- PEO (Professional Employment Organization)
- Individual Health Insurance
- Group Health and Employee Benefits
Individual Health Insurance
Article provided by: National Association of Health Underwriters
- What is individual health insurance?
Individual health insurance is coverage that a person buys independently. It can be sold to a single individual, to a parent and dependent children, or to a family. The majority of Americans get their health insurance coverage through an employer or through a government program, but five percent of the population purchases private health coverage on an individual basis. Each state separately regulates how individual policies may be marketed and sold.
- How can I buy individual health insurance coverage?
In almost every state, individual health insurance coverage can be purchased through licensed health insurance salespeople known as agents or brokers. Independent agents and brokers sell insurance plans from many companies, and they can help you find the coverage that best suits your individual needs.
Agents and brokers also provide service on the policies they have sold, and can help you process claims or with anything else you need regarding your policy. The insurance companies for which agents and brokers sell coverage pay them a commission for their work, so you will not be charged a direct fee if you want to use the services of an agent or broker. You can find agents and brokers who sell individual coverage via the Internet, or you may prefer to consult with one in person.
- How is individual insurance different from group insurance?
Individual health insurance is very different than group health insurance, which is the type of insurance that is offered through an employer. Since laws mandating what types of services must be included in individual policies are often different than those dictating what must be included in group policies, benefits are generally less extensive than what most people would receive through coverage they have through work. Individual consumers may be surprised to learn that some benefits that may be considered “standard' in a group policy, like maternity coverage or substance-abuse treatment, may not be included in an individual plan. Sometimes individual health insurance consumers have the option to pay extra for coverage of additional services like maternity coverage. This extra coverage is referred to as an optional rider.
Cost is often the primary factor for individual health insurance consumers, which is another reason why the benefits included in individual policies are often simpler. In addition, deductibles (the amount you have to pay before insurance benefits begin) and cost-sharing (the fees you pay directly to medical providers at the time of service) are also generally higher.
Individual health insurance companies are much more limited than group insurance companies in their ability to spread risk, so the laws concerning individual health insurance are different in most states. This means that applicants for individual insurance will need to complete a brief medical questionnaire when applying for benefits and, unlike a group insurance policy, in most states a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them "uninsurable."
- How are premium rates determined?
In the vast majority of states, when you apply for individual health insurance coverage, you are asked to provide health information about yourself and any family members to be covered. When determining rates, insurance companies use the medical information on these applications. Sometimes they will request additional information from an applicant's physician or ask the applicants for clarification.
If the insurance company is unable to obtain information necessary to accurately determine the risk of a particular applicant, it will underwrite more conservatively, meaning that the assumption relative to the missing information will be negative rather than positive.
Example: A person has a history of high blood pressure, but it is controlled with medication and he is not overweight. If the company is unable to determine if that individual smokes or if he has normal cholesterol, the company will assume that the missing information is negative and rate accordingly.
Once the company has determined your health status, you will be assigned a rate class by the company and put into a pool of other insured individuals with similar health status. Your premium will be the rate charged to that entire class of customers. Subsequent annual renewal premium rates will be determined not by your individual claims, but instead by the claims experience of the entire rating class pool.
- Are any pre-existing medical conditions covered?
Even though in almost every state an individual insurance company can choose not to offer coverage to people with serious medical conditions, most Americans don't have perfect medical histories and most still qualify for individual coverage. However, there are some individuals who do not decide to purchase health insurance coverage until they know that they have a medical problem that will require the use of benefits. This is known as "adverse selection", and it can be a serious problem for individual market insurance companies since their ability to spread risk is so limited.
To help prevent adverse selection, insurance companies are allowed to look back at your medical history for pre-existing conditions and may choose not to cover certain conditions for a specified period of time. This is known as an exclusionary, or pre-existing condition, waiting period. The amount of time an insurance company can look back at your medical history, and the length of time an exclusionary period can last, vary on a state-by-state basis. In some states, you can receive credit against a pre-existing condition waiting period if you have had prior health insurance coverage within a specified number of days. The amount of the credit against the waiting period is generally proportional to the length of the prior coverage.
Also, many states allow health insurance companies to issue elimination riders to people who have pre-existing medical conditions. Elimination riders allow for insurance companies to offer an individual with preexisting condition coverage but exclude coverage of that condition.
Example: An individual has severe seasonal allergies but can control them with medication. A company may offer the applicant two policy options: a policy at a more expensive rate with full allergy coverage and a pre-existing condition waiting period, or a cheaper policy with no waiting period that excludes allergy coverage. The individual may find that it is more affordable to buy the cheaper policy and pay for his allergy medication out-of-pocket.
- Can I still buy individual insurance if I have a very serious pre-existing medical condition?
In most states you can be turned down for individual coverage if you have a very serious medical condition (e.g., HIV or cancer). Fortunately, even though they are not required to do so, most states have developed some way to provide uninsurable people with access to individual health insurance coverage. Thirty-three states provide coverage to medically uninsurable people through high-risk pools. Twelve states use other means of providing uninsurable people with access to individual coverage (e.g., requiring that all individual health insurance companies issue individual policies regardless of health status, coverage through a designated health insurance company of last resort, etc.). There are five states that still have no means of providing individual health insurance access to people with catastrophic medical conditions. To find out what your state's options are for medically uninsurable individuals, check out our Health Care Coverage Options Database.
Since each state sets its own requirements for individual health insurance policies, how can I find out what the requirements are in my state?
To find out about each state's specific requirements regarding individual health insurance policies, you can visit NAHU's Health Care Coverage Options Database. The database also contains contact information for the state regulators of individual health insurance policies to use if you have questions or concerns.
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PEO (Professional Employment Organization)
- What is a PEO?
PEO’s (Professional Employer Organization,) are a modern marvel made possible by powerful technology, intelligent people, and the internet.
Think of a PEO as Large Company whose creates an umbrella for other businesses to come under to obtain Human Resources functions. Many employers are plugged in under this umbrella, creating a very large company, some which are over one hundred thousand strong. The employees under the umbrella are referred to as “worksite” employees of the PEO.
The Umbrella organization, or PEO, will do all the typical HR functions all companies need; payroll, quarterly tax filing, employee benefits and benefit administration, government compliance, workers compensation and administration, state unemployment administration and claims, employee handbooks, I9’s, W2’s, job descriptions, ………..etc.
A well run PEO can collect data, quote, contract, load systems, train, enroll, and have your company plugged into a fully functional, legally compliant HR “department,” with all the complementary systems, services, and benefits in a few weeks. It is the pre-packaged, perfected solution for those who want to run a business; in the fast lane.
PEO’s, through a contractual arrangement, provide the framework for an employer to come under the umbrella of a very large company for the purposes of obtaining some or all of the following:
- Wall Street quality professional HR Support and Administration
- State of the art HR Systems
- Fortune 500 Employee Benefits and Administration
- Affordable workers compensation and claims adjudication
- Complete payroll system and administration, and tax filing
- Compliance expertise for Federal, State and Local laws, mandates, and the like
The phenomenal speed and agility of the PEO to flex with an organization in times of; expanding or downsizing, insourcing or outsourcing, acquiring or merging, diversifying or consolidating, relocating, re-organizing, and all other “normal” business transitions is painless within the PEO model.
A well run PEO can navigate through upheavals like these seamlessly, because of sophisticated systems and the use of a Single Tax ID.
The exhausting administration demands, the potentially devastating pitfalls of non-compliance, the ever increasing governmental regulations, combined with our litigious society are making PEO’s, across all industries, more and more an essential adjunct to doing business. Once a company comes to realize and appreciate the true brilliance of operating under the PEO umbrella, they never step out into the rain again.
- Is a PEO more expensive?
There are reasons PEO’s are becoming the new competitive imperative in business of all sizes. It often cost less to operate your business under the PEO umbrella, as opposed to internal alternatives. Sometimes a company saves so much in benefit premiums alone that it more then covers any PEO service fees charged.
A simple analysis of your business can easily determine if you have a business case for a PEO, and if your business would save money going in this direction.
- Do you have a business case of a PEO?
Businesses with these specific situations often have a business case for a PEO and should explore a PEO solution.
- Need to compete with larger companies for professionals in high demand
- Have unaffordable health insurance rates
- Anticipate selling or merging
- Expect constant change in the size of the workforce
- Operate across many states
- Have very high turnover and many State Unemployment claims
- Have U.S. employees but are based overseas.
- Have very complex payroll situations
- Have high worker’s compensation insurance cost have many worker compensation claims.
- Have a large virtual staff
- Expect rapid growth
- Transitioning Independent contractors to W2 employees
- Have outgrown current HR expertise
Business Size: The PEO model works best for employers with, or planning to have at least 10 or more full and/or part time employees. The range in size accepted by PEO’s runs the gambit, from one employee into the thousands.
Business Type: Nearly all segments of industry are adopting PEO’s as their business model. Very blue collar to ultra white collar, and everything in between. Restaurants, Accounting Firms, Banks, Insurance Companies, Fast Food Chains, Manufacturing Organizations, Trucking Firms, Hospitals, Medical Practices, Marinas, Oil and Gas, Home Health, Dealerships, Assisted Living, Legal firms, Non profits, and the list goes on.
- Employee leasing vs. a PEO
- Traditional Employee Leasing
- A Temporary Agency
- A PEO, Professional Employer Organization
- An ASO, Administrative Services Organization.
The Traditional Employee Leasing Model of old involved a company, often a consulting firm, firing a segment of its' current workforce. The leasing company then immediately re-hired that segment and leased them back to the original employer. Prior to this event, a contractual arrangement had been made between the Employer and the Leasing firm.
Often the affected employees felt betrayed. Even if they kept the same job in the same location, they were working for someone else; they were no longer part of the same benefit plan, 401K, etc.
A Temporary Agency brings in Temporary employees, usually for a specific short term task. This can be one or many employees. When the task is complete, the employees go back to the leasing firm.
A PEO is an evolved form of employee leasing. In the "evolved" Professional Employer Organization, current employees' are not "fired" from their employer, but they are technically "hired" or "co-employed" by the Professional Employer Organization. The client company is referred to as the Work Site Employer or Client Company, and the PEO is referred to as the Employer of Record for HR and Administrative Functions, or Administrative Employer.
In the PEO Model, all employees, all managers, owners, and everyone drawing a paycheck is co-employed. No person is singled out. Everyone is on the same benefit plan, 401K, vacation schedule, etc. If explained correctly, no one feels "betrayed."
Payroll is processed by the PEO in this model. The payroll is processed under the Tax ID Number of the PEO. This is what provides the legal framework which allows participation in benefits and worker compensation insurance, and allows the PEO to file payroll taxes. For all of your payroll, taxes, fees, benefits, workers comp; you receive one invoice. The Invoice should be itemized clearly so you can determine what charges are pass through vs. fee. All these expenses are spread equally by pay periods, which greatly improve cash flow.
The ASO, or Administrative Service Organization, is like a PEO, except there is no Co-Employment Contract. The ASO will process payroll, but under your own Tax ID number. The ASO is a contractual option offered by most PEO’s, and if you do not need the PEO’s group benefits, it is an excellent option. Other services are normally the same as the PEO except your employees are never "hired" by the PEO. Many ASO's will administer your benefits. This is a great interim step in moving to the PEO model.
- Shopping for a PEO
Why not shop for a PEO yourself? Why do most companies use an intermediary or an "Authority" if you will, to help select the right PEO for their company? There are over 700 PEO's in business today. No two are exactly alike. It is the nuances within the different PEO’s that can determine which is the very best PEO for you.
If you're considering a PEO, one reason might be that you are overburdened, wanting to offload administrative work, and perhaps stressed out. What more stress? Shop for a PEO yourself. Want even more? Make a bad selection.
It is wise and productive to use experienced professionals who have worked through the PEO selection process many times, and therefore learned from experience what questions to ask, what to look for, and what to avoid. See Inside a well run PEO
If you want to buy land in an unfamiliar area, having a good real estate agent who knows tidbits like: "that land will soon be a neighbor to a state of the art asphalt plant" can keep you from wasting a lot of time and money.
Purchasing PEO services are much more complex then buying land, and having an good, experienced broker on your side who can protect you by knowing the right questions to ask, how to compare services and fees, how to evaluate benefits, what is negotiable, what is not, and why; can also save you a lot of time and money
- Guidelines for finding a PEO
Below is the National Association of Professional Employer Organizations (NAPEO) guidelines to companies considering a relationship with a PEO:
- Assess your workplace to determine your human resource and risk management needs.
- Make sure the PEO is capable of meeting your goals. (about 25 steps to this process)
- Meet the people who will be serving you.
- Ask for client and professional references.
- Check the firm's financial background.
- Ask for banking and credit references.
- Ask the PEO to demonstrate that payroll taxes and insurance premiums have been paid.
- Check to see if the company is a member of NAPEO, the national trade association of the PEO industry.
- Investigate the company's administrative and risk management service competence.
- What experience and depth does the PEO’s internal staff have?
- Does the senior staff have professional training or designations?
- Check to see if the PEO's risk management services have been certified by the Certification Institute at www.certificationinstitute.org.
- Understand how the employee benefits are funded. Is the PEO fully insured or partially self-funded? Who is the third-party administrator (TPA) or carrier? Is their TPA or carrier authorized to do business in your state?
- Understand how the employee benefits are tailored. Determine if they fit the needs of your employees.
- Review the service agreement carefully. Are the respective parties' responsibilities and liabilities clearly laid out? What guarantees are provided? What provisions permit you or the PEO to cancel the terms of the contract?
- Make sure that the company you are considering meets all state requirements.
If just reading this list exhausts you, hire a PEO Broker/Authority. If you did not even finish reading to the end of the list, certainly hire a PEO Authority.
A dozen or more other considerations should be added to this list, but the point is clear. A proper selection process takes time, experience, and specialized knowledge.
The job of a PEO Broker
- Understand Your business and HR needs
- Determine if a PEO solution right for you
- Identify TOP PEOs that fit your unique needs, and budget. (see inside a well run P E O)
- Pre-Qualification of PEO candidates
- Collect necessary Employer Data
- Prepare and send RFQ’s
- Review Bids, Eliminate non-competitive bids
- Analyze, Simplify, and Summarize bids
- Prepare Concise and easy to understand presentation
- Present Options
- Make recommendations
- Assist in Negotiation of PEO's Fees and contract provisions
- Assist through the contracting process
- Assist in negotiations of contract provisions
- Assist throughout the installation and enrollment process
- Do I give up control of my company?
Many employers exploring a PEO relationship can misunderstand where the PEO/Worksite Employer lines are drawn concerning control, liability, authority, and data access.
Control: You maintain ultimate control. You can fire your PEO. They can not fire you.
The Worksite employer maintains control over the employees’ jobs, tasks, pay, hiring, firing, etc. and all of the internal business functions; Advertising, Accounts Payable, Accounts Receivable, Financial data, Income, Expenses…etc. The PEO can not barge into your worksite uninvited and demand anything.
If the Worksite employer refuses to follow procedures, and causes risks for both the PEO and yourself, problem solving is warranted. If the Client Company continues blatant negligence, the PEO retains the right to terminate the contract, and rightly so, because they share the risks.
The PEO contract will always state that the PEO “retain the right” to hire, fire, reassign, discipline, etc. This is a necessity of the contract.
Liability: The PEO shares the liabilities of the workforce. If you are sued by an employee, the PEO is named in the suit. If Unemployment claims are filed, the PEO adjudicates the claim. If won, it negatively affects the PEO’s SUTA rate. If a workers compensation claim is filed, the PEO works the claim, and it can reflect on the PEO’s work comp modifier.
Authority: You maintain all real authority: 1. documents can not be signed on your behalf by the PEO. 2. The PEO cannot write checks against your accounts. 3. The PEO cannot make and implement decisions concerning your workforce without your permission and involvement. 4. The PEO does not have a key or access codes into your worksite. 5. PEO's will not visit unannounced, or go through your files.
Data Access: PEO's do not have ongoing access to your private accounting records or bank account information. As long as you are with the PEO, you will always have access into your employee records and payroll records.
The PEO will not and does not want to:
- take over your company
- act like your boss, you are certainly not working for them
- have access or visibility into your business financial data or bank accounts
- pull money from your bank or write checks from your account
- redirect your business plans
A PEO does want to:
- Shift non – revenue producing activities from the Client to themselves.
- Protect you from fines and lawsuits (they share your exposure).
- Create and help maintain all the important documents, logs, filings, manuals, etc. that will keep you from being sued or fined. (Employee Records, OSHA logs, Safety Manuals, Employee Handbooks, Job Descriptions, Hiring and Firing documentation and procedures, Cobra Compliance, etc.
- Handle workers compensation claims and unemployment claims.
- Keep up to date employee records, time and attendance, vacation accruals, sick leave, PTO, all aspects of payroll, quarterly tax filing, and other non – revenue producing but necessary administrative functions.
- Contracting with a PEO
Like many rapidly changing business models, laws can lag behind industry evolution. In some states the traditional employee leasing laws are still used to govern a PEO relationship. That is why the first part of a PEO contract often reads like an obsolete Employee Leasing Contract. Later, the same contact rescinds that outdated language and inserts the newer co-employment language. If you do not understand the reasons for a sometime strangely written contract, the contracting phase with a PEO can be somewhat baffling indeed.
There are lawyers who specialize in this area of contract law. (link to lawyers from OCIPEO)
- Inside a well run PEO
You have seen the cell phone commercial where "the network" of eager service people stands behind the single cell phone user with baited breath waiting to serve.
PEO are also about the network of people. When you contract with a PEO, you have essentially hired their Staff, whom you will and should depend upon and trust. They are your paid HR department after all.
What are the people like? How well are they trained? How well are they paid? What is their turn over like? How long have they been working for the PEO? Are they certified, licensed, do they have the right credentials? Has their backgrounds been checked? In the end, it is this group of people who make up the PEO that will matter most to you.
Walking through an established top notch PEO, look for the number of people in their workforce to be in proportion to the number of worksite employees that they manage. There is a direct and critical relationship between the number of Worksite employee’s that are managed by a PEO, and the number of Employees employed by the PEO.
Understaffed PEO's can spell trouble.
An under qualified staff or an under paid staff will also be trouble.
Check out the staff and review the organizational chart. Expect to see these titles: Certified Public Accountant, Certified Safety Manager, Certified Trust and Financial Advisor, Certified Employee Benefits Specialist, Senior Professional of Humana Resources, and Certified Payroll Specialist among the management staff.
If a PEO loses a payroll person, or an HR professional leaves the PEO, the total knowledge base or workflow should not be affected, and all processes should continue running without disruption to the Work Site Employer. Cross training is a must in a well run PEO.
Some very small or less well run PEO's are pieced together by re-outsourcing too many of the PEO's various functions. Core functions should not be re-outsourced.
Technology should be top notch. System and technology have been developed specifically for the PEO industry, and PEO's that have up to date technology can deliver the best interface, reports, and visibility to all the data you may ever need to see to manage your workforce.
If a PEO offers Health Insurance Benefits, the benefit participation should be in proportion to the number of worksite employees. If a PEO has 20K worksite employees, and 800 participate in benefits, an entire series of questions are warranted.
If a PEO offers health insurance benefits or workers compensation insurance, the structure of the insurance plans should be known and understood. Are the benefits self-funded, partially self-funded, fully insured, re-insured, what is the stop loss, is the Third Party Administrator Licensed in your state are among the questions that should be asked.
A well run PEO should have multiple redundant backup and disaster recovery systems in place. If a PEO is located in Florida, and they have a hurricane, or if it is located California, and they have an earthquake, your payroll should still be processed and on-time. It would be unrealistic to expect no disruption in service after a Cat 5 hurricane; however, a plan should be in place for time sensitive critical functions to continue regardless of the magnitude and duration of any disaster.
A PEO maintains very sensitive employee and payroll data. Data should be protected with the best in class security systems, firewalls, and physical security systems. Procedures should be in place which guarantees that the PEO’s employees do not remove sensitive data from the worksite.
Private vs. Public PEO's. Like any business, some PEO's are publicly held and others are private. The motivation and pressures the management endures can be very different in a Private firm vs. a Public firm. It can trickle down to you.
Small vs Large PEO: There are very large global PEO's and small regional PEO's. There is a relationship between size and flexibility and larger is not always better. It depends on your needs.
Certified vs. non Certified PEO: ESAC (www.esacorp.org) is the certifying company for PEO's. It is often said that ESAC is to PEO's as the FDIC is to banking, except that ESAC provides even more insurance, audits, and requirements then the FDIC. To get information on ESAC's checks and balances see https://www.esacorp.org/ESAC_SEC.asp. There are reasons PEO's, even major PEO's, choose not to be ESAC certified. In some situations certification is imperative.
- Can you be turned down by a PEO
PEO's can discriminate on who is accepted under their umbrella on a variety of factors. Here are a few:
- worker's compensation class codes
- prior worker's compensation claims
- state unemployment claims history
- industry type
- physical location's
- number of employees
- financial stability
- prior complaints
- lawsuits and pending investigations
- financial data
- number of years in business
- web access by employees
The decision to hire a PEO, as well as the decision for a PEO to accept a Client, is bilateral. A PEO that accepts every company that comes along is suspect. When a PEO that normally deals with larger firms accepts a smaller company into the fold, that smaller company can be neglected. The small employer often does not get the attention it deserves, and would have been better off with a PEO that works predominately with smaller companies.
PEO can accept a company but withhold some services. For instance, if the health risks in the group are too high, some PEO's will deny the group participation in their group insurance plan, but otherwise accept the group for all other services. Upon renewal, the company must be offered benefits. If denied Health Insurance, some PEO may still administer the client company's plan as if it were their own. Some will not administer it at all, and yet others will re-outsource the administration. Some are connected with brokerage firms that will shop benefits on the open market.
The same holds true with Worker Compensation Insurance. If the class codes or risk factor are too high for the PEO, some will deny the company while other will offer all other services but require that they maintain their own workers compensation insurance. Some will administer workers compensation for you without providing it, while others will not administer it unless they provide it.
Which situation is best for the Client depends on various factors that must be evaluated.
- Health Insurance Benefits within the PEO
Benefits are important and can later make or break your PEO relationship.
Examples of a few questions to ask when evaluating PEO candidates;
Is your plan truly a large group plan?
Are the benefits priced in 4 tiers, EE, ES, EC, Family. Can the company offer multiple plan options? Can the company contribute more to managements benefits vs. hourly employees? What participation is required?
Are all of the worksite employees within the PEO quoted together, or are the individual client companies being underwritten separately?
What is the history on rate increases with the PEO carrier?
Does the PEO require the Client Company to join their plan? Or, can you procure benefits outside of the PEO?
If the Client Company procures their own benefits at any point in time, will the PEO administrate the benefits, subcontract out all or part of the benefits administration, or will the administration fall back on the Client Company?
How many worksite employees participate in the plan? How many worksite employees does the PEO have?
How does the PEO avoid adverse selection? Is their a multi-tier rating structure? Can you be declined benefits?
If the group is classed into the most favorable tier, can it be re-classed later in a less favorable tier due to claims? If so, when? How many tiers can it jump?
How is the plan funded? Is it self-funded, partially self-funded, fully insured? Re-insured? How much re-insurance? Is the plan registered with the state? Is the plan structure legal in your state? Does the plan comply with your state mandated benefits?
Based on how each question is answered, there are likely more questions to be asked. If the benefit plan within the PEO is important to you, then a careful examination of the PEO’s plan is critical.
- PEO pricing structure - fees
Finding out exactly what Fees are being quoted for PEO services can sometimes be like swimming to the bottom of an ocean; exhausting and you never get there. Comparing Fees between companies can also be a challenge. Look for PEO’s that are very upfront and transparent with their fee structure. Analyze fees so that you know what the real cost is for service verses what fees are just pass through.
A few of the questions to consider:
- Is Workers Comp a profit center?
- Are Benefits a Profit Center, or are those cost a straight pass through.
- Are tax cut offs honored or does the PEO profit at the end of the year by continuing to charge taxes after cut offs?
- Are Single Wage Base documents being processed? If so, who benefits?
- Is your fee quoted per head, per check, as a percentage of payroll, or a combination?
- How is your fee displayed on the invoice, will the client be able to see it clearly every month?
One fee structure is not necessarily better than another. For example, a per-head fee may be good if you have highly compensated employees who receive large bonuses, but not good if 60% of your workforce is low wage part-timers. If a PEO profits from worker comp, it might be that they are self-funding and doing a good job of managing the work comp pool.
Group Health and Employee Benefits
The Texas Department of Insurance has put together the best and most comprehensive resource for obtaining General Information for small, medium, and large businesses.