In today’s rapidly evolving healthcare landscape, public sector organizations are constantly seeking ways to manage costs while providing quality health benefits to their employees. One approach is the self-funded health plan. But what exactly does it mean to have a self-funded health plan, and how does it differ from traditional health insurance?

What is a Self-Funded Health Plan?

A self-funded (or self-insured) health plan is a type of health insurance where the employer assumes the financial risk for providing healthcare benefits to its employees. Instead of paying fixed premiums to an insurance carrier, the employer pays for medical claims out-of-pocket as they are incurred.

Key Features of Self-Funded Health Plans

1. Cost Control and Flexibility:
   • Public sector employers have greater control over the plan design and can tailor benefits to meet the specific needs of their workforce.
   • Self-funded plans are often subject to fewer regulations compared to fully insured plans, allowing for more customization.
2. Financial Savings:
   • Any unused funds at the end of the year can be retained by the employer.
3. Risk Management:
   • Public sector employees can purchase stop-loss insurance to protect against unexpectantly high claims. This coverage kicks in when claims exceed a certain threshold, limiting the employer’s financial exposure.

How Self-Funded Plans Work

In a self-funded plan, the employer sets aside funds to cover anticipated healthcare costs. These funds are used to pay for employees’ medical claims directly. Employers can contract with a third-party administrator (TPA) to handle administrative tasks such as claims processing and provider network management.

Regulatory Environment

Self-funded plans in the public sector are primarily regulated at the federal level under the Employee Retirement Income Security Act (ERISA) and the Public Health Service Act (PHS Act). This means they are not subject to state insurance laws, which can provide additional flexibility but also requires adherence to federal standards.

Is a Self-Funded Plan Right for Your Public Sector Organization?

While self-funded plans offer many benefits, they are not without risks. Smaller public sector organizations may find it challenging to manage the financial volatility associated with high-cost claims. However, with the right risk management strategies, such as stop-loss insurance, even smaller employers can consider self-funding.

Partnering with Pierce Group Benefits

Self-funded health plans can be a powerful tool for public sector organizations looking to control healthcare costs and customize benefits. By understanding the mechanics and regulatory environment of self-funded plans, public sector employers can make informed decisions that best suit their organizational needs. To learn more about self-funded health plans, contact your dedicated Pierce Group Benefits Account Executive or reach out to a PGB Representative at partnership@piercegroupbenefits.com for further information.

As we start 2025, the landscape of employee benefits continues to evolve, driven by changing workforce demographics, technological advancements, and a greater emphasis on holistic well-being. Here are five key employee benefit trends to watch this year:

1. Long-Term Care Planning

As the population ages, long-term care insurance is becoming an essential benefit. Employers are offering long-term care insurance to help employees plan for future medical and personal care needs. This insurance provides coverage for services such as nursing home care, home health care, and personal or adult daycare. By including long-term care insurance in their benefits packages, organizations are helping employees secure their financial future and reduce the stress associated with potential long-term care expenses.

2. Mental Health Resources

The focus on mental health has never been more prominent. Employers are expanding their Employee Assistance Programs (EAPs) to provide comprehensive mental health resources. These programs often include access to therapy, counseling services, and stress management programs. This trend reflects a growing recognition of the importance of mental well-being in overall employee productivity and satisfaction.

3. Financial Wellness Programs

Financial stress is a significant concern for many employees. In response, employers are providing financial wellness programs that include budgeting tools, debt management resources, student loan repayment assistance, and retirement planning assistance. These programs aim to help employees achieve greater financial stability and reduce stress.

4. Fitness Incentives

The integration of technology into health and wellness programs is on the rise. Health apps that include online workouts and discounts on gym memberships are being incorporated into employee wellness initiatives, providing convenient and engaging ways for employees to stay healthy.

5. Sustainable Initiatives

Employees are increasingly valuing organizations that prioritize sustainability. Benefits that support these values, such as volunteer time off, green commuting incentives, and sustainable office practices, are becoming more common.

The trends in employee benefits for 2025 reflect a broader shift towards a more personalized, holistic, and flexible approach to supporting employees. By staying ahead of these trends, organizations can attract and retain top talent, foster a positive work environment, and enhance overall employee well-being.

Partnering with Pierce Group Benefits

Reach out to your Account Executive or email partnership@piercegroupbenefits.com to explore how your organization can leverage these trending benefits and other innovative solutions to maximize employee satisfaction. Our team is dedicated to helping you create a workplace that attracts and retains top talent while fostering a culture of well-being and success.

When it comes to life insurance, choosing the right type can be a daunting task. Two of the most common options are term life insurance and whole life insurance. Each has its own set of benefits and understanding these can help you make an informed decision. Let’s dive into the key benefits of term life and whole life insurance.

What is Term Life Insurance?

Term life insurance provides coverage for a specific period, or “term,” such as 10, 20, or 30 years. If the policyholder passes away during this term, the beneficiaries receive a death benefit.

Benefits of Term Life Insurance:

• Affordability: Term life policies are generally more affordable than whole life policies, making them accessible for many people.
• Simplicity: These policies are straightforward, with no investment component or cash value accumulation.
• Flexibility: You can choose the term length that best fits your needs, such as covering the years until your children are grown or your mortgage is paid off.

What is Whole Life Insurance?

Whole life insurance provides coverage for the policyholder’s entire life, as long as premiums are paid. It also includes an investment component, accumulating cash value over time.

Benefits of Whole Life Insurance:

• Lifetime Coverage: Whole life insurance covers you for your entire life, ensuring that your beneficiaries will receive a death benefit no matter when you pass away.
• Cash Value: Part of your premium goes into a savings component, which grows over time and can be borrowed against or withdrawn.
• Fixed Premiums: Your premiums remain the same throughout the life of the policy, providing predictability in your financial planning.
• Tax Benefits: The cash value growth is tax-deferred, and the death benefit is generally tax-free to your beneficiaries.

The Benefits of Enrolling in Both

When it comes to life insurance, you don’t have to choose just one type. By enrolling in both term life and whole life insurance, you can enjoy a range of benefits that cater to both your immediate and long-term needs.

• Comprehensive Coverage: By enrolling in both types, you can cover immediate needs with term life insurance and long-term needs with whole life insurance.
  Cost Management: Use term life insurance for high coverage at a lower cost during critical periods (e.g., raising children, paying off a mortgage) and whole life insurance for lifelong coverage and cash value accumulation.
• Flexibility: This approach allows you to adjust your coverage as your financial situation and needs change over time.
• Financial Security: The combination provides a balance of affordability, coverage, and investment, ensuring both short-term and long-term financial security for your family.

By leveraging the strengths of both term life and whole life insurance, you can create a robust and flexible life insurance strategy that adapts to your evolving needs and financial goals.

Partnering with Pierce Group Benefits

Employers who partner with us to provide both term life and whole life insurance options demonstrate a commitment to their employees’ financial well-being and security. Offering a comprehensive benefits package helps attract and retain top talent, fostering a loyal and motivated workforce. Employees benefit from having access to tailored life insurance solutions that meet their diverse needs, providing peace of mind and financial stability for their families. Together, we can ensure that your team is well-protected and financially prepared for the future. Contact your Pierce Group Benefits Account Executive or email partnership@piercegroupbenefits.com to learn more.

As the end of the calendar year approaches, it’s essential to take full advantage of the employee benefits that may reset on January 1. Whether it’s your flexible spending account (FSA), dependent care flexible spending account (DCFSA), dental insurance, or vision insurance, now is the time to ensure you’re making the most of what’s available to you. Here’s how to utilize these benefits effectively before the year ends.

Flexible Spending Account (FSA)

An FSA allows you to set aside pre-tax dollars for eligible medical expenses. Since these funds typically don’t roll over into the next calendar year, it’s crucial to spend them wisely. Here are some tips:

• Schedule Appointments: If you have outstanding medical needs, be sure to schedule your appointments before the year ends. This may include routine check-ups or any necessary procedures. Remember, your FSA can help cover eligible expenses, such as copays and prescription medications, making it easier to manage your healthcare costs.
• Stock Up on Supplies: Purchase eligible items through the FSA Store, such as first-aid supplies, contact lens solution, or even sunscreen, to use your remaining balance.

Note: While a flexible spending account (FSA) allows you to set aside pre-tax dollars for eligible medical expenses, it’s important to note that funds typically do not roll over into the next plan year. Therefore, any unused funds at the end of the plan year may be forfeited. Some FSAs may offer a grace period of up to two and a half months after the end of the plan year, allowing you to incur eligible expenses during that time. Alternatively, some FSAs may include a rollover provision, which allows you to carry over a certain amount of unused funds to the next plan year, subject to the maximum limit set by the Internal Revenue Service (IRS). However, these options are not guaranteed and varies by employer. Review your specific FSA plan for details to understand your options.

Dependent Care Flexible Spending Account (DCFSA)

If you have children or dependents, a DCFSA can help you save on childcare costs. Similar to an FSA, funds in a DCFSA typically do not roll over to the next calendar year, so consider the following:

• Plan for Childcare Expenses: Review your childcare expenses for the year and ensure you’re submitting claims for any eligible costs incurred.
• Utilize Care Services: If you have unused funds, consider enrolling your child in a holiday camp or after-school program to maximize your benefits.

Note: The rollover option does not typically apply to dependent care flexible spending accounts (DCFSA). Unused funds in a DCFSA are generally forfeited at the end of the plan year. However, some DCFSA plans do offer a grace period of up to two and a half months after the plan year ends, during which you can incur eligible expenses and use any remaining funds from the previous year. Review your specific DCFSA plan for details to understand your options.

Dental Insurance

Dental insurance often operates on a calendar year with an annual limit. To make the most of your coverage, be sure to utilize your benefits before they reset:

• Schedule Routine Cleanings: If you haven’t had your biannual cleaning yet, now’s the time to book an appointment. Preventive care is usually fully covered, so take advantage of it!
• Address Any Dental Issues: If you’ve been putting off dental work, such as fillings or crowns, consider scheduling these procedures before the year ends to utilize your benefits. You might also think about splitting up non-emergency treatments between the end of this calendar year and the beginning of the next. This way, you can maximize your coverage and ensure you don’t miss out on any benefits before they reset. Please consult with your dentist to determine the best approach for your specific needs.

Vision Insurance

Like dental insurance, vision benefits often reset at the end of the calendar year. Here’s how to maximize your vision coverage:

• Get an Eye Exam: If you haven’t had an eye exam this year, schedule one soon. Many plans cover the cost of an annual exam.
• Update Your Eyewear: If you need new glasses or contacts, use your vision benefits to purchase them before the year ends. Check if your plan offers discounts on frames or lenses.

Note: Please check your policy’s effective dates for the end of the plan year, as some dental and vision plans do not operate on a calendar year.

As the calendar year ends, take the time to review your benefits and make the most of what’s available. By utilizing your FSA, DCFSA, dental, and vision insurance, you can save money and ensure you’re taking care of your health and well-being.

Partnering with Pierce Group Benefits

At PGB, our dedicated team is committed to empowering clients’ employees to effectively utilize their employee benefits. If you have questions about how the end of the calendar year affects your benefits, contact your dedicated Pierce Group Benefits Account Executive or reach out to a PGB Representative at partnership@piercegroupbenefits.com for further information.

For most benefits, you elect to have the benefit for the entire plan year, with changes typically made during the next enrollment period. However, there are exceptions allowing you to make changes to your benefits outside of your enrollment period, known as qualifying life events (QLEs) or qualifying mid-year events.

What Are Qualifying Life Events?

Qualifying life events are specific circumstances, as defined by the Internal Revenue Service (IRS), that allow you to make changes to your benefits outside of the annual enrollment period. Common QLEs include marriage, divorce, birth, or adoption, and retirement. If you think you might need to make a change to your insurance coverage, review the list below to see if any of these events are applicable to your situation. It is important to note that “applicable” refers to a change that is directly related to the individual experiencing the QLE; changes based on financial reasons alone are not allowed under current IRS regulations; and documentation to confirm changes may be required.

List of Qualifying Life Events

Dependent Changes

• Birth, Adoption, or Foster Care Placement: Add a new dependent to your benefits within 30 days of the birth, adoption, or placement date. Required documents may include a copy of the birth certificate, adoption decree, or official state agreement for placement and the dependent’s social security number.
• Dependents Aging Out: Different policies have different age restrictions for dependent coverage, such as 18, 21, or 26 years old. Check your policy and notify the provider when a dependent has aged out to adjust your deductions.

Household Changes

• Marriage: Add a new spouse to your policy within 30 days of the marriage date, requiring a copy of the marriage certificate.
• Legal Separation: Remove a spouse from your policy within 30 days of the legal separation date, requiring a copy of the separation agreement or affidavit.
• Divorce: Remove a former spouse from your policy within 30 days of the divorce date, requiring a copy of the divorce decree.
• Death of a Spouse or Dependent: Remove a spouse or dependent from your plan within 30 days, requiring a death certificate.

Health Coverage Changes

• Loss of Employer-Sponsored Health Coverage: If you or a spouse loses health insurance coverage sponsored by your employer, you or your spouse may qualify to join the other’s health plan. Employees, along with their spouse, former spouse, and/or dependents, may have the opportunity to maintain their group health insurance coverage for 18-36 months under COBRA (Consolidated Omnibus Budget Reconciliation Act).
• Loss of Eligibility for or Entitlement to Medicare, Medicaid, or CHIP: If you, your spouse, or dependent becomes entitled to or ineligible for Medicare or Medicaid, or another similar government or state-sponsored program like CHIP, you qualify to adjust your health coverage accordingly.

Employment and Leave Changes

• FMLA Leave: A leave of absence covered under the Family & Medical Leave Act (FMLA) qualifies you to make changes to your benefits if needed.
• Non-FMLA Leave: A leave of absence not covered by FMLA that is for an applicable QLE qualifies you to make changes to your benefits if necessary. However, if a leave of absence occurs for an event not considered an eligible QLE, you will have to wait until the next annual enrollment period to enroll in or make changes to your coverage.
• Retiring: If you are retiring, you are eligible to make changes to your insurance coverage and may be eligible for government or state-sponsored coverage.
• Part-Time to Full-Time or Vice Versa: If you are transitioning to full-time, you may qualify for more benefits. If transitioning to part-time, you may need to update your coverage and stop deductions for benefits for which you may no longer be eligible for.
• Change in Spouse’s Employment or Coverage: If your spouse accepts a new position or changes coverage due to a change in residence or income, they are eligible to make changes to their benefits and may now be eligible to join your coverage.

Pierce Group Benefits (PGB) Accounts

• Transferring Employers: If you are transferring from one employer to another and both are PGB clients, you may be eligible to transfer your supplemental benefits. Please call our Service Center for assistance.
• New Hire: If you are joining an employer who is a client of PGB, please review the new hire eligibility and enrollment information found in your benefits guide or on your employer’s benefits microsite.
• Retiring: If you are retiring from an employer who is a client of PGB, many of your supplemental benefits are portable and can be moved from payroll deduction to direct billing or bank draft. Please call our Service Center for assistance.

Consequences of Inaction on Qualifying Life Events

If you do not take action following a qualifying life event, you will miss the opportunity to adjust your benefits to better suit your new circumstances. This could result in inadequate coverage or unnecessary expenses. For example, failing to add a new dependent within the required timeframe could leave them without essential coverage. Similarly, not removing a dependent after they have aged out could lead to continued deductions for someone no longer eligible for coverage. In essence, neglecting to act on a QLE can lead to financial inefficiencies and gaps in coverage, potentially impacting you, your spouse, and your dependents’ well-being. Therefore, it’s crucial to promptly address any QLEs to ensure your benefits align with your current life situation.

Partnering with Pierce Group Benefits

We understand that life doesn’t always follow an insurance plan year, and changes to your benefits may be necessary. It’s important to review the policies of your employee benefits and adjust as needed to ensure you, your dependents, and others covered under your plan are adequately protected, and that you’re not paying for those who are no longer eligible for coverage. For more information on QLEs, speak with your PGB Account Executive or get in touch with a PGB Representative at partnership@piercegroupbenefits.com.

Natural disasters can strike unexpectedly, like the flooding and landslides caused by Hurricane Helene in our home state of North Carolina, bringing destruction and uncertainty. This natural disaster has created a significant need for mental health, financial, and legal guidance, as well as resources for home and life management. During this challenging time, Employee Assistance Programs (EAPs) play an important role in providing support and resources to help you navigate the aftermath.

What is an EAP?

An Employee Assistance Program (EAP) is a company-sponsored, confidential program designed to help you and eligible dependents connect with external professionals and resources to address personal or work-related issues that may impact your job performance, health, and overall well-being.

EAP Resources for Hurricane Helene

EAPs provide essential support and referrals in the aftermath of Hurricane Helene, tailored to help you connect with professionals to manage the unique challenges and stresses that arise as you recover and rebuild. These services can include:

Counseling Services

EAPs offer confidential counseling to help you process experiences, manage emotions, and build resilience, tailored to the trauma and impact from Hurricane Helene, including support for:

• Trauma, Loss, or Grief
• Anxiety, Depression, or Stress
• Alcohol/Substance Use
• Behavioral Change

Financial and Legal Guidance

• Financial Consultations: Financial coaches assist with reorganizing the family budget and managing a financial crisis caused by Hurricane Helene.
• Legal Services: Access legal documents such as power of attorney, and call for a free legal consultation with licensed attorneys who can assist with legal challenges arising from the natural disaster.

Care Resources

• Elder and Adult Care Resources: Receive referrals for the elderly, disabled adults, and their caregivers during your consultation with our specialists, including finding temporary care solutions and support services.
• Childcare Resources: Consultants advise on how to select childcare centers, in-home care, after-school care, and disability resources, especially important when regular care arrangements are disrupted by Hurricane Helene.
• Pet Care Referrals: Consultants offer comprehensive referral services to assist with veterinary selection and boarding for pets affected by the natural disaster.

Home and Life Management Services

• Home and Transportation Resources: Obtain information and referrals for household repairs, transportation, and housing rental searches, particularly useful when dealing with property damage and displacement caused by Hurricane Helene.
• Identity Theft Resources: Access resources to protect and recover your identity if it has been compromised during a natural disaster, a common issue when personal documents or information are targeted by phishing scams posing as financial aid or donation requests.

Accessing Your EAP Services

If you are enrolled in an EAP through Pierce Group Benefits, contact the EAP by navigating to the provider’s contact information in the benefits guide on your organization’s custom microsite. Contacting an EAP service is free and confidential, with 24/7 availability and additional online resources on their websites.

Partnering with Pierce Group Benefits

In the wake of Hurricane Helene, the well-being of both employers and employees is paramount, highlighting the necessity of robust support systems to aid in recovery. Partnering with Pierce Group Benefits (PGB) provides access to comprehensive EAPs designed to offer support during these challenging times. For more information on EAPs, speak with your Pierce Group Benefits Account Executive or get in touch with a PGB Representative at partnership@piercegroupbenefits.com.

As individuals age or face a major illness or disability, many will find themselves needing long-term care to assist with essential daily activities. These services include tasks like dressing, eating, and moving around, and can be provided at home, adult day cares, assisted living facilities, or nursing homes. With increasing life expectancy, the likelihood of requiring long-term care rises, as nearly 70% of people over 65 will need some form of assistance during their lifetime, and about 35% will require care in a nursing home. Planning ahead for these services is vital in ensuring comfort, safety, and quality of life.

Financial Protection with Long-Term Care Insurance

Long-term care (LTC) insurance offers protection from the high costs associated with long-term care resulting from a covered illness or injury, such as heart disease, stroke, or broken bones and fractures. Most long-term care claims are filed between the ages of 80 and 89. The benefits from an LTC insurance policy typically pay towards expenses of home care aides, assisted living, and nursing home stays, up to the policy’s limit.

Without long-term care insurance, the costs can be staggering. Even a relatively short stay in a nursing home can cost, on average, between $8,000 and $10,000 per month. Having an LTC policy in place can help safeguard your savings, retirement, and other assets in the event of long-term care.

Additional Benefits of Long-Term Care Insurance

• Dual Benefits Option: In some hybrid LTC insurance and life insurance policies, the LTC insurance will pay for long-term care expenses first. If there is any benefit amount remaining, or if the long-term care is never needed, it can pay out like a life insurance policy.
• Fixed Premiums: Certain policies offer fixed premiums, meaning your costs won’t increase over time.
• Fully Portable: These policies can be fully portable, meaning you can keep your coverage even if you change jobs or retire.

Planning for long-term care is about more than just peace of mind; it’s about protecting your future financial health. Since most people will need some form of long-term care in their lifetime, considering LTC insurance can be an important step in your long-term financial strategy.

Partnering with Pierce Group Benefits

For employers, partnering with us to offer long-term care insurance shows your commitment to your employees’ future financial security by helping them manage the rising costs of long-term care. Our plans can enhance your benefits package and support employee retention and satisfaction. Employees can easily enroll in our LTC insurance plans and start planning for their long-term care needs today. To learn more, contact your Pierce Group Benefits Account Executive or email partnership@piercegroupbenefits.com for further guidance.