Question 1

What do your services cost?

Accepted Answer

Nothing!  At least, not for you.  We are paid by the carriers, and we don’t have contracts.  So, if you give us a shot and decide you want to use another benefits company, you’re free to move on.

Question 2

What are copays, deductibles, coinsurance, and out of pocket maximums?

Accepted Answer

Copay:
Co-pays are your fixed fee for certain covered medical services. The Copay is a set amount you pay each
and every time you use a particular service like visit the doctor, an X-ray, or a medication.
The amount of the copay is preset by your insurance provider and will be the same fixed amount no
matter how often you use the plan.

The most common copays apply to primary care, specialist, and urgent care visits as well as prescriptions
but not every plan has copays.

Deductible:
The deductible is the amount you pay for covered health care services before your insurance plan starts
to pay. Typically, if a service doesn’t fall under a copay, it falls under your deductible instead.

It’s important to note that your premium (that monthly membership fee) and your copays do not count
toward your deductible. Also, the deductible renews each year (usually calendar year) and you have to
start over towards meeting your deductible.

Coinsurance:
Co-Insurance is a cost the insurance carrier shares with you for covered medical services. Coinsurance is
usually described as a percentage of the expenses shared between you and the insurance company. It
applies after you have met your deductible and before your out-of-pocket maximum has been met.
Once you reach your deductible, coinsurance applies, and you and your Health Insurance plan share
your medical costs. For example, coinsurance of 80/20 means that your insurance will pay 80% of the
cost and you will pay 20%.

Out of Pocket Maximum:
As the name implies, the out of pocket maximum is the most you have to pay for covered services in a
year (usually calendar year). After you spend this amount on deductibles, copayments and coinsurance,
your health plan pays 100% of the costs of covered benefits.

Question 3

Who can you work with geographically?

Accepted Answer

While we have a Southeastern United States focus, we do business across 30 states from Florida to California. We don't mind racking up those frequent flyer miles.

Question 4

Do you help communicate and explain my employee’s benefits to them?

Accepted Answer

Yes! We connect with of your employees within your preferences to ensure they each have clarity on
their benefits, whether that means emailing, calling, texting, sending carrier pigeons, or creating smoke
signals.

Question 5

What is a Qualifying Event?

Accepted Answer

A Qualifying event is a life change that gives you the ability to enroll in your employer’s health insurance plan outside of the annual Open Enrollment period or New Hire Enrollment.

Here are some examples of qualifying events (but not a full full list).

1. Losing qualified health coverage
2. Getting Married or Divorced
3. Having a baby or adopting
4. Death in the family

Question 6

What annual compliance topics do I need to be aware of?

Accepted Answer

There are several factors that determine what compliance regulations apply to you, PCORI Fees, 5500 filing, 1095s, Medicare Part D notices, Transparency notices, are just a few that you may be subject to.

Question 7

What size companies do you work with?

Accepted Answer

PBC partners with companies ranging from 5 to 1000 employees, serving each of them as if they were our only client.

Question 8

How does offering benefits to my employees affect my taxes?

Accepted Answer

Employee benefits offer pre-tax savings for healthcare plans for your employees and contributions toward benefits can reduce your company’s overall tax liability.

Question 9

How long has PBC been in business?

Accepted Answer

PBC was founded by experienced health insurance professionals in May of 2007 to pursue their goal of offering the highest level of service to clients of all sizes and backgrounds.

Question 10

As a business owner, do I have to pay anything towards employee’s benefits package?

Accepted Answer

Medical insurance carriers typically require a 50% contribution towards the employee-only rate. This contribution can also reduce your overall tax liability.

Resources & FAQs

There's no such thing as a stupid one, but there are common ones. PBC is here to help.

Tools we provide to help you succeed.

PBC provides you with the following tools and more for no additional charge and with the goal of having you never have to call a 1-800 number again.

Frequently asked questions