Affordable Care Act health insurance reform law requires most people,
including children, to have health coverage or pay a penalty.
If you don’t have employer-provided coverage, we can help. We
assist you with obtaining health insurance through Oregon’s
health insurance exchange to get the coverage you need with the premium
tax credit you deserve. We also offer a wide selection of individual
health insurance plans for individuals and families that meet the
requirements of the Affordable Care Act and operate outside of the
Oregon health insurance exchange as direct health insurance through the
company of your choice.
We also offer programs to protect your health and finances, such as
short-term health insurance, dental insurance, vision insurance, life
insurance, long-term care insurance, and critical illness insurance.
can help you find a medical insurance plan that fits your budget, from
a plan that offers generous coverage to a high-deductible plan designed
primarily to protect your family from the cost of catastrophic illness
or injury. These plans meet the requirements of the Affordable Care Act
health care reform law so you won’t have to pay a penalty.
can also buy supplemental insurance plans that will pay some of the
costs your health insurance plan won’t cover. These include
hospitalization insurance (or hospital indemnity insurance), critical
illness insurance, and long-term care insurance. These supplemental
insurance plans will pay benefits if you are hospitalized, suffer from
a covered illness, or require long-term care.
Medical insurance plans with
full coverage fall into three major categories:
Organization (PPO) plans:
are the most common type of health plan today. A PPO contracts with a
network of doctors; plans typically reimburse a higher percentage of
fees for in-network doctors. Members can use non-network providers but
will have higher copayments. Plans usually include features to avoid
unnecessary health expenditures, such as requiring pre-authorization
for elective procedures or a primary care physician’s
for visits to specialists. Most plans also include wellness or disease
management benefits designed to keep your employees healthy and control
your claim costs.
Organization (HMO) plans:
HMO requires members to use physicians within the HMO’s
HMOs typically do not pay anything for out-of-network treatment, except
in cases of emergency. HMOs give your employees less flexibility in
provider choice, but often cost less and involve lower out-of-pocket
payments than other plans.
Point-of-Service (POS) plans:
plans combine features of HMOs and PPOs. Most POS plans require members
to choose a primary care physician from within the POS network, but
allow them to use out-of-network specialists with a referral from a
primary care physician. Co-payments will be higher for out-of-network
Health Savings Accounts (HSAs)
you want protection from catastrophic illness but you want to pay less
in premiums, you can take advantage of a high-deductible health plan
linked to a health savings account. These plans offer lower premiums
than a plan with full coverage. You can use the savings to build funds
in a health savings account, which you can use for any tax-qualified
with an eligible high-deductible health plans and no other health
insurance can have an HSA. You use account balances to pay for
qualified health expenses and funds can accumulate from year to year.
employers fund their employees’ HSAs–employer
to an HSA are not considered taxable income. Contributions you
make, up to the annual maximum, are tax deductible. Withdrawals used
for eligible medical expenses are not taxable, and interest on your
funds is also not taxable.
Life insurance is the
foundation of any family’s financial plan.
insurance can help ensure your family can maintain its lifestyle if a
breadwinner dies prematurely. Many insurance experts advise purchasing
life insurance equal to five to eight times the individual’s
Life events that affect your
need for coverage include:
known as permanent life insurance, offers tax-advantaged savings for
retirement and estate protection. Term life insurance provides pure
death benefit coverage for a specific time period (one to 30 years) and
has no cash value.
- Birth of a child
- Buying a home
- Children attending private
school or college
- Retirement savings
- Estate planning and protection
- Desire to make a charitable
life insurance, also known as cash value programs, provide death
benefits plus additional benefits, including the tax-deferred
accumulation of funds. Whatever your life insurance needs, we can help
you find both term and whole life coverage at competitive rates.
Term life insurance comes in
Policy owners can renew coverage at the end of their policy term
without having to submit new medical information, though the premium
rate will generally rise with each renewal.
A convertible policy allows the insured to convert term coverage into a
permanent policy without providing evidence of insurability (usually a
medical exam), in exchange for a higher premium, which remains fixed
Permanent Life Insurance
Level-premium policies have a fixed premium for a certain number of
years (usually 10 or 20), while the death benefit remains unchanged.
Although the rate locks in for the policy period, it can jump
considerably upon renewal.
life insurance provides lifelong protection and includes a savings
element that grows on a tax-deferred basis and may become substantial
over time. Premiums are generally higher than for term insurance, but
they remain fixed.
permanent insurance has a face value and a cash value. The face amount
is the money that will be paid at death, while cash value is the amount
of money currently available to the policyholder. Permanent life offers
other benefits–purchasers can withdraw some of the money,
a loan using the cash value as collateral or use the cash value to pay
premiums, provided there is enough money accumulated.
Different types of permanent
life policies include:
- Whole or
permanent life: The face amount of the policy is fixed, while premiums
remain level and must be paid on a regular basis. It offers a death
benefit and a savings account, which grows based on insurance
or adjustable life: More flexible, employees can pay premiums at any
time, in virtually any amount, and may change the amount of the death
benefit, although an increase usually requires a medical examination.
After accumulating sufficient funds in the cash value account,
employees may alter premium payments, a useful feature if an
employee’s economic situation has suddenly changed.
insurance encourages preventive dental care, which saves an estimated
$4 for every $1 spent by eliminating the need for expensive, invasive,
and painful procedures.
Care Act requires all new (non-grandfathered) health insurance plans in
the individual and small employer markets to include dental coverage
for children age 18 and younger as an “essential health
benefit.” This means if you’re getting coverage for
18 or younger on an individual or small group plan, dental coverage
must be available as part of the plan or in a stand-alone plan. This
rule does not apply within the Oregon health insurance exchange,
wherein pediatric dental plans are required to be offered, but you are
not required to enroll in one.
health care reform law requires most people to have health coverage or
pay a penalty, this doesn’t apply to dental coverage.
insurers must make dental coverage available to individuals age 18 or
younger, you don’t need to have dental coverage, even for
children, to avoid the penalty.
don’t need dental insurance to avoid penalties under the
Affordable Care Act, dental insurance helps many people afford
expensive dental care.
dental insurance plans cover:
- Twice-yearly cleanings and
- Annual x-rays
- Restorations (fillings and
- Periodontics (treatment of gum
- Endodontics (root canals)
- Bridges and dentures
Some also cover orthodontics.
Many dental insurance plans let you see any dentist, while some use a
network of dentists.
offer managed-care plans designed to encourage wise use of dental
benefits, with lower out-of-pocket costs for preventive services such
as exams, x-rays, and cleanings. Some plans also offer benefits for
orthodontics, but pay a lower percentage for orthodontics than for
restorative services such as fillings and root canals.
Dental Insurance Plans
The different types include:
this “traditional” insurance plan, the plan pays
according to a formula—usually a percentage of the
dentist’s fee, up to a “usual and
The dentist can bill insureds for the difference, or copayment. Most
plans also have patients pay a deductible per visit or per series of
treatments as well.
Preferred Provider Organizations
dental PPO consists of a network of providers who agree to accept a
certain discounted payment for their services. PPO plans give insureds
financial incentives to use these “preferred
paying higher percentages of claims they submit than for those
submitted by non-preferred providers. Insureds pay the uncovered
portion out of pocket.
Dental Health Maintenance
an HMO, dentists agree to provide specified dental services to members
in return for a periodic per-capita payment—usually
Payments do not depend on the number or type of services rendered, and
the HMO accepts the financial risk for providing covered dental
services to members.
plans require participants to use an HMO dentist, but some plans
provide reduced benefits for members who use out-of network dentists. A
participant may have to pay a deductible, co-payment, or any amount
exceeding plan coverage levels.
Provider Organizations (EPOs)
Within EPOs, you are required
to get your dental care from in-network dentists only–these
is no out-of-network coverage.
nursing homes costing an average of $83,000 annually (more so in urban
areas), long-term care needs can stretch the finances of almost any
family. Medicare and Medicare Advantage do not cover custodial care in
a nursing home, assisted living, or home healthcare setting. Unless you
have savings or long-term care insurance, when you can no longer take
care of yourself, you would have to spend down your assets until you
qualify for Medicaid.
care insurance (LTC) can help you pay for the cost of nursing home and
other long-term care for yourself or for an elderly dependent.
study by the U.S. Department of Health and Human Services says that
people who reach age 65 will likely have a forty percent chance of
entering a nursing home. About ten percent of the people who enter a
nursing home will stay there five years or more.
policies vary widely. However, they all cover non-medical custodial
care services excluded by medical insurance (including Medicare and
Medicare Advantage). Coverage kicks in when the insured cannot perform
two or more “activities of daily living,” such as
toileting, transferring, bathing, dressing, or continence, or when he
or she becomes cognitively impaired due to senile dementia or
What to look for
- Guaranteed Renewability and
To qualify for tax advantages,
LTC plans must offer these features, although insureds can elect not to
buy inflation protection.
- Coverage for Home Health Care
disabled individuals do not require nursing home care, but simply need
help with activities of daily living. A policy that provides benefits
for home health care can help the insured stay in the comfort of his or
her own home.
an LTC policy, insureds can include LTC premiums they pay with other
unreimbursed medical expenses, subject to a cap that increases with
age. Benefits received from LTC policies generally do not count toward
taxable income, as long as the benefits do not exceed an
insured’s actual long-term care expenses.
- Disability Income
your most valuable possession? Your home? Its contents? For most
working individuals, their ability to earn an income is worth far more
than these physical assets. If you have a high school diploma, your
lifetime earnings potential exceeds $1 million. As education increases,
so do earnings.
example, the “average” man with a professional
earn $4.03 million over his working life, while the
“average” female professional will earn nearly $3
A disability can jeopardize this valuable asset.
Short-term Disability (STD)
typically have a waiting period of 0 to 14 days before a covered
individual will receive benefits, and they provide benefits for a
maximum of six months to one year.
Long-term Disability (LTD)
usually begin paying benefits 30 to 180 days after the disability
occurs, once the covered individual has exhausted sick leave and
short-term disability benefits.
National Association of Insurance Commissioners (NAIC) says that a male
U.S. worker at age 35 faces a one-in-five chance of a disability taking
him off his job for 90 days or more. For a 35-year-old woman, that risk
increases to one in three.
adults don’t have the savings needed to pay their expenses if
they were unable to earn an income for 90 days or more. Disability
income insurance replaces a portion of an insured’s
pre-disability income when they cannot work or cannot work full-time
due to a disability.
most effective disability benefit plan designs coordinate sick leave,
short-term disability (STD) and long-term disability (LTD) benefits, so
that once the insured exhausts sick pay and STD benefits, LTD benefits
begin immediately. Disability income insurance replaces only a portion
of lost income to give disabled individuals some incentive to return to
gainful employment after a disability.
face a bewildering array of health plan choices. Should you stick with
Original Medicare, which provides only hospital and medical coverage?
How about original Medicare plus a Medicare Supplement from a private
insurer? Or, should you opt to buy a Medicare Advantage plan through a
private insurer to take care of your health insurance needs?
Supplement or “Medigap” Plans
you have Original Medicare (Parts A and B), a Medicare Supplement plan
can fill the “gaps” left in your coverage,
deductibles, co-payments, and uncovered services.
Part B has a monthly premium. For an additional, low monthly premium,
which you’ll pay to a private insurer, a Medigap plan can
you avoid unpleasant financial surprises. Policies cover individuals
only (no family coverage), so you and your spouse will need separate
Advantage plans (also called “Part C”) take the
Original Medicare. Written by private insurance companies, they include
all the benefits of Medicare Parts A and B and often include other
coverage, such as bundled Medicare prescription drug coverage (Part D).
If you have a Medicare
Advantage plan, you do not need (and cannot use) a Medicare Supplement