Employee Benefits

Employer sponsored health, life and disability insurance. The James Group, LLC provides customized health, life and disability solutions for business.

Consumer Driven strategies

The James Group has extensive experience with implementing and managing consumer driven strategies for our client base. Options include:

• Health Reimbursement Account (HRA)
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• HS A/HRA combination
• FSA/HRA combination
• HS A/Limited FSA combination

All consumer driven strategies need an Employee Education component and senior management buy-in and participation. The James Group, LLC will be involved with you every step of the way as you implement your consumer driven strategy.

Wellness

The Federal Government has approved 2 Wellness plan models under the Affordable Care Act

• Basic plan, activity driven with HRA (or HSA) reward-least expensive
• Enhanced plan, typically utilizes biometric screening, coaching and measurement/achievement. You may utilize an HRA/HSA reward or tiered premium based on participation and achievement-most expensive

Full blown wellness programs are expensive, usually with no immediate premium or claims savings. When will you see the benefits? You must take a long term strategy position: 5+ years. Wellness programs can be very effective, but the most recent data still shows Disease Management is still the best way to reduce large claims, and the least expensive. Let The James Group® help you with your Wellness strategy!

Telemedicine

Telemedicine is one of the most rapidly growing segments of healthcare and can be added to your plan offering (employer or individual) for a fraction of the cost of your medical plan premium. Telemedicine can help reduce urgent care and emergency room visits after hours and on weekends with a faster call back window than scheduling a physician office visit, driving to an urgent care facility or making the trip to the Emergency Room. Access is readily available via telephone, PC and mobile app 24/7.

Minimum Essential Coverage (MEC)

Coverage required by the Affordable Care Act is deemed Minimum Essential Coverage. MEC coverage may be offered by employers to avoid ACA penalties and by individuals to comply with the individual coverage mandate.

MEC plans may be either fully insured or self-funded depending on your goals. Your offer strategy may bring full or partial ACA compliance and most MEC plans offer Preventive care only with an employee option to purchase supplemental coverage.

Annual Plan Renewal Strategy

When your employer plan renews, The James Group is there with you every step of the way. The James Group handles all aspects of your group plan renewals, including:

• Full Market Shop at renewal
• RFP to all carriers available in the market
• Go to the market early to have plenty of time to work on cost, plan design, revisions and explanation of large claims
• Traditional fully-insured
• Self-funding/reinsurance
• MEC (Minimum Essential Coverage)
• Include self-funded with reinsurance options in marketing strategy as appropriate
• The most flexibility with plan design
• Up-front cash flow advantage early in plan year (must plan for catch up as claims begin to come in later in plan year)
• Large claim accommodation options to assist with cash flow management in case of large claim
• Review and recommend Consumer Driven strategies to manage premium cost and encourage employee involvement in their health care

After the renewal has been finalized, The James Group is there to help you complete the process:

• Assist with scheduling the Open Enrollment period
• Set up and manage the enrollment meetings, materials and enrollment process for your employees
• Available to answer questions about coverage elections and plan design
• Collect final enrollments, proof and submit to carrier(s)
• Follow up with the appropriate carriers to finalize enrollment adds, changes, terms, etc.
• Assist with any additional OE needs.
• Then, The James Group® is available throughout the plan year to review performance of the plan(s) with management and assist employees with questions, claim issues and other insurance needs.

The Affordable Care Act

The James Group has worked tirelessly to become knowledgeable in all aspects of the ACA. Our expertise gained from working with our existing multi-ownership clients has given us insight into the challenges associated with management contracts and multi owner arrangements. Prior to starting The James Group the management team managed 8 major hospital system/alternate site health care partnerships and management contracts. We understand how expanding your health insurance coverage to all employees will financially and operationally impact your management and owner partners. Contact The James Group today to learn how to avoid the mandatory large employer pay or play penalties before it’s too late.

The James Group has proven experience at moving over 40 employers (over the last 12 months) from management/salaried carve-out plans to fully ACA compliant major medical plans available to all ACA eligible employees. These clients have included:

• Hotel/Hospitality Management
• Corporate owned branch locations
• Health Care Facility Management
• Employers with large numbers of seasonal employees

Employer Value added solutions for our joint clients with our partner Human Resources and Payroll expert

• Electronic online medical and voluntary benefit enrollment (annual and new hire ongoing)
• Monthly insurance carrier invoice reconciliation and problem resolution
• Monthly insurance carrier bill payment
• Affordable Care Act (ACA) expertise in house. Integrated ACA large employer reporting solution (Sections 6055, 6056)
• ACA Lookback Period Tracking Report
• ERISA Form 5500 reporting
• New hire enrollment, plan selection counseling, claim assistance and problem resolution customer service for Employer and Employee
• Robust Voluntary Benefit Package w/ no participation requirements: Dental, Vision, STD, LTD, Life/ADD, Sec 125, FSA, Dep. Care, HRA, HS A

Individual Health

Health insurance you buy on your own, not employer sponsored. Visit our “Get a Quote” page.

Life

Purchase life insurance to protect those that depend on you for their financial support. Visit our “Get a Quote” for individual life quotes or contact us for life insurance as part of an employee benefits package.

Disability Income

Disability insurance is designed to provide a stream of income should you become temporarily or permanently disabled. Contact us for assistance with disability income coverage as part of your employee benefits package or to request an individual disability quote.

Long Term Care Insurance

Long-term care insurance (LTC) helps to pay for both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods of time.