Employee Benefits

Hardenbergh’s Approach to Employee Benefits

At Hardenbergh Insurance Group (HIG), we do not work for the insurance carrier, we put our expertise to work for your business, and your employees. Your choice for an employee benefits broker has far-reaching effects. Did you know a broker helps you manage a budget of about 25 to 40 % of your payroll? Even a small difference in capabilities, strategy, technology, and the results can have a dramatic difference on your bottom line since Health Insurance is a leading expense for every business.

A broker’s work does not only impact the financial wellbeing of your company. It often has a profound effect on the health and welfare of employees and their families. For that reason, we partner with you and consult on how to maximize your Employee Benefits Package so that everyone wins. HIG does this by learning about your business and listening to your needs. From there HIG offers strategic solutions to meet those needs.

Once a benefits package is designed, the next step is to communicate the benefits package and offer employee support. Whether your company is ready to do Open Enrollment online with our enrollment tool or you require in-person support, we can customize a communication strategy that fits your organizations’ needs.

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HR & Compliance

HIG aligns with your Human Resource department to efficiently handle Employee Benefits issues to allow your team to concentrate on your business and your employees. Whether you are facing budgetary issues, compliance concerns or need help with employee engagement we can help you achieve those goals. We understand a healthy benefits package can make a positive impact on your employee’s overall morale and is a one of your best recruitment tools.

Here is what you can expect from us:

Carrier Audit & Reconciliation
Onsite or Online Open Enrollment Support
Benchmarking
Voluntary Benefits Analysis
Monthly Benefit Newsletter
5500 Reports
Erisa Wrap Documents
COBRA & State Continuation
Employee Surveys
ACA Reporting
COVID-19 Resources
HIG Academy Educational Opportunities
Compliance Calendar for Employee Notices
HR Support
Online Benefit Enrollment
Claims & Appeals Support
Wellness Campaigns
Medicare Consultation

The Basics Of Employee Benefits

All plans provide coverage for visits to primary care physicians and specialists, hospital, and emergency/urgent care. Regardless of what kind of plan(s) you select your employees will need to help in understanding this difficult landscape. When searching for the right coverage for your employees, the terms may be overwhelming. To make it easier, we compiled a list of commonly used terms used for health coverage.

Allowed Amount - The maximum amount your plan will pay for healthcare services. You may also hear related terms such as “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference.
Appeal - A request for your health insurer to review your grievance again.
Balance Billing - When a healthcare provider bills for the difference between what the provider is charging and the allowed amount. For example, if the provider is charging $100 and the allowed amount is $70, then you are responsible for the remaining $30.
Co-insurance - Your share of the costs of a covered health care service after you’ve paid the deductible. You pay co-insurance plus any deductibles you owe. You pay a portion, and the carrier pays a portion.
Co-payment - A fixed amount you pay in addition to the amount paid by the insurer.
Deductible - The specified amount of money you pay for health care services before your health insurance or plan begins to pay. The deductible may not apply to all services.
Grievance - A official statement of complaint that you communicate to your health insurer or plan.
In-network Co-insurance - If your expenses surpass the out of pocket limit, your health insurance plan will pay the remaining amount. In-network co-insurance amounts are usually much less than out-of-network co-insurance.
In-network Co-payment - A fixed amount you pay for covered health care services, usually when you receive the services, to providers who contract with your health insurance or plan. In-network co-payments usually are less than out-of-network co-payments.
Network - The facilities, providers and vendors your plan has contracted with at a discount to provide health care services.
Non-Preferred Provider - A provider who does not have a contract with your health insurer or plan to provide services to you. You will pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.
Out-of-network Co-insurance - The amount you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. You will pay more for out-of-network co-insurance than in-network co-insurance.
Out-of-network Co-payment - A fixed amount you pay for covered health care services from providers who do not contract with your health insurance or plan. You will usually pay more for out-of-network co-payments than in-network co-payments.
Out-of-Pocket Limit (or commonly referred to as Maximum Out-of-Pocket) - The most you pay during a plan period before your health insurance or plan begins to pay in full the allowed amount. This limit does not include your premium, balance-billed charges or health care that is not covered by your health insurance or plan.
Preferred Provider - Your health insurance or plan has contracts with preferred providers who are able to provide services to you at a discount. It is a managed care organization that consists of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates.
Premium - The amount that must be paid by your employer or sponsor for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.
Provider - A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law who helps in identifying or preventing or treating illness or disability.
Specialist - A health care professional whose practice is limited to one particular area and is certified by a specialty board as being qualified to limit their practice. Specialists are primarily responsible for providing emergency medical treatment, limited primary care and health protection and evacuation from a point of injury or illness.
UCR (Usual, Customary and Reasonable) - Rates established based on the geographic region and the medical service provided to you. The UCR amount sometimes is used to determine the allowed amount.

Employee Benefits FAQ

It is very easy to make mistakes even from just a processing standpoint. Errors can cost American taxpayers billions of dollars per year. Hardenbergh will help you navigate the complexities of the ever-changing healthcare system. Some things to consider is the health care reform checklist, diagnosis, whether you own a business, and more. Here are some commonly asked questions that may help you in the process:

Getting Married - can I add my new spouse on the coverage or do I have to wait for open enrollment?
I am expecting a baby soon. What are the requirements for adding my baby to my coverage?
Am I required to contribute to my employees health care premiums?
How do I navigate COBRA rules and regulations?
What is the difference between an HRA, F.S.A. and H.S.A.?
What are the minimum amounts of hours my employees have to work to be eligible for health benefits?
As an employer, am I required by law to offer benefits to my employee’s spouses and/or dependents?
Am I allowed to ask my employees questions about their health conditions?
I am getting married soon. Can I add my new spouse and/or stepchild(ren) to my coverage or do I have to wait until there is an open enrollment period?
How long may my dependent children remain covered under my benefit plans?
When am I eligible to enroll for benefits?
How can I determine if my doctor is in-network?
What is the process to file a claim appeal for a denied claim?
Can I participate in both and H.S.A. and an FSA?
Can I change my Flexible Spending Account (FSA) election?
Can I use my Medical FSA to reimburse my spouse’s deductible and/or co-payment expenses, even if he/she is enrolled in a different health plan?
How often does my prescription drug plan formulary change?
If I am disabled on a long-term basis, will I continue to receive income?
What is the difference between pre-tax and post-tax long-term disability (LTD) plans?
Are there preexisting condition limitations if I change health plans?

COVID-19 and Wellness

Covid-19 has affected us globally impacting the physical and mental health of you, your employees and their families. We work closely with carriers to remain current on initiatives, coverage and services so we can share this vital information with you.

The advent of Covid has also highlighted the overall importance of wellness and wellness programs. Improved wellness can also help save substantial dollars by both reducing time away from work for your employees and by lowering medical expenses. Our partnerships with wellness organizations position us to help you make this often-overlooked component a part of your benefits customized benefits package.

Click here for COVID-19 Resources