Episode Transcript
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Speaker 1 (00:05):
Hi, This is Brian Thomas, host to the fifty five
Kersey Morning Show Monday through Friday and facilitator of this segment,
which we call Rethink Healthcare together with John Ruhlman from Cover. Sincey,
there's a better way to get medical insurances by having
a team work for you. Don't talk to somebody that
works for an insurance company. They're not going to steer
you in the right direction. John works with hundreds of
(00:28):
insurance companies, thousands of insurance policies which he layers, and
he can explain that like he has so many times before,
but fundamentally, since he's not working for them, he's working
for you. He knows all kinds of tricks of the
trade to get you better medical insurance coverage for less money,
whether you're an individual or a group. Last week we
talked about the fact that you're not stuck where you
(00:50):
are necessarily, So if you think you can't get out
of what you're in, then initiate the conversation with John
and the team to see if there's a better way
to get your medical insurance coverage for less money. John,
we haven't talked about groups for a while, and I
use this illustration when I'm talking with my listeners and
(01:12):
plugging your wonderful organization and team at COVER. Since he
my friend Jeff, who I think has literally followed my
advice on every sponsor on my show, and I always
hear back from him, and every time I mentioned cover
since he he sends me an email with three smiley
faces on it. Because Jeff and his team you insured.
He's a small businessman and I don't know how many
(01:34):
employees he's got. I can't recall ten or twelve, but
you improved his business's bottom line by multiples of ten
thousand dollars. I think it was forty or some one
thousand dollars. So his business became more profitable through working
with you, and his employees are infinitely more happy with
the insurance coverage you got them, and they're paying less
(01:56):
money and have better coverage. So he's got a leg
up on his competition by way of just mere employee
retention and happiness. So that's the kind of thing you
can do for a group. Yeah, so let's talk a
little bit how that works. I mean, yeah, how employers
can get better coverage for them and their employees.
Speaker 2 (02:14):
Absolutely, So, I mean, you know, one of the big
things that you know, especially if you're an employer has
less than fifty employees. You know, and we've talked about
this in numerous times on the show, but the big
thing to really look at in these situations is, you know,
you're not obligated to pay for health insurance or you're
not gonna get penalized because I have less than fifty employees.
(02:36):
So that doesn't actually start until you have over fifty employees, right,
So there's no mandate that I have to provide coverages
for my employees, but you want to, right, I look
at as it's a perfect hiring tool, it's great for retention,
and ultimately, you know, even as even as a small
employer myself, I realized that if I wasn't pushing benefits
(02:56):
through my office, I probably have three or four employees
that which is never did it. Even though they work
and see claims all day long, they still have that
mental side where they're like, it's just an expense that
I don't want to pick up this, I don't want
to do this. Right and the group side, right, the
group side of health insurance has followed kind of the
(03:17):
marketplace pricing. Right, So when we were doing groups. You know,
before Obamacare healthcare dot gov, right, they weren't as expensive
as they are now. So if you go to healthcare
dot gov and you're like, well, i'm a small business owner,
I want to see what it will look like for
my group. Just go look and see what the full
price plans are on the marketplace. That's probably gonna be
about your group rate. So I mean, you're probably gonna
(03:38):
be looking at seven eight, nine hundred a month per employee.
You know, family a husband and wife starting at fourteen
to fifteen hundred bucks, families close to two thousand. That's
a group rate. And now you're probably listening to I'm
phibly not gonna do that, right, that's unaffordable, right, I
can't go that route. How do I get other types
of insurance? And that's where we really come in and
(03:58):
come up with some really unique scenario. And I always
tell employers like, listen, we do a census form. We
break it down for each employee and their senses. Form
is very in detail because we're gonna ask things like,
of course, like where their address is, but I want
to know who their doctor is, what prescriptions they're currently taking,
what is their medical history? You know, because I want
(04:19):
to line up a plan specifically around each individual employee's needs.
And each employee could be different, right you know. I
mean maybe I'm an employee that goes to this hospital,
but you have another employee that goes through this other hospital. Group. Well,
if I decide to go out and I'm gonna go
get some Blue Cross plan that covers this hospital and
doesn't cover that hospital, well sorry, Joe, you got to
(04:41):
change your health insurance plan or are you going to
change your doctor because it's not gonna be covered over there.
So you know, it's kind of a one size fits
sum when you do group plans, and you know, we
try to make it each plan fits all because each
plan is going to be specifically tailored to their individual
And the other thing that we do BRAN is we
ask income. I want to know what these employees are
(05:03):
not just with you, but their whole family. So I
wouldn't know what the spouse makes, and that's all in
our senses for them. Because one of the things you
have to realize is that, especially with some employers out there,
I mean, if you have employees making thirty forty fifty
grand a year, you know they could qualify for tax credits. Now,
if you do group health insurance, they don't qualify. So
I can't. I mean, somebody making let's say thirty forty
(05:25):
fifty grand a year, maybe their spouse makes twenty thirty grand,
or maybe as a family they make eighty grand a year,
they have a family of four, Well, do you realize
I can probably get them a marketplace plan like major
medical health insurance for like less than two hundred bucks
a month. That same plan would cost you two grand
on a group That's insane. So as an employer, we
(05:45):
want to offer these benefits. I want to do something
for my employees to keep them. But you don't realize
you're actually hurting them by even doing group insurance yea
in some cases yeah right, And and that's always the
toughest pill for them to spa. Even you mentioned Jeff M. Markhan,
that's a tough pill for him to swallow. When I
was presenting that to him, he's like, that doesn't make sense.
(06:08):
That doesn't I know, that doesn't make any sense. I
was like, well, just follow me, let me walk you
through this. And then when we started breaking down and
showing him the cost of what it would be for
the employees, and we really we break it down on
the whole spreadsheet. Every employee they get to see exactly
what their cost is and we show them the bottom line.
He's like, oh my god, like there's a huge saving.
(06:29):
It's not just me as the employer. I'm not just
saving it on my side. My employees are paying less, right,
so they're happy. Yeah, you know, and he was in disbelief.
Speaker 1 (06:41):
I'm telling you. He just when he got back with me.
He told me in advance when he was having the
meeting with you, and after the meeting he's like, oh
my god, you have no idea. This is so amazing.
I mean, he truly was just blown away by what
you were able to do.
Speaker 2 (06:54):
Yeah, he earmarked a couple of employees. Goes, these guys
are gonna be a little tough. You have to really
break it down for them, and you know, one of
them was. And we sat down for quite a while
and talked about it, and I thought it was so reassuring.
At the end, he goes, Listen, he goes, I've never
covered my wife. What can we do for her? You know?
And I was like I felt really good at that
(07:15):
point because we were able to make a connection. He
finally understood. It's you know, we're not rolling into an
employer group and going, hey, we're the new guys and
you're not overconn who's gonna buy from us? And you
don't have any other options? I mean, you have every
option under the sun. We're just gonna try to make
it make sense. And my goal walking into your business
is to help you and help your employees, because I
build my business on people that are happy with what
(07:36):
the service we provide and the coverage that we're offering,
and let them know that things can happen, things can change,
and employees might have different situations in the future, and
we can adapt what we're doing to them. It's it's
a unique time, Brian, in today's market because twenty years
ago when I was writing insurance, is like I wrote
you a plan. Well, now your situation changes and your
plan didn't really cover everything the right way, But don't
(08:00):
have any other options because now you have this biload
of medical stuff going on and I can't change you.
But in today's market, we can make those adjustments. We
can make those changes even on the fly. I got
I had a client the other day literally calling and go, hey,
they're putting me on this really expensive medication healthy dude
was on. We call them the Dude plans. It's a
cheaper plan. It's just like it doesn't have It's not
(08:22):
the shiny Mercedes with all the bells and whistles. I mean,
it was a good quality four whel drive vehicle, but
you know, it didn't have the navigation and all that, right.
I mean, it was what he needed at that point
in time. But his situation changed, something popped up and
this was like a I mean it was thousands of
dollars in medication a month this person was going to do,
and I was able to move them to you know,
(08:43):
it's definitely a more expensive plan, but it was nowhere
near what he was going to have to pay for
that drug. And now he's happy. He's like, well now
my drug's cover. Because don't understand how you can do that.
I was like, this is what we do. Yeah, I mean,
there's options. My goal is to write you to the
plane that makes the most sense at the time, and
then life happens, things come up and we can adjust
that plan and make those plans and just that and
(09:04):
we do that for each one of those employees. Well
and the other company.
Speaker 1 (09:07):
I think it's important for me to interject here because
I maybe somebody's listening for the first time. This has
come up before. I have to bring it up again though.
But in addition to doing for the employer groups what
you just explain by way of putting medical insurance coverage
in place and doing a very specific employee by employee
analysis and package, you continue providing services after they have
(09:33):
insurance through you by solving the problems that we all
encounter with medical insurance companies. You're going to have a
company that's where your policy came from, and sometimes the
world's an imperfect place. Screws, fall out, claims, don't get paid.
Do you get an EOB that says you owe me
six hundred and seventy five dollars, Like, wait a second,
why did I get this? And they don't have to
call the insurance company. They call you, and your team
(09:54):
solves the problem for them.
Speaker 2 (09:55):
We caught, We solve the problem, and you know we're
also there to help re educate. That's right, Listen. That
is huge because I tell every employer when when we're done,
everything's signed and everything's put through, and I call them
back like everything's approved. Everything's good, We're good for next month.
And I go, I'm going to tell you something. You're
no longer in the insurance business, right I want you
(10:17):
answering questions from employees. I don't want you.
Speaker 1 (10:20):
To refer to people over to HR.
Speaker 2 (10:22):
Nope, nope, I mean we are when it comes to
your health insurance. They come to go, hey, I got
a question, how this works? Again, just I give him
a sack of cards, like you, just hand my card
back to them. Call John, Call John's office, Call John's office,
easy to go, because I don't want you at the
end of the day, you know, I mean, you're free
of the burden, free of the burden and worry about
(10:43):
your business. We got you covered and we're there to
answer every question and you know, and re educate because
you know. Again, even when I do these presentations, I
meet with them, I go over their coverage and again,
these are packages, Brian, These aren't just one size plans
right there. We build them out. We do Section one
twenty five, so they're gonna have extra layers of coverage.
We'll have accident policies, they're gonna we're gonna our goals
(11:05):
to reduce their out of pocket expenses. So we're layering
upon layering of coverage, which sometimes they understand at that
initial presentation when we first meet with them for like
an hour and we go over everything with them. Well,
guess what happens ten months later when something comes up.
They're like, I know he told me something, he had
this extra card. I don't know what I'm doing. So
they called to her office, re educating me, walking back
(11:26):
through the scenario, explain to him how it works. So
they have that constant reassurance that it's not a you know,
we're selling you something. Good luck figuring it out on
your own.
Speaker 1 (11:37):
You mentioned I think you just mentioned section one. Yeah,
well wefresh it's recollection about that skirts.
Speaker 2 (11:48):
Sometimes I just kind of get into that way where
I'm like, it's industry terms every day.
Speaker 1 (11:52):
I could relate to this when I first started practicing
law with in house with Anthem, after I was out
in litigation in Chicago, and that's where I moved after
we moved back to Chicago, and I was not entirely
up to speed on the area of law healthcare. I
was a litigation specialist, so this is just another area
of litigation. But I remember the first meeting I was
in and the letters that were coming out of they
(12:13):
were like, just oh, on the so and so, and
you got to do this, And I just had no idea.
The jargon yeah, just was beyond my comprehension.
Speaker 2 (12:21):
So I had to learn a lot.
Speaker 1 (12:22):
So with that in mind, like someone's I was sitting
in the meeting, someone said oh, this is under section
one twenty five and like, huh what so let's dive in.
Speaker 2 (12:32):
No, we'll dive in that. And yeah, I forget that
sometimes too. I actually just hitting on that rep point.
I actually have to train my team to I'm not
saying dumb down their presentations, but I go, you have to.
You can't use a lot of the jargon. You have to.
That's why we use a lot of analogies right for
clients so they can kind of understand. Because I know
insurance and sometimes you might think it's an easy concept
when you really get into it, it's it's very convoluted.
(12:55):
There's a lot of a lot of a lot of
things that I think just try to confuse people so
they just don't use it. So the insurance companies not
to pay bills, right, But you know, we really break
it down, you know, that's what I stress with my
team all the time. We really break it down. So
the goal is to really help you understand how things
work in the scenarios that you're going to go through.
(13:16):
So we do do that. So yes, I do apologize
for throwing something out there and not explaining it, but
uh yeah. Section one twenty five is a cafeteria plan.
So a lot of those companies that come knocking on
your door trying to sell you employee benefits, you know,
outside of your major medical some of those places that
have a duck for you know, a mascot and stuff
(13:36):
like that AFTAB, but you know, they do what's called
Section one twenty five plans. So it's a way to
get secondary or supplemental insurances that we can do pre
text right, and we can get into the weeds if
you call in and we can walk you through exactly
those scenarios. But the biggest thing it's pretext. Just like
(13:57):
you're doing your group health benefits in a lot of cases.
You know, when we work with groups, what we realized
and this is you know what I guess what I
realized because I was the first person that really started
doing this, was I want to maximize a section one
twenty five side of our business with our employers, because
(14:19):
those are the benefits if you have a good indemnity plan.
That's what these companies sell. It's basically first dollar coverage.
It pays a certain amount depending upon if you have
a doctor visit or an MRI or surgery, or even
a hospitalization, confinement or cancer. There's a fixed dollar amount
that they pay. It's not designed to be the only
level of coverage because you're going to be out a
tremendous amount of money. So if a policy says I'm
(14:41):
going to pay two grand every time you get chemo
and your bills twenty grand every time you go in,
you know you're out eighteen grand. So it's we use
this in culmination with a major medical plan. But when
we go into these groups, and this is what we found.
If you already have a current group plan. Again, let's
say you're paying eight hundred bucks a month for employe,
they're paying four hundred bucks. You're paying four hundred dollars, right,
(15:03):
that's kind of a good even split. So when we
come in and do these plans, we go to the
employers to say, listen, the goal here I think is
a lot of your employees are going to qualify for
huge tax credits. So what if we go back to
the employee and go, hey, I'm going to take you
out of that four hundred dollars a month plan that
you're paying for. I'm going to have you directly pay
for a marketplace plan. But because of your income it's
(15:25):
only one hundred and twenty bucks a month. They're like
sold right sure, Because again an employer, as an employer,
I cannot and I'll preface this because we'll get into
this in a second, I cannot directly pay for a
tax credited healthcare marketplace plan. If they want to pay
full price, I can do it, and we'll talk about that.
But if it's eight hundred bucks and goes down to
(15:46):
one twenty, I can, as an employer, pay for the
one twenty. So we just get the employee to pay
for it because they're used to paying four hundred, Well,
one twenty is a huge savings for them. So now
we're taking the four hundred dollars that you're paying right
now for that group plan. So again, now what's gone.
You're saving four bucks a month, right, So we go
what can we use that money for? So what if
we take a couple hundred bucks a month out of
that and put it towards these Section one twenty five plans,
(16:09):
these first dollar coverage options, so you can still write
it off as an employer, and if the employee wants
to upgrade and get more coverage, you can pay roll
to DUCTUM. So it's a tax savings for you, tax
savings for the employee. But now what we're doing is
we're providing as an employer, the supplemental insurance to go
with their one hundred and twenty dollar a month plan.
(16:30):
So now I've taken something that maybe wasn't as good
as the group plan that I had, and I made
it way better. I call it polishing the turd, but
I mean, basically that's the scenario that we're doing. We're
making that plan really good. So now as an employer,
we're helping them pay off their deductibles, their co insurance.
Most of the plans that we write, these employees don't
(16:51):
even have copes anymore because the cope they have with
their major medical plan is being paid for by the
secondary so not not paying anything when they go to
the doctor. It's amazing. So all the prohibitive side, and
that we always talk about going well, I mean I
have a fifty dollars copay to go to the doctor.
I'm not sick enough. Well, when I tell them, like, well,
your secondary plan pays seventy five, you have a fifty
dollars copay, So technically speaking, I'm overpaying on your doctor visit.
(17:14):
You're making twenty five bucks if I give you twenty
five bucks when you go to the doctor, right, and
they go, oh, yeah, I'm making money. And that that's
how some employees think good better and you'll feel better
and you don't have take tomorrow off and I'm not
going to have to go figure out to get a
tempt service first. I whatever it is, right, So you're
making their plan better, You're providing more coverage, and at
the bottom line is what that just helped you with.
So if I just saved you forty fifty percent, as
(17:35):
the employer, I just saved him that employeer sixty seventy percent,
everybody is a winner. You're all saving money and now
you're providing the best level of coverage you've ever had
to your employees, and they're gonna stop thinking like, oh man,
my employer, you know, yeah, I know he pays for
health insurance, but it's garbage because every time I go
to use it, I got to pay money and I'm
(17:56):
gonna go find someplace else to work. Then maybe it's
not as bad because that's that the mentality of some employees.
And one of the employers I just talked to the
other day I told I was like, listen. I was like,
you know, you've always told me situations like I got
to keep hiring people. I got to some people got left.
I got to keep hiring people. I was like, if
you ever sat down in an interview and talked about
(18:17):
what you offer for health insurance, he goes, No, people
just want to know that you offer. I was like,
why don't you have a conversation with the next potential
prospect for you as an employment, have a conversation of
the package that you have for health care benefits. See
if it sparks their interestsmart.
Speaker 1 (18:31):
Oh, I can imagine it would.
Speaker 2 (18:32):
And I had I put this to a couple of
my employers, and I actually had one call back one time.
He goes, I hired someone because of that because because
they literally they were shopping around. I didn't even know
because they were they were sick and tired of the
health care benefits they had with another employer, and they go, literally,
when I'm kind of going through, I'm like, I'm basically,
(18:52):
how we do our package. You'll have you'll have health insurance,
but with our package, you know you're not going to
pay thousands of dollars. Have ever have to use your plan?
We actually cover that, help cover that for you. They're like,
oh my god, that's way better than they've ever had
because I am using my insurance and nothing ever gets
paid for.
Speaker 1 (19:09):
Plus I got ninety two hundred dollars out of pocket liability. Yeah, yeah,
careplay I mean yeah.
Speaker 2 (19:13):
I mean, and and you know it's like now you
can hire better people because you, you, as a client
of ours, have the best healthcare plan out there. So
if you're in an hvac business and you're like, I
got a plan with John and the other guys don't,
I mean, guess what, guys, the sky's the limit. If
you can start talking about benefits, Yeah, I mean, maybe
go after that big guy guy that's does a really
(19:34):
good job together hvac company, because you know, I offer
better benefits. Poach him. Yeah, I mean that that's a
scenario I'm just saying, you know that wonderful point. Yeah,
I mean, but you get the benefits. Oh my god,
I'm going to go out looking they got crappy medical insurance? No, no,
absolutely not, and you.
Speaker 1 (19:51):
Give up this insurance. This is it works out too well?
Speaker 2 (19:54):
Yeah exactly. I mean, when's the last time you've got
and worked for somebody and uh, you know, you use
the insurance they have, then the insurance company paid you
to use your plan, like what Like I'm getting checks
back from the insurance from my employer, like this is amazing.
I mean, that makes it better.
Speaker 1 (20:11):
But again, people listening to going shake their head, going,
that can't be true.
Speaker 2 (20:14):
It can't be true. I mean, yeah, it's not.
Speaker 1 (20:16):
My son's a great illustration, man. I mentioned it many
times before. He went to the doctor and the physical
was one hundred and twenty five bucks I think, and
he ended up getting a check for almost two hundred
and fifty bucks covered the not in his monthly premium.
Speaker 2 (20:28):
Yeah, I mean, what a scenario, right, I mean, and
you're right. I mean it hasn't helped the hundreds of
businesses that we help in the area that are still
with us because they love their benefits. Right, I mean,
and that's and that's what we're we're doing, and it's
it's and people are like, wow, well, you know, I
don't hear a lot of information. I mean, these these
things must be new. No, these plans that we do
(20:49):
with clients, they've been available for sixty seventy years. But
the problem was, you know, most people weren't going to
pay a lot more money to add these on to
their cheaper plans with reductibles. Didn't make sense back then.
But now the fact that health insurance is so over
inflated on the premiums and the inductibles are so much higher.
By being able to go this route, I'm still saving
(21:11):
you money and you're still getting better coverage, which I think,
again is usually the hardest conversation that I had to
have with employer because it doesn't make sense how you
can buy something cheaper and get more from it. But
that's what we do every day. That's what you do
every day.
Speaker 1 (21:27):
Again, the benefit of working with a broker who's on
your side of the table and dealing with these insurance companies. Now,
one thing I've mentioned over and over again my friend
Jeff in his group that you benefited just in an
amazing way.
Speaker 2 (21:40):
Things.
Speaker 1 (21:41):
Things are praises all the time. He came back to
you after getting the medical insurance, and he said, even
emailed me, told me, I'm meeting with John and the
team to get dental and vision as well. You do
dental vision and.
Speaker 2 (21:53):
Life ental vision, life disability coverage. I mean, we could
do everything of your old group guided in. We have
everything under the sun here. I mean we even do
I even help clients with annuities. I mean basically when
you're a client of ours, I mean outside of I'm
not gonna hear I'm not your financial planner. I don't
do property and casualty, right, you know, we can basically
handle everything in the house. And I have a lot
(22:15):
of very good scenarios for group guys for these because again,
like I said, even most big group guys don't work
with as many carriers as that we do, so we
have so many different options. And you know, he came
to me, Jeff came to me and goes, I had
a really good dental plan and then some company bought
the company that I have and they change networks and
now nobody takes it. And I'm looking at I'm like, well,
(22:36):
are you just not happy. You're not happy to plan, right?
I go, what make you happy? He goes, I want
to be able to go to my dentists and be
paid for. I was like, okay, so who's your dentist?
And he goes this guy. I was like, I have
a plan that pays for that dentist. I was like,
you want to do it for your group? He's like really,
I'm like, yeah, it's that simple. Jet. Just tell me
what you need and I will make it happen. That's
helped me help. You'll help you just tell me what
(22:57):
you want. Don't don't not tell them, But once you
tell me, I can I can figure out a solution.
And I figured, you know, a long time ago. It's like,
I'm in the solution business, not just to help. I'm
trying to figure out solutions all day long.
Speaker 1 (23:09):
Understood.
Speaker 2 (23:10):
So I want to give this one more thing here
because we kind of like hinted on groups and some
of the options that are out there right now. And
one of my one of my one of my employees,
one of my agents, actually came in here a couple
of months ago. Ash and he ran into a group
here recently and they're way overpaying on their group I have.
I think it was they had like twelve fifteen employees.
(23:32):
Well a problemen, you're in a small group like that, right,
I think a couple of these employees end up having
a really bad year last year. So they ended up
getting socked the last few years with huge, huge increases
because I remember, when you do group insurance, especially at
that size, you know the rating on your group is
going to be based upon the health of your group. Yep.
So yeah, so if I go out there and I
want a landscaping company and I got a bunch of
(23:53):
twenty five year or twenty six year olds, I'm probably
get a lot better deal than the group with a
bunch of fifty year olds and sixty year olds. Right.
So they were looking at doing what's called an EKRA.
So an EKRA basically it's a health reimbursement account for
individuals and one of the things I kind of pointed
to him, and I know he walked this employer through this,
(24:14):
and I think there was a big disconnect as far
as what the group guy was trying to tell them
and what we were trying to explain to him. Yes,
the EKER is basically a way that an employer can say, hey,
I want to provide a certain amount of money so
that you can then go and use that money to
buy health insurance. Right, so it's a health reimbursemccount. Basically,
(24:37):
I'm sending a side of money and the company does
the calculations to figure out how much for each employee.
But let's just say at the end of the day,
I'm providing five hundred bucks a month for each employee, right,
so it's pretext I can write it off as an employer.
The employee can use that money to pay for their
health insurance premiums. But here's a bad scenario behind us,
and this is why I don't really recommend them for
(24:58):
groups under fifty. Once you do a NIKRA, the employee
can't qualify for tax credits. Oh no, all right, and
that's a big thing. So in their scenario, I think
it made sense because of what they were paying was
so high in premiums for the group plan that even
paying more on the EKER made sense for them to
be able to go then then go out and buy
(25:20):
a full place marketplace plan. Guess what's going to happen.
So I'm kind of going back to those numbers, you know,
seventy hundred dollars for an individual, fifteen hundred for employee spouse,
you know, two grand for a family. So yeah, I
might be freeing up five six, seven hundred dollars a
month for that employee to then go and use that
might to buy a full price marketplace plan. But they're
still going to be paying a ton of money. Yeah,
(25:42):
unrelievable when again, a lot of the employees we found
out were probably in the less than two hundred dollars
range if they weren't going to do this IKRA plan.
So where the ekera really makes sense if you're listening like, oh,
I've looked into this, This may make sense if you've
got a lot of high income employees. I've a client
right now that it made really good sense for because
(26:02):
they run an architect firm, so every one of their
employees made like one hundred and fifty two hundred thousand plus.
It could makes really good sense at that point because
he's not these guys aren't getting tax credits. But for
most of the employers that I help, where their employers
are making thirty forty fifty sixty grand a year, it's
a terrible option. Because they're good save So I mean
the fact that you're putting that money aside to give
(26:22):
them cost you more money than if they were to
go buy it on their own. Without it, they can
get a cheaper on their own. So by going that route,
it's just not something I would recommend because that money
you're paying, which is in their case, I think they're
paying over one thousand dollars a month for employee, which
is really good for the employee in the sense except
for them I can attax credits. But we could have
(26:46):
gone in there and probably wrote them a group plan
for what they're paying one thousand dollars for for less
than five hundred bucks a month for each employee, So
I could have saved them fifty percent and probably still
save the employees like forty or sixty percent because they
all call it five for tax credits. So again you
get to be very careful and knowing how these plans work.
It's a huge push right now, Brian, I see ekras everywhere.
(27:07):
I got a company the other day called me to
see if my business wanted to do an ekra. It
just didn't make sense. But if you have but if
you have over fifty employees and you have to provide
health insurance. AKRA is a good option right now. So
that's something we can help your business with. If you
haven't looked at it, maybe you're just getting really you're
on the shaft end of premiums because you're like, I
got fifty five employees and I'm paying a ton of money.
(27:29):
Give us a call. We can look at ANICRA because
that makes sense in your scenario. Well, and.
Speaker 1 (27:35):
The conclusion I always draw every week we do this
show is I suppose even if you are, you know,
stuck in your group plan, like the scenario we talked
about last week, I'm already I'm committed. Basically, I did
open enrollment at my employer, and I know I have to,
you know, stick with it. If you mentioned that you
can get the family members separately ensured, that's you can
(27:56):
do that. But they're hearing this and they're going, wait
a second. I know there's a better way out there
that they might get ahead of the game before the
fall when they had the next open enrollment and have
a conversation with you for you to explain to them, Okay,
when that opportunity exists, here's what we can do for
you and here's what it's going to cost you compared
(28:17):
to what you're doing now, and you kind of clear
the air and get them solidified on the notion like damn,
right in November, I am calling cover sency.
Speaker 2 (28:25):
Yeah, and I think I step further. I have an
open door policy of my employees because there's so much
stuff that I don't know. I'm like, hey, if you're
running into a sentence, I mean, even my agents, look,
they'll see different plans and they'll come John, I want
you to look at his plan that I think is a
really really good they offer. I'm like, I don't like this,
so we're not doing it any or yes, I like this.
As an open door policy, I want I want that information.
I'm telling you right now. If you're an employee of
(28:46):
mine and you came in and go, hey, John, I
just heard something that I think can save this money
for our company and I think will help all of us,
I want you to listen to this guy. I mean,
I bonus employees when they literally real something like that.
I mean, I'm not saying that's always in that scenario,
but think about on that realm is if you're listening
to U right now, you're you're you're in a group
(29:07):
plan and you have less than fifty people that you're
working with. Take us back to your employer. I mean
we can help them. Yeah, get the ball roll. Employee,
you can get Yes, absolutely, because I can help you
as the employee, help the employer. It's a win situation
all across the.
Speaker 1 (29:20):
Board, and always is when we talk with you. John
Rolman from Cover Sincy online Coversincy dot com. You can
get the ball rolling by filling the form out online
at Coverscincy dot com, or just give them a call
five one three eight hundred call that's five one three
eight hundred two two five five. This has been another
edition of Where You Think Healthcare together with John Roland
Hi, This is Brian Thomas, host to the fifty five
Kersey Morning Show Monday through Friday and facilitator of this segment,
which we call Rethink Healthcare together with John Ruhlman from Cover. Sincey,
there's a better way to get medical insurances by having
a team work for you. Don't talk to somebody that
works for an insurance company. They're not going to steer
you in the right direction. John works with hundreds of
(00:28):
insurance companies, thousands of insurance policies which he layers, and
he can explain that like he has so many times before,
but fundamentally, since he's not working for them, he's working
for you. He knows all kinds of tricks of the
trade to get you better medical insurance coverage for less money,
whether you're an individual or a group. Last week we
talked about the fact that you're not stuck where you
(00:50):
are necessarily, So if you think you can't get out
of what you're in, then initiate the conversation with John
and the team to see if there's a better way
to get your medical insurance coverage for less money. John,
we haven't talked about groups for a while, and I
use this illustration when I'm talking with my listeners and
(01:12):
plugging your wonderful organization and team at COVER. Since he
my friend Jeff, who I think has literally followed my
advice on every sponsor on my show, and I always
hear back from him, and every time I mentioned cover
since he he sends me an email with three smiley
faces on it. Because Jeff and his team you insured.
He's a small businessman and I don't know how many
(01:34):
employees he's got. I can't recall ten or twelve, but
you improved his business's bottom line by multiples of ten
thousand dollars. I think it was forty or some one
thousand dollars. So his business became more profitable through working
with you, and his employees are infinitely more happy with
the insurance coverage you got them, and they're paying less
(01:56):
money and have better coverage. So he's got a leg
up on his competition by way of just mere employee
retention and happiness. So that's the kind of thing you
can do for a group. Yeah, so let's talk a
little bit how that works. I mean, yeah, how employers
can get better coverage for them and their employees.
Speaker 2 (02:14):
Absolutely, So, I mean, you know, one of the big
things that you know, especially if you're an employer has
less than fifty employees. You know, and we've talked about
this in numerous times on the show, but the big
thing to really look at in these situations is, you know,
you're not obligated to pay for health insurance or you're
not gonna get penalized because I have less than fifty employees.
(02:36):
So that doesn't actually start until you have over fifty employees, right,
So there's no mandate that I have to provide coverages
for my employees, but you want to, right, I look
at as it's a perfect hiring tool, it's great for retention,
and ultimately, you know, even as even as a small
employer myself, I realized that if I wasn't pushing benefits
(02:56):
through my office, I probably have three or four employees
that which is never did it. Even though they work
and see claims all day long, they still have that
mental side where they're like, it's just an expense that
I don't want to pick up this, I don't want
to do this. Right and the group side, right, the
group side of health insurance has followed kind of the
(03:17):
marketplace pricing. Right, So when we were doing groups. You know,
before Obamacare healthcare dot gov, right, they weren't as expensive
as they are now. So if you go to healthcare
dot gov and you're like, well, i'm a small business owner,
I want to see what it will look like for
my group. Just go look and see what the full
price plans are on the marketplace. That's probably gonna be
about your group rate. So I mean, you're probably gonna
(03:38):
be looking at seven eight, nine hundred a month per employee.
You know, family a husband and wife starting at fourteen
to fifteen hundred bucks, families close to two thousand. That's
a group rate. And now you're probably listening to I'm
phibly not gonna do that, right, that's unaffordable, right, I
can't go that route. How do I get other types
of insurance? And that's where we really come in and
(03:58):
come up with some really unique scenario. And I always
tell employers like, listen, we do a census form. We
break it down for each employee and their senses. Form
is very in detail because we're gonna ask things like,
of course, like where their address is, but I want
to know who their doctor is, what prescriptions they're currently taking,
what is their medical history? You know, because I want
(04:19):
to line up a plan specifically around each individual employee's needs.
And each employee could be different, right you know. I
mean maybe I'm an employee that goes to this hospital,
but you have another employee that goes through this other hospital. Group. Well,
if I decide to go out and I'm gonna go
get some Blue Cross plan that covers this hospital and
doesn't cover that hospital, well sorry, Joe, you got to
(04:41):
change your health insurance plan or are you going to
change your doctor because it's not gonna be covered over there.
So you know, it's kind of a one size fits
sum when you do group plans, and you know, we
try to make it each plan fits all because each
plan is going to be specifically tailored to their individual
And the other thing that we do BRAN is we
ask income. I want to know what these employees are
(05:03):
not just with you, but their whole family. So I
wouldn't know what the spouse makes, and that's all in
our senses for them. Because one of the things you
have to realize is that, especially with some employers out there,
I mean, if you have employees making thirty forty fifty
grand a year, you know they could qualify for tax credits. Now,
if you do group health insurance, they don't qualify. So
I can't. I mean, somebody making let's say thirty forty
(05:25):
fifty grand a year, maybe their spouse makes twenty thirty grand,
or maybe as a family they make eighty grand a year,
they have a family of four, Well, do you realize
I can probably get them a marketplace plan like major
medical health insurance for like less than two hundred bucks
a month. That same plan would cost you two grand
on a group That's insane. So as an employer, we
(05:45):
want to offer these benefits. I want to do something
for my employees to keep them. But you don't realize
you're actually hurting them by even doing group insurance yea
in some cases yeah right, And and that's always the
toughest pill for them to spa. Even you mentioned Jeff M. Markhan,
that's a tough pill for him to swallow. When I
was presenting that to him, he's like, that doesn't make sense.
(06:08):
That doesn't I know, that doesn't make any sense. I
was like, well, just follow me, let me walk you
through this. And then when we started breaking down and
showing him the cost of what it would be for
the employees, and we really we break it down on
the whole spreadsheet. Every employee they get to see exactly
what their cost is and we show them the bottom line.
He's like, oh my god, like there's a huge saving.
(06:29):
It's not just me as the employer. I'm not just
saving it on my side. My employees are paying less, right,
so they're happy. Yeah, you know, and he was in disbelief.
Speaker 1 (06:41):
I'm telling you. He just when he got back with me.
He told me in advance when he was having the
meeting with you, and after the meeting he's like, oh
my god, you have no idea. This is so amazing.
I mean, he truly was just blown away by what
you were able to do.
Speaker 2 (06:54):
Yeah, he earmarked a couple of employees. Goes, these guys
are gonna be a little tough. You have to really
break it down for them, and you know, one of
them was. And we sat down for quite a while
and talked about it, and I thought it was so reassuring.
At the end, he goes, Listen, he goes, I've never
covered my wife. What can we do for her? You know?
And I was like I felt really good at that
(07:15):
point because we were able to make a connection. He
finally understood. It's you know, we're not rolling into an
employer group and going, hey, we're the new guys and
you're not overconn who's gonna buy from us? And you
don't have any other options? I mean, you have every
option under the sun. We're just gonna try to make
it make sense. And my goal walking into your business
is to help you and help your employees, because I
build my business on people that are happy with what
(07:36):
the service we provide and the coverage that we're offering,
and let them know that things can happen, things can change,
and employees might have different situations in the future, and
we can adapt what we're doing to them. It's it's
a unique time, Brian, in today's market because twenty years
ago when I was writing insurance, is like I wrote
you a plan. Well, now your situation changes and your
plan didn't really cover everything the right way, But don't
(08:00):
have any other options because now you have this biload
of medical stuff going on and I can't change you.
But in today's market, we can make those adjustments. We
can make those changes even on the fly. I got
I had a client the other day literally calling and go, hey,
they're putting me on this really expensive medication healthy dude
was on. We call them the Dude plans. It's a
cheaper plan. It's just like it doesn't have It's not
(08:22):
the shiny Mercedes with all the bells and whistles. I mean,
it was a good quality four whel drive vehicle, but
you know, it didn't have the navigation and all that, right.
I mean, it was what he needed at that point
in time. But his situation changed, something popped up and
this was like a I mean it was thousands of
dollars in medication a month this person was going to do,
and I was able to move them to you know,
(08:43):
it's definitely a more expensive plan, but it was nowhere
near what he was going to have to pay for
that drug. And now he's happy. He's like, well now
my drug's cover. Because don't understand how you can do that.
I was like, this is what we do. Yeah, I mean,
there's options. My goal is to write you to the
plane that makes the most sense at the time, and
then life happens, things come up and we can adjust
that plan and make those plans and just that and
(09:04):
we do that for each one of those employees. Well
and the other company.
Speaker 1 (09:07):
I think it's important for me to interject here because
I maybe somebody's listening for the first time. This has
come up before. I have to bring it up again though.
But in addition to doing for the employer groups what
you just explain by way of putting medical insurance coverage
in place and doing a very specific employee by employee
analysis and package, you continue providing services after they have
(09:33):
insurance through you by solving the problems that we all
encounter with medical insurance companies. You're going to have a
company that's where your policy came from, and sometimes the
world's an imperfect place. Screws, fall out, claims, don't get paid.
Do you get an EOB that says you owe me
six hundred and seventy five dollars, Like, wait a second,
why did I get this? And they don't have to
call the insurance company. They call you, and your team
(09:54):
solves the problem for them.
Speaker 2 (09:55):
We caught, We solve the problem, and you know we're
also there to help re educate. That's right, Listen. That
is huge because I tell every employer when when we're done,
everything's signed and everything's put through, and I call them
back like everything's approved. Everything's good, We're good for next month.
And I go, I'm going to tell you something. You're
no longer in the insurance business, right I want you
(10:17):
answering questions from employees. I don't want you.
Speaker 1 (10:20):
To refer to people over to HR.
Speaker 2 (10:22):
Nope, nope, I mean we are when it comes to
your health insurance. They come to go, hey, I got
a question, how this works? Again, just I give him
a sack of cards, like you, just hand my card
back to them. Call John, Call John's office, Call John's office,
easy to go, because I don't want you at the
end of the day, you know, I mean, you're free
of the burden, free of the burden and worry about
(10:43):
your business. We got you covered and we're there to
answer every question and you know, and re educate because
you know. Again, even when I do these presentations, I
meet with them, I go over their coverage and again,
these are packages, Brian, These aren't just one size plans
right there. We build them out. We do Section one
twenty five, so they're gonna have extra layers of coverage.
We'll have accident policies, they're gonna we're gonna our goals
(11:05):
to reduce their out of pocket expenses. So we're layering
upon layering of coverage, which sometimes they understand at that
initial presentation when we first meet with them for like
an hour and we go over everything with them. Well,
guess what happens ten months later when something comes up.
They're like, I know he told me something, he had
this extra card. I don't know what I'm doing. So
they called to her office, re educating me, walking back
(11:26):
through the scenario, explain to him how it works. So
they have that constant reassurance that it's not a you know,
we're selling you something. Good luck figuring it out on
your own.
Speaker 1 (11:37):
You mentioned I think you just mentioned section one. Yeah,
well wefresh it's recollection about that skirts.
Speaker 2 (11:48):
Sometimes I just kind of get into that way where
I'm like, it's industry terms every day.
Speaker 1 (11:52):
I could relate to this when I first started practicing
law with in house with Anthem, after I was out
in litigation in Chicago, and that's where I moved after
we moved back to Chicago, and I was not entirely
up to speed on the area of law healthcare. I
was a litigation specialist, so this is just another area
of litigation. But I remember the first meeting I was
in and the letters that were coming out of they
(12:13):
were like, just oh, on the so and so, and
you got to do this, And I just had no idea.
The jargon yeah, just was beyond my comprehension.
Speaker 2 (12:21):
So I had to learn a lot.
Speaker 1 (12:22):
So with that in mind, like someone's I was sitting
in the meeting, someone said oh, this is under section
one twenty five and like, huh what so let's dive in.
Speaker 2 (12:32):
No, we'll dive in that. And yeah, I forget that
sometimes too. I actually just hitting on that rep point.
I actually have to train my team to I'm not
saying dumb down their presentations, but I go, you have to.
You can't use a lot of the jargon. You have to.
That's why we use a lot of analogies right for
clients so they can kind of understand. Because I know
insurance and sometimes you might think it's an easy concept
when you really get into it, it's it's very convoluted.
(12:55):
There's a lot of a lot of a lot of
things that I think just try to confuse people so
they just don't use it. So the insurance companies not
to pay bills, right, But you know, we really break
it down, you know, that's what I stress with my
team all the time. We really break it down. So
the goal is to really help you understand how things
work in the scenarios that you're going to go through.
(13:16):
So we do do that. So yes, I do apologize
for throwing something out there and not explaining it, but
uh yeah. Section one twenty five is a cafeteria plan.
So a lot of those companies that come knocking on
your door trying to sell you employee benefits, you know,
outside of your major medical some of those places that
have a duck for you know, a mascot and stuff
(13:36):
like that AFTAB, but you know, they do what's called
Section one twenty five plans. So it's a way to
get secondary or supplemental insurances that we can do pre
text right, and we can get into the weeds if
you call in and we can walk you through exactly
those scenarios. But the biggest thing it's pretext. Just like
(13:57):
you're doing your group health benefits in a lot of cases.
You know, when we work with groups, what we realized
and this is you know what I guess what I
realized because I was the first person that really started
doing this, was I want to maximize a section one
twenty five side of our business with our employers, because
(14:19):
those are the benefits if you have a good indemnity plan.
That's what these companies sell. It's basically first dollar coverage.
It pays a certain amount depending upon if you have
a doctor visit or an MRI or surgery, or even
a hospitalization, confinement or cancer. There's a fixed dollar amount
that they pay. It's not designed to be the only
level of coverage because you're going to be out a
tremendous amount of money. So if a policy says I'm
(14:41):
going to pay two grand every time you get chemo
and your bills twenty grand every time you go in,
you know you're out eighteen grand. So it's we use
this in culmination with a major medical plan. But when
we go into these groups, and this is what we found.
If you already have a current group plan. Again, let's
say you're paying eight hundred bucks a month for employe,
they're paying four hundred bucks. You're paying four hundred dollars, right,
(15:03):
that's kind of a good even split. So when we
come in and do these plans, we go to the
employers to say, listen, the goal here I think is
a lot of your employees are going to qualify for
huge tax credits. So what if we go back to
the employee and go, hey, I'm going to take you
out of that four hundred dollars a month plan that
you're paying for. I'm going to have you directly pay
for a marketplace plan. But because of your income it's
(15:25):
only one hundred and twenty bucks a month. They're like
sold right sure, Because again an employer, as an employer,
I cannot and I'll preface this because we'll get into
this in a second, I cannot directly pay for a
tax credited healthcare marketplace plan. If they want to pay
full price, I can do it, and we'll talk about that.
But if it's eight hundred bucks and goes down to
(15:46):
one twenty, I can, as an employer, pay for the
one twenty. So we just get the employee to pay
for it because they're used to paying four hundred, Well,
one twenty is a huge savings for them. So now
we're taking the four hundred dollars that you're paying right
now for that group plan. So again, now what's gone.
You're saving four bucks a month, right, So we go
what can we use that money for? So what if
we take a couple hundred bucks a month out of
that and put it towards these Section one twenty five plans,
(16:09):
these first dollar coverage options, so you can still write
it off as an employer, and if the employee wants
to upgrade and get more coverage, you can pay roll
to DUCTUM. So it's a tax savings for you, tax
savings for the employee. But now what we're doing is
we're providing as an employer, the supplemental insurance to go
with their one hundred and twenty dollar a month plan.
(16:30):
So now I've taken something that maybe wasn't as good
as the group plan that I had, and I made
it way better. I call it polishing the turd, but
I mean, basically that's the scenario that we're doing. We're
making that plan really good. So now as an employer,
we're helping them pay off their deductibles, their co insurance.
Most of the plans that we write, these employees don't
(16:51):
even have copes anymore because the cope they have with
their major medical plan is being paid for by the
secondary so not not paying anything when they go to
the doctor. It's amazing. So all the prohibitive side, and
that we always talk about going well, I mean I
have a fifty dollars copay to go to the doctor.
I'm not sick enough. Well, when I tell them, like, well,
your secondary plan pays seventy five, you have a fifty
dollars copay, So technically speaking, I'm overpaying on your doctor visit.
(17:14):
You're making twenty five bucks if I give you twenty
five bucks when you go to the doctor, right, and
they go, oh, yeah, I'm making money. And that that's
how some employees think good better and you'll feel better
and you don't have take tomorrow off and I'm not
going to have to go figure out to get a
tempt service first. I whatever it is, right, So you're
making their plan better, You're providing more coverage, and at
the bottom line is what that just helped you with.
So if I just saved you forty fifty percent, as
(17:35):
the employer, I just saved him that employeer sixty seventy percent,
everybody is a winner. You're all saving money and now
you're providing the best level of coverage you've ever had
to your employees, and they're gonna stop thinking like, oh man,
my employer, you know, yeah, I know he pays for
health insurance, but it's garbage because every time I go
to use it, I got to pay money and I'm
(17:56):
gonna go find someplace else to work. Then maybe it's
not as bad because that's that the mentality of some employees.
And one of the employers I just talked to the
other day I told I was like, listen. I was like,
you know, you've always told me situations like I got
to keep hiring people. I got to some people got left.
I got to keep hiring people. I was like, if
you ever sat down in an interview and talked about
(18:17):
what you offer for health insurance, he goes, No, people
just want to know that you offer. I was like,
why don't you have a conversation with the next potential
prospect for you as an employment, have a conversation of
the package that you have for health care benefits. See
if it sparks their interestsmart.
Speaker 1 (18:31):
Oh, I can imagine it would.
Speaker 2 (18:32):
And I had I put this to a couple of
my employers, and I actually had one call back one time.
He goes, I hired someone because of that because because
they literally they were shopping around. I didn't even know
because they were they were sick and tired of the
health care benefits they had with another employer, and they go, literally,
when I'm kind of going through, I'm like, I'm basically,
(18:52):
how we do our package. You'll have you'll have health insurance,
but with our package, you know you're not going to
pay thousands of dollars. Have ever have to use your plan?
We actually cover that, help cover that for you. They're like,
oh my god, that's way better than they've ever had
because I am using my insurance and nothing ever gets
paid for.
Speaker 1 (19:09):
Plus I got ninety two hundred dollars out of pocket liability. Yeah, yeah,
careplay I mean yeah.
Speaker 2 (19:13):
I mean, and and you know it's like now you
can hire better people because you, you, as a client
of ours, have the best healthcare plan out there. So
if you're in an hvac business and you're like, I
got a plan with John and the other guys don't,
I mean, guess what, guys, the sky's the limit. If
you can start talking about benefits, Yeah, I mean, maybe
go after that big guy guy that's does a really
(19:34):
good job together hvac company, because you know, I offer
better benefits. Poach him. Yeah, I mean that that's a
scenario I'm just saying, you know that wonderful point. Yeah,
I mean, but you get the benefits. Oh my god,
I'm going to go out looking they got crappy medical insurance? No, no,
absolutely not, and you.
Speaker 1 (19:51):
Give up this insurance. This is it works out too well?
Speaker 2 (19:54):
Yeah exactly. I mean, when's the last time you've got
and worked for somebody and uh, you know, you use
the insurance they have, then the insurance company paid you
to use your plan, like what Like I'm getting checks
back from the insurance from my employer, like this is amazing.
I mean, that makes it better.
Speaker 1 (20:11):
But again, people listening to going shake their head, going,
that can't be true.
Speaker 2 (20:14):
It can't be true. I mean, yeah, it's not.
Speaker 1 (20:16):
My son's a great illustration, man. I mentioned it many
times before. He went to the doctor and the physical
was one hundred and twenty five bucks I think, and
he ended up getting a check for almost two hundred
and fifty bucks covered the not in his monthly premium.
Speaker 2 (20:28):
Yeah, I mean, what a scenario, right, I mean, and
you're right. I mean it hasn't helped the hundreds of
businesses that we help in the area that are still
with us because they love their benefits. Right, I mean,
and that's and that's what we're we're doing, and it's
it's and people are like, wow, well, you know, I
don't hear a lot of information. I mean, these these
things must be new. No, these plans that we do
(20:49):
with clients, they've been available for sixty seventy years. But
the problem was, you know, most people weren't going to
pay a lot more money to add these on to
their cheaper plans with reductibles. Didn't make sense back then.
But now the fact that health insurance is so over
inflated on the premiums and the inductibles are so much higher.
By being able to go this route, I'm still saving
(21:11):
you money and you're still getting better coverage, which I think,
again is usually the hardest conversation that I had to
have with employer because it doesn't make sense how you
can buy something cheaper and get more from it. But
that's what we do every day. That's what you do
every day.
Speaker 1 (21:27):
Again, the benefit of working with a broker who's on
your side of the table and dealing with these insurance companies. Now,
one thing I've mentioned over and over again my friend
Jeff in his group that you benefited just in an
amazing way.
Speaker 2 (21:40):
Things.
Speaker 1 (21:41):
Things are praises all the time. He came back to
you after getting the medical insurance, and he said, even
emailed me, told me, I'm meeting with John and the
team to get dental and vision as well. You do
dental vision and.
Speaker 2 (21:53):
Life ental vision, life disability coverage. I mean, we could
do everything of your old group guided in. We have
everything under the sun here. I mean we even do
I even help clients with annuities. I mean basically when
you're a client of ours, I mean outside of I'm
not gonna hear I'm not your financial planner. I don't
do property and casualty, right, you know, we can basically
handle everything in the house. And I have a lot
(22:15):
of very good scenarios for group guys for these because again,
like I said, even most big group guys don't work
with as many carriers as that we do, so we
have so many different options. And you know, he came
to me, Jeff came to me and goes, I had
a really good dental plan and then some company bought
the company that I have and they change networks and
now nobody takes it. And I'm looking at I'm like, well,
(22:36):
are you just not happy. You're not happy to plan, right?
I go, what make you happy? He goes, I want
to be able to go to my dentists and be
paid for. I was like, okay, so who's your dentist?
And he goes this guy. I was like, I have
a plan that pays for that dentist. I was like,
you want to do it for your group? He's like really,
I'm like, yeah, it's that simple. Jet. Just tell me
what you need and I will make it happen. That's
helped me help. You'll help you just tell me what
(22:57):
you want. Don't don't not tell them, But once you
tell me, I can I can figure out a solution.
And I figured, you know, a long time ago. It's like,
I'm in the solution business, not just to help. I'm
trying to figure out solutions all day long.
Speaker 1 (23:09):
Understood.
Speaker 2 (23:10):
So I want to give this one more thing here
because we kind of like hinted on groups and some
of the options that are out there right now. And
one of my one of my one of my employees,
one of my agents, actually came in here a couple
of months ago. Ash and he ran into a group
here recently and they're way overpaying on their group I have.
I think it was they had like twelve fifteen employees.
(23:32):
Well a problemen, you're in a small group like that, right,
I think a couple of these employees end up having
a really bad year last year. So they ended up
getting socked the last few years with huge, huge increases
because I remember, when you do group insurance, especially at
that size, you know the rating on your group is
going to be based upon the health of your group. Yep.
So yeah, so if I go out there and I
want a landscaping company and I got a bunch of
(23:53):
twenty five year or twenty six year olds, I'm probably
get a lot better deal than the group with a
bunch of fifty year olds and sixty year olds. Right.
So they were looking at doing what's called an EKRA.
So an EKRA basically it's a health reimbursement account for
individuals and one of the things I kind of pointed
to him, and I know he walked this employer through this,
(24:14):
and I think there was a big disconnect as far
as what the group guy was trying to tell them
and what we were trying to explain to him. Yes,
the EKER is basically a way that an employer can say, hey,
I want to provide a certain amount of money so
that you can then go and use that money to
buy health insurance. Right, so it's a health reimbursemccount. Basically,
(24:37):
I'm sending a side of money and the company does
the calculations to figure out how much for each employee.
But let's just say at the end of the day,
I'm providing five hundred bucks a month for each employee, right,
so it's pretext I can write it off as an employer.
The employee can use that money to pay for their
health insurance premiums. But here's a bad scenario behind us,
and this is why I don't really recommend them for
(24:58):
groups under fifty. Once you do a NIKRA, the employee
can't qualify for tax credits. Oh no, all right, and
that's a big thing. So in their scenario, I think
it made sense because of what they were paying was
so high in premiums for the group plan that even
paying more on the EKER made sense for them to
be able to go then then go out and buy
(25:20):
a full place marketplace plan. Guess what's going to happen.
So I'm kind of going back to those numbers, you know,
seventy hundred dollars for an individual, fifteen hundred for employee spouse,
you know, two grand for a family. So yeah, I
might be freeing up five six, seven hundred dollars a
month for that employee to then go and use that
might to buy a full price marketplace plan. But they're
still going to be paying a ton of money. Yeah,
(25:42):
unrelievable when again, a lot of the employees we found
out were probably in the less than two hundred dollars
range if they weren't going to do this IKRA plan.
So where the ekera really makes sense if you're listening like, oh,
I've looked into this, This may make sense if you've
got a lot of high income employees. I've a client
right now that it made really good sense for because
(26:02):
they run an architect firm, so every one of their
employees made like one hundred and fifty two hundred thousand plus.
It could makes really good sense at that point because
he's not these guys aren't getting tax credits. But for
most of the employers that I help, where their employers
are making thirty forty fifty sixty grand a year, it's
a terrible option. Because they're good save So I mean
the fact that you're putting that money aside to give
(26:22):
them cost you more money than if they were to
go buy it on their own. Without it, they can
get a cheaper on their own. So by going that route,
it's just not something I would recommend because that money
you're paying, which is in their case, I think they're
paying over one thousand dollars a month for employee, which
is really good for the employee in the sense except
for them I can attax credits. But we could have
(26:46):
gone in there and probably wrote them a group plan
for what they're paying one thousand dollars for for less
than five hundred bucks a month for each employee, So
I could have saved them fifty percent and probably still
save the employees like forty or sixty percent because they
all call it five for tax credits. So again you
get to be very careful and knowing how these plans work.
It's a huge push right now, Brian, I see ekras everywhere.
(27:07):
I got a company the other day called me to
see if my business wanted to do an ekra. It
just didn't make sense. But if you have but if
you have over fifty employees and you have to provide
health insurance. AKRA is a good option right now. So
that's something we can help your business with. If you
haven't looked at it, maybe you're just getting really you're
on the shaft end of premiums because you're like, I
got fifty five employees and I'm paying a ton of money.
(27:29):
Give us a call. We can look at ANICRA because
that makes sense in your scenario. Well, and.
Speaker 1 (27:35):
The conclusion I always draw every week we do this
show is I suppose even if you are, you know,
stuck in your group plan, like the scenario we talked
about last week, I'm already I'm committed. Basically, I did
open enrollment at my employer, and I know I have to,
you know, stick with it. If you mentioned that you
can get the family members separately ensured, that's you can
(27:56):
do that. But they're hearing this and they're going, wait
a second. I know there's a better way out there
that they might get ahead of the game before the
fall when they had the next open enrollment and have
a conversation with you for you to explain to them, Okay,
when that opportunity exists, here's what we can do for
you and here's what it's going to cost you compared
(28:17):
to what you're doing now, and you kind of clear
the air and get them solidified on the notion like damn,
right in November, I am calling cover sency.
Speaker 2 (28:25):
Yeah, and I think I step further. I have an
open door policy of my employees because there's so much
stuff that I don't know. I'm like, hey, if you're
running into a sentence, I mean, even my agents, look,
they'll see different plans and they'll come John, I want
you to look at his plan that I think is a
really really good they offer. I'm like, I don't like this,
so we're not doing it any or yes, I like this.
As an open door policy, I want I want that information.
I'm telling you right now. If you're an employee of
(28:46):
mine and you came in and go, hey, John, I
just heard something that I think can save this money
for our company and I think will help all of us,
I want you to listen to this guy. I mean,
I bonus employees when they literally real something like that.
I mean, I'm not saying that's always in that scenario,
but think about on that realm is if you're listening
to U right now, you're you're you're in a group
(29:07):
plan and you have less than fifty people that you're
working with. Take us back to your employer. I mean
we can help them. Yeah, get the ball roll. Employee,
you can get Yes, absolutely, because I can help you
as the employee, help the employer. It's a win situation
all across the.
Speaker 1 (29:20):
Board, and always is when we talk with you. John
Rolman from Cover Sincy online Coversincy dot com. You can
get the ball rolling by filling the form out online
at Coverscincy dot com, or just give them a call
five one three eight hundred call that's five one three
eight hundred two two five five. This has been another
edition of Where You Think Healthcare together with John Roland
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