (26:22):
Perfect.
So you're offering the hands-onsupport for the restaurant
owner to make sure that thatemployee gets set up with a plan
of their choice.
They fully understand the insand outs of the plans and the
cost, and then you're providingthe information to the
restaurant owner that needs tobe sent over to payroll.
If there is an additionaldeduction per paycheck, that
needs to happen.
James Douglas (26:44):
Absolutely.
And so when you start to lookat right and a restaurant owner
can only wear so many hats,right, and they always find a
new hat to wear because it's thehat is needed to be worn their
(27:09):
plate or if this is one hat thatwe can assist in implementation
and administration and ongoingsupport, then having a licensed
agent and broker on deck isincredibly helpful, because it's
not the employer's job to sithere and say, like you should be
on this plan, like no, theemployee should pick what plan
they want to be on.
But that's essentially what wedo in the small group model is
say like, hey, we go to acarrier and then we say we're
going to offer Blue Cross, blueShield, we're going to offer a
(27:33):
Cigna plan.
And OK, well, if we're offeringCigna plans, only, how many
plans of Cigna do we get tochoose?
Well, now, right, we might givetwo, maybe three options, and
that's going to cost thebusiness owner right, money to
do that.
And so when we say, okay, weoffer health insurance, here are
your choices one, two, maybethree.
(27:53):
Well, if you only have twochoices, that's a dilemma, and
if you have three, you're justlike, okay, well, I guess this
is the the the best for me basedon what I have and right, we
all have to play the cards thatwere dealt, but understanding
that your employees truly aregoing to have choices and
options once they go to theindividual market and look at
(28:17):
what's available.
So, just for context, there aresix health insurance carriers
here on the front range inDenver carriers here on the
front range in Denver.
So, like where I live personally, there are 87 plans that I can
choose from.
So if you put a small groupoption in place and there are
three plans to choose from andpeople still can't pick those
(28:38):
three plans and I come on boardand say, hey, here's 87, that's
incredibly confusing.
But there are filters andvalues that you can put in place
, like just a little practicethat I have everyone literally
anyone that I help I have themprioritize these five things
your doctor premium, deductible,office visit co-pays and
(29:00):
prescription co-pays.
And so I don't care what theorder is, but I have them
identify what is the mostimportant thing of those five
variables.
And if they say premium is thenumber one thing that we need to
pay attention to, I go find thecheapest plan that's available.
But if they say, james, mynumber two focus is deductible.
I have to have a low deductible.
(29:22):
Well then I can't just go findthe cheapest plan because that's
probably going to have a higherdeductible.
I now have a second filter ofsaying okay, well, what is the
most bang for your buck, right?
And then I need to have mydoctor in network.
I need to have prescriptionoffice visit co-pays at this
threshold because I go this manytimes.
So many times people will sithere and say like, oh, I need
(29:43):
the best, I need a gold plan,but I only go to the doctor once
a year.
Well, it's really hard torecommend that you fork out $400
a month for a gold level planif you only go one time and
every single ACA compliant planis going to give you an annual
wellness exam paid for at ahundred percent, one time per
year right and so if I can savethe employee money on the back
(30:06):
end, then they are incrediblyexcited.
If I can save the employee moneyon the back end, then they are
incredibly excited.
If I can save the employer onthe back end money that they
don't have to give to a carrier,right then they now have
additional funds that they canput into like an end of the year
party salary or compensationraises, party salary or
(30:33):
compensation raises Right youwould be.
You would be shocked at thethings that employers can can
provide if they have theresources and bandwidth to do it
.
They're very generous.
Christin Marvin (30:42):
I love it.
I'm I'm not surprised by you,because you've always just been
professional and caring andhospitable, but I love what you
just said about looking out forthe employee and the employer.
That's awesome.
James Douglas (30:54):
Cause.
I know you mean it?
Christin Marvin (30:56):
I know you which is great so what
absolutely?
What have we not talked about?
What else do listeners need toknow about?
About you, about the company,about what you offer?
James Douglas (31:11):
need to know about you, about the company,
about what you offer.
Yeah, I mean, I think it's ajourney right Like you didn't
start your restaurant to becomea healthcare expert and so
understanding that trust doesabsolutely need to be built, and
putting trust in a person whois licensed to understand that
there are affordable Care Actcompliant plans.
(31:32):
And then there are companiesout there who parade around
acting like health insurancecompanies and they say things
like we have PPO networks, whenthey really don't.
They just rent a piece of acarrier's network because
carriers do do that.
And so now they put outmarketing material saying we
offer a PPO and this is really,and they don't have to charge
(31:54):
the prices that an ACA compliantplan includes because they're
not including all of thebenefits.
And so when you're looking atsome of these off, we'll just
call them non-compliant plans.
The pricing is very low andthey tell you this low co-pays,
low deductible but what theydon't tell you is that they stop
(32:17):
paying after a certainthreshold.
And so if you find yourself ina very bad place medically and
you have a $100,000 claim, well,it turns out that this
non-compliant plan might stoppaying after 10 grand and you
still get stuck with 90,000,right.
(32:38):
And then, when you look at anAffordable Care Act compliant
plan ACA compliance there are 10essential health benefits that
are included in each and everyplan, Whether you agree with
them or not.
They are all included in anannual wellness exam.
One time per year is oneambulatory and emergency care is
one.
So no matter where you go inthe world right now, right
(33:02):
Carriers do not like paying forcare outside of the U S, let
alone, uh, outside of theirnetwork.
And so, understanding that,there's verbiage in a document
called an explanation ofcoverage that is 100 pages plus
deep, and in that evidence ofcoverage it states things like
you have urgent and emergentcare wherever you are.
(33:23):
So if you were to fly out ofstate or out of the network or
out of the country, then there'sa word, one word that kind of
revolves around how much yourhealth insurance company is
going to pay, and the word isstable.
And so if you get hurt out ofnetwork, it is that facility's
job to get you stable, and onceyou are stable, it is your
(33:46):
responsibility to get back innetwork as quickly as possible,
Otherwise you will start toincur.
So urgent and emergent care isincluded in all ACA compliant
plans, Right.
All of this information is stuffthat the restaurant owner does
not have to know, because weknow it and understanding that
(34:08):
it is going to take time totrust and understand.
Like, okay, these are thethings that are important to me
and it's the restaurant, thebusiness owner's job to
communicate that to me.
And then it's my job to makesure that I service and make
sure that you are not onlygetting those things hopefully
I'm exceeding those expectationsbut also you have enough wit
(34:29):
around it where you're not justblind and just blind trusting
that I'm going to take care ofeverything.
I am, but it's also veryhelpful to know that there's a
trusted relationship in placeand you don't have to right.
I'm going to tell you what youneed to pay attention to.
Christin Marvin (34:44):
Kind, of thing.
Yeah, I wish you were aroundback in the day when I was
choosing plans, because I willsay I've unfortunately been
surprised by a couple of ourhealth insurance plans of
covering not covering thingslike ambulance rides and then
getting, you know, some $3,000bills in the mail going oh this
is great, right?
Um.
So it makes so much sense,obviously, to tailor it to your
(35:06):
lifestyle, right?
Whether you, like you said, ifyou're traveling, or what you do
for physical fitness, or howyou spend your time or hobbies
or whatever.
But yeah good, you know we'realways learning, aren't we Down
the road?
James Douglas (35:19):
Oh yeah.
Christin Marvin (35:21):
Are you licensed only in Colorado?
James Douglas (35:25):
I am licensed in Montana and Colorado and then I
have business in California,Texas, and actually I might be
coming to Arizona pretty quick.
Christin Marvin (35:37):
How can people get a hold of you?
James Douglas (35:40):
They can find me on my website
soul2soulbenefitscom.
That's S-O-U-L to S-O-L-E.
Benefitscom, that's S O U L twoS O L E, and so, just so people
have context, that is, takingthe person and physically
getting them to where they wantto go.
Um, that's kind of how we cameup with the name soul to sole
benefits.
com.
Christin Marvin (36:02):
Um, or uh, I mean, obviously you're connected
with you and um, yeah, that'syeah that's really cool, you
know, for anybody that'slistening here, if you want to
connect with me or have meconnect you with James, there's
an option Now.
If you just go to the top ofthe show notes, you can simply
click click the link and send mea text message with your email
(36:23):
address and I'd be happy toconnect you guys, James, for
anybody that's listening, that'soutside of where you're
licensed.
What would you recommend?
Where can they go to startlearning more about tax credits
and find a health insuranceprovider?
James Douglas (36:37):
Yeah, so just a small piece of what I was doing
prior to opening the agency.
I was a regional sales directorfor a fintech company for the
22 most Western states in thecountry, and so I actually know
many of the markets across thecountry, and if you have
(36:58):
questions you can still reachout to me, and then I have
partners all across the country.
I'll make sure that you end upin excellent hands.
Christin Marvin (37:06):
I love it.
You are a wealth of knowledge,my friend.
Thank you so much.
Thanks for the work that you'redoing to supporting the
industry.
You know it.
I know we both love it and itmeans a lot to us, but it means
a lot to me for sure.
So thank you so much for beinghere.
Really appreciate your time.
Thank you for breaking thisdown and making it a little bit
more digestible.
For sure it's very important.
(37:26):
This is a very complicatedsubject.
A little bit more digestible,for sure it's very important.
This is a very complicatedsubject and, again, just excited
about the customization here,the creativity, your passion
behind this and knowledge ofboth the restaurant industry and
the health insurance industryyou know, spending 10 years in
both.
You are the expert, soeverybody's in good hands and,
yeah, just can't.
Can't.
Thank you enough.
(37:47):
Really appreciate your time.
James Douglas (37:48):
It was a pleasure being here.
Thank you for having me.
Christin Marvin (37:51):
Absolutely, we'll stay connected.
All right, everybody.
Thanks so much for listening.
If you know anybody in therestaurant industry who could
benefit from listening to thispodcast, please feel free to
share it with them.
You can listen in anywhere youlisten to your shows.
Thanks so much.
We'll talk to you next week.
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