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Health
benefits concern the physical well being of employees and their
families. Broadly speaking, this could include such things as medical
coverage, dental and vision insurance, prescription drug plans,
certain types of disability coverage, and counseling services, often
called employee personal assistance programs (EAP). You might also
have a flexible spending account, which allows you to pay for certain
medical and dependent care expenses out of pretax dollars.
Dental
plans
Dental plans come in almost as many forms as regular healthcare
coverage. Basic dental coverage usually has categories of coverage
for preventive care, routine restorative care and major restorative
care. Make sure you are aware of the maximum annual benefits that
the dental plan offers. There are limits to what an insurance company
will pay in a calendar year. If you know you have some major restorative
work to be done, you need to pay special attention to your plan's
maximum annual benefit, which usually runs between $1,000 and $1,500.
You also want to know if the plan offers an orthodontia benefit
and if so, are there lifetime maximums for this benefit.
Vision
coverage
Most employers offer either a comprehensive vision insurance plan
or some type of vision coverage as a free side benefit or optional
purchase benefit along with the health insurance plan. Typically,
an employer will offer vision coverage as a discount program. Costs
will vary by employer but should provide you with at least a 10
percent discount. Vision coverage is meant to cover only predictable
costs such as comprehensive annual or bi-annual exams, lenses, frames
and contact lenses.
Prescription
drug plans
Prescriptions are the fastest growing component of health care costs.
To address this, health insurance companies have prescription drug
programs designed to keep drug coverage affordable. Health insurance
companies usually offer prescription plans with various co-payments
and deductible arrangements. A co-payment can be a flat amount or
a percentage of the total cost of the drugs. Your plan most likely
will have different levels of coverage for generic and brand name
drugs. Generic drugs have the same active ingredients in the same
amounts as the matching brand name drugs, but usually cost less.
Many plans want patients to use generic drugs and will provide more
coverage for them than for brand name drugs. If you want a brand
name drug, you may have to pay a greater share of the cost.
Short-term
disability
Short-term disability (STD) coverage provides you with income when
a non-work related disability like injury, sickness, or pregnancy
requires you to be away from work for an extended period of time.
A benefit is usually paid from the beginning of an injury, or after
a short period of time if a disability is due to sickness or pregnancy.
STD plans can be designed to stand alone or coordinate with an employer's
sick leave plan.
There
are often restrictions for STD coverage eligibility. For example,
some employers may require an employee to have 30 scheduled hours
of work per week, or there may be a waiting period before an employee
is able to qualify for the STD program. Some STD plans allow an
employee to receive 100 percent of base salary (or prior year's
W-2 earnings, whichever is greater) for the first 15 days, and then
a percentage of base salary thereafter, up to a maximum of 180 days
for each period of continuous disability.
Flexible
spending accounts/Section 125 plans
A flexible spending account (FSA) is a type of cafeteria plan authorized
under Section 125 of the Internal Revenue Code. An FSA is a special
kind of account, funded by the employee on a pre-tax basis, that
provides for tax-free reimbursement of eligible expenses. FSA's
may be set up to provide reimbursement for eligible medical expenses
or dependent care expenses (child or elder care).
The
contributions you make to an FSA are deducted from your pay before
your federal, state, or social security taxes are calculated. These
deductions are never reported to the IRS. The end result is that
you decrease your taxable income.
At
the beginning of the plan year, which usually starts January 1st,
your employer asks you how much money you want to contribute for
the year (there are limits). The amount you designate for the year
is taken out of your paycheck in equal installments each pay period
and placed in a special account by your employer. As you incur medical
expenses that are not fully covered by your insurance, you submit
a reimbursement form explaining the eligible expense and proof of
payment to the plan administrator, who will then issue you a reimbursement
check.
Any
expense that is considered a deductible medical expense by the Internal
Revenue Service and is not reimbursed through your insurance can
be reimbursed through the FSA. Also, in September 2003 the IRS ruled
that money in a flexible spending account could be used to buy non-prescription
drugs. In order to be reimbursed for an over the counter drug, the
drug must alleviate or treat personal injuries or sickness, such
as cold medicines, antacids, allergy medicines, and pain relievers.
Expenditures merely benefiting the general health of an individual,
such as vitamins or food supplements, are not reimbursable under
an FSA.
The
ruling is significant because most over-the-counter drugs are not
covered by health insurance plans. In addition, some medications
that were previously available only by prescription, such as the
allergy drug Claritin, are now sold over the counter. Therefore,
people who use those drugs can no longer rely on their insurance
to pay for them.
With
a dependent care account, pre-tax money can be used to help pay
the costs of any caregiver providing services while you're at work.
This includes the nursery school for kids or the home health aide
looking after a disabled spouse.
One
of the largest drawbacks to flexible spending accounts is the "use
it or lose it" requirement. When you set up an FSA you have to estimate
how much you'll spend on out-of-pocket health care costs or dependent
costs during the year. If you don't spend all of the money in your
FSA account by December 31st, or the end of your plan's calendar
year, money left in the account is forfeited. Luckily, you have
three months after the end of the calendar year to submit claims
for eligible expenses incurred during the previous calendar year.
In order to determine how much to contribute to an FSA, make a list
of the expected out-of-pocket medical expenses for you and your
dependents for the next year. It is always wise to be conservative
so you don't risk forfeiting any money.
Employee
(personal) assistance programs
To protect employees' mental health and to offer short-term counseling,
many companies offer third-party employee assistance programs (EAP).
These typically cover the first few visits to a counselor and end
in a referral to a counselor whose services may be covered under
a group health insurance plan. These services can be a first step
for coping with difficult personal issues like work/life balance,
family problems, substance abuse, depression, or financial difficulties.
By offering an EAP, an employer implicitly acknowledges that those
issues may exist for some employees, and signals that counseling
is an appropriate step.
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Linda Jenkins, Salary.com contributor, Modified 12-5-2004
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