Pathway Health Insurance Experts, Inc. has more than 30 years of experience serving the employee benefit needs of small businesses and employers throughout the US, and we are one of the few benefit firms that hold the prestigious designation of Small Group Specialist in Texas. Because we understand healthcare, and particularly the small health insurance market, we are uniquely positioned to help today’s employers analyze needs, cost drivers and navigate thier options.
Our services are geared to:
- Lower and/or stabilize costs
- Simplify plan enrollment
- Ease compliance and complex regulations
- Increase productivity
- Attract top employees
- Give employees more benefit options
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Employee Benefit, Compliance & Other HR Services
As a ‘one stop shop,’ we do the leg work for you.
- Because every group is different, we work closely with each & every client to evaluate & understand particular dynamics, budget, & goals.
- We survey the marketplace and shop with various carriers to locate the right plan(s) for your particular company. Since we work with more than 20 top-rated carriers, we can advise you of the market & help you determine which carriers are most competitive for a company your size and, for your particular industry.
- We provide valuable guidance on compliance issues, such as the ACA, HIPAA, COBRA, ERISA and other regulations.
- If applicable, we’ll help minimize a potential tax penalty by ensuring that you have a qualified plan that meets the Affordable Care Act guidelines.
- We assist with claims and billing questions or problems, when needed.
- We have a proactive renewal process that ensures your plan continues to meet your needs and financial objectives.
Benefit Programs We Offer
Group Health Plans
The cost & range of protection provided by your health insurance plan will depend upon which plan you select.
We offer traditional health plans through most major carriers. Depending on your needs, we have plans that offer the Minimum Essential Coverage (MEC) as required by the Affordable Care Act (ACA) to full customized packages that offer a rich variety of benefits.
A Health Maintenance Organization (HMO) requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Members are required to designate a primary care physician who treats and directs health care decisions and who coordinates referrals to specialties within the HMO network. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). Most HMOs charge a small co-payment depending upon the type of service provided.
With a Preferred Provider Organization (PPO) members save the most money on healthcare, if they use providers within their network. If providers outside of the network are used, it is possible that those services may not be covered at all. Deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits.
A Health Savings Account (HSA) combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute, tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.
A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax favored savings account. Employers contribute to the savings account, which can be used for to fund co-pays and other qualified expenses prior to the deductible being met.
Single, Dual or Triple Option Plans offer eligible employees a choice between several different types of plans as described above.
For more information contact us at info@pathwaymarketplace.com or call 214-707-6056.
SHOP (Marketplace)
We can help you obtain the small business tax credit available to eligible employers through the Federal Marketplace, Small Business Health Options Program (SHOP). Eligible employers may have their premiums reduced by as much as 50%. To be eligible, you must cover at least 50 percent of the cost of employee-only (not family or dependent) health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 (as adjusted for inflation beginning in 2014) per year.
We suggest you use our Business Tax Calculator to find out if you qualify. Those who qualify will be able to purchase traditional group health plans (PPOs) through SHOP.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Group Life Insurance
These plans can be written in conjunction with your health plan or, separately. Often times, it’s less expensive to purchase a separate policy.
For more information contact us at info@pathwaymarketplace.com or call 214-707-6056
Group Dental Plans
Dental Plans offer a variety of diagnostic, preventative care, & corrective services including cleanings, exams, x-rays, fillings, root canals, orthodontia for children, & emergency care.
Whether on an employer paid basis, or offered as a voluntary benefit (where employee pays all of the premium), employees appreciate dental coverage as part of their Employee Benefits Package.
To learn more about our group dental products, please contact us at info@pathwaymarketplace.com or call 214-707-6056.
Group Vision Plans
Vision Plans provide routine eye exams, prescription eyeglasses, contact lenses, prescription sunglasses, discounts on non-covered items and accessories, LASIK surgery, and offers a choice of retailers or independent providers, & more.
This is an inexpensive way to add to your Employee Benefits Package.
To learn more about our group vision products, please contact us at info@pathwaymarketplace.com or call 214-707-6056.
Group Disability
That’s why Employer sponsored disability plans, either involuntary (Employer pays all or part of the premium) or voluntary plans (Employee pays all of the premium) are an added benefit to your Employee Benefits Package. And, the premiums for group are generally less than an individual policy.
Disability insurance provides a person who becomes disabled with income to cover their living expenses while disabled.
Short-term disability coverage can serve as a bridge between sick leave & long-term disability. It can cover an employee who is off work on a temporary basis due to an accident or illness. This type of coverage usually lasts from one month to 2 years.
Long-term disability coverage will normally pick up where the short-term disability left off. And, it’s there to cover longer lasting and/or permanent disabilities due to sickness or illness. These plans can be designed to cover the employees up to retirement age.
For more info contact us at info@pathwaymarketplace.com or call 214-707-6056.
Group Long-Term Care
This too is an added benefit to your Employee Benefits Package. And, the premiums are less, as a group, than they normally are on an individual basis.
Studies have shown that more than half of the U.S. population will require long-term care at some point in their lives, due to the fact that we are living longer. The prospect of long-term care is one of the most important issues your employees may have to face. The cost of long-term care is expensive and generally not covered by other employee benefits which is why Long-Term Insurance is becoming an increasingly popular supplemental group product for many employers.
To learn more about supplemental Long-Term Care insurance for groups, please contact us at info@pathwaymarketplace.com or call 214-707-6056.
Group Retirement Plans
Americans are living longer & spending more time in retirement. In fact, the average American will be retired for 18 years. A retirement nest egg is probably the largest amount of money you’ll ever need to accumulate.
How will you do it?
There are a number of Employer sponsored retirement plans available including 401ks, SEP Plans, IRAs & others.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Wellness Benefits
Through many of our carriers, Wellness and Healthcare Consumerism is incorporated into your health insurance programs. This has proven to help lower claims for insurers, as well as lower premiums for employers and increase employee satisfaction and productivity. Employees have access to Information and tools about nutrition, exercise, preventative medicine, substance abuse and many other healthy alternatives to make decisions that improve overall health and well-being.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Flexible Spending Accounts (FSAs)
A Flexible Spending Account (FSA) is a cafeteria plan under Section 125 of the tax code and allows for benefits to be paid with pre-tax dollars which results in tax savings to both the employee and the employer.
The average working employee in America spends thousands of dollars annually on certain types of medical benefits, daycare expenses and transportation services. By participating in an FSA, an employee’s taxable income is reduced, which increases the percentage of pay they take home and allows them to pay for these benefits and services with the pre-taxed dollars, in essence giving them a discount on these services.
Here’s how it works:
This tax-favored savings account is funded solely by the employee through regular pre-tax payroll deductions. Employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. Throughout the plan year, funds can be withdrawn from the account (tax-free) to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Some FSAs include work-related parking and transit costs. The administrator of the FSA account can issue a debit card that is tied to the FSA making it easy to use the account when needed.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Premium Only Plans (Pops)
A Premium-Only Plan lets employees purchase their own individual insurance with pre-tax dollars, potentially saving employees thousands annually in taxes and premiums combined.
Employees elect a set amount of pre-tax dollars to be deducted from each payroll. The employee purchases an individual health insurance policy in which he/she chooses completely on their own and is responsible for paying the monthly premiums directly to the carrier.
The employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Partially or Fully Self-Funded Health Plans
Partially Funded Health Plans (Shared Funding)
Shared Funding Plans allow small employers to take advantages of all the cost savings and benefit design features of a self-insured plan that typically is designed for larger groups. Any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan.
Here’s how it works.
First, an employer will select any of the fully insured plans that the carrier offers and rates will be determined by the group’s claim history. Stop-loss insurance is added to protect against catastrophic claims.
Just like with an insured plan, the carrier will handle the administration of the plan, processing claims and offering members on-line access to benefit explanations and other reporting tools.
Premiums for shared funding plans are generally much lower than fully insured plans because the employer shares some of the risk.
Employers who opt for shared funding plans may save even more costs by implementing wellness programs into the workplace.
Self-Funded Health Plans
When employers self-fund their own health plan, they will benefit from a significant savings in premiums, increased cash flow, tax advantages in addition to having more control over the benefits that the plan offers.
Although not always a popular choice for small employers, today, self-insured plans are considered to be good options for both small and large employers. Pathway Health Insurance Experts, Inc. can help you set up and maintain self-funded health plans and will be happy to give you a no cost analysis to determine if a self-funded health plan option is right for your company.
Here’s how it works:
A self-funded health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. A third party (a TPA) is engaged to handle claims and processing. Because self-insured employers run the risk of large catastrophic claims, they will purchase stop-loss insurance to protect them in such an event. Even with the additional expense of stop-loss insurance, employers can enjoy saving thousands in premiums and other advantages.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Key Person Benefits
Key Person Benefits, such as Life Insurance and Disability Insurance are tailored for key personnel in a company, whose continuation in the business is crucial to it’s success. This is usually the owner, the founders or perhaps a few key employees. Key Person polices can be customized to wrap around the group plan for key executives, which protects the business in the event of a sudden critical illness or death, in addition to the executive’s family.
Here are some examples of using Key Person Insurance for Executive Planning:
Key Person Life Insurance is designed to protect your business should one of the main partners pass away unexpectedly. This policy will name your business as the beneficiary and premiums are billed under the business name. Benefits and premiums are tied the value you have established through financial records. Benefit payments are made to the business to help minimize financial loss should your business lose the insured (key personnel) due to death.
A Business Overhead Disability policy prevents businesses from going under from regular overhead expenses while the business owner is unable to work and run the business due to disability. These types of policies will typically pay for things like employee salaries, rent and utilities, among other expenses.
Buy-Sell Agreements are intended to protect a business after the death of a key employee. Buy-Sell Agreements (also known as Continuation Agreements) are tied to and funded by life insurance policies. The agreement sets out the details of the transfer of business interest by the key-person (or his/her estate) upon a certain triggering event–usually death, disability and retirement. The surviving or continuing business owner or partner can rest assured knowing that they will be able to purchase the key-person share without interference from other survivors of the key person and his/her estate.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.
Voluntary (Worksite) Benefits
We offer a rich variety of Voluntary Benefits to help your employees manage rising healthcare cost and risk. Employees can purchase voluntary benefits at reduced group rates through pre-taxed payroll deductions. We can help your employees get the additional voluntary employee benefits coverage they want or need—at no cost or hassle to your company. Following are examples of our Voluntary Products offered to your employees:
Life – Term and Permanent (Cash Value) Life Insurance
Accident Insurance – Offers different benefit level choices to fit your employee’s needs and budget, and provides cash benefits in addition to regular health insurance and/or disability insurance, in the case of an accidental injury.
Disability – Provides your employees with an option to purchase additional disability coverage to supplement their employer provided coverage.
Long-Term Care – Whether an employer sponsored benefit or on a voluntary basis, Long-Term Care insurance goes a long way to help protect your employees’ financial future and well-being.
Dental & Vision – Dental and vision benefits are one of the most requested health benefits from employees, behind major medical and life insurance. Yet with rising premiums, many employers are challenged to keep them in the traditional benefit offering. Studies show that offering voluntary Dental and Vision is a perfect way to help employers off-set these costs pressures, while promoting good health for their employees and ensuring employee satisfaction.
Critical Illness – Surviving a critical illness is very common with the advances in modern medical technology. Critical Illness Insurance pays a cash benefit directly to your employees, which can be used to help reduce the personal financial impact of fighting a critical illness and keeping up with everyday bills through that process.
Hospital Indemnity – This plan will pay a lump-sum payment directly to the insured which can help your employees with out-of-pocket expenses and everyday bills when they are off work due to a hospital stay. The coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.
Gap – Gap insurance provides benefits that supplement a major medical and comprehensive benefit package. It works by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if your employees have a $5,000 deductible on their major medical coverage, gap coverage could pay up to $4,000 of that deductible.
Final Expense – This type of life insurance has a much lower face value than traditional term insurance because it is intended to only cover costs related to a person’s final expenses. Therefore, these policies can often be purchased by your employees at a low or reasonable premium.
To find out more information, contact us at info@pathwaymarketplace.com or call 214-707-6056.