FAQ

Frequently Asked Questions

Is EASE health insurance?

No. EASE plans are self-insured health plan designs, which may be offered by employers to their eligible personnel for compliant health coverage. Plan sponsors may seek insurance and/or reinsurance for such plans, but the acquisition of (re)insurance does not change the plan, its coverage, or its legal status.

Under federal law, all companies have the right to self-insure and big companies almost always do, because self-insurance gives them better control and cost efficiency than traditional insurance carriers. EASE plans let small and medium-sized companies take advantage of these same valuable benefits.

EASE plans include vendor management services, combining the right team of service providers for your plan that will ensure its smooth administration. EASE vendors do not sell, negotiate, market, or assist in insurance transactions of any kind.

It can be, which is why small and medium-sized companies have usually avoided it – thus giving yet another big advantage to Wall St. over Main St. But with the simplicity of EASE, as well as the prudent selection of reinsurance, any employer can cover 100% of its financial exposure to claims cost, and – because EASE plans are bundled with a package of vital services – they are much easier to implement and support than a traditional employee benefits plan. HR departments love EASE!
Employers who procure reinsurance that covers 100% of any financial exposure to claims are responsible only for their set monthly funding amounts. If total participant claims exceed the amount funded, a reinsurer covers the rest.
That depends on the type of reinsurance procured for your plan. EASE plan designers and consultants can offer general information on these types of arrangements, but EASE does not sell, negotiate, or market insurance products, and does not engage in any transactions of insurance.
MEC stands for Minimum Essential Coverage, a standard that was established under the Affordable Care Act, aka Obamacare. MEC consists almost entirely of wellness and preventative care. All EASE plans provide MEC, as well as additional benefits.
No. All EASE plans meet MEC standards, but EASE metal-level plans also provide Minimum Value, a separate legal standard that ensures full protection from ACA’s employer mandate penalties. Employers subject to the employer mandates should offer a plan or plans with both MEC and Minimum Value to their full-time employees to remain compliant. EASE believes that “MEC” plans offered by themselves do not reliably satisfy key ACA requirements.
ACA has specific compliance requirements for group health plans. To be ACA compliant, a plan must cover at least 60% of “actuarial value” of a plan with “substantial coverage” of traditional major medical benefits. These include Physician & Emergency services, Hospitalization, and Prescription drug benefits. Employees who choose an employer-sponsored Minimum Value plan may not be required to contribute more than 9.66% of their gross pay toward the premium and/or program costs. EASE metal-level plans are fully ACA-compliant Minimum Value plans that have been certified by independent member actuaries of the American Academy of Actuaries. The federal government considers licensed actuaries qualified to evaluate plans and certify that they meet all requirements.

Cost and features are obviously very important. But there are also some “red flags” that employers and their advisors should be on the lookout for:

  • Does the program include an actuary-certified Minimum Value (MV) plan, which is offered to all eligible participants? (If not, it may not be compliant.)
  • Does the plan designer stand behind its product? (All EASE plans come with an ACA compliance guarantee – if a sponsor ever gets fined or penalized due to any EASE plan defect, EASE pays – you don’t.)
  • Does the plan require participation in a health indemnity product? (Plans which are subject to ACA – including “MEC” Plans – may not legally be coordinated with “excepted benefits,” including health indemnity plans. Combining participation requirements, obtaining both plans on a single contract, or improperly coordinating health indemnity coverage could all violate IRC § 9831-32, which leads to penalties of $100 per affected employee per day under IRC § 4980D – the so-called ACA “Death Penalty.”)
  • Does the plan designer have a strong record of success in the ACA compliance market? (Since before the employer mandates, EASE plans have been successfully implemented and administered without any major changes to plan structure, coverage interruptions, claims payment issues, or other service problems common to some of our competitors. Failure to mail ID cards, unrecognized placement of reinsurance, and dubious structures are bad for our industry, and worse for employers who, as plan sponsors, must bear the brunt. We encourage you to ask around.)

All EASE plans offer benefits in excess of the minimum federal standards, ranging from efficient to premium metal-level plans. Contact us today, or check out our coverage options here.

In addition to EASE plans, other Voluntary Benefits (or “ancillary” or “excepted” benefits, as they are sometimes called) are available from our referral partners, for use alongside our plans in an uncoordinated manner. Through these offers, employers can add benefits for their employees to elect and contribute from 0%-100% of the cost. Employees can also select from a wide array of options to build customized benefits packages that best fit their needs.

Absolutely. We innovate and customize unique designs for clients of all varieties across the country on a regular basis. Please let us know your goals or circumstances and we will create the plan that best fits your needs.
Under the Affordable Care Act, companies with 50 or more full-time employees are required to offer comprehensive benefits or face potential penalties. EASE offers metal-level plans that meet these requirements, with no minimum participation requirements.
All ease plans come with an ACA compliance guarantee – if a sponsor ever gets fined or penalized due to any ease plan defect, ease pays – you don’t.

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