benefits-101

Benefits 101

We realize benefit plans can be complicated so to help you understand the basics of how benefit plans work, please find below an overview of several benefit topics that may help you gain a better understanding of your benefit options through Intact.

In addition to the information below, you have access to a Brainshark library with overviews on many topics as well. You can access the Brainshark library here.

Premiums

Premiums are the amount you pay each pay period to participate in the plan. This amount is generally paid on a pre-tax basis (depending on the type of benefit plan) and does not count towards your deductible or out of pocket maximum. The premiums, also referred to as contributions, for all Intact plans can be found here.

Deductibles

Deductibles are the amount of covered expenses that you will pay out of pocket before the plan starts paying coinsurance. There are some exceptions, like certain preventative services, that will be covered by the plan prior to your deductible being met.

In the Intact medical plan there are both individual and family deductibles and out of pocket maximums. This means that one individual will only need to meet the individual deductible prior to the coinsurance kicking in. All family members will work towards the family deductible and out of pocket maximums.

Coinsurance

The coinsurance is where the plan starts to share a percentage of the costs with the member. Generally, on the Intact medical plan for in-network services the plan will pay 80% and the participant will pay the remaining 20%. The coinsurance percentage varies depending on the type of service and the plan. Coinsurance applies to medical and dental plans.

Out-of-Pocket Maximum

Once the out-of-pocket maximum has been met, the plan will pay for all remaining covered services during the plan year, up to the lifetime maximum. There are individual and family out-of-pocket maximums as well as in and out of network out of pocket maximums. The out of network maximums are significantly higher than the in-network out-of-pocket maximums so it is important to stay in network as much as possible.

Health Reimbursement Account (HRA)

For employees enrolled in the HRA medical plan, your medical plan is paired with an HRA account. At Intact, the only funding that may be available through your HRA is the annual incentive funding. Details of the annual incentive funding requirements are covered later in this overview. Funds deposited into your HRA can be used for medical or pharmacy expenses. The maximum balance that you can have in your HRA at any given time is $750 if you are enrolled in employee only coverage or $1,500 if you are enrolled in any other tier of coverage.

Health Savings Account (HSA)

The Health Savings Account (HSA) is a product that combines a high-deductible medical plan with a tax-advantaged savings account.

Annual Incentive Funding

In exchange for completing a preventive care visit and the online Health Assessment, employees and enrolled spouses are eligible to receive $350 each in incentive funding (up to a maximum of $700). This employer funding will go into your HRA or HSA after the preventative exam and your Health Assessment have been completed. Both steps need to be completed between January 1 and November 30 of the plan year.

Flexible Spending Account (FSA)

Each calendar year employees have the option to set aside pre-tax dollars to pay for eligible health care or childcare expenses. This allows you to save on tax dollars, however the funds need to be used each calendar year or you will lose any remaining funds so it is important to only set aside an amount that you know you can use. There are two different FSA plans, so you need to elect the appropriate plan for your needs.

Health Care Flexible Spending Account – This can be used for eligible health care expenses like medical, pharmacy, dental and vision expenses. If you are enrolled in the HSA medical plan, your HCFSA will be limited to dental and vision expenses until your full family medical deductible has been met.

Dependent Care Flexible Spending Account – This account can be used for eligible childcare or adult dependent care expenses that are necessary to allow you and your spouse, if married, to work, look for work, or attend school full time.

Intact Insurance Specialty Solutions is the marketing brand for the insurance company subsidiaries of Intact Insurance Group USA LLC. Coverages may be underwritten by one of the following insurance companies: Atlantic Specialty Insurance Company, a New York insurer; Homeland Insurance Company of New York, a New York insurer; Homeland Insurance Company of Delaware, a Delaware insurer; OBI America Insurance Company, a Pennsylvania insurer; OBI National Insurance Company, a Pennsylvania insurer; or The Guarantee Company of North America USA, a Michigan insurer. Each of these insurers maintains its principal place of business at 605 Highway 169 N, Plymouth, MN 55441, except The Guarantee Company of North America USA, which is located at One Towne Square, Southfield, MI 48076. This material is intended as a general description of certain types of insurance coverages and services. Coverages and availability vary by state; exclusions and deductibles may apply. Please refer to your insurance policy or consult with your independent insurance advisor for information about coverages, terms and conditions. Some coverage may be written by a surplus lines insurer through a licensed surplus lines broker. Surplus lines insurers do not generally participate in state guaranty funds and insureds are therefore not protected by such funds.