Health Benefits Advisor for Employers (2024)

Glossary

Pre-existing Condition Exclusion

A limitation or exclusion of benefits for a condition based on the fact that you had the condition before yourenrollment date in thegroup health plan. A pre-existing condition exclusion may be applied to your condition only if the condition is one for which medical advice, diagnosis, care or treatment was recommended or received within the 6 months before yourenrollment date in the plan. A pre-existing condition exclusion cannot be applied to pregnancy (regardless of whether the woman had previous coverage), or togenetic information in the absence of a diagnosis. A pre-existing condition exclusion also cannot be applied to a newborn ora child who is adopted or placed for adoption if the child has health coverage within 30 days of birth, adoption or placement for adoption and does not later have asignificant break in coverage. If a plan provides coverage to you through an HMO that has anaffiliation period, the plan cannot apply a pre-existing condition exclusion. A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for alate enrollee). A pre-existing condition exclusion that is applied to you must be reduced by the priorcreditable coverage you have that was not interrupted by a significant break in coverage. You may show creditable coverage through acertificate of creditable coverage given to you by your prior plan or insurer (including an HMO) or by other proof. The plan can apply a pre-existing condition exclusion to you only if it has first given you written notice. If your plan has both awaiting period and a pre-existing condition exclusion, the exclusion begins when the waiting period begins. In some states, if plan coverage is provided through an insurance policy or HMO, you may have more protections with respect to pre-existing condition exclusions.

The Department has developed a model general notice of pre-existing condition exclusion and a model individual notice of pre-existing condition exclusion that can be used by agroup health plan or a health insurance issuer. Correct use of the model notices will general assure compliance with regulatory requirements.

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Health Benefits Advisor for Employers (2024)

FAQs

What are a benefits advisor's responsibilities? ›

A benefits advisor assists HR teams with understanding, selecting, and managing employee benefits packages. Their impact is invaluable to creating a satisfied workforce and helping your business comply with labor laws. Managing employee benefits is just one piece of the HR puzzle.

Should I accept a job with no health benefits? ›

If you'll be in the same or an even better financial position with your new job with no benefits, then you may want to seriously consider accepting the offer. However, if the loss is greater than the gain, then your next step is to negotiate.

Why would employers choose to provide health insurance to their employees? ›

Savings for employers

Here are all the tax savings you get by offering group health insurance plans: Employer contributions are tax-deductible. Employer payroll taxes are reduced by 7.65 percent of employee contributions. Employer workers compensation premiums are reduced.

What is an employee benefits consultant? ›

A benefits consultant is an employer's partner on all things benefits. Also commonly referred to as an employee benefits broker or benefits advisor, these consultants build and manage benefits strategies for employers.

Is it hard to be a benefits advisor? ›

To have a successful career as a benefits advisor, you must understand relevant laws, such as COBRA and the Affordable Care Act (ACA) and have solid interpersonal and analytical skills. Similar job titles include HR benefits coordinator and health care benefits consultant.

What are the roles and responsibilities of an advisor? ›

The Role of the Advisor

Intervene in conflicts between group members and/or officers when necessary. Be knowledgeable of policies that may impact the organization's decisions, programs, etc. Provide continuity and stability as student leadership changes. Provide an outside view or perspective.

What is the main downside of employer provided health insurance? ›

Lack of flexibility

Because the employer chooses group insurance, employees don't have a say in what network they'll be on, the deductible they'll need to meet, or the premium they'll have to pay.

Is employer health insurance worth it? ›

Advantages of an employer plan: Your employer often splits the cost of premiums with you. Your employer does all of the work choosing the plan options. Premium contributions from your employer are not subject to federal taxes, and your contributions can be made pre-tax, which lowers your taxable income.

Why do most people get their health insurance from their employer? ›

Because the government does not provide health insurance to working Americans, it has little ability to constrain growing health care costs. And because health insurance benefits are untaxed, employers have been partly shielded from the increasing cost of medical care.

What is a benefit consultant's job description? ›

Key Responsibilities of a Benefits Consultant

Conducting comprehensive analyses of existing benefits programs to identify areas for improvement or cost savings. Designing, recommending, and implementing new benefits plans or modifications to existing plans that meet client objectives and employee needs.

What is a benefits specialist employee? ›

What is an employee benefits specialist? Benefits specialists are a crucial part of a company's human resource department. These professionals manage and administer a company's employee benefit and compensation programs, including disability insurance, retirement benefits, healthcare plans, life insurance, and more.

What is a benefits package for employees? ›

An employee benefits package includes all the perks and benefits provided when working for a company outside of an employee's wages and salary. Some organizations offer a handful of benefits, with the basics including medical insurance, life insurance, dental insurance, a 401k, holidays, and paid time off.

What is the job description of a benefits agent? ›

Benefits Representative Duties & Responsibilities:

Plan and develop employee benefits packages, such as retirement plans, insurance coverage, pension programs, paid time off, etc. Organize and conduct benefits meetings, new hire orientations, benefits fairs, etc.

What does a benefits advisor do in Aflac? ›

Work directly with employers to help solve benefits challenges with our plans and services. Generate sales with company provided leads, personal networking, referrals and cold calls. Conduct engaging sales presentations and enrollments at worksites and remote environment.

What is the role of a benefits representative? ›

As a benefits representative, your duties are to develop benefit packages based on job classification and seniority, answer employee questions regarding their coverage, and regularly review these agreements in an effort to develop a more cost-effective plan.

What is the responsibility of a benefits manager? ›

Benefits managers administer an organization's employee benefits program, which may include retirement plans, leave policies, wellness programs, and insurance policies such as health, life, and disability.

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