I'm steering clear, you know what the CDC says about second hand snark......

Choosing the plan and provider (insurer) does not make the plan. Running numbers for what is available is not designing a plan. It's choosing. Employers can also set different tiers of coverage and what they will pay. But the plans (actual coverage) themselves are offered by the insurance companies who design them.

Wildchild, there is an entire industry around self-insured plans. We don't have an "insurance carrier" - self-insured plans use a TPA. We build our own plans and have a TPA to run them. I am not sure why this is such a controversial concept. However considering this is my actual professional career, there is a chance I know what I'm talking about. 😂

^^^Same thing happened to my wife, Elmer, to the tune of "a lot of money." It's how I became aware of self-insured plans and the flexibility they offer. And I was very thankful for them.

Glad to hear it food. When I said "advise the insurance company", I more properly should have said "advise the third party administrator". I said what I said because we happen to use an insurance company.

Self-insured plans are really the best of both worlds. The employer saves money with cheaper costs (no underwriting profit or contingencies to pay for) and employees in most (but not all) cases know that there's flexibility to resolve unintended oddball situations.

It should be mentioned that even insured plans offer medium plus sized employers the ability to custom tailor coverages and design plans "not on the menu".

Yes Ally there are. But no one was talking about self insurance before now. They were talking about what insurance companies will pay for testing.

" They were talking about what insurance companies will pay for testing. "

This has gone full circle.

What I hope you've learned is that you were wrong about what an "insurance company" will pay for testing (or anything else). It depends upon the provisions of the plan the patient is covered by. And, because often people are covered by plans with customized provisions that are different from both what Medicare would allow and what an insurance company's standard plans would allow, one can't assume anything.

What people should also learn about self funded health insurance plans are the fact they have a competitive edge over fully insured plans offered by insurance companies. They don't need to comply with a few of the ACA reforms and are exempt from state insurance mandates under ERISA, so they can elect to cover state mandated benefits but not required to do so. They also are exempt to employer Insurance premium taxes which are 2%-3% depending on state. Also under ERISA rules they don't need to fund future retiree insurance benefits, so if business goes south so can the benefits.

Self insured plans almost exclusively use fee for service providers locking out Integrated Delivery Systems which are more economical multi specialty group practices such as the Mayo Clinic and the Cleveland Clinic to name a few. These integrated delivery networks are much more focused on health care quality to the people they serve.

The Mayo Clinic in my area is the place to go when all others fail if you can get in, but acceptance is determined by application and reserved for the more critical and previously diagnosed cases as hopeless. A brother given 5 months to live after a blotched Whipple procedure was accepted and tests showed he had 2 days to live because of the blotched operation, he lived 3 1/2 years after the Mayo. My younger brother was just accepted at the Mayo after a decade of failure from every specialist in the twin cities for his problem. If either brother was apart of the 87% of self insured plans locking out IDN's the Mayo would not be possible. So careful what you wish for, and self insured plans can be a double edged sword .

In other news;Hospitals are dropping medicare advantage plans left and right. Take it for what it's worth.

kevin -- Ironically, there was a full page ad in this morning's Chicago Tribune welcoming the large Rush Medical system into the United HealthCare fold.

" tax revenue lost to the federal government by self insured plans amounts to hundreds of billions and closer to half a trillion a year "

How so?

It appears to be a greatly exaggerated and likely untrue allegation, not surprisingly. I was suggesting you could show otherwise if you wanted to or could, also unlikely. I have no further interest.

Kevin an awesome post, courteous and factual.

Thanks for your honesty. I think there's still a disconnect between what you think you're saying and what you're saying.

" the revenue loss was for all health care plans through exclusions and expenditures to be closer to $300 billion "

Do you know what this means? And what it refers to? And why it may be?

" ERISA does exempt state taxes on employer paid premiums for Self funded plans but not fully funded plans, and this exemption does cost all the States 20 to 30 billion a year in lost revenue. "

Do you know what this means? And what it refers to? And why it may be?

I believe the answer to my questions is No.

Yes I to all your questions Elmer, the question should be do you know and if not it doesn't matter. I also wonder if you know in your sentence " I believe the answer to my questions is No" the correct verb to use is "are", but again doesn't matter.

He is referencing one answer, Kevin, wouldn't it be 'is'? But you are right, what really matters here is all of us trying to have a meaningful courteous conversation and exchange our views.

Then why would an insurance plan be scorned by providers? They don't pay in a timely manner? They fight claims?

Those have long been problems with all sorts of reimbursements to providers. Smaller hospitals and individuals can't make payroll if they aren't getting reimbursed for six months to a year, or if they're tied up in back and forth about disputed claims.

If the subject of a sentence is plural, use “are”. The answers to my questions are no. The answer to my question is no. The answer to my questions is no. Signed, The Grammar Police.

" Yes I to all your questions Elmer "

I don't for a minute believe this comment. Pick a few and explain what you think they mean.

My question was implied and singular, do you know what you're talking about? Broken down to sub-parts. Then and now, I suspect the answer to my question is No.

Chisue, in answer to your question - one of the biggest points of contention is reimbursement rates. Various insurers and networks negotiate rates with providers, and providers will stop accepting certain carriers or plans if they aren't willing to accept the rates offered. But yes, carriers can play games with claims submissions and/or payment timelines too.

Elmer, I'm flattered you have reached out seeking help understanding IRS exclusions and what expenditures are but I don't have the patience for a tutoring session with you. It's quite simple to understand so possibly you can reach out to others for assistance.

I'm quite knowledgeable of the tax codes and can understand IRS publications with ease but there are times even I need to consult a CPA. Just this year I consulted CPA's with a few complex tax questions and needed help, so you should do the same and consult a professional for advise regardless of the simplicity involved to avoid confusing misinformation

You are very knowledgeable in grammar and I will not argue of your accomplishment, I on the other hand little interest in the subject dedicating my time to hands on interests. I was taught to weld at the age of 8 and started fabricating the coolest mini bikes and go carts scrap metal could build, and have never stopped adopting new interests. Some grammar makes no sense to me like when you stated;

"Do you know what this means? And what it refers to? And why it may be?" Is see 3 questions as plural, and then saying "I believe the answer to my questions is No."? Well it sounds dumb the 1st time I say it out loud and even dumber the 2nd time. So I don't get it.

Rest assured that 1) with a BA and MS from top universities in areas relevant to the discussion, 2) having earned a CPA license at the earliest opportunity under law at the beginning of my career, and 3) having spent my career in public accounting as a partner of a global firm, there is likely no topic or situation in the areas of taxation, tax policy or governmental finance that I don't know substantially more than in your wildest dreams you think you know. Use as a starting point the old phrase "I've likely forgotten more than you've ever learned, and I haven't forgotten much".

Pissing contest?

Agree, Lucille. It doesn't matter how many degrees you have, I have three advanced degrees myself. So what?

WIth whatever field any of you have expertise in, it's easy for you to spot someone blowing smoke, a pretender. The topic was very much in my wheelhouse. It was clear to me with the first comment on the healthcare cost subtopic that he hadn't a clue what he was talking about and I gave him a chance to strike out. Which he did twice.

It's not a pissing contest.

EVERYTHING is in your wheelhouse, it seems.

Yes, it's true about many topics, not just the one I spent my career immersed in as in this instance. It's oftentimes the case with people who are curious, interested in learning about a wide range of topics and widely read for that reason. It can also depend upon whom the comparison is with and what their professional training or personal proclivities are or aren't.

Thanks for noticing.

YES! the right organ for sure. I had a liverwurst sandwich along with my daily glass of home made tomato juice to take me through to a diner. Organ meat is a best source of B12 said to be a antidepressant but only about 3 oz's because I don't want to overdo the happy feeling.

Well, I'm feeling dumb as a post because I'm lost. I don't know squat about tax codes. I do have (only) one master's degree - but it's only tangentially related to where I've ended up in my professional life, and I did not stay at a Holiday Inn Express last night.

Nonetheless, I'd really like to understand how an employer's self-funded insurance plan is "hurting" the federal government, or the state governments, or whoever. And I'd also like to know if this alleged revenue loss would apply if the self-funded employer is tax exempt.

(and no, I'm not going to google it.....)

Not knowing anything about a specific subject doesn't make you dumb, and there is no such thing as a dumb question, only dumb answers.

A self funded plan has a competitive edge by law over fully funded plans for a number of reason I mention earlier but technically any qualified health plan hurts the federal governments revenue collections in the tune of $300 billion because of one little tax law. But the same tax law saves the people with an employer sponsored health plan $300 billion in excluded taxes. Some lawmakers hate this and would prefer to repeal the tax law while others want to control how much would be excluded for specific tax payers based on income, they call it tax equality.

Health insurance premiums paid by an employer for an employee is considered a fringe benefit. Nearly all fringe benefits given to an employee are taxable at the fair market value of the benefit to be added to the employee's income. The little tax law I mentioned excludes taxation of insurance premiums paid by an employer on a qualified plan. This exclusion is in the code of federal regulations title-26/part-1/section-1.104-1#p-1.104-1(d)

To be clear both self funded and fully funded health plans hurt the federal governments tax collections but save the tax payers a bundle.

I saw your post this morning but was hoping the alleged forum CPA would clock in to answer your question but he must be busy, maybe out with the alleged forum doctor? I learned to read and understand "stupid" while in the military looking for loopholes in the regulations and found many. Tax regulations are written differently and more complex, and more like a confusing legal documents but I can manage even without a college degree. The actual internal revenue tax codes are simple to read and understand with issues and court decisions to the issues, but they are then interpreted by the Treasury and written into regulations using a "complex stupid legal" language. Gets better, then the regulations are dumbed down and condensed into IRS publications for guidance and to help tax payers. By the way I know nothing about taxes and just smoke cigars and spit tabacee juice while whittling on sticks waiting for my relief check so I kin buy some moonshine. Can hit a shot glass with my organ from 12 feet too!

I am fascinated. I may end up having to google it.

So it isn't so much a self funded plan issue as it is any employer health plan premium?

I'd really like to understand

Absolutely, a valid request. My father was a doctor, a scientist, and a cancer researcher. He loved talking about science, and would always say that people who knew what they were talking about should be able to offer explanations that anyone could understand, and was always happy to take the time to explain answers to my questions when I was a child in a way that I could understand.

Later, IRL, I would gather with neighbors at kitchen tables to discuss news and concerns. Never once were credentials offered or required. As has been said above, there are no dumb questions, and no one was ever mocked for their concerns.

If I had to choose between clear, patiently given replies and those who don't take time/patience but instead demand that their offerings be judged as correct due to their credentials, I would choose the former every time. My father delivered those explanations, even though he was a MD and Ph.D. and I hope my post here honors the memory of his patience and love for science.

Kevin - Correct me if I’m wrong but it appears to me that in your discussion of tax exclusions for insurance plans, you answered a question that wasn’t asked. Here was your post-correction statement:

ERISA does exempt state taxes on employer paid premiums for Self funded plans but not fully funded plans, and this exemption does cost all the States 20 to 30 billion a year in lost revenue.

Are there even employer premiums on self-funded plans in a traditional sense? I thought the whole point of self funding was to avoid that. Do you have that sentence backwards? I believe employer premiums to fully funded plans are tax exempt, which would explain why states lose revenue on these. And I understand that people object to the current exemptions.

Disclaimer: I’m not claiming any expertise, this is just my understanding, right or wrong.

I adore you Lucille. Thank you. :) I try hard not to give into my occasional snarky tendencies, although I don't always succeed.

I love learning new things, from people who know what they are talking about. The most beloved people in my life are incredibly intelligent people who give their knowledge freely, without making me feel like an idiot for asking questions. I've also found that the smartest people know the limits of their knowledge and I try hard to live by that creed in my own life.

I would have loved your father!

Thank you Lucille. Of all the smartest people I have met or known (including several nobel prize winners), none of them have ever trotted out their credentials. I've worked with many PhDs and none of them ever used their title of "Dr". All the smartest people I've known have been open to learning from others, were humble and recognized the limits of their own learnings, were willing to expand their knowledge from whomever they could, and didn't put anyone else down or lorded their degrees over anyone else. They didn't need to. They had nothing to prove.

Whether presenting fact or opinion, addressing the audience pleasantly and speaking clearly and at their level is a benefit to getting your point across, doing otherwise puts your efforts at risk. But when looking for facts, I find it best to turn to a knowledgsble person even if they’re abrasive or pompous or otherwise unpleasant. (General statement, NOT directed at anyone.) Of course there’s no rule saying a knowlegable person can’t be pleasant but if they’re not, so be it.

When it comes to areas of accountancy I’ve never been given reason but to accept Elmer as an SME. How wifi calling works on an iphone, not so much. 😉 If there’s disagreement between Elmer and Kevin there’s a chance it’s factual, but it’s an even greater chance it’s a communication issue between two people who have no use for each other.

But when looking for facts, I find it best to turn to a knowledgsble person even if they’re abrasive or pompous

I understand that in teaching circles there is a controversy about whether teachers should be experts, or skilled at explaining and teaching. Having knowledge is one thing, being able to explain something to someone else is a different skill set entirely. So if one was looking for the 'best' it might be someone who knew what they were talking about and also were patient and knowledgeable in how to teach.

And of course, knowing what you are talking about does not always require a credential. And as evidenced by high dollar litigation where both sides retain experts who then say completely different things, credentials aren't necessarily a guarantee of anything. (And as evidenced by George Santos, credentials don't even always guarantee credentials).

But when looking for facts, I find it best to turn to a knowledgsble person even if they’re abrasive or pompous

But who needs to be talked down to and insulted? Nastiness overshadows what is being told.

There are enough pleasant people out there that know their stuff. I’ll choose them.

Food, I'm neither a proponent for or against self funded plans and have no expertise in any tax or insurance field. I only dig to the actual sources on questionable topics for information I need to know, or just want to know.

I believe you are right and there is nothing one could classify as a premium except a premium the employer would make to a reinsurance company to pay above the companies budgeted expenditure if needed, or a partially funded plan maybe. How ERISA exempts any state imposed taxes is a mystery to me because I haven't dug into it. But contrary to popular beliefs taxes do exist on premiums, and paid to the state by the insurance company

This is the tax law in my state on gross premiums.

"Except as otherwise provided in this section, a tax is imposed on every domestic and foreign insurance company. The rate of tax is equal to two percent of all gross premiums less return premiums on all direct business received by the insurer or agents of the insurer in Minnesota, in cash or otherwise, during the year."

The federal law was given in my comment to Alley excluding premiums from income tax because it's a fringe benefit. If the exclusion was repealed I would guess with a self funded plan all payments for medical expenses on behalf of the plan would become fringe benefits and become taxable. To sum it up there are advantages (and a competitive edge given by law) and disadvantages, but I really wished I this thread would get back to vitamins, nutrition and good stories.

The only reason I even responded on the subject of insurance and taxes was the big bag of wind that blew in from the west causing total chaos. I enjoy harmless threads like this and the good stories told, like the last one from Luclllle and to me are priceless. and even your stores are enjoyable.

You like my stories? Well then here’s another one that gets us back on topic: I take multivitamins in part because they taste good and I can say they’re healthy. I have a terrible sweet tooth, an addiction in every sense that I’ve struggled with for years. I give up sweets for Lent, figuring if the adage that 30 days starts or breaks a habit holds any water, 46 should be a sure bet. I do allow myself my vitamin gummies during that time. It allows me to sleep, but ultimately probably hurts my goals as I’ve not had lasting success to date.

" I'd really like to understand how an employer's self-funded insurance plan is "hurting" the federal government "

They don't, they're more or less revenue neutral from a policy standpoint. And not something that can be regulated.

Let's keep terms clear to avoid confusion - employee health benefit plans can either be self-insured or insured. Those of larger employers, especially private sector ones, tend to be self-insured in whole or in part. Which it is will usually be invisible to the employee - indeed, most don't know. Or think that because an insurance company is the contact point and administers benefits and coverage (always the case) that there's insurance involved.

Should it be the case that any Peanut Gallery members has deep expertise in a particular area and has encountered someone who doesn't but pretends to be knowledgeable, the pretender is easily identified. That's what elements of these comments have been like. Why I tried (in an atypical way) to bring it to an end. The mistakes of understanding, mistakes in comments, misuse of words, confusion, make it very clear to me the subject matter ignorance involved.

food, your comments are right on. I wouldn't call the differences in comments offered differences in fact. This is not a very complicated area but one for which a pretender can easily be confused and led astray, as is plain for anyone to see.

As for Wifi calling with an iPhone, be sure to have your Airplane mode setting turned on. It's very useful for phone calls made when abroad.

Hey Elmer, thanks for confirming what I had just said in a couple of posts even if you did paraphrase my posts, but fine with me and you're welcome. But your work, or lack of, had little clarity or any mention of source reference, which you continuously insist from others. Wait, was I your source? LOL.

It reminds me how you always jumped into a HVAC and electrical discussions and gave advice on these somewhat cautious subjects with no expertise at all. You pretended by paraphrasing others as if your own from verified experts in the field, any you even had the nuggets to argue with the Technically trained and experienced professionals,

Maybe it comes down to the arguments you enjoy as a competitive challenge which I can understand. I joined the army boxing team, (1974-76) and also earned a blue belt in Taekwondo for the competitive challenge and often got the tar beat out of me, but I enjoyed it and congratulated the victor. It seems you love to argue but hate losing and need to accept both, but you always leave the thread a sore loser without excepting defeat. When one insults his opponent in a debate is the moment he has lost. You lost this one even without insults but I don't expect a handshake, but what I would expect from you is to apologize to a person in a previous argument you insulted (you know to who Mr. macho man) so resolve the matter.

This came across my news feed and I remembered this thread...

Multivitamin may slow memory loss

"Taking a daily multivitamin may protect against memory loss in older adults, according to a trio of studies that included more than 5,000 participants.

Taken together, the three studies found that compared to a placebo, taking a daily multivitamin slowed cognitive aging by about two years, said Dr. Chirag Vyas, an instructor in investigation at Massachusetts General Hospital. "

Perhaps this has been addressed but is there a particular multi-vitamin that is easier on the stomach? i just feel peppier when im on them, whether it’s all in my head, or not.

A single metastudy can show possibilities but nothing more. Drawing any conclusions is more than premature because until the biology or chemistry is investigated, nothing is really known. An NBC piece on this article has the following comment from an expert:

" The notion that vitamins alone could protect cognitive function in older adults is plausible, but there are some caveats based on the relatively short studies, said Dr. Richard Caselli, a professor emeritus of neurology at the Mayo Clinic in Arizona."

@ sjerin - I always take my multi in the morning after eating breakfast - IOW, not on an empty stomach. Some vitamins and nutrients are better absorbed with food anyway.

Yes, I do that too but it still makes me uncomfortable.

sjerin, my mother used to get stomach upset when she took capsules over tablets because there was something in the capsule that bothered her. She'd dump out the contents and take it that way without issue. If there's something specific that bothers you, be sure to check the ingredients...it may not be the vitamin but the other additives they use to make the pill.

If you do a search, there are vitamins that claim to be easier on the stomach, so you're not alone.

Thank you for the good suggestion, Annie.

I hope you’re feeling some better now.