AHEAD OF THE CURVE
TECHNOLOGIES @ YOUR FINGERTIPS
Local professionals serving employers by connecting & educating employees with exclusive benefit communication & administration platforms.
AHEAD OF THE CURVE
Local professionals delivering innovative cost-effective health insurance & employee benefit solutions.
Local professionals structuring Self-Funded Arrangements, Alternative Funding Plans, Direct Primary Care Models & Doc-In-The-Box Models for our middle and large group market segments.
Health insurance at work for you…
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.
We are a privately owned & independent firm headquartered in Asheville, NC. We currently serve over 200 employers in North Carolina and service the health benefits for over 10,000 individuals. On our journey to design a better healthcare model, we have invested in strategic partnerships and integrated our agency’s systems with the top insurance carriers, technology providers, & compliance vendors. When other agencies have “sold out” or “offer no way out”, our local professionals have the resources and the expertise to “help out”. Through embracing change, predicting out-comes, and acting nimble, we support our clients with the information & tools they need to adjust to a dynamic employee benefit environment. We serve clients operating in the Medical Care & Delivery space, Legal & Tax Services space, Manufacturers of raw materials & finished goods, Food Service Provid-ers, Hospitality businesses, Non-Profit Organizations, and many more industries. We are contracted with ALL major health insurance providers and have access to unique health plans that are ONLY available to our agency. We also design and implement health plans specific to a client’s appetite for risk to sustain an affordable healthcare model. Let us design a better model for you & your employees.
Insurance Consulting Services
For employers with > 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 & approved by employer.
Insurance Brokerage Services
For employers > 100 full time employees, Insurance carrier pays agency fees, not the employer. Fees are either a % of premium or a Per Employee Per Month (PEPM) Fee.
Which platform will best meet your needs…
Fully Insured Group Health Plans
Employer pays a fixed monthly premium and the the insurance carrier assumes all claim liability risks. Major Insurance Carriers (ie BCBSNC, UHCNC, AETNA) administer the plans for all sizes of employers. Plans are subject to all federal & state taxes and regulations.
Level Funded Health Plans (Hybrid Plan)
Is a Partially Self-Funded (PSF) Plan with a fixed monthly premium. If actual claims are lower than expected, then the employer shares the savings with the insurance carrier. Employer retains a portion of the claim liability & contracts with the insurance carrier to cover excess claim liability. These Plans are administered by Major Insurance Carrier (ie BCBSNC, UHCNC, AETNA) & employers must have > 25 full time employees to be eligible for coverage. These plans are exempt from many federal & state taxes and regulations.
Self Funded & Partially Self Funded (Psf) Group Health Plans
Employer pays a variable premium subject to claim utilization, retains a portion of the claim liability & contracts with a reinsurance carrier to cover the excess claim liability. PSF Plans are administered by an Insurance Carrier or Third Part Administrator and employers must have > 50 full time employees to be eligible for coverage. PSF 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. Variations of PSF 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 PSF Plan
How providers are paid matters. With this hybrid Self-Funded or PSF 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 & contracts with a reinsurance carrier to cover the excess claim liability. PSF Plans are administered by an Insurance Carrier or Third Part Administrator and employers must have > 50 full time employees to be eligible for coverage. PSF 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)
Employer contracts with a PEO to provide outsourced services in payroll, human resources, employee benefits, and tax compliance. Depending upon the cost savings / 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. PEO manages all federal and state employee-related compliance including payroll taxes, human resource assistance, OSHA, and the Affordable Care Act (ACA).
Benefits & Services
Medical, Dental, Disability, Life, Vision, Critical Illness, Accident, Gap, EAP, IRC Section 125 Premium Only Plans (POP), Flexible Savings Accounts (FSA), IRC Section 105 Health Reimbursement Arrangement (HRA) Plans, Health Savings Accounts (HSAs), COBRA Administration.
Benefit Administration Systems / One Touch Platform
Setup for Online Benefits, Medical Eligibility Data Transfer, Combined billing statement for Multiple Carriers, COBRA, Flex, HRA/HSA administration, Online / Personalized Employee Benefit Enrollment Process, 24/7/365 Employee Access, Benefit Statements , Payroll Deduction Reports, ACA Reporting/Compliance, Enrollment Meeting Support (Group Meeting, Webinar, Co-browsing, Laptop, Call center).
Legal, Regulatory & Financial Compliance Solutions
Is your company compliant, let us help out…
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 appeals 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 Accounts (FSAs), Health Reimbursement Arrangements (HRAs), Group Term Life Insurance, and Self-Insured Medical Plans do not discriminate in favor of Highly Compensated Individuals (HCI). 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.
Human Resources, Payroll & Benefit Administration Consulting
Payroll Administration, Payroll Tax Management, Benefits Coordination, ACA Compliance, New Hire Reporting, New Hire & Termination Processing, Time and Attendance, Payroll Portal for Managers & Employees, EEOC Reporting – Equal Employment Opportunity Commission.
Work Comp Placement, OSHA Management, HR Compliance, Employment Law Support, Company Handbook Development & Ongoing Updates, Analysis of Current Workforce, Background Screening Job Description Development, Performance Reviews, Compensation & Benefits Planning, Employee File Audits, EPLI – Employment Practice Liability Insurance, Employee Relations Guidance.
Group Benefits Administration
401(k), Medical, Dental, Vision, Supplemental – Term Life / AD∓D, Holiday Savings Fund, Income Replacement Policies
Professional Employment Organization (PEO) / Employee Leasing Services
PEO provides outsourced services in payroll, human resources, employee benefits, tax compliance, and risk and safety to small and medium-sized businesses. Depending upon the cost savings / service an employer can implement some or all the PEO’s services. Co-employment arrangement is established creating shared liability allowing the employer to focus on their core competencies. PEO manages all federal and state employee-related compliance including payroll taxes, human resource assistance, OSHA, and the Affordable Care Act (ACA).
BCBSNC, UHC, LFG, Sun / Assurant, Principal, Crescent TPA, NCMS MEWA
Technology / Benefit Administration
ADP, GIS, Zvwave, Benefit Connect
Employee Leasing / Payroll / HR
ADP Total Source, Advisor HR, Carolina HR
Legal, Regulatory & Financial Compliance
Constangy Books & Smith, Zvwave, Gould Killian CPA
Legislative Advocacy for Group Clients
National Association of Health Underwriters (NAHU) and the Society for Human Resource Management (SHRM)
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 our community.
The 2017 Annual Open Enrollment Period for the Federal Health Insurance Marketplace runs from November 1, 2016 to January 31, 2017. If you live in North Carolina and need to sign up for a health insurance plan or make changes to an existing health insurance plan, you must do so during this three month Annual Open Enrollment Period!
Penalties increase in 2017 for remaining uninsured. So act now, and let one of WNC Health Insurance’s personal reform advisors help you understand your health insurance options under the Affordable Care Act. WNC Health Insurance is your resource for understanding the complex rules of subsidized insurance plans, discounts and requirements for enrolling in North Carolina health insurance plans offered on the Federal Health Insurance Marketplace. We can help you determine whether you qualify for government subsidies to help you pay for your insurance premiums, and we will guide you through the enrollment process from start to finish. As local Asheville health insurance agents, we are here to help you find the best health insurance options available. Our agents are knowledgeable in Health Care Reform and ACA enrollment requirements, and can help you find the right coverage for you and your family. If you miss the 2017 Annual Open Enrollment Period, you may not enroll in a health insurance plan unless you experience a life event that qualifies you for a Special Enrollment Period. If you experience any of the following after January 31, 2017, you may qualify for a limited 60-day Special Enrollment under the Affordable Care Act:
- You lost your job
- You lost your health insurance due to a job change
- Your income changed making you eligible for premium subsidies
- You just got married
- You just finalized your divorce
- You experienced a death in the family resulting in a loss of health insurance for yourself and/or your dependents
- You had a baby, adopted a child, became a foster parent or kinship provider
- You recently moved to Western North Carolina from anywhere outside of Western North Carolina
WNC Health Insurance is here to serve as a resource for you, whether you are enrolling in Affordable Care Act insurance during Annual Open Enrollment, a Special Enrollment Period, or are selecting a plan outside of the Federal Health Insurance Marketplace. We are your one stop shop for the best individual, family, and group health insurance in North Carolina. Come and visit us at our Asheville health insurance store. If you prefer, we can even help you enroll over the phone!