Master Your Finances Kurt Baker with Theresa Semple – Transcript

Written by on July 25, 2022

0:00:00.0 ANNOUNCER: So you wanna know the ins and outs of managing your money? Well, lucky for you, you’re just in time for another episode of Master Your Finances, with certified financial planner professional, Kurt Baker. Kurt and his panel of experts are here for you, and will cover topics from a legal and personal standpoint. They’ll discuss: Tax efficiency; liability; owning, managing and saving your money; and more. Master Your Finances is underwritten and powered by Certified Wealth Management and Investment, and Rider University. Rider offers continuing studies programs for adults who need flexibility. Want to add new skills to your resume? Take a continuing studies course at Rider University. Now, let’s learn how we can better change our habits, with Kurt Baker.
0:00:45.8 Kurt Baker: Have you heard about the Trans-barrier, a coverage rule which can help empower you with the critical information you need to make informed healthcare decisions? Are you aware of the, “No surprise Act”? Which can help protect you from surprise medical bills? With nearly 20 years of experience in the industry, Theresa Semple is an employee benefits professional, who will show you the importance of employer-employee education, regarding the company’s benefits offerings. Get ready to learn the best marketing practice for re-engaging with your customers, post-quarantine. Welcome to the show, so…
0:01:20.9 Theresa Semple: Thank you Kurtis.
0:01:23.6 Kurt Baker: So we’ve seen a lot through the quarantine. We were going full steam, we kind of stopped, then we went back. So What have we learned from all that? Kinda give us some ideas of what we learned here.
0:01:32.7 Theresa Semple: Well, we learned that employees… We learned that the employees really do need protection… Or the consumer, I should say. There are so many people who don’t understand what they have, and it’s very frustrating. Well, the government has finally come to the table and said, “It is now time to make sure that the employee, consumer understands what they have and how to utilize it.” So one of the options, or one of the ways, is the transparency in Coverage Act. And that, what that does is, new ID cards are being sent to employees by the carriers. That ID card will have their deductible on it, it’ll have their maximum out-of-pocket listed on the ID card. It’ll give them ways to look up cost estimators under the machine readable files. Every carrier has to have, on their website, under the “public” section, that link.
0:02:34.0 Theresa Semple: Somebody can now look up, “What is that gonna cost me from my specific plan for that knee surgery?” Instead of getting that sticker shock explanation of benefits, or the bill. The next level is the explanation of benefits. The employer must make sure that their employees understand them, and can read them. How many times do I myself get questions from employees saying, “I know you went over this, can you go over it again with me?” “Yes, definitely.” Because it’s confusing. And, as I’ve always said to my clients, and their team members, “You should be a consumer, you need to ask questions. Don’t ever just accept what they tell you.” Well, that’s what it, this transparency is about, asking questions, finding out the answers. Sometimes you’re gonna need to use an advocate. That could be a broker, consultant, your HR person, or the employer themself.
0:03:39.5 Kurt Baker: Wow. This just reminds me of a story years ago when our children were young and my son had to get his tonsils taken out. I remember going down to CHOP, Children’s Hospital of Philadelphia, and we were going… We had insurance and everything. So I went in, and I’m like… Just, I asked the question, I go, “So what is this gonna cost us?” Because I thought there might be something that we had to pay or whatever, I had no idea, I was just… Nobody can answer the question. And I was like, “Wait a minute. You don’t know?” I go, “Well, just give me some specifics. Well, what’s the operation cost?” They couldn’t answer that. I go, “What’s the room gonna cost?” couldn’t answer that. So is this, in theory, the solution to that, them not even literally being able to answer the questions? ‘Cause My understanding is there’s this big long chart of… That’s very complicated on the back end, that depending on your whole circumstance, and where it’s coming in from, and I don’t even understand it, and a matter fact, people that are involved in it say it’s… “We hardly understand it.” And they’re working with it. Right?
0:04:31.1 Theresa Semple: Mm-hmm.
0:04:31.4 Kurt Baker: And so it’s an extremely complex system. Is this in an effort to try to simplify that a little bit…
0:04:35.9 Theresa Semple: Yes.
0:04:36.3 Kurt Baker: So we can kinda at least know, “Where are we gonna stand?” ‘Cause as you know, we get these bills back and say, “Okay, this is $78,000, and that the adjusted price is like $20,000. The amount you pay is $237.15, or something, right? Or it could go the other way, obviously. But it’s this… It’s all these numbers, and you’re like, “What do all these numbers actually mean? And what are they doing to me as a consumer? What does that big number mean, anyway? Who is paying that, by the way?” So that’s what I always wonder.
0:05:03.9 Theresa Semple: Well, you’re correct in everything you’ve said. What it does is, it’s protecting you. It’s giving you the knowledge to know that, you’re not gonna get hit with a $78,000 bill that you have no recourse.
0:05:16.9 Kurt Baker: Right.
0:05:17.2 Theresa Semple: Think of Air Ambulance. You’ve heard horror stories. $48,000, $72,000, a client got hit with, for a four-minute medevac. It was ridiculously price-pointed.
0:05:34.9 Kurt Baker: Right.
0:05:35.0 Theresa Semple: This protects them. This gives them opportunities to look at, and say, if it’s beforehand. With the Transparency Act, it makes the employee a consumer. They have some skin in the game. So when you have skin in the game, protect yourself. And this is up to the employer to make sure of it. And the penalties are really on the employer if they don’t make sure their employees are educated. That’s why it’s critical. You need to work with somebody who knows how to help your employees navigate the Transparency Act. And make sure that they have everything, and the tools they need to protect themselves.
0:06:18.7 Kurt Baker: Well, I’m all for that, having lived in the world of compliance, and disclosure, and upfront, and before anybody does anything, you need to make sure they understand. And I would just like… I was always just confused, literally, about why is this huge industry, never really have to discuss with us, what’s the cost structure at all? And to the point where they hardly even understand it themselves, it seems like, that’s what it feels like from our perspective. So that’s a good step. So, one thing, and I don’t know if this is true or not, but tell me, but my understanding is like a… This is in process, because I was reading an article not too long ago, where it’s like some of them weren’t in compliance, quite yet. They’re still working on this, so if they get into these things, are they always… It’s still not quite there, right? They’re working on it, right? Is that my understanding?
0:07:00.4 Theresa Semple: Yes.
0:07:01.7 Kurt Baker: It’s getting there?
0:07:02.2 Theresa Semple: They’re… Okay, the facilities are working on, it’s a work in process.
0:07:10.8 Kurt Baker: Okay.
0:07:11.3 Theresa Semple: And I can understand it’s being a moving target for them because you know they have doctors, every doctor has a different contract, every nurse has a different contract, so I understand that. The carriers are under the gun to get this done, but many of them had it on their websites already, under the public sector, public option looking. But is it up to par to everything they have to have? Not yet, but they are working on it. So I’m not saying… I wouldn’t say both parties aren’t trying to do their due diligence. There are some facilities, it’s from rumors, and you hear it in the grape vine in my industry, that are not doing it at all…
0:07:55.7 Kurt Baker: Right.
0:07:55.8 Theresa Semple: Well, you know what? Shame on them. Shame on them, because you’re gonna be fighting a consumer. Because the consumers are gonna start pushing back…
0:08:03.0 Kurt Baker: Right. So we just need to ask, if somebody’s not disclosing this information, I guess from a consumer perspective, just still ask, right?
0:08:10.0 Theresa Semple: Always ask.
0:08:10.9 Kurt Baker: And make a formal request if you need to, and document that you have asked the question. So that if something happens later, at least you’ve made the request, I would assume, and then you can follow it from there. But I guess it’s a huge step in the right direction. But as anything, when you’re literally trying to change an entire industry in the way they’re set up internally, it’s gonna take a little while, right? And some are gonna resist, as you pointed out, I wasn’t… That’s interesting to me. ‘Cause my understanding is, it’s a law now.
0:08:34.4 Theresa Semple: It’s a law. They can resist, but it’s the law.
0:08:37.0 Kurt Baker: So, that sounds like a little litigation coming down the road…
0:08:39.2 Theresa Semple: Oh, I’m sure.
0:08:39.8 Kurt Baker: But at least to you as an individual, just that’s what I was… What you have to do is just protect yourself. And document what you’ve done, if you’ve made a request, that way you don’t get hit with this large bill unexpectedly, that at least they should have told you this what the answer was ahead of time, correct?
0:08:53.0 Theresa Semple: That’s exactly it.
0:08:54.0 Kurt Baker: Okay.
0:08:54.7 Theresa Semple: They need to protect themselves. And I’m big on employees, consumer protecting themselves. It’s one of the parts of being a broker that I need to do. I need to always make sure my clients and their teams understand what they have, how to utilize it. It’s critical, and every broker and consultant, and HR person should be doing that to make sure… ‘Cause ultimately, we are there to protect the employer…
0:09:22.4 Kurt Baker: Right.
0:09:24.2 Theresa Semple: And the employees.
0:09:24.3 Kurt Baker: So the providers, the insurance providers are they… ‘Cause it sounded like they weren’t all exactly, are they… Are some doing a little bit better job than others? And that’s maybe where you come in and kinda help people navigate, right? Because you need to understand what’s happening, correct? And that’s where that navigation portion is coming in.
0:09:40.0 Theresa Semple: Well, somebody recently came to me and said, I have to have a hernia operation. And I have a $2500 deductible, but I have an 8550 maximum out-of-pocket with a 50% co-insurance. Now, does that all make sense to you, or would you be looking at me like, “What?” They knew to ask me specifically, because they understood everything I drilled into them.
0:10:07.5 Kurt Baker: Right.
0:10:08.8 Theresa Semple: But they said, ‘How do I know what it’s gonna cost me?” We went through with contracted providers, that means the doctor of the facility, it took us about a month to get them to come to the table with information, and it was only a guesstimate…
0:10:29.7 Kurt Baker: Wow!
0:10:29.8 Theresa Semple: That I could get to the employee. We had CPT codes, diagnosis codes. We had treatment planned with… The provider did everything in their power to give us as much as we could.
0:10:41.0 Kurt Baker: Yeah. Because my…
0:10:41.4 Kurt Baker: And we couldn’t got the information still, because…
0:10:44.3 Kurt Baker: Yeah, well, and my understanding… And that sounds interesting to me, because my understanding is, as an example, in a hernia operation, ’cause one of the things that was told to me was, “Well, we don’t know how many… How much the anesthesiologist’s gonna need to give you. And are you gonna… ” So some of these things are variable expenses, I guess. But, at least you’d wanna know the range, like, “Hey, what are the parameters. The doctor is gonna come in, if he has to spend… ” I don’t know, if it’s a flat rate, or if it’s an hour, or two hours, whatever the cost structure is, at least tell us as much as you know, so at least I understand what… If something happens, or there’s complications, and yes, I guess I understand that’s gonna be a little bit more. But, excellent… We’re listening to Master Your Finance. We’re gonna take a quick break, we’ll come right back.
0:11:23.5 ANNOUNCER: This is Master Your Finances with Kurt Baker, certified financial planner professional. Learn about tax efficiency, liability, owning, managing and saving your money, and more, from Kurt and his experienced panel of guests. Master Your Finances is underwritten and powered by Certified Wealth Management and Investment, and Rider University. Rider university offers flexible education for adult learners. For more information, it’s
0:11:53.4 Kurt Baker: Welcome back. You’re listening to Master Your Finance. I’m here with Theresa Semple, and we’re talking about the Transparent Coverage Act. So, that came out, which is great, because now we have at least some indication of what the cost are gonna be up front, which, frankly, all the years I’ve been doing this, as far as a consumer, I was always mystified by the fact that they couldn’t tell me how much something was gonna cost, and you were always… It was always like getting the negative lottery where you’re like, “What’s… ” You open up the medical bill and you’re like, “Gee, what’s this gonna be this time?” [chuckle] Is it gonna be like $22.32? Or is it gonna be like $12,805? You’re like, you never knew, right? It was like…
0:12:30.5 Theresa Semple: You never know.
0:12:31.2 Kurt Baker: It was like, you open that thing and be like, “Okay… “
0:12:33.5 Theresa Semple: And you held your breath.
0:12:33.8 Kurt Baker: Exactly. And then you’re like, “Okay… ” Now thank goodness that’s starting to go, get a little bit more under control. So, I don’t know, have you got some interesting stories there? So what else have you seen as far as that goes?
0:12:45.3 Theresa Semple: Well, one of the other aspects of the Transparency Act is your provider directories, how many times have you yourself looked on website of the carrier that you have, and then called the doctor’s or office and they say, “Oh, we don’t participate.”
0:13:00.4 Kurt Baker: Oh yeah, sure.
0:13:02.1 Theresa Semple: So, then you go back to the website and you’re looking for another provider, and you find that happens. And it happens a lot.
0:13:09.8 Kurt Baker: Right.
0:13:10.1 Theresa Semple: Now the carriers have to make sure those are updated like weekly, because of that reason. People have looked on the website and then made an appointment with the doctor’s office.
0:13:19.1 Kurt Baker: Right.
0:13:19.6 Theresa Semple: Because in the website it says, “Participating.”
0:13:23.0 Kurt Baker: Agree.
0:13:24.5 Theresa Semple: They go. They get to the doctor’s office, and it’s out-of-network. “Well, I don’t have out-of-network benefits, Oh my God, do I pay out-of-pocket or do I leave?” If you’ve waited six weeks for a specialist appointment, you were really stranded, and that shouldn’t happen to you. So the carriers now have to make sure their directories are accurate.
0:13:47.6 Kurt Baker: And one thing always, I thought was interesting, sometimes they cover… Like say at Blue Cross, this is not to pick on them, but you would have them, and they go, “Yeah, we take them.” And they go. Oh, when you get there, they go, “But we don’t take that plan.”
0:14:00.1 Kurt Baker: Oh, it’s like, “But wait a minute, you told me you take that carrier.” But then, that happens with all carrier, not just that…
0:14:03.6 Theresa Semple: It happens to all of ’em.
0:14:04.3 Kurt Baker: And I’m like… So I’ve got in the habit, frankly, is that, when you’re going to a new provider, you just… No matter what it says, you reach out and say, “Look, here’s what we have,” and sometimes you even send the card over, “is this something you take?” And then if they say yes… And sometimes it takes them a little while to figure it out, I’ve noticed. They don’t always know right away, that’s what I find interesting is they’re not always sure.
0:14:24.8 Theresa Semple: I always tell clients and then their team, never say, “Do you accept.” Always say, “Do you participate.”
0:14:34.8 Kurt Baker: Do your participate.
0:14:36.1 Theresa Semple: And read it off your ID card. Or call me and let me know, and I’ll tell you the exact verbiage. Because if you say, “Hey, do you participate with horizon of New Jersey?” “Yeah, we participate.” Okay, there’s an OMNIA, there’s an advantage, there’s direct access. Maybe they don’t participate with the OMNIA. So you need to clarify for yourself. So, the way, again, is to make sure that employee is educated.
0:15:05.0 Kurt Baker: Right.
0:15:06.0 Theresa Semple: On the benefits, and what the name, and what the verbiage to use at all times. So, ’cause that’s a tricky slope. And also, and with that, one of the other options that you really need to make sure employees understand is, since covid hit mental health has been…
0:15:23.0 Kurt Baker: Right.
0:15:24.0 Theresa Semple: It’s gone through the roof. And it doesn’t mean… I hate to say this word, it doesn’t mean you’re crazy, we’re not, we just need somebody else to bounce something off of. Well, the Mental Health Parity Act gave you access to therapists, the same way you would see a doctor for a heart disease or for diabetes, it’s not like the carrier years ago would say, well, you had 30 visits.
0:15:53.3 Kurt Baker: Right.
0:15:53.4 Theresa Semple: Well, okay, what happens for the rest of the year when I use those 30 visits up? I still need help. So now that’s stopped that.
0:16:03.0 Kurt Baker: Interesting.
0:16:03.2 Theresa Semple: So with that, now there’s a mental health… Federal mental health hotline that employers have to make sure their employees have it. And the hotline for the mental health assistance is 800-273-TALK. And it’s, that’s there 247. And what will happen is, if you call it in, it will guide you, work with you, to find somebody local to you, but it will also help you immediately.
0:16:36.0 Kurt Baker: Right. Okay.
0:16:36.2 Theresa Semple: And that’s critical. And employers need to know and share that information. That’s also part of the transparency.
0:16:42.0 Kurt Baker: Yeah. That ties in… I know this is the original line, they have the new one out, 988, right? So that’s the same system.
0:16:50.9 Theresa Semple: That’s the same. That’s like a 911.
0:16:54.7 Kurt Baker: Just rolled out like the… Just a few days ago, so.
0:16:55.3 Theresa Semple: Few days ago, I have not tested it yet… I have not tested it yet.
0:17:00.7 Kurt Baker: But one thing I found out… I remember reading, years ago, ’cause we were non-profit, that they do mental health with youth, but I mean… My understanding is that several years ago that the mental health cost for an employer has actually surpassed the physical health cost, as of a few years ago. So this is even more important now, because we’re recognizing, even before COVID hit, that this had already crossed that line where it was more than 50% of the cost. I don’t know what the number is now, I’m sure we’ll have to wait for the stats to come out, but we just intuitively know it’s gonna be even higher, just talking to people and understanding what they’re going through.
0:17:30.0 Theresa Semple: Let’s utilize benefit, and it should be…
0:17:32.5 Kurt Baker: Right.
0:17:32.5 Theresa Semple: It’s utilized as much as you fill your prescriptions for your blood pressure. It’s something that you are going to use not just once a week, and I mean once a month. You’re gonna use it probably twice a month, sometimes three times a month, depending on what your therapist feels you need. So it is becoming a benefit that is widely utilized and it’s needed. It’s a needed benefit.
0:17:58.0 Kurt Baker: And it sounded to me like, and correct me if I’m wrong, but are they no longer… ‘Cause there used to be caps, where you could see if… You can see a therapist like three times, and anybody that’s been in therapy, or know anybody that’s been in therapy, this is a long-term thing. This is months…
0:18:12.8 Theresa Semple: It’s a long term relationship, yes.
0:18:12.8 Kurt Baker: Months though, if not year, if not years. This can be… There’s people that I know that have, they’ve been in therapy for many, many, many, many years. And it’s a critical part of their maintenance, to keep them healthy.
0:18:22.0 Theresa Semple: It is.
0:18:22.7 Kurt Baker: Just like as you pointed out, diabetics have their medicine. Is it mental health? That is the medicine that those people need, and it’s critical that they take their medicine, frankly.
0:18:31.4 Theresa Semple: Yes, and that’s exactly what it is, it’s there. There’s no limit on it any longer.
0:18:35.9 Kurt Baker: Good.
0:18:38.4 Theresa Semple: And then the last piece of the Transparency in coverage is the Arista document. Most people look at me like, “Huh, what? What is that?” So I always tell them, my clients. “Well, it’s the Employee Retirement Income Security Act of ’74.”
0:18:53.2 Kurt Baker: Right.
0:18:53.4 Theresa Semple: Okay, what is that?
0:18:55.2 Theresa Semple: Realistically, it’s about a 400 page document that you, as the employer, and you could have one employee, you can have 500 employees, you better have your document if you are ever audited. Because what it does is, it lists basically your protocols in your office, it lists your handbook, it lists your summary of benefits, anything that encompasses you running your business, that impacts the employees. And it is a critical document. It’s been around for a lot of years, but it’s now being enforced. And the Transparency Act now is really bringing it to the forefront again. So it’s one of the things I, I’m always knocking on my clients and saying, “Do you have your document?” Uhm, most of them look at me like, “Huh?” And I’m like, “You need to do this.” And it’s not an expensive document, but being penalized, whoo, can be very expensive.
0:19:58.3 Kurt Baker: Right. And it’s for the benefit of your employees too, and for yourself. So it’s a constructive document to begin with. So if you don’t have it, you should anyway, regardless of what the law says, but that if the law is gonna come in and walk in your door one day, and knock on the door and say, “Hey, I’d like to see your records.”
0:20:13.4 Theresa Semple: I’ve had quite employees, who’ve said, “Theresa, do you know where I could get that at the office?” And I laughed, because I’m like, “Oh, they don’t have it.” I have to call again to the client saying, “I was just asked for this document.” I know you don’t have it, and I’m not telling you who asked. But if they… You have a 30 day window to get it to them.
0:20:34.4 Kurt Baker: Yeah. They better put it together. Then.
0:20:35.5 Theresa Semple: I said, so let’s get going. And I… ‘Cause I have all the information. You just have to pay the fee for the third party administrator. Yeah, So.
0:20:45.3 Kurt Baker: Right. I just can’t imagine somebody not running one of these, where the third party administrator. Well it’d just be… [laughter] Compliance is huge. Stay in compliance, you’ll definitely appreciate it well.
0:20:55.7 Theresa Semple: Yeah. I do what I do well, what I don’t, I give out.
0:20:57.4 Kurt Baker: Absolutely, absolutely, 100%. So that’s fantastic. So, any other insight into what’s going on here with us? And so, you got some other acts that maybe will come out that we should be…
0:21:11.5 Theresa Semple: Well, there’s the No-Surprise Act. And that is really dealing with medical billing, that surprise billing for that non participating provider. You go through an emergency room and you don’t know, as you’re being brought in or being triaged, “Does that doctor participate?” You’re gonna stop and say, “Hey, wait, do you participate with this carrier?” They probably don’t even know, their billing teams know. So all of a sudden you’re getting a bill for $400 because that doctor saw you at the emergency room. Now you have avenues, you can dispute that bill. And between you and the carrier and the provider, you’ll try to work on it. I hate the word, “Try” it to me is a weasel word, but you’s work on it, and then you see if you can come to a resolution. If you can’t, then you’re gonna go to an independent dispute resolution team. And once that arbitrator gets involved, and their decision is final. So it really does behoove providers to negotiate with the carrier on behalf of the employee. And I do explain to people, when you go to a doctor’s office and they give you all those papers, do you read them? Most, my client, employees tell me, “I do.”
0:22:42.1 Kurt Baker: Actually I do. Well, that’s me. My wife gets mad. She’ll say, “He’s gonna read ’em all.”
0:22:42.4 Theresa Semple: I do. And that’s what my husband says, the same thing. “She’s gonna read everything before she signs ’em.”
0:22:48.3 Kurt Baker: You need to understand what you’re signing, please.
0:22:50.8 Theresa Semple: Because, I tell them, if you’re signing a waiver, that doctor doesn’t participate, and you sign that waiver without realizing it, guess what? They can bill you, and you don’t have any recourse. So, again, you need to be educated. Don’t sign things without reading them. Even if you just skim it, skim for specific words.
0:23:13.2 Kurt Baker: No, it’s… I agree with you, 100 percent. It’s important, because they do have the waivers in there. And I think it’s important what you stated early on, which is, make sure the person participates. Now, I guess one question I have is, if you’re in an emergency room, you don’t really have a whole lot of choice. It’s the doctor on call, it’s the people that are there. I assume there’s, hopefully, there are some provisions for that aspect of medical insurance, right?
0:23:35.6 Theresa Semple: There are.
0:23:36.0 Kurt Baker: If you come in and you really don’t have a choice, do you really have to be that concerned, if you’re literally on like… Life threatening issues happening to you, a car accident, whatever the case may be, you come in the emergency room. I don’t wanna be worried about like, “Oh, wait a minute. You can’t see me. Well, I wanna see the doctor over there.” So. [laughter]
0:23:52.9 Theresa Semple: Yes. And that is, that’s what your emergency room benefit is, okay. That protects you, that if you are in the emergency room and a doctor that doesn’t participate, and you receive a bill, first phone call you’re gonna make, to your HR department, your broker, your employer, whoever, the consultant. And say, “I received this emergency room bill. And I only have a hundred dollars emergency room copay.” or, “I already paid my thousand dollar deductible, why am I getting this bill on top of it?” ’cause that’s now our job to make sure the carrier goes back to the provider and let them negotiate.
0:24:35.0 Kurt Baker: Okay.
0:24:37.2 Theresa Semple: Now, if they can’t agree, that’s when they’re gonna go to the dispute resolution team. But you’re not gonna pin that on the employee.
0:24:45.7 Kurt Baker: That is awesome. Listening to Master Your Finances, we’re gonna take a quick break and we’ll be right back.
0:24:50.4 Theresa Semple: This is master Your finances with Kurt baker, certified financial planner professional. Learn about tax efficiency, liability, owning, managing, and saving your money and more from Kurt and his experienced panel of guests. Master Your Finances is underwritten and powered by Certified Wealth Management and Investment and Rider University. Rider University offers flexible education for adult learners, for more information it’s step.
0:25:18.2 Kurt Baker: Welcome back. You’ll listen to master your finances. I am here with Theresa Semple, and we’re talking about medical billing, and how we’re opening up the books. So now we have a little bit better understanding what’s going on as consumers, for those of us out there. And like me, I know me for sure, I’ve always been mystified by the fact that this was such a mystery, so to speak, and they… Nobody could seem to know what was being charged for anybody. I’m glad to see this finally happening. And the parity rules with mental health, I love that.
0:25:47.7 Kurt Baker: And then this No-Surprise Act, I just like the name of it. And I hope it’s true, and it continues ongoing, and now you have a little bit of recourse, where you can go in and get an arbitrator involved if they don’t work it out for you. So, at least you feel like you have some leverage over the process, which is kind of nice when you feel like, that everybody is against you, and it’s this huge system machine, and you’re just this one little person trying to say, “Gee, I don’t understand this, please help me out.” And they’re like, “Yeah, tough.” [chuckle] “We’ll just keep sending the bill to you till you pay it. Or it goes to collection or whatever.”
0:26:15.6 Theresa Semple: Let’s just keep sending it.
0:26:17.4 Kurt Baker: You don’t want any of that stuff. But you also have another thing that I thought was interesting, it was, I guess the Disclosure rule, which is something that’s also taken…
0:26:25.6 Theresa Semple: That was launched this year also. 2022’s been a very interesting year for compliance. And what that rule is, Kurtis, is that brokers must notify their clients what their commission is. If you received more than $1000 in commission, and going… Being invited by the client to go, or being invited by the carrier to go to a golf outing, well, that’s technically commission. So you have to disclose all of that. And you have to send it to them in writing. And they’re supposed to sign off and send it back to you. The sign off, send it back to you is not really a rule. Most of my associates in the industry, we all make it a rule, because if that client employer is audited and cannot produce that document, it’s not the broker who gets fined, it’s the client employer who gets fined. So most of my associates in the industry make the client send it to them, and we keep copies for them. So if they ever…
0:27:38.1 Kurt Baker: You’re protecting them.
0:27:40.2 Theresa Semple: Ever get that knock on the door, we have the documents for them.
0:27:44.1 Kurt Baker: Yeah. Yeah, I know most small employers are much more interested in earning their income, and making their business run. And so it’s good that you have somebody, they’re kind of watching and saying, “Look, by the way, you really need to have this in place because if you don’t, you may have a very unhappy day in the future, if somebody stops in and asks you for it.” So it’s good that you’re protecting them, and good that the industry is doing that as well.
0:28:02.4 Theresa Semple: Well that’s our job. That’s what our job is to protect the employer and protect the employees. You get a commission. And if you’re getting… To me, a commission is your paycheck. And if I’m taking a paycheck from somebody, I’m going to do my job for them. Simple as that.
0:28:16.9 Kurt Baker: Right. And that disclosure things kind of flow through a lot of industries. I remember though, the mortgage industry, it flows through the securities industry, it’s flowing through it. And I think insurance was kind of last, ’cause I think they had more people out there saying, “Oh, no. People are gonna buy stuff from us.” Well, no, they know you’re earning an income, so. That’s one I never… Always puzzled me, I have no issue being transparent with people, we earn what we earn, and we earn it, so it’s not… Why is that an issue? And I think most people that work and make an income understand that other people work and they make incomes as well.
0:28:48.3 Theresa Semple: Correct.
0:28:48.4 Kurt Baker: That’s usually how the society works. Right?
0:28:50.3 Theresa Semple: Well, like you said, I don’t work for free. I have no problem disclosing what I make in a commission. And I do understand and expect an employer to have expectations of us, me, what I do. And they’re entitled to those expectations.
0:29:07.4 Kurt Baker: Absolutely.
0:29:08.3 Theresa Semple: And one of those expectations is for me to protect them. I have to keep them compliant. Sometimes they’re kicking and screaming, but I’m going to keep them compliant.
0:29:14.7 Kurt Baker: Well, good for you. Love it, love it, so. So what else we got going on out there these days? I know we have a lot of rules going in place, a lot of open books, it’s transparencies, so any stories about what you’ve seen happening?
0:29:28.1 Theresa Semple: What’s going on right now is everybody’s scrambling. Everybody’s working on making sure they have everything they need. Employers are putting on their website, they’re open public website, the link to the carrier for the machine-readable files for you to look up your cost estimators. There’s a lot of moving targets right now, and our industry is getting very tight in what there is available for the small employer in New Jersey or actually small employer anywhere, and so it’s very difficult for them. So what can we do to alleviate some of that stress for an employer?
0:30:13.0 Kurt Baker: So how is this small employer market… And they got hurt, small employers got hurt more than most segments during the pandemic. They got shut down, and they don’t necessarily have the resources to sustain. They can’t go to the public markets and say, “Gee, we’re gonna issue some more debt and just carry ourselves to the next two years.” They don’t have a lot of the luxuries larger entities had. And I feel like they were kind of discriminated against in some ways, right?
0:30:33.6 Theresa Semple: They were.
0:30:34.2 Kurt Baker: Like the big box store was opened, but the poor grocery on the corner couldn’t stay open. It was kinda like, “Wait, wait a minute. Don’t they kinda do the same thing?”
0:30:39.6 Theresa Semple: Well, let’s say it, you look around, I don’t know anybody in my industry who has not had clients in the small industry that have been hurt or closed, because they just couldn’t stay open, it wasn’t sustainable anymore. And that was the sad part. And one of the things that’s very frustrating is, there is the Employee Retention Act, now that has nothing to do with my industry. But a very good associate of mine who does payroll, he was really educating me on it, trying to get me to understand it, because I am speaking about it, very generally, to my clients, telling them, free money. There’s nothing you have to do, except if you… If the dots all connect, you get it and you don’t have to pay it back. It’s worth taking the time.
0:31:32.6 Kurt Baker: Sure.
0:31:34.3 Theresa Semple: And I find… It’s frustrating, I find some employers have said, “I just don’t have the time,” I’m like, that’s a stab in my heart when they say that. Let’s just investigate… Let me see how I can help you. But Josh from, the associate I’m working with, he’s been fantastic in really explaining it, and helping employees, because… I mean employers. Because everybody’s struggling, and if there’s a way for you to get money from the government that you don’t have to pay back, and you’re not gonna be taxed on, to me, it’s a win-win. And once that money is done, it’s done.
0:32:13.5 Kurt Baker: Right.
0:32:14.2 Theresa Semple: This came about because of COVID. Really, I think it… From what I understood, it was there, but nobody understood it. Nobody really used it, banked into it.
0:32:23.2 Kurt Baker: Yeah, some of those rules changed, I had a guest on a few weeks ago about this. And some of the rules have altered. So, when people thought they weren’t eligible because they made it really clear that if you took out PPP loan you couldn’t reimbursed. But now that’s all changed. But the other side of it is, and I’ll just pick a pitch for that. Yes, please get that checked out because most, not most… Many employers who got one or more of the PPP, especially if they got more than one PPP loans, it means they have the quarterly declines that were necessary to qualify. So as long as the other pieces match, and you’re right, it’s literally get a consultant who knows what they’re doing about this, they will run all the numbers through. It’s fairly complicated, so you need to make sure you have somebody on the other end that understands this thing.
0:33:04.0 Theresa Semple: Exactly.
0:33:04.5 Kurt Baker: And so if they understand it and they run it for you, there’s at least a good chance there’s some money there for you. And really, to reimburse you for the losses you took during the pandemic.
0:33:14.8 Theresa Semple: Exactly.
0:33:15.5 Kurt Baker: And it’s really targeted towards the smaller employers. And you’re right, many employers, I tell small employers this all the time and they go, “Oh wow, thanks for telling me. I had no idea.” And they go and they check it out. And they do, many times, get… And some of these numbers are big, depending on what they’re doing.
0:33:30.5 Theresa Semple: Exactly.
0:33:31.8 Kurt Baker: This could be many thousands of dollars per employee. And yeah, so definitely check that out. It’s a benefit that’s there, and it may expire any minute because the government pulls the plug on these things.
0:33:44.2 Theresa Semple: Quickly.
0:33:47.7 Kurt Baker: We don’t… We never know, ’cause they can literally pull the plug at any point in time, and that’s the danger that we just don’t know when it’s gonna end. They haven’t told us, so.
0:33:53.9 Theresa Semple: So that’s kind of what I do. I work outside the box, seeing what I can hear in the industry, what’s going on, what they should be aware of. Like I said, sometimes it’s in my wheelhouse, it’s when with the benefits compliance. Sometimes it’s not it, it could be your payroll, sometimes it’s HR, which frankly, I would jump off a bridge if I had to do HR. But it’s… And if I hear these things, I make sure they have the information. I will get them the information and say, “Now you need to speak to it’s expert. And here’s a list of experts, people that I vetted.” And those, employment attorneys, HR people. Because it’s critical to always… New Jersey is a moving target constantly for the small employer. Actually, any employer.
0:34:43.5 Kurt Baker: That’s true.
0:34:45.6 Theresa Semple: But realistically, the government doesn’t look at employers as… They look at them, I think they get treated almost as if they’re stealing, and they’re not. They’re hard-working people, looking to protect their employees, and do what’s right. And it’s very frustrating, I feel very frustrated for my clients.
0:35:04.5 Kurt Baker: So what are you seeing are like the priorities for the small employer now that they’re coming back out. Just in general, from a benefits perspective, ’cause I know the employer-employee situation is challenging. So what are they doing to retain their employees through their benefits?
0:35:20.9 Theresa Semple: Oh, they’re looking outside the box, benefits are not… Benefits are critical, but how about pet insurance? How about… We’re bringing now into clients, not only pet insurance, supplemental insurance. Everybody knows supplemental through Aflac and Colonial, but there’s others out there. They’re looking at ways to do education seminars, lunch and learns, how to get a mortgage, how to qualify. What do you need to do? Education on the financial side, especially for the younger population coming out of college, they’re looking for ways to offer them a thank you, a personalized thank you, instead of, “Hey, give everybody… Take everybody on the team out to lunch.” So they’re really looking and struggling with outside the box thinking because it’s a competitive market at their small group market right now.
0:36:12.6 Kurt Baker: Absolutely, we’re gonna take a quick break. You’re listening to Master Your Finances, we’ll right back.
0:36:16.2 ANNOUNCER: This is Master Your Finances with Kurt Baker, certified financial planner professional. Learn about tax efficiency, liability, owning, managing and saving your money and more from Kurt and his experienced panel of guests. Master Your Finances is underwritten and powered by Certified Wealth Management and Investment and Rider University. Rider University offers flexible education for adult learners. For more formation, its
0:36:45.0 Kurt Baker: Welcome back, you’re listening to Master Your Finances. I’m here with Theresa Semple and we’re talking about benefits. And before we left, we were talking about some other out-of-the-box type of ways to keep employees, especially as a small employer, coming out of the pandemic in a very competitive employee market. So they’re kind of a little bit in the driver’s seat right now. And I know small employers, traditionally, have had a little bit of a disadvantage against the large employers ’cause they can offer this huge smorgasbord of just all kinds of benefits. But that’s no longer the case, so to speak. You can actually do that as a small employer as well. So why don’t you talk to a little bit about how small employers are being competitive against larger employers, and how in many cases, they’re the better option for these high quality employees that are looking for a job?
0:37:30.9 Theresa Semple: What a lot of the small employers are looking to do, it’s the outside the box. “What can I do for my team to retain them?” Okay, great. Medical, dental, vision, life insurance, perfect. How about disability? Did you look at disability? Do you have employees that are outside of New Jersey, in a state that doesn’t offer disability. Well, guess what, they might want a disability policy because they need to protect themselves not for the year down the road, but for the immediate disability. So you can put in a disability policy for them. You can offer them supplemental. Everybody knows supplemental through Aflac and through the Colonial, there are many other providers, but it’s a great benefit because guess what? They can take it with them.
0:38:19.6 Kurt Baker: Mm-hmm, oh.
0:38:21.7 Theresa Semple: And that’s critical. You want benefits that the employee, that can… That are portable for an employee. And so, now look at everybody I know has a pet. Pet insurance can be very expensive. And you want to… Maybe you’ll offer that, the employee pays for it. The carrier works one on one with the employee, but they get a discounted rate. And sometimes those discounted rates on the premium are 50%.
0:38:54.6 Kurt Baker: Wow.
0:38:55.2 Theresa Semple: So you might wanna look at that, because now you’re bringing something else in. How about education? Work with them on their car insurance, bundling their insurances. How they can save on a… Do they need apartment insurance? How many young people don’t have apartment insurance?
0:39:16.6 Kurt Baker: Most, unfortunately. And that’s a… And I know, a relative of mine actually lost her rental property in a fire and lost everything because she didn’t think to have rental insurance, which kind of surprised me because she was highly educated. But it happens all the time because…
0:39:28.2 Theresa Semple: Happens constantly.
0:39:29.6 Kurt Baker: People literally don’t think about it, and it’s really inexpensive.
0:39:33.3 Theresa Semple: Very inexpensive. So, now you negotiate with a carrier to get your team a discount on their car insurance. A discount on their apartment insurance, or homeowners insurance. So these are things that you, your consultant, your broker can all work with you on. Because the more you can offer them, doesn’t mean you have to pay for it.
0:40:00.3 Kurt Baker: Right.
0:40:00.9 Theresa Semple: It means you have to let them know you’re thinking of them. You’re interested in their future wellbeing, obviously a 401k.
0:40:08.9 Kurt Baker: Right.
0:40:09.8 Theresa Semple: Everybody wants that. And that is critical. Even if you can’t match it, at least put something in for them. So those are the things that I work with clients on many times, we have those conversations, especially in the past year. The past year it’s been critical. I’m trying to think of other things that… I am drawing a blank on some of the other things we’ve done.
0:40:34.4 Kurt Baker: That’s alright.
0:40:34.9 Theresa Semple: But I find that employees are grateful. I got calls when we put in a disability from employees that were in Kansas and Pennsylvania. And they were like, “Oh my God, thank you for doing that.” They were stressing over, one’s pregnant, and was stressing over what it was she gonna do. It makes me feel good. Like I walked to hung up that phone call and I had a smile. I’m thinking, “Wow.” That was it. That would make me feel proud of myself. So you have to look at ways to help. And like I said earlier, I work for that client. Yes, I bring the carrier to them, but my goal, and I work for that client, not the carriers, and that’s always been my mindset. So I like to make sure that the carrier, the employee, and the employers know that. I’m there for them. Every employee gets our contact information direct in my company.
0:41:34.8 Kurt Baker: Oh, that’s great.
0:41:35.1 Theresa Semple: And they get our business cards, they get our cell phones, they get… And that’s critical because I don’t want them hanging in limbo, thinking, “Who am I gonna call? Oh my God, this just happened. Oh my God, my wife just had this. I need this. What do I do?” Pick up the phone and call Theresa. Pick up the phone and call Kim. Pick up the phone and call Nicole. There’s always somebody who’s gonna help you. And that’s what we should be doing.
0:42:01.6 Kurt Baker: So it sounds like we’re putting together the whole package. Right? So we started off, we got a lot of… The Transparency Coverage, was just fantastic, I love that. So we get more information. The ID cards are showing more information about what benefits they have, so they have a better understanding of what their cost structure is going to be. Is there anything else that they should be doing to kind of plan ahead for the year? So that each year… I mean employer, should they be reviewing these things on an ongoing, basically, I know things change with the insurance coverages over time. Just like with auto insurance, you hear about, “Hey, you wanna review it every once in a while.” Because what you put in place 3, 4, 5, 10 years ago may not necessarily be the best combination of what’s going on now.
0:42:46.5 Kurt Baker: ‘Cause I see it all the time. I mean, you get kind of this drift, where somebody grabs the business, then all of a sudden things change for them. And then other carriers come in and they do a little bit better job. So there’s this constant battle back and forth between the different providers, is what I’ve noticed over the years. So how often should somebody actually go in and say, “Hey, we kinda need to take a wholesale kind of look at all this stuff and see, are we really doing the best combination?” ‘Cause as you point out, you got these group benefits, negotiated rates on some of these things, like pet insurance. There’s just a lot of stuff going on there that… I don’t know, to me, it sounds like at least every once in a while somebody should go and say, “Let’s just take a quick look and see what we got.”
0:43:23.6 Theresa Semple: Realistically, it’s a constant look.
0:43:28.2 Kurt Baker: Okay.
0:43:29.0 Theresa Semple: Realistically.
0:43:29.6 Kurt Baker: Okay.
0:43:31.2 Theresa Semple: What actually happens is at least once a year.
0:43:33.9 Kurt Baker: Once a year? Okay.
0:43:34.7 Theresa Semple: I mean, I… There is not a client that should ever renew, just renew on anything.
0:43:39.4 Kurt Baker: Okay.
0:43:40.3 Theresa Semple: Always my thinking is if you don’t ask, the carrier’s never gonna knock on my door and say, “You know, let me reduce that for that person, I could.”
0:43:49.5 Kurt Baker: Okay.
0:43:51.0 Theresa Semple: So you have to ask, you have to push a little bit. But you have to review at minimum once a year. Nobody gets to renew as is, until we discuss it and review it. ‘Cause I’ve gotta make sure they understand changes. There could be something different four months ago and they need to understand that. The other thing is, it’s a moving target, you should be reviewing it. Like you said, you have pet insurance, you’re doing seminars, lunch and learns. These are all things that you have to review continuously to see, is it up to par? Is it up to speed? What’s changed in that industry? Do we want this now, instead of that program? So you need to review things constantly. And it should never be just once a year as most people, but a minimum of once a year.
0:44:40.9 Kurt Baker: Okay. And I guess the other part of this, as an employer, once I know what are these different options are, I should be in contact with my employees and say, “Hey, look, one of these are important to you, right?” And then find… Depending on the size, whether you’re five employees or 500, shouldn’t you kind of get a sense of what your employees are looking for as far as their benefit structure goes. Because you might be surprised, you may have a benefit, and they’re like, “Well, I don’t really use that.” But you may have other benefits like, “Look, I’ve heard my friend has this benefit over there. Is there any way we could get that on board?”
0:45:09.7 Theresa Semple: Yeah.
0:45:10.9 Kurt Baker: Is there a way to communicate that, to say… You’re gonna get feedback from employers, make sure you’re providing what they’re actually looking for.
0:45:15.9 Theresa Semple: One of the things, it’s a protocol in my company. And I know a lot of other brokers do the same thing, and consultants. We need access to the employees.
0:45:23.9 Kurt Baker: Okay.
0:45:24.7 Theresa Semple: I don’t necessarily need access to you, the business owner. Because you’re gonna tell me, “This is the bottom line, this is what’s important.”
0:45:31.6 Kurt Baker: They want the smallest number at the bottom of the page. [laughter]
0:45:34.5 Theresa Semple: Yes. And you’d be surprised at how many people, when I talk to the employee, it’s really a specific benefit, they’re willing to pay more out of their own pocket for that benefit. And I always tell the client, “Please don’t just assume on your employee’s behalf, let me chat with them, because they’re gonna tell me.” and they do. And this way I can come back to you and explain to you, and you have a better understanding of your own team. Even if you don’t work with me, you’ll at least have a better understanding of your team to know what they really want and need.
0:46:13.3 Kurt Baker: Well, that’s incredible. Wow. So yeah. So now we got more transparency, which is awesome. And so it sounds like it’s gonna take a little bit of time for that to flow through, as that’s my understanding. But it’s work, it’s a work in progress. A lot of stuff is showing up on the websites now. So if they go to the employer websites, they’ll be able to see that information. A lot more on the ID cards, so they get the ID card that shows more details about what their benefits are. And so you also have the, I guess the… It’s the Transparent Coverage, and then we have the other one which is the surprise act…
0:46:43.0 Theresa Semple: No Surprise Act.
0:46:45.7 Kurt Baker: No-Surprise Act. Which is also good. So that if you go to an emergency room and you find, “Hey, I got this bill that literally surprised me.” So, yeah, I like the name of the bill. Then please have a conversation because you do have some leverage now which you did not have in the past, but you just had to kinda battle it, so to speak, almost like a court you felt like, it was silly.
0:47:05.0 Theresa Semple: Well how many times, Kurtis, would you… Did you, in your lifetime have a doctor walk into your room in the hospital? You don’t know that doctor, you don’t know who they are. They look at the chart, they sign the chart, and you get a bill.
0:47:18.0 Kurt Baker: Yeah, no, I’ve had… Yeah. Fortunately I’ve never be in the hospital for this little bit, but I know what you’re saying. Where like, “Where did he come from?” “Oh no, he visited. He just was double-checking, he was… ” “I’m like, what did he do? I don’t remember doing anything.” I remember the… We don’t even remember the person coming in. And no, I get it, 100%. And they’re usually not little bills.
0:47:34.6 Theresa Semple: That act would… That act will protect that person.
0:47:35.1 Kurt Baker: So yeah, I can just be a doctor and just roam the hospital.
0:47:40.6 Kurt Baker: That’s what it felt like at least. I know that’s not true, and I know that’s not true. I have a lot of doctors that I love, but it’s what it feels that way sometimes. So, yeah. So that’s great. And then to analyze it, and the mental health is a huge part of what we’re doing now, so that the Parity Act, we’re all hopeful it’s for real this time, it sounds like. ‘Cause if this is like the multiple times they’ve tried to do this, but it sounds like it’s actually for real. So they can’t cut your benefits off, if you need a therapist, you can keep getting your therapist just like you could with any other care and that’s huge, in my opinion. And then reviewing the benefits and making sure you’re getting employees what they’re looking for, I also think is really big. And I think a lot of employers, unless they’re paying attention, they kinda let that slide a little bit. And you might be able to offer more of what your employees want and then potentially at a lower cost too, it’s not necessarily a negative thing from an employer standpoint, you may actually save a little money when you review those and you negotiate your pricing when you go forward. Theresa, you’ve been awesome, we appreciate it very much.
0:48:36.5 Theresa Semple: Thank you, Kurtis.
0:48:36.6 Kurt Baker: You’ve been listening to Master Your Finances, have a great day.
0:48:40.4 ANNOUNCER: That was this week’s episode of Master Your Finances with Kurt Baker. Certified financial planner professional. Tune in every Sunday at 09:00 AM to expand your knowledge in building and managing your wealth. Missed an episode, no worries? You can subscribe to a free weekly episode of Master Your Finances to listen to, on your favorite podcasting platform, Apple, Spotify, Google Podcasts, whatever. Master Your Finances is underwritten and powered by Certified Wealth Management and Investment and Rider University. Rider, offers continuing studies programs for adults who need flexibility. Want to add new skills to your resume? Take a continuing studies course at Rider University.

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