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NJ Insurance Plans - Mike Sheeran, CFP

New Jersey Health Insurance - Reviews and Recommendations

Affordable Small Business Dental Insurance From HorizonBlue Dental

March 6, 2012 By Mike Sheeran

Horizon DentalLooking for affordable Dental Insurance from HorizonBCBS Dental?

HorizonBlue Dental has recently updated their plan summaries to make it easier to understand the dental benefits.



 

Horizon Dental Summaries

 

Horizon Dental Option Plan

The Horizon Dental Option Plan offers a great way to save premium dollars without reducing benefits. Members have the freedom to receive dental services from any dentist. If you use a dentist who participates with the Horizon Dental Option Plan, you can maximize your benefits and save money. Discounts on participating dentists’ charges range between 10 and 30 percent. You have the option of selecting from over 115,000 participating dental offices nationwide. With any choice made there’s always a dental benefit and you are always covered for eligible services because of the plan’s out-of-network benefit.

  1. Horizon Dental Option 100/100/50
  2. Horizon Dental Option 100/80/60
  3. Horizon Dental Option 100/80/50

 

Horizon PPO Dental Plan

In-Network

The Horizon Dental PPO Plan, a Preferred Provider Organization Plan, offers the lowest fees available to our customers through our Horizon Dental PPO Network of participating dentists. These dentists accept our reduced allowances as payment in full, less any applicable deductible and/or coinsurance.

Out-of-Network

With an out-of-network option, members may go to a nonparticipating dentist and may have to pay the dentist his/her usual fees in advance. Members must then file claims for reimbursement. Reimbursement is based on our reduced allowances, and members are responsible for any charges in excess of these amounts.

  1. Horizon Dental PPO 100/100/50
  2. Horizon Dental PPO 100/80/60
  3. Horizon Dental PPO 100/80/50

 

Horizon PPO Access

The Horizon Dental PPO Access Plan provides 100 percent coverage for the most frequently needed dental services when you visit a participating dentist.

In-Network

The plan covers frequently needed, eligible preventive and diagnostic services, such as exams, cleanings and X-rays, as well as selected basic services, such as amalgam (silver) fillings and space maintainers, at 100 percent. For eligible major or specialty services, such as root canals, crowns and bridges, you’ll pay only a reduced Horizon Dental PPO Plan allowance to participating dentists. There is no annual deductible, no annual maximum and no wait period for major services.

Out-of-Network

The plan allows you to use nonparticipating dentists for certain eligible preventive and diagnostic services, however you may have to pay for any charges above the Horizon Dental PPO Plan allowance, pay dentists at the time of service and submit claims for reimbursement. There is no out-of-network benefit for major or specialty services.

  1. Horizon PPO Access
  2. Horizon PPO Access 1050

 

Horizon Dental Choice

Horizon Dental Choice saves your company money and increases employee satisfaction through its cost-effective design and comprehensive benefits.

No deductibles

No annual benefit maximums

No copayments for most eligible routine services

Low copayments for eligible major specialty services

Horizon Dental Choice is an HMO-type of coverage that features a strictly credentialed network of participating dentists. It’s a great addition to your benefits program, either in combination with another Horizon Blue Cross Blue Shield of New Jersey dental plan or as an alternative to your existing traditional program.

  1. Horizon Dental Choice witht Ortho
  2. Horizon Dental Choice no Ortho

 

Horizon Dental Companion

The Horizon Dental Companion Plan is available only when combined with a Horizon Blue Cross Blue Shield of New Jersey medical plan.

In-Network

The plan covers frequently needed, eligible preventive and diagnostic services, such as exams, cleanings and X-rays, as well as selected basic services, such as amalgam (silver) fillings and space maintainers, at 100 percent. For eligible major or specialty services, such as root canals, crowns and bridges, members pay only a reduced Horizon Dental PPO Plan allowance to participating dentists. There is no annual deductible, no annual maximum and no wait period for major services.

Out-of-Network

The plan allows members to use nonparticipating dentists for certain eligible preventive and diagnostic services, however they may have to pay for any charges above the Horizon Dental PPO Plan allowance, pay dentists at the time of service and submit claims for reimbursement. There is no out-of-network benefit for major or speciality services. The Horizon Dental Companion Plan is available only when combined with a Horizon Blue Cross Blue Shield of New Jersey medical plan.

  1. Horizon Dental Companion Plan

 

 

 

Please contact me for information on adding one of the Horizon Dental plans today. Horizon Dental Quote

Filed Under: NJ Dental Insurance Tagged With: Dental Insurance, Horizon BCBS, Horizon Dental, Horizon Dental Companion, Horizon DOP, Horizon PPO, Small business employee benefits

HRA vs HSA – Health Reimbursement Arrangement Vs Health Savings Account

March 5, 2012 By Mike Sheeran

HRA Vs HSASmart business owners who are looking to save money will quickly be rushed into the world of HRA’s and HSA’s (Health Reimbursement Arrangements and Health Savings Accounts). The two can a bit confusing at first so I’d like to discuss the differences between the two.

In this article, I’ll discuss what a HRA and an HSA are, how they are are used and how they can help save you or your business some premium dollars.

HRA Vs HSA

HRA Definition: An HRA is plan that is set up under IRS code section 105H and is established for the purpose of reimubursing employees for qualified medical expenses.

  • HRA’s are employer funded only
  • Money can be rolled over year to year if the employer chooses
  • Funds deposited and dispursed are tax deductible to the business and tax free for the employee
  • No limit on how much can be reimbursed
  • Any qualified medical expense can be reimbursed

 

HSA Definition: An HSA is often used in two different contexts. The first is the actual savings account and the second is referring to the health plan you are to be covered under.

  • HSA Savings Account – this an account that can be funded by an employer or employee for the purpose of paying for medical expenses.
  • Limits on how much money can be put into the account each year.
  • Money rolls over year to year.
  • Funds are completely employee owned
  • Can be used to pay for any qualified medical expense on a tax free basis
  • Must be covered by a HSA Qualified Health plan to make deposits into the savings account.
  • You can read more about HSA Rules for 2012 here.

HRA VS HSA In the real world

When I am working with new and renewing groups, using one of these great strategies is usually first in my list of options. Each one has their pros and cons so lets look at how each one would work for a company.

ACME LLC – has a 100% HMO where the employer pays 100% of the premium and they just a got another 20% increase.  They are comparing an HRA vs an HSA to save money. They have decided on purchasing a HSA qualified health plan but now need to pick the funding arrangement.

The company will be saving about 40% in premiums using the high deductible health plan and don’t want employees to have any large medical bills.

Option 1: HRA – The employer has decided to refund employees their full medical deductible. As employees use the plan, the employer will reimburse them dollar for dollar up to the set limit. Any unused money is retained by the employer

Option 2: HSA – The employer does not want to bother with claims and wants to give the employees money to pay for their claims. The employer makes monthly deposits into each employees Health Savings Account until he has paid an amount equal to their medical deductible.

Under Option 1, the employer has the chance for much greater savings but there is a little more work involved in reimburseing everyone. Option 2 is a bit easier and more flexible, but once the money is given to the employee, it is gone. If an employee quits, they keep the money.

 

If you own a business and are weighing HRA vs an HSA, please call me for a health insurance quote or to hear how these strategies can help with your bottom line.

Filed Under: Small Business Health Insurance Tagged With: Health Reimbursement Arrangement, Health Savings Account, HRA, HRA Vs HSA, HSA

High Deductible Health Plan Pros and Cons

March 5, 2012 By Mike Sheeran

high deductible health plan pros and cons

Insurance companies in NJ have been raising their premium rates tremendously over the las few years, so many small business and employees are considering the switch to a high deductible health plan. It is important to evaluate all of the different options and to weigh the pros and cons of having a high deductible health plan so you can make the best choice for your family.

Before I get started into the pros and cons of having a high deductible health plan, lets make sure everyone is talking about the same thing. In this case, a high deductible plan, HDHP for short is a plan that has a higher deductible than most other plans and also has a out of pocket dollar maximum that a participant may have to pay throughout the year. So one example may be a plan with a $2500 single deductible and a $5,000 maximum out of pocket. These plans are usually HSA Qualified but that is not necessary for the purpose of this post.

 

 

High Deductible Health Plan Pros and Cons

 

High Deductible Health Plan Pros

  1. Significantly lower health insurance premiums. In some cases, companies and individuals can slash their premiums by as much as 50% by changing to a high deductible health plan.
  2. Self funded employers will see much lower claims usage when moving from a rich plan design to a higher deductible option. Lower claims equals lower renewal and more savings.
  3. Employees also benefit with lower renewal rates because the price increases won’t be passed to them in the form of higher payroll deductions.
  4. If the high deductible health plan is HSA Qualified, there are significant tax advantages. Also see ( HSA Rules for 2012)
  5. For employees leaving the company, another pro of a high deductible plan will be lower COBRA premiums. Don’t forget that when you leave, you now are paying 102% of the full monthly insurance premium.

 

High Deductible Health Plan Cons

  1. High Deductible in the beginning of the year. This is obvious, but worth mentioning. If you have any scheduled visits shortly after enrolling in new plan, you must be prepared to pay much larger fee for your service.
  2. High deductible at the end of the calendar year. Most plans run calendar year so if you start the high deductible plan in November, the deductible will reset in January. You now have the potentional to pay the full deductible in November and December only to have it reset in a January.
  3. More paperwork. Since you are now paying instead of the insurance company, expect to be getting a lot of different bills. Luckily the larger claims aren’t that frequent, so your paperwork should be fairly limited.
  4. Will you avoid care? Even when the premium savings are there, some people will outright avoid proper medical care for fear of the potential bill. I can certainly understand this but you should focus on the total maximum out of pocket and consider the worst case scenario. My personal plan had a $5,000 maximum out of pocket. I knew that under the worst case scenario, I would be paying about $400 per month if I manage to max the plan out. Not too bad if I had a $1,000,000 claim.

 

Now that we reviewed some of the pros and cons of a high deductible health plan, lets look at how to evaluate options.

 

How to evaluate different high deductible health plan options

Step 1 – get the monthly premium for the different plan options and convert them to annual

Step 2 – add the annual maximum out of pocket for each of the plans to the annual premiums

Step 3 – evaluate

 

Example:

Plan 1 Annual Premium is $5,000 with a $5,000 maximum out of pocket.

Plan 2 Annual Premium is $9,000 with a $3,000 maximum out of pocket

Plan 3 Annual premium is $13,000 with everything covered 100%

In this example you have the potential to pay up to $10,000 in plan 1, up to $12,000 in plan 2 or a guaranteed $13,000 in Plan 3. So despite having a higher deductible, plan 1 would be the best choice in my opinion.  The other benefit is that if you don’t use the plan at all, you have the potential to save $8,000 in premium compared to plan 3.

 

If you have any questions on evaluating the pros and cons of a high deductible health plan, please contact Mike Sheeran for more information.

 

 

 

Filed Under: Small Business Health Insurance Tagged With: Group Health Insurance, Health Insurance, Health Savings Account, High Deductible Health Plan, HSA, Individual Health Insurance

Affordable Health Insurance For College Students – Your One Stop Guide to Health Insurance Options

February 21, 2012 By Mike Sheeran

health insurance for college students

Are you a college student and need health insurance or are looking at all of your options for coverage while in college?

If so, I put together resource links for you so that you can get the best possible coverage for the lowest possible price.

 

Health Insurance for College Students

 

 

Health Insurance for College Students Option 1: Dependent to 26 Coverage

What is it?

The dependent to 26 law was enacted in March of 2010 and allows all children to stay on their parents health insurance plan up until the age of 26.

How much does it cost?

If you your parents already are paying for a parent/child or family health insurance contract, there will be no change in premium for them. If they are single or two adults now and need to add you, then they will pay an increase in premium.

Benefits

It is seamless health insurance coverage for college students and many times the parents do not have to pay an increased health insurance premium.

Additional Resources

United States Department of Labor

New Jersey Department of Banking and Insurance

 

Health Insurance for College Students Option 2: Dependent to 31 Coverage – DU 31

What is it?

Dependent to 31 coverage permits young adults to continue being covered by health insurance up until age 31. These benefits can kick in after the adult ages out of the Dependent to 26 plan. There are some eligibility restrictions so check out the resource pages below for all of the information.

 

How much does it cost?

This health insurance for college students is priced at a reduced rate compared the group plan. In many cases, you will pay about 30% less that what a single employee would pay on the group. You will be billed directly to your home and while you are still technically part of your parent’s group plan, you don’t show up on their statement.

Benefits

You can stay on the plan until age 31 and get a 30% discount on the insurance.

Additional Resources

New Jersey DOBI Coverage for Young Adults up to Age 31

 

Health Insurance for College Students Option 3: COBRA and NJ Continuation of Health Insurance Coverage

What is it?

For college students needing health insurance coverage that have exhausted options one and two, you still have the option of continuation of coverage through state and government programs. In most cases, you can continue your health insurance plan for an additiotional 18 months and sometimes up to 36 months.

How much does it cost?

The premium will be dependent upon the single rate of whatever your previous health insurance cost before plus and additional 2%.

Benefits

You can keep your same policy for an additional period of time without making any changes.

 

Additional Resources

US Department of Labor – COBRA

New Jersey Continuation

Everything you Ever Wanted to Know about NJ Continuation Coverage

 

 

Health Insurance for College Students Option 4: Individual Health Insurance Coverage

What is it?

Individual coverage is offered through the state and there are approximately 8 plans available each from most carriers. The plans between the carriers are very similar and are offered on a guaranteed issue basis.

How much does it cost?

These are priced based on your age, sex location and can vary from las low as $200-$250 per month up to $600 per month based on the plan.

Benefits

These policies are guaranteed issue so you can purchase them regardless of your medical condition.

Additional Resources

 Guide to Individual Health Insurance

New Jersey Individual Health Insurance Program Buyers Guide

 

Health Insurance for College Students Option 5: Insurance Through Your College

What is it?

Many colleges will have deals worked out through major insurance carriers to offer to their students. Each college will offer a different type of plan with varying benefits. Sometimes these plans are full insurance plans and other times they may offer limited benefits.

How much does it cost?

Prices will vary from plan to plan so check with your college.

Benefits

These polices are easy to obtain since they are through the school and may possibly be the least expensive premium option.

 

Additional Resources

Guide to Individual Health Insurance

New Jersey Individual Health Insurance Program Buyers Guide

 

 

Additional Resources

Healthcare.gov – Grads and Other Young Adults

Health Insurance Resources for Uninsured New Jersey Residents

 

 

Summary

College students have many options for getting or keeping health insurance while away at school and even when they return. Please examine each option carefully and compare the prices to the benefits being offered.

Filed Under: Individual Health Insurance Tagged With: affordable college student health insurance, Affordable student health insurance

Affordable Dental Insurance from Horizon Blue Cross Blue Shield

August 17, 2011 By Mike Sheeran

Horizon Blue Cross Affordable Dental CoverageIf you are looking for affordable dental insurance in New Jersey, look no further.  Horizon Blue Cross Blue Shield offers two dental insurance plans designed for individuals and families who don’t have the option to purchase dental insurance through their employer.

These aren’t premium plan options but. you will find your dental expenses to be much lower by utilizing these plans and the network compared to no insurance at all. Between the two options, the individual dental plan is a better choice but it is a little bit more money.

 

Affordable Dental Insurance from Horizon Blue Cross Blue Shield

 

Option 1: Horizon Dental Centurion

Cost:$60 per single or $84 per covered family.

The Horizon Centurion Dental Program is an affordable individual and group dental program. Horizon Centurion offers reduced fees to members when they obtain their eligible dental services from one of the participating dentists in our Horizon Dental PPO Network.

These dentists have agreed to accept less than normal fees for all eligible dental services. When members use these dentists they will only be required to pay the dentist the reduced fee and will not be balanced billed for charges above that amount. The Horizon Centurion Dental Program is the ideal way for members to obtain affordable dental care.

 

Horizon Dental Centurion Video

 

Get the Horizon Dental Centurion Application– PDF

Look Up Horizon Blue Cross Dental Directory

 

Option 2: Horizon Individual Dental Plan –

Cost $180 per person per year and an additional $68.40 for each dependent child

Horizon Individual Dental offers eligible preventive and basic services with no deductible or copayment. Other eligible major services are available at significantly reduced fees. Horizon Individual Dental uses the Horizon Dental Choice Network of participating dentists.

Get the Horizon Individual Dental Plan

Look Up Horizon Blue Cross  Dental Directory

 

 

In case you are still on the fence on whether to purchase dental insurance or not, please read what Horizon Blue Cross has to say on the matter.

Did you know your dentist can spot serious health risks?

Routine dental visits can do more than keep your teeth clean. They also provide early detection of serious health risks like diabetes. Recent studies show that periodontal disease is one of the complications brought on by diabetes; a staggering one-third of people with diabetes have severe periodontal disease. And, if you have already been diagnosed with diabetes, periodontal disease can make it more difficult for you to control blood sugar levels.

Horizon Blue Cross Blue Shield of New Jersey strongly believes in working with our members to help them take control of their health. We have the ability to integrate medical and dental care to provide comprehensive solutions to your health care needs through our dental awareness programs. If you are a Horizon BCBSNJ member and have diabetes, you will receive valuable educational material highlighting the link between diabetes and good oral health.

We recognize the connection between good oral care and good overall health. If you have not seen your dentist recently, make an appointment right away.

Filed Under: NJ Dental Insurance Tagged With: Dental Insurance, Dental Insurance NJ, Horizon Blue Cross Blue Shield, Horizon Dental Plans

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