Tax and Finance
A defined budget strategy is typically a post-tax contribution that an employer provides to eligible employees that staff can use to help cover monthly insurance premiums or other medical costs.
Similar to a child tax credit, premium tax credits help eligible individuals and families cover the premiums for their health insurance purchased through the Health Insurance Marketplace. To get this credit, you must meet certain requirements.
For employers with less than 50 full time employees, you have two options to fund individual health insurance: post-tax where employees can receive tax credits or pre-tax (tax free) via an HRA (technically QSEHRA). In most cases, our clients find that the post-tax with tax credits is more advantageous than pre-tax HRA or their pre-tax group plan. For employers with over 50 employees, QSEHRA is not available, so the premiums are post-tax but eligible to be reduced by tax credits.
Legally, you cannot force people to use their provided budget for health benefits, but in almost all cases, people use the budget for their health insurance. Participating in the RH platform helps encourage people to use their budget for health insurance.
Medical Insurance Details
Medi-Share is a Christian healthcare bill sharing program that provides an affordable alternative to health insurance.
Medi-Share is not insurance. It’s a faith-based community of support, where members not only share each other’s medical bills, but encourage and lift one another up in prayer. Every month, members contribute a set dollar amount (monthly share) toward the costs of other members’ medical bills. This is similar to a premium, but goes directly to pay other members’ medical bills. This monthly amount is typically about 50% less than an insurance monthly premium.
Medi-Share members have a member ID card, access to a large PPO network, and pay a provider fee at each visit. Medi-Share employees administer sharing by determining bill eligibility according to the Medi-Share Guidelines.
Medicaid is a plan typically administered by an insurance company (Anthem in Indiana, Kaiser in California, etc.) that is funded by the government. This funding reduces member’s premiums and out of pocket medical expenses.
Medicaid provides a broad level of health insurance coverage, including doctor visits, hospital expenses, nursing home care, home health care, and the like. Medicaid also covers long-term care costs, both in a nursing home and at-home care. Medicare does not provide this coverage.
You may qualify for free or low-cost care through Medicaid based on income and family size. In all states, Medicaid provides health coverage for some low-income individuals, families and children, pregnant women, the elderly, and people with disabilities.
Medicare benefits are divided into two parts. Part A primarily covers inpatient hospital, skilled nursing facility care, hospice and home health care. Part B primarily covers preventative services and medically necessary services such as ambulance services, mental health care, durable medical equipment, etc. You must be age 65 or older to be eligible for Medicare benefits.
Individuals qualify for a Special Enrollment Period (SEP) if they have had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. In most cases, joining the Remodel Health platform ends group coverage, which triggers a life qualifying event. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan.
Visit help.remodelhealth.com and follow the instructions for adding or dropping an employee.
Coverage and Plan Details
Depending on the plan you select, the network will vary. We recommend calling your chosen insurance company, visiting your provider website, or calling your doctor directly to ask if they accept the carrier you have chosen.
On average, it takes approximately two weeks after the first payment has been made for an ID card to arrive, however, it can vary depending on carrier chosen. During open enrollment (usually early November through mid-December), the process and delivery may take longer.
It could depend on your organization’s eligibility, but most coverage begins on the 1st of the month following enrollment.
In most cases, no. If your organization offers for you to participate in payroll deduct and you opt in, Remodel Health will make the first payment (and all subsequent payments) on your behalf. If your organization does not participate in our payroll deduct program, you are responsible for your own payments.
To access your benefits online, reach out to your Remodel Health member care coordinator to help gain access to your online account.
To submit a claim to your insurance carrier, contact the member services department of your chosen carrier. Remodel Health cannot submit claims on your behalf.
Yes, all plans through the Remodel Health platform are individual plans not connected to any employer. However, any budget provided by your employer to assist with monthly premium costs would discontinue at termination of employment, so individuals would assume the full monthly premium cost. Remodel Health will also not make payments on your behalf if you are no longer employed by an organization on our platform.
Depending on the plan, you may need to follow a different process. Remodel Health cannot cancel your plan on your behalf. Please contact your chosen carrier’s customer service department to cancel your insurance plan, and inform your Remodel Health member care coordinator of your intent to cancel.
Who Do I Contact If...?
For issues with claims or medical bills, contact your chosen carrier via the number on the back of your ID card.
If you receive a late premium notice, please contact your Remodel Health member care coordinator as soon as possible and send them a copy of your notice.
Remodel Health cannot stop bills sent to your home. Typically, members can change how they receive their monthly notifications by looking online at their carrier’s website or by calling their customer service department.
Yes, if you have had any major life change that may affect your insurance coverage, please let your member care coordinator know as soon as possible about any adds, drops or changes to your life situation.