Employee benefits

Winter 2023 Issue

Long-term care insurance – but what if I don’t need it?

By Tom Strangstalien, Insurance Advisor

We all know the risks of a long-term care event devastating our family’s finances as well as our mental and personal well-being. Roughly half of those who reach the age of 65 will require some form of long-term care assistance during their lifetime.

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Rising health insurance premiums

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Health insurance premiums are constantly on the rise. According to the Centers for Medicare & Medicaid Services, “U.S. health care spending grew 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person.” Everyone from employees to employers are feeling the squeeze of high-cost premiums.

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Exercise your financial muscles to get financially fit

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

“Those who work their land will have abundant food, but those who chase fantasies have no sense.” This ancient advice from Proverbs illustrates the importance of financial fitness.

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Medicare questions to ask

By Mary Krueger, Medicare Specialist

Before enrolling in Medicare, there are several decisions Medicare recipients need to make regarding their existing coverages or changes in their health insurance needs.

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Small business claims that can be surprisingly expensive

By Society Insurance Human Resources, reposted with permission from Society Insurance

While running a small business, there’s a decent chance that throughout its course you’ll have to file some sort of insurance claim (often unexpectedly). Whether due to fire, theft, on-site injury or other incident, some experts estimate that 75% of small businesses faced an insurance-worthy incident just last year.

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Rising health insurance premiums

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

Health insurance premiums are constantly on the rise. According to the Centers for Medicare & Medicaid Services, “U.S. health care spending grew 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person.” Everyone from employees to employers are feeling the squeeze of high-cost premiums. As rising premiums keep employers frustrated, benefits-users are also enduring less and less being paid by insurance. Business owners are having to make decisions like sacrificing benefits to save money on premiums to afford higher wages. Many employers are asking if they should self-fund. 

Having a really big company with lots of the employees covered by the health plan means these employers have more money being paid into the premium pools – the basic rule of large numbers. In Wisconsin, any group with more than 50 employees is considered a large group and is not qualified for the Affordable Care Act marketplace plans. While companies with as few employees as 50 may qualify for a self-funded benefit, it could also be a liability that causes a business bankruptcy. An employer can hedge their premium dollars against only having a few high-cost health care claims per year. These same strategies don’t work for smaller companies, because they may not have many employees enrolled in the health plan (especially if the employer contributions are too low) which means they have even fewer premium dollars to cover when their work family does have a high-cost claimant(s).

For example, if a smaller group (50 employees for this scenario) has a high-cost claimant who costs $50,000 a year, that means a lot of your collected premiums are needed just to cover this one claimant. Assuming an average employee premium of $1,000 a month per employee (averaging employee and family), your employer premiums are $50,000 a month ($600,000 a year). That means one employee used one-twelfth of your premium funds.

In our example we have only covered $50,000 in claims and we still have 49 remaining insureds who may each spend the $12,914 average. The math, 49 persons at $12,000 means $588,000 potential you may have to pay. This is not yet taking into account that there are multiple people in your employee’s families who may have claims.

It is not just claims you pay for when you are self-funded, you are also responsible to pay for a selected insurance company or third party administer (TPA) to process your groups’ claims, your use of a network for discounts, a pharmacy benefit manager, stop loss insurance, Patient-Centered Outcomes Research Institute (PCORI), terminal liabilities, aggregate accommodations and other administrative costs just to name a few.  This all may not make sense yet or it might sound like another language. Just let me know and we can talk. Give me a call at 608.442.3734. While true self-funding may not be the best answer for your company, utilizing strategies, other funding arrangements and even our association health plan may be a solution.

Fall 2022 Issue

Affordability testing

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

The Affordable Care Act (ACA) brought a lot of extra work to employers and insurance companies. Whether you are pro-health care reform or against it, per the Health Affairs article, the ACA has not made insurance more affordable.

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Don’t forget to call your mom – and your insurance agent

By WisMed Assure Service Team

With the intention of easing administrative burden for WisMed Assure client physicians, several of our Medical Professional Liability carriers have significantly reduced or suspended asking for renewal applications over the past few years. While this does save time, renewal applications were an opportunity to touch base, review and discuss any changes to your practice that could impact your premium or coverage.

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Year-end tax planning for 2022

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Want to put thousands of dollars back into your pocket? Who doesn’t. Choices you make during your employer’s open enrollment period and for year-end tax planning can really add up.

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Graded premium disability? Yes, you can!

By Tom Strangstalien, Insurance Advisor

I recently worked with a young physician to set him up with personal disability protection to provide some financial security if life throws him and his family a curve ball. Prompting our planning was that one of his peers in the general surgery specialty sustained a serious hand injury, ending his ability to perform hands-on surgery.

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5 ways to develop inclusive hiring practices

By Society Insurance Human Resources, reposted with permission from Society Insurance

Inclusive hiring practices recognize diversity and embrace a wide range of perspectives that candidates from all walks of life bring to the organization. And according to research from Monster, “Four in five (86%) candidates globally say diversity, equity and inclusion in the workplace is important to them.”

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Affordability Testing

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

The Affordable Care Act (ACA) brought a lot of extra work to employers and insurance companies. Whether you are pro-health care reform or against it, per the Health Affairs article, the ACA has not made insurance more affordable. Many health insurance carriers have stated the ACA, Summaries of Benefits and Coverage, machine readable files and other changes imposed added costs to insurance companies, which simply passed these costs on to employers and employees in premiums.

Insurance premium affordability is very important because it allows for more money to employers and employees and is a requirement for groups with 50 or more employees. As you may know, health care reform requires employers with 50 or more employees to offer a group health insurance option that is affordable and meets the minimal essential coverages or the employer can face a potential monetary fine (the 2022 fine was $4,120 annually per subsidized employee). Additionally, the employer should be testing to confirm the affordability requirement is being met for their employees’ premium charges. Based on health care reform’s 2023 rules, to be considered affordable in 2023, an employee cannot be charged more than 9.12% of the employee’s household income.

Do you need to test your affordability? Are you offering a plan similar to other health care companies in your areas? WisMed Assure is the only insurance agency in Wisconsin focused on health care clients and we would love to tell you more about what we can do! Please call me at 608.442.3734 or email chris.noffke@wismedassure.org.

Summer 2022 Issue

Do you have the old or the new life insurance?

By Tom Strangstalien, Insurance Advisor

September is Life Insurance Awareness Month and is the time when I urge all our members to take a moment to reflect on the life insurance protection they have in place. Not too long ago, life insurance (especially term life), was generally viewed as a commodity.

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Build your financial wisdom

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Join us for online educational sessions presented by WisMed Financial exclusively for Wisconsin Medical Society members. Session topics include retirement planning, social security and tax planning.

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Open enrollment

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

We’re rapidly approaching autumn and it’s time to start thinking about your open enrollment. Many companies fail to properly do an open enrollment, or maybe it’s your first time.

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Workers’ Compensation rate changes & good news for health care professionals

By Brian Fowler, WisMed Assure Account Director

Starting October 1, 2022, Workers’ Compensation rates in Wisconsin will drop for the seventh year in a row. Unlike many other states, Work Comp rates in Wisconsin are set by the state and are the same for every insurance carrier. The decrease is 8.47% over all employee classifications.  

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$111,000 more from Social Security

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

With more than 2,700 rules and 567 separate filing strategies for Social Security, 96% of people fail to make the optimal claiming decision and miss out on $111,000 of benefits for the average household.

$111,000 – that’s a lot of money. Let’s look at some of the rules for Social Security so your decision is better informed.

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How to prevent floods from damaging your business

photo of cars on a flooded road

By Society Insurance Team, reposted with permission from Society Insurance

The continued impact of extreme weather events isn’t lost on businesses: according to one report, businesses can expect to see roughly $13 billion in flood damage in 2022. Tornados, derechos, and severe thunderstorms all threaten billions in damage, but with spring just ahead, let’s focus on how you can protect your business from the threat of flooding.

Businesses everywhere are susceptible to flood damage—so how can they prepare?

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Lower Health Insurance Costs with Strategy and Unique Offerings

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

In 1946 the Wisconsin Medical Society established WPS to help physicians and residents pay for the costs of health care. Seventy years later I had the chance to help create another opportunity for health care professionals, the Wisconsin Medical Society Welfare Benefit Trust (WMSWBT) or the Association Health Plan (AHP). This year I was able to negotiate with our carrier partner, WPS, to lower our rates for all new groups. This has shown significant cost reductions for groups by decreasing their premium rates (up to 40% for some areas).

One Milwaukee-area group enrolled with the rates seen here:

An example of rates for the Marathon County area:

If you haven’t spoken with us about all the services, strategies and benefits available to you through the Wisconsin Medical Society’s insurance agency, reach out today. Even if your current health plan is in the middle of its cycle, we can still find savings for you and your employees (employees can even get deductible credits for health care dollars spent).

Let me give you a no obligation quote today – we can give you a preliminary rate within 2 days of receiving your census. You’ll see that we offer great rates, unique services and are the only agency that exclusively serves the health care community. Let’s schedule a time to talk.

Happy Spring!

Look out! Open Enrollment Is Upon Us!

Never fear… WisMed is here

By Chris Noffke, GBDS – VP of Employee Benefits

November is coming and so too are your updated employee health plan costs… if the carriers are up to speed!

Regardless, it is time to start thinking about and planning for open enrollment. In addition to being prepared so that employees have the time, information, and support they need to select a plan that best fits their needs, here are some important changes you need to know;

  • 2021 affordability percentage is 9.83%, up from 9.78% (This applies to groups of 50 or more employees)
  • Out of Pocket Maximums for 2021: $8,550 for self-only coverage and $17,100 for Family
  • HDHP and HSA Limits for 2021 (see chart)

Compliance, compliance, compliance… talk about fun!

In all seriousness, here is a reminder of when to submit your ACA Disclosures and Notices:

  • Special Enrollment Notice: Initial Eligibility and each Open Enrollment and also must be in SPD (Summary Plan Description).
  • SBCs (Summary of Benefits and Coverage): Required 30 days prior to new plan. Must be provided during each annual enrollment. If an employee must enroll to continue coverage, the SBC must be provided when open enrollment materials are distributed.
  • CHIP Notice: Annually, before beginning of plan year. Recommend to include with Open Enrollment materials and upon initial eligibility.
  • Medicare Part D Creditability: Must be sent before October 15, regardless of your plan year.
  • Women’s Health and Cancer Rights Act (WHCRA): Annually & upon initial enrollment / Usually sent at Open Enrollment.

Market Updates

General opinion on this year’s premium increase range widely between 4 and 10 percent for group benefits.

As to trends in plan design in response to COVID, a survey conducted by Mercer in June found that 37 percent of employers do not anticipate adjusting benefits for 2021. It also found that 48 percent are taking a wait and see approach.

While waiting to see what plans will actually cost, I believe we need to be mindful of what’s almost certain to occur in 2021. Many plans have made gains this year because employees are deferring elective care, but, as COVID releases its grip, it will almost certainly result in a much higher than normal plan usage in 2021.

Some of you may have an opportunity to lower costs if you are willing to change insurance companies. But, look at any “gift horse” very carefully, you could be facing an even larger increase than normal next year if you switch to a company that is trying to grab marketing share.  If you are uncertain what to do, but find yourself in a situation where status quo means accepting a significant increase, we should talk.

And, if you would like to discuss how you can prepare now for what’s ahead, contact me.

Open Enrollment Safety

We will still be hosting town hall meetings but will be doing so with COVID-19 safety in mind. 

Please contact me to discuss arrangements for virtual enrollment meetings for your employees.

Chris Noffke

608.442.3734 direct


Navigating Testing in a COVID Environment

By Chris Noffke, GBDS – VP of Employee Benefits

Navigating insurance benefits is complex and confusing for consumers and business owners alike. Today’s insurance landscape requires people seeking benefits to understand insurance terms like deductibles, coinsurance, out of pocket limits, annual out of pocket limits (yes this can be different caps) and many others.

On top of that, you now have to understand the ins and outs of preventative care coverages and COVID related no-cost, shared-cost coverages.

Currently most insurers are covering the COVID tests, antibody testing, and treatment with no cost share. But be aware, these 100% covered costs will eventually become the patient’s responsibility. Some testing may continue to be covered at no cost to the patient but you may be billed if you go outside of your network or don’t have an approved reason for testing.

We can begin to understand why by looking at the cost of one of these tests. A local PPO (preferred provider organization) reported that they have seen the cost of COVID Antibody testing (Codes 86328 and 86769) range from $23 – $1,023.92, which is one of the major issues with understanding your cost shares.

So, while this test may be covered based on current legislation, when will it no longer be covered? As of right now, there is a lot of speculation that once the “state of emergency” ends, you may see no cost end too.

Currently, to get an antibody test done, it needs to be ordered by a healthcare professional in an office visit, urgent care room or emergency room. Although there are some guidelines for how out of network visits will be covered, patients are sure to see costs shifted to them.

What does the future hold?

When I think about our healthcare future and how COVID-19 will impact the cost of care, it causes a significant sense of concern. With so many people avoiding seeing a physician during social distancing, we should anticipate a surge of chronic illnesses with higher than average claims costs. Staying home means those with anxiety, depression and obesity may be spending even more of their time on couches and this means less physical activities and socialization.

A recent report by Milliman – the highly respected risk management consulting firm – states, “We expect an increase in costs after the Pandemic due to deferred care and pent-up demand… The estimate of services deferred to 2021 is beyond the scope of this paper, but those costs are likely to be very significant.” The report says that ‘very significant’ is an understatement, as it speculates there will be at least $75 billion and as much as $575 billion in deferred care.

And that’s for non-COVID care! Another analysis, commissioned by America’s Health Insurance Plans, estimates that total costs of COVID-19 for commercially insured individuals could range from $44.6 billion to $438 billion over the next two years.

Arriving at a clear conclusion is impossible given the volatility of our times. But, what we can do is work together to protect each other while aggressively looking for ways we can collaborate to protect our healthcare future.

For a comprehensive look at COVID-19 related insurance coverage, check out this Health Affairs article by Katie Keith and take a look at Wismed Assure’s Covid-19 Updates page for added tools and resources.