Healthy Tips

Questions often arise in the California health insurance acquisition process concerning size of the company and available benefits for small businesses and the effect the size of a company may have on the premiums and the products available.

Companies 2-5 employees

The minimum size required in California to qualify small for Small Business coverage is to show 2 eligible employees minimum. Both eligible employees do not usually have to enroll in the plan if one is able to waive the plan offer due to alternate group coverage through spouse or employment. Companies with size 2-5 employee will see rates assigned typically at the highest allowable rate adjustment factor of 1.1 which includes the 10% additional cost above standard rate book price. You can review our guide on rate adjustment factor R.A.F here. This isn’t always an automatic health premium assignment. Some carriers will allow detailed health statements to be completed and offer discounting off the maximum number.

Companies 6-10 employees

Once the 6-10 employee size is attained the California health insurance plans begin to offer discounting. Options also open up frequently for multiple plan options and combinations for employees to choose personal plan of choice. Note: over the last few years these options have become more and more prevalent at the 2-5 company size as well. Another impact of reaching the ten employee threshold is the option of a company enrolling as a carve out can be available. Carve out enrollments, as we discussed in our alternate section is the practice of splitting out a class or population within a company to offer a specific group of employees coverage, excluding the rest. Each employee is likely to be required to complete an employee health questionnaire, sometimes called an employee health statement, which asks the employees to disclose personal health information regarding employee and dependent health history, treatment, and current condition. This information is used to assign pricing.

Companies 10-49 employees

At the 10-25 employee size range rate adjustment factor assignments can be guaranteed. Promotional pricing with stipulations on prior health, enrollment size, and current R.A.F levels can qualify a business for guaranteed pricing offers. Individual health statements are often not mandatory at this level, so underwriting becomes simplified for the consumer. To receive better pricing a group often will, however, complete employee health questionnaires. With many California carriers this is handled on an Employer level health questionnaire as opposed to the Employee level. Best pricing rate adjustment factor number is now the best allowable .90 or minus 10% off standard premium price.

Split Carrier Options

The health insurance carrier will commonly allow a ’split carrier’ option usually with the stipulation the majority of the employees enroll with the host carrier. Most carriers have a requirement to split employee enrollment with another health insurance carrier to maintain both a minimum employee enrollment amount and a percentage level. For example, one major health insurance carrier requires a minimum of 5 people enrolled and 75% employee participation whichever is greater. The one California health insurance carrier which is most frequently split with is Kaiser Permanente, as they will accept down to one employee enrolled on their side with no percentage rule.

Composite Rates

Beyond the 50 Employee level the market commonly switches to composite rates, which means instead of age banded pricing a company will receive cost figures based strictly on employee family type. This means that each single employee enrollment receives the same price regardless if they are 25 or 75 years old. This can be an advantage or disadvantage to the particular employee. The 25 year old employee, for example, may receive higher pricing versus an age banded rate schedule if they are enrolled with a company with 90% of their employee base averaging ages over 50. Conversely, the 60 year old employee may receive a better price using composite pricing if the composite price is based on company population which averages in the 20’s and 30’s.

There is no shortage of health-related infomercials or pop-up ads circulating on the Internet and television today. In fact, the health industry relies on attention-grabbing headlines and quick bits of information to make customers pay attention. This is not the right way to market a product, and it may also be unethical. Marketing any product can be difficult in such a competitive market due to the wide range of products available.

Along with the usual methods, marketing health products often requires a need to support the claims being put forth by the company. This usually takes on a fact-based approach, providing statistics and research to support their information. Caution must be used when marketing health products because false claims may be harmful to an individual’s health or life. In many cases, the supportive evidence is funded by the company promoting the product! This is a strong reason to be cautious about the product.

I n order to provide statistics, a variety of research methods must be followed. When marketing health products, some companies choose to conduct scientific tests and others opt for a more generic approach. Scientific research will not only provide valuable data, but also prove to the company itself that the product works as expected.
There are three main types of tactics involved in marketing health products:

1. Influencing potential buyers

In this case, health product marketing relies on influence to attract new customers. This type of marketing is often seen on late-night infomercials, complete with celebrity host. Using a popular or well-qualified spokesperson, the company attempts to sell their products by drawing the buyers into the opinions and claims of others. Many consumers associate a familiar name with trust, causing some companies to invest millions of dollars by marketing health products through a famous face.

2. Association with celebrity endorsement

Similar to the above-referenced method, marketing health products using this technique may also require the use of a celebrity. However, it is not the opinion of the famous individual that consumers are drawn to, it’s the product itself. Fitness equipment, for example, is a popular product involved in marketing health products. When a muscle-bound celebrity fitness guru takes to the stage, viewers gain faith in the equipment. As they watch the spokesperson flex, they begin to believe that the product will provide them with the same results.

3. Promotion of health benefits

Some products claim to have special health protection or prevention capabilities. When this type of strategy is used for marketing health products, the company will point out the reasons why you need to buy their product. This method may also include a direct comparison to other products on the market.

Marketing health products may prove to be more difficult than that of other goods or services because of its close connection to people’s health. It is important to take a step back and consider the facts and testimonials being provided, in order to avoid risking the well-being of viewers or consumers. Some products in the market may work as claimed, but most do not. It is difficult for the consumer to choose from the diamond from the rough. The simplest way to make a decision is to look for unbiased, third party information about the product.

Over the last 10 years, as California health insurance costs have increased significantly, there has been an explosion in both the availability and marketing of so-called discount health plans as we term them in the industry. It’s important to understand how they work and more importantly, how they do NOT work.

First a quick refresher on the whole point of health insurance protection to begin with. Health insurance is coming full circle back to its original design and intent. Originally, health insurance was structured to actually protect from the really big bill. Typically, you had a choice of high deductible and a very simple plan design. As the market matured, copays, co-insurance, and other bells and whistles began to appear. This trend started in the group health insurance market. Group health plans became a tool to for attracting and keeping valued employees. This benefits “arms race” came with a price tag. In the early 90’s, medical claims and the resulting premium increase exploded on to the scene. In response, plan designs retreated towards their original form with higher deductibles.

The advent of Discount health plans

Around this time, advertisements began to appear for plans that were significantly lower – even $10 monthly. What were these plans and more importantly, how were the companies able to offer them for such a low monthly premium. These were the “discount plans”.

Essentially, a discount plan allows the member to take advantage of negotiated rates across a network. This is the same discount afforded to PPO members when they use a PPO provider. The discount plans can reduce the cost of the medical care by a certain percentage (usually 30-60%) but they lack the one crucial feature of a California comprehensive health insurance plan…the maximum out-of-pocket. This max out of pocket is the real reason to have health insurance or any type of insurance for that matter. The whole part of insurance is to cap your exposure in a given situation of catastrophic health issues. The problem with discount plans is that they typically do not have a cap on the back-end. This means that with a $100,000 health claim, you may have it discounted by 40% but you’re still responsible for $60,000. The underlying health insurance costs have skyrocketed and it’s possible to have claims of 100’s of thousands of dollars…especially for facility based care (hospital, surgicenter, etc).

A good way to tell if a prospective plan is a “discount plan” is the pricing. If it seems to good to be true, it probably is. They other big determining factor is if they advertise that they that you cannot be declined due to health. For individuals and family health insurance plans in California, people are required to go through medical underwriting, which means that they must qualify based on health. This doesn’t apply to Group health insurance plans which are guaranteed issue. If the ad says that you will not be declined, that is a clear signal that there is an issue. In health insurance, there is something called “Adverse Selection”. This means that a plan which attracts higher risk members will eventually collapse under the weight of its claims issues. The only way a discount plan can avoid this “adverse selection” is to not really pay claims. They are offering discounts…not payments to claims.

Alternatives to discount plans

It’s important to make sure you cover the big bills. To keep costs down, we recommend quoting the lowest cost, comprehensive plans on the market. This typically falls under the HSA (Health Savings Accounts) or high deductible plans. The nice thing about the HSA plans is that they are comprehensive…they don’t carve out benefits as some of the hospital plans on the markets do. You can run your own individual/family health plan instant quote on HSA and other health plans.

Natural Health is Quality Health

In our hectic day to day world, our health is becoming a more important factor in merely keeping pace with the expectations that are demanded of us. More than 65% of Americans are actively seeking new ways to boost energy, contribute to their health in natural and effective ways, or to rearrange their lifestyle to bring more of nature’s balance to the forefront of their daily lives. Natural health carries a wide variety of interpretations, but everyone can agree that natural health is always the preference to chemically induced—symptom covering—pseudo health.

Finding Natural Health Products that Work

Business is booming in the natural health industry and of course there are ample products out there claiming to provide the benefits of natural health while providing a strong foot hold for energy increase and immune system balance. It can be difficult to find natural health products that live up to their promises. Many “energy drinks” on the market today provide nothing more than a significant amount of B 12 vitamin complexes and caffeine to make you feel as though you have a tremendous amount of energy, at least until that inevitable crash hits. It is not uncommon for those interested in finding natural health products that produce more energy and help balance out the body’s natural system to purchase the realm of available products only to find themselves discouraged and dissatisfied with the result. The average household can spend upwards of $700 per year trying out new products that claim to boost energy, revitalize the immune system, and provide a balanced and essential combination of natural ingredients to enhance mental and physical performance and still not find a product that they are satisfied with.

Many companies make a lot of promises. Whenever there is a new trend in the health market, there are more companies than a consumer can research ready and willing to market the next big miracle in natural health products. For consumers, relying on advertisements becomes a guessing game of integrity, and few companies deliver.

Natural Health Energy

Natural health energy comes from a high level of nutrition balanced with good habits and products that are formulated for providing long term energy derived from natural sources. Of course, caffeine is technically considered a “natural source” and consumers are advised to check the labels if they choose a different method of boosting their energy level. If a consumer is searching for a natural health energy product, their available choices shrink down to about literally ten different products. This type of energy is delivered to the body in a metabolizing manner that the body can process for real, honest results and a higher level of bodily care. Taking care of the body is definitely one guaranteed way to gain more energy.

Synthetic Health vs. Natural Health

With energy products marketed all over the place, there is a question for the results oriented individual whether there is a significant difference between synthetic health products versus natural health products. For some consumers, the only thing that matters is the bottom line; does it boost a person’s energy? An energy boost may be more important to some consumers than the origination of the product or how it is made. In all relevant studies, products that are designed around the natural health principles are able to deliver better results than those made of synthetic materials. It’s not rocket science. Any natural material is going to be absorbed more effectively and efficiently by the cellular structure of the human body than the man made synthetic components. This is true whether you are talking about energy products, health products, or even vitamins. Anything derived from a natural source is bound to provide a better platform for the body to absorb the potential benefits.

Natural health products that are designed to stabilize immunity and provide an increase in long term and short term energy generally have the additional effect of promoting youthful qualities in the body. The ability to eliminate free radicals and other age promoting factors is often a semi—intentional side effect of creating a natural health product that is so distinctly balanced.

Natural Health that Originates in History

As our productive powers, our technological advancements, and our societal expectations leap into the future, many scientists, physicians, and researchers are now starting to look backward to find answers to some of today’s most asked questions. Good health is not an accident. There are many cultures throughout the world that have been able to maintain a very high standard of health without the interference of Western medicine. Our technologically sound advancements now allow for enhanced study of these cultures, practices, and their traditional herbal and natural health remedies. There has been a great amount of success in bringing forth these historical facts and introducing them into our present day society.

Thus, everything we have learned so far as a society about natural health, rejuvenating the body’s cells and spirit, and of course, enhancing health and energy can be traced back to the historical ancestors of yester—year. Combining this new found age old information with the technology of today allows for the mass production of some of the most impressive natural health solutions to date.

Choosing Natural Health Products

When consumers choose natural health products, especially those with a claim for enhancing energy, most find that the research they can do on their own is sufficient provided they stick to all natural products. Natural health energy offers consumers a more advanced choice in today’s world of relentless media advertisements and self induced pressure to find the right product right away. Consumers need to be mindful of the fact that their choice of a natural health product is something that they are likely to introduce into their body on a daily basis, and thus their research should be thorough, involve a small amount of patience, and be able to be backed by an independent source.