What's to stop me from receiving a $500 benefit tax-free and buying a $250 plan?
I'd think you should be able to do that and put whatever is leftover in an HSA.
Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
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Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#62Congrats!
How do you handle discrimination in your case?
I'll give you an example: 50% of your employees are young and healthy and they opt out of the health plan offered and go with Savvy.
How do you handle the remaining 50%, assuming that some of them are older, have cancer, or have kids with disabilities, diabetics or whatever.
Would ANY health plan accept to cover only the sick and old?
This is based a concept called mutualization.
I'll be interested by your point of view, or if any of your clients came across cases like that?
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#63What's to stop me from receiving a $500 benefit tax-free and buying a $250 plan?
The money your employer gives you can only be spent on insurance or medical expenses. So in your example you can buy the $250 plan and have $250 / month leftover to pay for prescriptions, doctor visits, or other medical expenses. You wouldn't be able to pocket the remainder as cash.
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#64Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#65So we're adding another middleman to the healthcare system? It seems like we should be working toward the exact opposite of this. I view any service like this that makes money from the healthcare industry but doesn't actually provide healthcare as a huge inefficiency that will further increase the price of healthcare. What's next? A startup that helps you choose between these middlemen companies?
This insanity has to stop. I want to be able to get healthcare and pay the people providing it directly and know my costs up front. It's as simple as that when it comes to healthcare. As for "insurance", I don't want to go bankrupt if I get cancer. These are two separate issues. Insurance should not be required for healthcare.
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#66This is nice for remote companies. We went to the pain of trying to get a good price Kaiser group plan but found out that Kaiser doesn't operate in other states that we have employees in.
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#67The health plan rates available to individuals cost quite a bit more than ones negotiated by a big company or consortium of smaller companies.
When I last had to do my own insurance, it was $2200/month for a high end, lowish deductible plan that covered my family. Choice is nice, but the costs are so high now that I'd rather have the lower negotiated rates with less choices.
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#68Earlier quoted context omitted.
They’re substantially worse. ACA plans have worse networks, higher deductibles, and higher max out of pockets. Imagine if they didn’t? No employer under 50 employees would bother getting group coverage as they could get better coverage for less via the QSEHRA route.
I had ACA coverage before we offered group health insurance to our employees and did not find these things to be true: the network for my ACA silver plan was the same (fine) network as we get now, the deductible options are the same (but I was opting for higher deductibles to go with an HSA on the ACA plan, which is what I think most startup employees should do), and the out-of-pocket costs were the same. I suspect t…
My POV (from GA) is that this is going to be highly state-dependent.
For example, the first couple years of the ACA there were N vendors providing ACA plans materially similar to small group plans. Today, most of those vendors have abandoned the individual market. So the quality of plans/carriers available to ACA purchasers vs small groups is vastly different today.
In 2015 it was the case the $500 in the individual market was roughly equivalent to $500 in the small group market. Today, $500 (or $1000) spent in the individual market won't buy you the same coverage as $500 in the small group market.
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#69Congrats! How do you handle discrimination in your case? I'll give you an example: 50% of your employees are young and healthy and they opt out of the health plan offered and go with Savvy. How do you handle the remaining 50%, assuming that some of them are older, have cancer, or have kids with disabilities, diabetics or whatever. Would ANY health plan accept to cover only the sick and old? This is based a concept ca…
To prevent this kind of thing from happening, regulations state that you cannot offer both Savvy and a traditional group health plan within the same "class" of employees (IRS-defined, things like full-time vs. part-time vs. seasonal, etc.). If you were to offer Savvy, you can scale your employer contribution based on age and number of dependents to help address the higher costs of healthcare for those employees.
Small groups can get large price increases if their members have serious health issues, and for them it can be cheaper to use us and get employees all the same tax savings, but buy on the individual market.
Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance
#70Earlier quoted context omitted.
As an employee whose has been on the receiving end of this, I won't work anyplace that does it. I'm sure I'm not the only one.
Honest question as someone who's never worked at a place that does this -- what left you feeling negative about it? Are the marketplace plans substantially worse than the employee plans, or are there extra caveats that come along with QSEHRA, or was it something else?
My marketplace options were bad, expensive, and numerous. Coupled with relocation, I had next to no information about what plans/providers/networks were decent, and had a very short time to research and decide about what to spend on.
Routine services were ok (I did splurge a bit to have low specialist and prescription copays). Dental was not affordable.
Going to a different job that took care of finding decent coverage options that fit the company and location made my life a lot easier and improved my quality of care and out of pocket expenses, while removing much of the stress in finding a healthcare provider that fit my needs and budget.
That's why I won't do it. It's too stressful, too expensive, and the quality of the plans are shit.