TECHNOLOGIES @ YOUR FINGERTIPS
AHEAD OF THE CURVE
COMPLIANCE CHAOS - SOLVED!
For more than 15 years WNCHI has helped Asheville Area Habitat for Humanity keep our medical insurance costs stable without reducing the top-shelf benefits that we offer our incredible staff. In addition to assisting our employees and managing our insurance plans, WNCHI has been a long-time supporter and advocate of Habitat’s work, helping more families in our community build strength, stability and self-reliance.
On 1.1.17, Asheville Gastroenterology Associates (AGA) merged with Carolina Mountain Gastroenterology and formed Digestive Health Partners. With a narrow time window to complete the complex merger, the WNCHI professionals met with our management team and listened to our issues and goals. Based on those meetings, WNCHI developed & implemented a comprehensive strategy. Securing commitments from insurance carriers with steadfast implementation timelines, WNCHI's experienced employees utilized innovative benefit administration systems to deliver a stable transition for all our staff and the management team responsible for employee benefits.
The Eblen Charities is a non-profit organization whose outreach helps thousands of families each year with medical and emergency assistance. Since 2004 we have counted on the dedicated staff @ WNCHI to educate our employees, resolve administrative issues, & help our management team to navigate the chaos within the health insurance industry. Eblen Charities is a proud client of WNCHI & WNCHI has been a strong supporter of our efforts through the years.
Since our practice opened 40 years ago, Carolina Hand and Sports Medicine has helped thousands of Carolinians return to optimal health and mobility. WNCHI is not only our trusted employee benefit agency, but more importantly a strategic partner that has helped our practice grow with innovative solutions that no other agency has been able to replicate since 2010. Previously, when our medical practice has solicited RFPs from other agencies, the proposals were not as competitive & some agencies even have withdrawn from the RFP process when it was made known they were competing with WNCHI.
Biltmore Medical Associates is committed to providing the best Internal Medicine Care to individuals in our community. For over 17 years, WNCHI has delivered unparalleled service, benefits & rates to our physicians & staff. As the largest independent health insurance agency & serving the most extensive healthcare provider client segment in Asheville, WNCHI has the experience, expertise and resources to meet our unique benefit needs.
Health Insurance at work for you by connecting your business to the health insurance resources that you need to retain and attract talented employees…
We can all agree that the current healthcare system is broken with skyrocketing costs from insurance carriers, compliance chaos from regulatory agencies, & unresponsive brokers without a strategy or the resources to build a better healthcare model. To navigate a defective system and provide a better model, we have developed proprietary solutions that deliver superior outcomes for our group clients. Our approach looks at how healthcare is accessed & delivered to your employees and underlying financial framework that funds the employee benefit plan. Based on our review, we match the most beneficial funding model with innovative benefit designs and implement unique ways to access healthcare which deliver lower benefit costs to employers & employees. Addressing the source of healthcare access & delivery is the first step to building a sustainable employee health plan. We can help you take that first step in the creation of a flexible solution for your business needs.
WNC Health Insurance is a privately owned and independent firm headquartered in Asheville, North Carolina.
- We currently serve over 200 employers in North Carolina.
- We have sustained double digit client growth for the last five years by embracing change, predicting outcomes, and acting nimble.
- We provide our clients with as much information as they need to proactively adjust to a dynamic employee benefit environment.
- We serve clients operating in Medical Care and Delivery, Legal and Tax Services, Manufacturing, Food Service, Brewing, Hospitality, Non-Profit Community Service, Information Technology and many more.
- We are contracted with ALL major health and ancillary insurance providers and have access to unique health plans and health insurance quotes that are ONLY available to us. We design and implement health plans specific to a client’s appetite for risk to create an affordable healthcare model.
Insurance Consulting Services
For employers with more than 100 full time employees, agency fees are an add-on to the monthly billed insurance rates or a flat fee payment made by employer on a monthly or quarterly basis. Fees are disclosed, negotiated and approved by employer.
Insurance Brokerage Services
For employers with less than 100 full time employees, insurance carriers pay agency fees, not the employer. Fees are either a percentage of premium or a “Per Employee Per Month” (PEPM) Fee.
Which platform will best meet your needs…
Fully Insured Group Health Plans
With a fully insured group health plan, the employer pays a fixed monthly premium and the insurance carrier assumes all claim liability risks. Major Insurance Carriers (i.e. BCBSNC, United HealthCare, Aetna) administer fully insured health plans for all sizes of employers. Plans are subject to all federal & state taxes and regulations.
Level Funded Health Plans
A level funded health plan Is a Partially Self-Funded Plan with a fixed monthly premium. If the actual claims for the plan year are lower than expected, then the employer shares the savings with the insurance carrier at the end of the year. The employer retains a portion of the claim liability and contracts with the insurance carrier to cover excess claim liability. These plans are administered by major insurance carriers (i.e. BCBSNC, United HealthCare, Aetna) and employers must have more than 25 full time eligible employees and 20 employees enrolled in the plan to be eligible for coverage. These plans are exempt from many federal & state taxes and regulations.
Self-Funded and Partially Self-Funded Group Health Plans
The employer pays a variable premium subject to claim utilization, retains a portion of the claim liability and contracts with a reinsurance carrier to cover the excess claim liability. Partially Self-Funded Plans are administered by an insurance carrier or third party administrator and employers must have more than 50 full time employees to be eligible for coverage. Partially Self-Funded Plans provide extensive claims data which allows employers to customize their benefits to realize significant cost savings. These plans are exempt from many federal & state taxes and regulations. Variations of Partially Self-Funded Plans: Captives, Administrative Services Only (ASO) Plans, Association Plans, Multiple Employer Welfare Agreement Plans(MEWAs) & Cooperatives.
Direct Primary Care Model Within a Self-Funded or Partially Self-Funded Group Health Plan
How providers are paid matters. With this hybrid Self-Funded or Partially Self-Funded Plan, an employer contracts directly with primary care providers to achieve additional cost savings on claim utilization. The employer pays a variable premium subject to claim utilization, retains a portion of the claim liability and contracts with a reinsurance carrier to cover the excess claim liability. Partially Self-Funded Plans are administered by an insurance carrier or third party administrator and employers must have more than 50 full time employees to be eligible for coverage. Partially Self-Funded Plans provide extensive claim data which allows employers to customize their benefits to realize significant cost savings These plans are exempt from many federal & state taxes and regulations.
Professional Services Organization (PEO)
The employer contracts with a PEO to provide outsourced services in payroll, human resources, employee benefits, and tax compliance. Depending upon the cost savings per service, an employer can implement some or all the PEO’s services. A Co-Employment Arrangement is established creating shared liability allowing the employer to focus on their core competencies. The PEO manages all federal and state employee-related compliance including payroll taxes, human resource assistance, OSHA, and ACA.
Benefits & Services
- Short Term Disability
- Long Term Disability
- Critical Illness
- Section 125 Premium Only Plans
- COBRA Administration
Benefit Administration Systems / One Touch Platform
- Setup for online benefits
- Medical eligibility data transfer
- Combined billing statement for multiple carriers
- COBRA, FSA, HRA and HSA administration
- Online personalized employee benefit enrollment process
- 24/7/365 employee access
- Benefit statements
- Payroll deduction reports
- ACA reporting and compliance
- Enrollment meeting support: group meeting, webinar, co-browsing, laptop, call center).
Legal, Regulatory & Financial Compliance Solutions
Is your company in compliance? Let us help with…
Employers must ensure all employees are aware of COBRA and its limitations. Businesses who fail to comply with all aspects of COBRA can face legal issues and financial penalties. IRS penalties include fines of $100 a day, per beneficiary, for noncompliance.
Providing plan participants with important information such as the major features of the plan and how the plan is financed. (Plan documents & SPDs.) Fiduciary duties for those who manage assets covered by a plan. Setting up procedures for employee grievances about the plan, as well as an appeal for those grievances. The fines may not exceed $1,000 per day for each violation, for noncompliance.
The fines ARE $100 per day per beneficiary for each violation, for noncompliance.
An employer may be liable for compensation and benefits lost by reason of the violation, for other actual monetary losses sustained as a direct result of the violation, and for appropriate equitable or other relief.
If 100 or more of your employees participate in a health and welfare benefits plan, you must complete IRS Form 5500. Failure to do so can mean possible criminal penalties for deliberate failure to report, and fines of up to $1,100 a day (per employee) for missing or incomplete information.
HIPAA violations are expensive. The penalties for noncompliance are based on the level of negligence and can range from $100 to $50,000 per violation.
Medicare Part D
Employers who sponsor group health plans must provide prescription drug coverage to Medicare Part D-eligible individuals. Insurance carriers certify whether or not a health plan is creditable; however, employers are responsible for the actual notifications and liable for con-compliance penalties.
Employers are obliged to ensure that their Flexible Spending Arrangements (FSAs), Health Reimbursement Arrangements (HRAs), Group Term Life Insurance, and Self-Insured Medical Plans do not discriminate in favor of Highly Compensated Individuals. The penalty for failure to meet the nondiscrimination tests is that the plan sponsor must pay an excise tax equal to $147 per day per non-highly compensated employee who is discriminated against, to a maximum of $500,000 per taxable year for inadvertent failures. Thus, for each employee affected, the annual penalty on the employer will be $36,500, subject to the annual cap of $500,000.
Employers are responsible for the CHIP Notice which must be sent annually – not just to plan participants but also to each employee who is or might become eligible for employer group health benefits & should be part of annual open enrollment packet. Noncompliance could result in a penalty from the Department of Labor (DOL) of $100 per day per non-notified employee.
Technology / Benefits Administration
Employee Leasing / Payroll / HR
Legal, Regulatory and Financial Compliance
Legislative Advocacy for Group Clients
ACA Outreach & Education Advocacy for Individual North Carolinians
We have partnered with Mission Hospital, Federally Qualified Health Centers (WNCCHS/Minnie Jones), and Buncombe County Health and Human Services to provide education, outreach, and an insurance home to those individuals without health insurance in Asheville, WNC, and throughout North Carolina.