California Insurance Services
offered by Bohannon Insurance Agency, Inc.
Group Health Insurance For Employers
Bohannon Insurance Group (BIG) can provide employers with health benefit solutions and education to help them achieve their goals. It has been our experience that employers face several concerns when making decisions about health care benefits for their employees:
- Providing quality benefits at a reasonable cost;
- Making sure that their program attracts and retains quality employees; and
- Making sure their benefits remain competitive with other employers in the labor market.
BIG offers a full range of benefit and administrative services.
LET OUR FRIENDLY SERVICE PROFESSIONALS ASSIST YOU WITH:
410(k) Services
A 401(k) plan is a qualified deferred compensation plan which enables you to save money, lower taxes, and invest in your financial future. Under a 401(k) plan, your elective contributions are made on a before tax basis; that is, the amount deferred will be excluded from your taxable income. This may currently lower your taxes. The following are some advantages of our 401(k) plan.
- Elective deferrals are voluntary and the amount you contribute is up to you. (Federal law limits the deferral to 25% of salary or $11,000, whichever is less
- Deferrals are made before tax; therefore, you pay less in Federal and State income taxes
- Earnings and income are not taxed until the money is distributed from the plan. When you receive your retirement benefit you may be in a lower tax bracket than you are currently.
Our qualified professionals will help design an investment strategy that is taylored to your companies needs.
COBRA Administration
"COBRA" stands for Consolidated Omnibus Budget Reconciliation Act of 1985. BIG has partnered with industry leaders to offer our clients online cobra administration services. Click here to view our cobra services. To read more about COBRAOnDemand our online COBRA service click here.
COBRA - Federal
COBRA is the federal health care continuation law. COBRA requires that if an employee or other "qualified beneficiary" loses employer-provided health coverage due to termination of employment or another specified "triggering event," the group health plan must offer continued health care coverage to the qualified beneficiary. The qualified beneficiary may be (and typically is) required to pay the full cost for the coverage.
COBRA may be continued for a maximum of 18, 29 or 36 months, depending on the qualifying event or series of events that occur. The initial 18-month time period can be extended for covered dependents to 36 months as a result of the occurrence of a second qualifying event. Coverage may also be extended to 29 months when a disability determination is made prior to or during the first 18 months of COBRA coverage.
18-month COBRA maximum period when loss of plan coverage is due to:
- voluntary termination of an employee,
- involuntary termination of an employee (except for gross misconduct), or
- reduction in the amount of hours an employee works.
36-month COBRA maximum period for spouse and dependent children when loss of plan coverage is due to:
- death of the covered employee,
- employees Medicare entitlement,
- divorce or legal separation from employee, or
- dependent child ceases to be a dependent according to the plan's eligibility rules.
Note: The 36-month maximum period is modified when the employee is entitled to Medicare prior to a termination or reduction in hours. In this case, the 36-month time period begins on the date of Medicare entitlement, rather than the date of the qualifying event. If the date on which the employee became entitled to Medicare was more than 18 months from the date of the qualifying event, the maximum period of COBRA continuation coverage is 18 months.
29-month extension of benefits due to disability:
COBRA continuation coverage is extended from the usual 18 months to 29 months if a qualified beneficiary is determined by the Social Security Administration to be disabled at the time of termination of employment or reduction in hours, or anytime during the 60 days following those qualifying events.
A disabled individual must provide proper notice to the plan administrator of the Social Security Administration's disability determination within 60 days of the determination and before the end of the original 18-month COBRA coverage period.
To whom does the disability extension apply?
The 29-month disability extension applies to all qualified beneficiaries covered under COBRA who become disabled within 60 days of the qualifying event. All dependent qualified beneficiaries may receive the extended coverage along with the disabled qualified beneficiary. The extended period terminates before the end of the 29-month period if the person is no longer disabled, becomes entitled to Medicare after the date of the election, or stops making timely premium payments. The qualified beneficiary must notify the plan administrator within 30 days of the Social Security Administration s determination that the qualified beneficiary is no longer disabled.
What is the amount of the premium for the disability extension?
Employers may charge up to 150 percent of the applicable premium for the 11-month disability extension period for a disabled qualified beneficiary. If the disabled qualified beneficiary does not remain on the plan or does not elect coverage, non-disabled beneficiaries may remain covered and the maximum rate reverts to 102 percent. COBRA coverage can be terminated for all qualified beneficiaries on the later of:
- the first day of the month that is more than 30 days after a final determination by the Social Security Administration that a disabled qualified beneficiary is no longer disabled, or
- the end of the applicable COBRA coverage period had the disability extension not occurred.
Note: COBRA mandates only the minimum limits for continuation coverage. An employer may extend the length of coverage, but before doing so should obtain the consent of insurance carriers and HMOs.
Please read this document for more information: http://www.dol.gov/pwba/pubs/COBRA/cobra99.pdf
Cal-Cobra
Cal-COBRA is available under California law and applies to employers who have 2 to 19 employees. Federal COBRA applies to employers who have 20 or more employees. It is governed by federal law. (See above for Federal COBRA information) The Department of Managed Health Care is responsible for seeing that health maintenance organizations (HMOs or health plans) in California provide Cal-COBRA coverage as required by law.
The idea of Cal-COBRA is to provide the same general advantages to small groups in California as federal COBRA provides to larger groups. The main advantages are:
- the right to keep your group coverage under certain conditions when it might otherwise end, and
- the right to keep nearly the same premium rates as the employer group has.
The important difference in premiums is that your employer will no longer be making a contribution to the payment, and you will have to pay the entire premium yourself.
Who Can Enroll in Cal-COBRA?
In order for someone to enroll in Cal-COBRA one of the following things, called "qualifying events," has to happen:
- Loss of coverage because employment of the covered employee ends (unless employment ends because of gross misconduct of the employee), or loss of coverage because the hours of the covered employee's employment are reduced
- Loss of coverage because of divorce from the covered employee
- Loss of coverage because one is no longer a dependent of the employee under the group plan
- Loss of coverage because the covered employee has become eligible for Medicare
- Loss of coverage because of the death of the covered employee
Who Cannot Enroll in Cal-COBRA?
You are not eligible for Cal-COBRA if you are one of the following:
- Eligible for Medicare
- Covered by another group health plan, unless:
- that other group health plan has a pre-existing condition exclusion or limitation that applies to you, or
- that other group health plan is a group conversion plan (basically the offer of an individual plan) that you choose not to accept
- Terminated from employment because of gross misconduct
- Someone who fails to choose Cal-COBRA in writing when it is available
- Someone whose allowed eligibility period has been used up.
Benefits Under Cal-COBRA
Anyone covered under Cal-COBRA has the same benefits as active covered employees. If active employees have open enrollment periods when they can change from one plan to another, Cal-COBRA enrollees may do the same. If the employer changes the employees from one plan to another, the Cal-COBRA enrollee must be allowed to transfer into the new group along with active covered employees. No restrictions based on pre-existing conditions are allowed. If the group plan offers special coverage, such as dental or vision coverage, that must be provided to the Cal-COBRA enrollee as well.
Choosing to Have Cal-COBRA
If your employment ends or your hours are reduced, your employer must notify both you and the health plan that a qualifying event happened. If you have any other qualifying event, you should notify both the employer and the health plan. Within 60 days of the qualifying event, you must notify the health plan in writing that you want to enroll in Cal-COBRA. The 60 days do not start to run until you receive notice that Cal-COBRA is available.
The health plan then must send you a premium notice and information about completing the enrollment. (There may be a part of the group contract that requires the employer rather than the plan to send you the notice.) The booklet that explains your health plan benefits, called an Evidence of Coverage, contains information about Cal-COBRA as well.
Premiums must be paid when due. There is no break in your coverage if you enroll and pay on time.
The Time Period for Continuing Coverage under Cal-COBRA
If a former employee gets Cal-COBRA coverage because employment ended or because working hours were reduced, Cal-COBRA for the former employee, spouse, and dependents may continue for up to 18 months.
If the former employee's spouse or dependent gets Cal-COBRA coverage because of any of the following reasons, their coverage may continue for up to 36 months:
- death of the former employee
- divorce from the former employee
- the former employee becomes eligible for Medicare
- the dependent is no longer considered a dependent under the group plan.
Certain people found eligible for Social Security Disability may be eligible for up to 29 months.
A Small Employer's Responsibilities Under Cal-COBRA
Small employers have a duty to do all of the following under Cal-COBRA:
- Notify the health plan in writing, within 30 days of termination or reduction in hours, that the person is eligible for Cal-COBRA
- Refer the eligible person to the health plan to start the Cal-COBRA coverage or manage the enrollment for the person
- In case the employer changes from one health plan to another group plan, it must promptly notify all persons currently on Cal-COBRA that they have a right to continue coverage with the new group plan. The employer must also give the new group plan the names of all persons on Cal-COBRA so the new plan can offer the coverage as it is required to do.
When Cal-Cobra Ends
Cal-COBRA will end as soon as one of the following happens:
- The time period stated in the law passes (usually 18 or 36 months)
- Premiums are not paid when due
- The covered person moves outside the health plan's service area
- The employer no longer offers any health coverage to its employees
- The covered person becomes eligible for Medicare
- The covered person enrolls in another group policy
If the end of Cal-COBRA comes because the legal time period has been used up, the health plan must notify the enrollee when the end of coverage is coming. It must offer any additional continuation benefits that might be available under Senior COBRA. If Senior COBRA is not available, the plan must determine if the enrollee is eligible for individual coverage under HIPAA. Finally, if the enrollee is not eligible for one of these programs there may be conversion rights that are available through the plan.
Follow this link for more information: http://www.dmhc.ca.gov.
Consolidated Billing
No longer will you need to process multiple applications and send them to various locations. Just imagine, you hire a new employee and they are now eligible for benefits. You hand them a comprehensive benefit package provided by us and request that they call our office with any questions. After the employee completes the consolidated enrollment form that includes all lines of group coverage and the Cafeteria plan and 401(k) election forms, you send this information to our local office. We then provide the information to all of the insurance carriers, set up their Cafeteria and 401(k) accounts and send the required COBRA dependent notification to their home. They will be listed on the very next months consolidated bill.
No Longer will you need to spend countless hours talking to doctor''s offices and insurance carriers, verifying coverage. An employee calls in and says that they are attempting to receive care somewhere. You give them the phone number for us. We then verify coverage for the employee, contact the provider and give them the confirmation that they need regarding coverage, and then help the employee with any bills associated with the claim.
Your insurance bill auditing process now only requires that you review one statement each month rather than one for each carrier. You receive your monthly bill for your employee benefits. All of your coverages are incorporated on this bill and broken down by individual employees. The bill is already formatted and departmentalized to represent the different profit/cost centers in your company.
You will no longer be required fill out the appropriate forms, contact each carrier, fill out the change section of each insurance carrier''s bill and handle the COBRA billing. An employee leaves the company. You fill out the employee termination form and fax it to our office. We immediately begin the process of notifying the individual carriers and the COBRA process is initiated. A letter is sent to their home notifying them of their rights under COBRA. If they do elect COBRA, the enrollment and payments are processed by our office and sent directly to the carriers.
Customer Services
We set ourselves apart from our competitors by providing daily services for our employers and their employees.
Our staff is dedicated to completing all issues and customer inquiries in a timely fashion.
- SUBMIT CLAIMS FOR PROCESSING - REQUEST ITEMIZED BILLS, MEDICAL RECORDS, ETC., FROM PROVIDERS IF NEEDED FOR PROCESSING CLAIM.
- CHECK CLAIM STATUS WITH CLIENT'S MEDICAL GROUP/INSURANCE CARRIER AND REPORT BACK TO CLIENT, PROVIDER, EMPLOYER, ETC.- FOLLOW-UP IF NOT COMPLETED.
- WRITE LETTERS OF APPEAL TO PHYSICIAN OR MEDICAL GROUPS REGARDING MEDICAL SERVICE.
- PRESCRIPTIONS: CONTACT PHARMACY AND/OR CARRIER WHEN PROBLEMS ARISE, AND REPORT BACK TO CLIENT, PRIMARY CARE PHYSICIAN, ETC.
- ASSIST WITH REFERRALS FROM PRIMARY CARE PHYSICIAN TO SPECIALISTS
- MAKE ADDRESS CHANGES, PRIMARY CARE PHYSICIAN CHANGES, AND DEPENDENT CHANGES AS REQUESTED BY CLIENT.
- ORDER ID CARDS SEND/DELIVER APPLICATIONS, BROCHURES, PROVIDER BOOKS, ETC.
- PREMIUM BILLING RECONCILIATION, WHICH INCLUDES CORRESPONDING WITH CARRIERS ON BEHALF OF EMPLOYER.
- EMPLOYEE MEETINGS: EXPLAIN BENEFITS; PLAN GUIDELINES; AND THE VALUE OF THE BENEFIT PACKAGE YOU HAVE PROVIDED.
- NEGOTIATE CONTRACT WITH CARRIER UPON RENEWAL. THIS INCLUDES RATE NEGOTIATIONS AND BENEFITS DESIGN AS NEEDED.
- PROVIDE ON-SITE CUSTOMER SERVICE REPRESENTATIVE TO ANSWER ANY QUESTIONS THAT MAY ARISE REGARDING THE HEALTH BENEFITS. THIS SERVICE IS PROVIDED QUARTERLY, SEMI-ANNUALLY, ETC., OR AT THE REQUEST OF THE CLIENT.
- PROVIDE ON-LINE ELIGIBILITY SERVICES THROUGH OUR HR PRODUCTS.
- THIRD PARTY ADMINISTRATOR SERVICES. WE ARE A LICENSED THIRD PARTY ADMINISTRATOR AND PERFORM THE BILLING AND ELIGIBILITY FUNCTION FOR THE BUILDING INDUSTRY ASSOCIATION OF CENTRAL CALIFORNIA.
Dental Insurance
Our agency is very active in the group and individual dental insurance marketplace. Whether you are investigating dental insurance for an individual, a group plan for a small start up, or a partially self-funded multi-state corporate group plan, our agency is prepared to assist you.
We can help you evaluate your needs, survey the marketplace, prepare side by side plan and price comparisons for your review, and then help you implement the plan(s) that you determine best meet your objectives.
Human Resource Tools
Human Resource Information System.
Bohannon Insurance Group provides their clients a set of tools to help manage their benefits package. Our system can provide a completely automated way of tracking employee information, helping you manage the difficult job of analyzing employee data. This information can be used in tracking costs and evaluating the benefits you provide your employees.
Online Benefit Administration Features:
- Enrollment
- Benefits Viewing
- Consolidated Billing - reconcile all carrier invoices in one itemized bill
- COBRA admininstation
- Section 125 administration
This service is a valuable tool in helping you organize the unmanagable task of managing your benefits package. Click here to learn more about these services.
Life Insurance
Our agency is very active in the group and individual Life insurance marketplace. Whether you are investigating Life insurance for an individual, a group plan for a small start up, or a 1000 employee multistate corporate group plan, our agency is capable and prepared to assist you. We can help you evaluate your needs, survey the marketplace, prepare side by side plan and price comparisons for your review, and then help you implement the plan(s) that you determine best meet your objectives.
Long Term Disability
When faced with an employee who's been disabled, uninsured employers have few options. Do you continue to pay all or part of a salary? Offer unpaid leave? Terminate employment? For an employer and employee, the choices can be devastating. An insured Long Term Disability plan will replace up to 66 2/3% of an employee's income up to the age of 67 in a situation where catastrophic illness or injury exists. A managed LTD plan allows an employer to outsource the difficult decisions surrounding a disabled employee to disability experts. Along with income protection, most disability plans offer rehabilitation and return-to-work services that are essential to the recovery of disabled employees. The goal of Long Term Disability insurance is to financially protect and proactively return disabled employees to a productive life.
Long Term Disability FAQ's
How many people really use their LTD plan?
There is a 1 in 5 risk that a 35 year old will be disabled for 90 days or more before age 65. You are more likely to become disabled than to die during your working years.
How much will LTD cost the company?
The general rule is that a fully insured LTD plan will cost a company about one half of one percent of the company's monthly payroll.
Will an LTD plan pay a disabled employee who returns to work on a part-time basis?
Yes, most LTD plans will pay an employee who is limited from performing all of their job functions, and has suffered a 20% or more loss of income as a result.
What are the most common income replacement percentages?
Most companies implement a plan that replaces 60% or 66⅔% of an employee's income in the event of a disability. The highest percentage available is 66⅔%.
Medical Insurance
Our agency is very active in the group and individual medical insurance marketplace. Whether you are investigating medical insurance for an individual, a group plan for a small start up, or a partially self-funded multi-state corporate group plan, our agency is capable and prepared to assist you. We can help you evaluate your needs, survey the marketplace, prepare side by side plan and price comparisons for your review, and then help you implement the plan(s) that you determine best meet your objectives.
Section 125 Cafeteria Plan
Cafeteria Plans - also known as Flexible Benefit Plans, Section 125 Plans allow employees to pay for certain benefits with pretax dollars. This allows them to save taxes on insurance premiums, out of pocket health care and or related child or dependent care expenses. Any dollar the employee defers into the flex plan is withheld before any taxes are calculated. The employer will save their portion of social security tax, Medicare, payroll and any other state-required taxes.
The employee may elect to participate in any of three accounts. Federal, State and Social Security taxes are saved on every dollar contributed to the plan.
- PREMIUM ACCOUNT allows employees to pay their group insurance premium contributions pretax, increasing their take home paycheck;
- HEALTH CARE SPENDING ACCOUNT allows employees to use pre-tax monies to cover deductibles, co-pays and other non covered expenses;
- DEPENDENT CARE SPENDING ACCOUNT allows employees to save taxes on child or dependent care expenses.
Cafeteria Plan FAQ's
What is a Section 125 Plan?
Section 125 is a provision of the Internal Revenue Code that allows employees to pay their share of the cost of certain group insurance benefits, unreimbursed medical expenses, and dependent care expenses with pre-tax dollars. Under this provision, your paycheck is reduced by the amount you elect for the year. That money is removed from your salary structure before Federal Income, State Income, and Social Security taxes are calculated, and placed in a separate account. This results in lower taxable income, and higher take-home pay.
What pre-tax accounts are available to me?
There are 4 accounts:
- Premium Payment Account
- Medical Reimbursement Account
- Dependent Care Reimbursement Account
- Personal Policy Account
How does a Premium Payment Account work?
A Premium Payment Account allows you to have your contributions toward certain group insurance benefits deducted automatically from your paycheck, before taxes are calculated.
What is a Medical Reimbursement Account?
Under this provision, you elect an annual amount to be taken out of each paycheck, pre-tax. These funds are available to reimburse you for out-of-pocket medical, dental, and vision expenses, such as deductibles and co-payments. A sample list of eligible expenses is provided in this packet.
What is the Dependent Care Reimbursement Account?
The Dependent Care Reimbursement Account allows you to pay for your childcare or disabled adult care expenses while you are working, with tax-free dollars.
What is the Personal Policy Account?
The Personal Policy Account allows you to pay for individually owned health insurance plans with pre-tax dollars, such as your Blue Cross, Blue Shield or Kaiser plans. Unfortunately, group insurance premiums from another employer do not qualify.
How do I enroll in the Section 125 Plan?
After you have reviewed the plan, and have had your questions answered, you must complete the enrollment form contained in this package. Everyone must sign the enrollment form, even if you are declining participation. To elect to participate in the Premium Payment Account, just check the appropriate box. If you are enrolling in the Medical Reimbursement, Dependent Care, or Personal Policy Accounts, you must elect the annual amount to be withheld from your paycheck, taken in equal increments per pay period.
What is the plan year?
Your specific plan year is specified in the Plan Information Summary. It does not have to be the same as the calendar year, and, if this is the first year of the plan, it may be shorter than 12 months. Remember to consider these facts when making your annual elections.
Are there any limits to the amount I can set aside for reimbursement?
Every plan is different. Your employer sets the limits on your plan. The maximum and minimum amounts you can elect are outlined in your Plan Information Summary included in this package. For Dependent Care Reimbursement accounts, the law allows you to elect up to $5,000 a year for single, or married taxpayers filing jointly, and $2,500 for married taxpayers filing separately.
Can I make changes in my election or drop out before the end of the plan year?
The only time tax law regulations will allow you to make a change is if there is a change in your family or employment status affecting a need for a benefit. Some examples of status changes are: marriage or divorce, the death of a spouse or child, the birth or adoption of a child, or a change in pay or hours of employment for you or your spouse.
Can I switch dollars between accounts?
No. The dollars must be used in each account as specified on the election form.
How do I enroll and use the Medical Reimbursement Account?
Determine how much you expect to pay this year for medical expenses that are not covered by your insurance plan. These expenses could be insurance co-payments, deductibles, prescriptions, eyeglasses and exams, chiropractic treatments, dental work, orthodontics, lab fees and special education for a learning disabled child. Fill in that amount on the form to be taken out of your paycheck over the year. When you incur an eligible expense, just mail or fax a receipt for the expense, along with a voucher to Pre-Tax Administrators, and we will send you a reimbursement check for that amount.
What if I don't incur enough expenses within the year to get back the money deposited in my reimbursement account?
Unfortunately any dollars not used for expenses are forfeited. This is what is known as the "use it or lose it" provision of Section 125. It is very important to be conservative and accurate in estimating your expenses for the plan year.
How do I enroll and use the Dependent Care Reimbursement Account?
Fill in the amount on the enrollment form that you want to have deducted from your salary for dependent care expenses for the year. That amount will be divided equally for each pay period, and deducted from your pay. You must then submit a receipt for those expenses from the provider of the dependent care to Pre-Tax Administrators, along with the voucher. You must include the name and tax identification number of the provider, the dates of service, and the amount paid for the services. The expense will be reimbursed up to the amount that you have accumulated in your account at that time. The balance of expenses will be carried over to future months, and additional payments will automatically be disbursed as funds are available.
Who is considered an eligible dependent?
Your dependent(s) under the age of 13, or any dependent who is physically not able to care for himself is considered to be a qualified dependent.
Can I use the Dependent Care Account if I pay a family member for childcare?
Yes, but they must be reporting that income on their tax return. If that family member is your own child under the age of 19, you may not claim those expenses.
Are there any other requirements for using the Dependent Care Reimbursement Account?
Yes. Your spouse must be working, be a full time student, or unable to care for him or herself.
Can I take tax credit for reimbursed dependent care or medical expenses on my income tax return if I am in this Plan?
No. Expenses reimbursed under this plan may not be used when calculating your medical expense deduction or the dependent care tax credit. Because for a few individuals it is sometimes more advantageous to take the dependent care tax credit on your tax return, than to participate in the dependent care reimbursement account, you should discuss which alternative is the best for you with your tax advisor, or the enrollment counselor.
Do I have to file any forms with the IRS?
Yes. You must file form 2441, Child and Dependent Care Expenses, when you file your 1040 with the IRS.
How do I use the Personal Policy Account?
This account is used to pay for your individually owned insurance plans. To participate in this plan, fill in the amount you will be electing on the enrollment form, and submit a copy of the title page of your plan, indicating the name of the insured, the policy number, and the premium amount. When you receive your insurance bill, send or fax a copy of the bill with your voucher, and we will send you a reimbursement check for the amount that is in your account at that time. If there is a balance left on the expense, it will be carried forward to future months, and reimbursed as the funds become available.
What happens if I leave the company?
If you leave the company, your deductions automatically stop. You will be allowed to submit claims for expenses incurred while you were participating in the plan. You may submit claims up to the end of the grace period specified in your plan, usually three months after the end of the plan year. If you want to continue participating in the Medical Reimbursement Account, you can convert your plan to COBRA, and continue making your contributions voluntarily after tax, until the end of the plan year. By converting to COBRA, you can submit claims for expenses incurred after your termination.
Short Term Disability
An injured employee is worried about many things, including surviving without a paycheck. Since the accident happened off the job, Worker's Compensation won't cover it. If an employee has to rely on savings, research shows this will last on average just 4.8 weeks. An insured Short Term Disability plan can replace up to 100% of the income lost due to injury of sickness. Focusing on short term disability is the first step to gaining control of overall disability costs. A well-managed STD plan can help an employer identify, track and handle claims professionally and consistently. Active claim management through a fully-insured plan can help shorten the duration of disabilities through rehabilitation and return-to-work efforts, reducing your costs and preventing short term disabilities from turning into long term ones.
Short Term Disability FAQ's
Will our Worker's Comp cover short term claims?
62% of disabilities occur off the job. These are not covered by Worker's Comp.
Doesn't State Disability pay for short term disabilities?
Yes, but SDI only pays 55% of income up to $334 per week. An STD plan can be designed with higher percentages and maximums to replace a larger amount of income. The STD plan will pay on top of SDI to these higher amounts.
Does an insured STD plan cover pregnancies?
Yes, pregnancies are covered as any other disability.
How often do short term disabilities occur?
The average occurrence of STD claims is 65 per 1,000 insured lives per year.
State Disability
California State Disability Insurance (SDI) is a partial wage-replacement insurance plan for California workers. The SDI program is State-mandated, and funded through employee payroll deductions. SDI provides affordable, short-term benefits to eligible workers who suffer a loss of wages when they are unable to work due to a NON WORK-RELATED illness or injury, or a medically disabling condition from pregnancy or childbirth.
The majority of California employees, approximately 12 million workers, are covered by the SDI program. Some employees are exempt from SDI; for example, railroad employees, some employees of non-profit agencies, employees who claim religious exemptions, and most government employees.
Four other states and one Commonwealth offer a disability insurance program. They are Rhode Island, New Jersey, New York and Hawaii, and the Commonwealth of Puerto Rico. Each state operates its program independently.
* NOTE: This information was taken from the California State Disability website. More information is available by going to:
http://www.edd.ca.gov/direp/diind.htm.
Vision Insurance
Vision care insurance is insurance that provides coverage for services relating to the care and treatment of the eyes. It typically covers services delivered by an optometrist or opthamologist. Depending on the specific plan, some or all of the following services may be covered:
- Yearly eye exams
- Glasses (with an annual limit)
- Contact lenses and fitting (with an annual limit)
- Glaucoma screening
Some vision plans may provide more extensive coverage (such as certain eye surgeries), while others may limit coverage to "reasonable and customary" charges incurred during routine eye exams. Reasonable and customary charges generally don't include the cost of glasses and contact lenses. With some employer-sponsored vision plans, coverage may be even more narrowly limited to the medical treatment of certain eye conditions. This is rare, however.
How much does it cost?
Vision care insurance is generally available for a small, nominal annual premium (often as little as $50 a year). What’s more, your employer may pay the premium, or part of it, thereby further reducing your cost.
How does it work?
Vision care insurance may provide direct payment to the eye care provider for the services you receive. Or you may be required to cover the charges out-of-pocket at the time of service, and then file a claim for reimbursement. It depends on the specific plan.
Where do you get it?
Almost everyone who has vision care insurance gets their coverage through work. Employer-sponsored vision care plans may be self-funded or self-administered plans. Vision insurance may also be part of an employer’s group health insurance plan, or one of several options from which employees can choose under an employer’s cafeteria benefit plan. Commonly, an employer will purchase group vision insurance through an HMO, insurance company, or other organization that offers group vision care plans.
Individual vision care policies are scarce because they’re generally not cost effective from an insurer’s standpoint. If you don’t have access to vision care coverage through your employer, you will likely have a difficult time obtaining this kind of insurance through an individual, stand-alone policy. Some individual health insurance policies may include vision coverage, however, or allow you to add it for a slightly higher premium.
Who should have it?
Anyone who has access to employer-sponsored vision coverage should probably take advantage of it because the minimal cost is outweighed by the benefits. If you don't have coverage and you have no vision problems, you should probably just forego vision insurance and "pay as you go" for annual eye exams. However, if your vision expenses are relatively high (glasses, contacts, etc.) and you don’t have employer coverage, you may want to look into other ways of obtaining vision insurance.
We hope this explanation of California insurance services proved useful.