FREQUENTLY ASKED QUESTIONS

Explore our most frequently asked questions or, reach out to our team to address any concerns that may arise.

What is Minor Medical?

Affordable Care Act compliance at the lowest cost to the employer. Our minor medical healthcare benefit plans are designed to focus on Daily Usable Benefits employees need at a price they can afford. Most insurance coverage is unaffordable for working people. With Minor Medical employers can offer insurance that acts like Major Medical at a fraction of the cost.

What is Major Medical Coverage?

Securing Major Medical coverage for mid-sized employers. Our benefit plans combine the advantages of self-funding medical cost with the protection of stop-loss insurance. These plans provide the stability of a group captive, and successful risk management strategies.

The combined strength can help mid-size employers (50-1000) reduce health care cost, streamline health care delivery, improve employee wellness, and achieve long-term financial stability.

What is MEC?

Minimum Essential Coverage (MEC) refers to insurance plans that meet the Affordable Care Act requirement for having health coverage. Examples of plans that qualify include: Marketplace plans; job-based plans; Medicare; and Medicaid & CHIP.

Note: Starting with the 2019 plan year (for which you’ll filed taxes in July, 2020), the personal mandate penalty no longer applies.

What is ACA Compliance?

ACA-compliant coverage refers to a major medical health insurance policy that conforms to the regulations set forth in the Affordable Care Act (Obamacare). These plans can be sold on or off the exchange, but all new individual major medical policies sold after January 1, 2014 are required to be ACA-compliant.

What is Level Funding?

A Level Funding platform allows the employers to regain control of their plan design and cost.

Level Funding is a type of self-funding that is unique to the marketplace. Level funding allows groups to safely transition to self-funding with predictable monthly claim funding and protections to limit liability.

What is an ALE?

Per the IRS: Whether an employer is an ALE is determined each calendar year, and generally depends on the average size of an employer’s workforce during the prior year. If an employer has at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is an ALE for the current calendar year

Who am I working with at Innovative HIA?

You’re working with the founder and CEO directly. I’m here to support you as you present options to your clients. By partnering with me, Bob Gardner, you get access to our internal TP, the best rates in the industry and a wide variety of benefits options to meet any employer’s needs all under one roof. Simplify the complex, save your clients money.

Who provides the coverage you offer?

We have our own TPA: SBMA is a San Diego based Insurance provider specializing in affordable, ACA compliant benefit. With in-house customer service, an online registration and self-management portal and a wide variety of benefits options, SBMA is a one-stop shop for you to present to your clients.

What is a captive Insurance Company?

A captive insurance company provides insurance coverage to its owners.

What is a Group Captive?

It is an insurance facility for unrelated participants who join together to share risk. Each participant has a desire to control its own risk. Add this – subtract that as it suits their specific situation.

What is the difference between a “standard” market insurance program and a captive insurance program

All risk is assumed by and all profits are retained by the insurance carrier. A captive program allows the captive participants to share in the risk for a potential reward of lower cost, underwriting profits, and investment income.

What entity issues the Medical Stop-Loss insurance policy?

The programs use a domestic A.M. Best A+ rated, class XV carrier that is an admitted carrier regulated by the Department of Insurance for the state where the policy is issued.

Why take the risk of a Captive Insurance policy?

Risk vs Reward.Companies take the chance on Captive because of the opportunity to capture the profits your fully-insured carrier has been enjoying.

Is there more risk in a self-insurance captive vs fully insured programs

Comparing both programs side by side over a one-year period the captive might appear to have more risk. Structure and protection is key to your solutions. Employers handle all incurred small claims up to a limit, the captive handles all medium claims up to a limit, and the reinsurance policy protects for all large claims.

Our solution is not a one-year solution. It looks at your risk long term and controls it. Simply put, if you’re unhappy with your current health insurance situation and have been putting your company’s well-being in the hands of the large insurance companies, whose interest do you think they are looking out for?

How does the captive protect from catastrophic losses?

Each captive program includes the protection of reinsurance/stop-loss agreement that limits any catastrophic or aggregation of risk. The program’s reinsurance structure limits the participant’s maximum loss and means the participant will never be required to fund more than its premium and collateral. The carrier assumes the program risk is about the aggregate and specific occurrence attachment points.

Why is collateral required?

To fund the captive assumed risk above the premium, net of expenses. This ensures all potential losses are funded up front and participants are not required to contribute more money.

Can I keep my current benefits?

You can have any plan design that meets your needs and the federal requirements. Most members keep their existing plan intact for the first year and slowly make changes as they progress.

Innovative Health Insurance Advisors | Las Vegas, NV | Phone: Toll Free: 800-339-0688 | Email: info@innovativehia.com

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The information contained in this website is for general information purposes only. The information is provided by Innovative HIA, LLC and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information, products, services, or related graphics contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.

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