Intellect Betrays God’s Gift of Faith

Your life is a gift.

You didn’t create yourself in your life, right? That’s not a surprise to you I assume. But, how often do you consider how you got here? When you think about the series of events, that created you as human, I mean the timing of events back in history. You pick how far back. But, go at least as far as to include your grand parents.

Your grandparents met, married, had a family of which your parents were one of a few siblings, right? Then your parents met and you were one of a few siblings. That’s most common for many of us. Sure, your circumstances are unique and different than this but it doesn’t change the point; you, yourself did nothing to get here.

Think of how much we know about the complicated science of DNA coming from two different people and the merging of DNA to become a unique person. What about the influences from how and where you were raised? These influenced who you have become and how you think. The point? Your existence had nothing to do with you. I like how the Church says husband and wife cooperate with God to create another human.

So, why do I bring all this up?

Your intellect is God’s gift to you.

If your life and mind aren’t something of your doing it can be said it was a gift from God. Now, sure you’ve used it to get where you are now and presumably you’ve put your mind to work learning so that you might become the best version of yourself.

How Ironic

How ironic that God’s gift of intellect can be used to harm the relationship with the very God who gave the gift.

God in his magnanimity gave you a mind and the freedom to use it anyway you choose. This makes me laugh-out-loud. Most atheists I know have created an argument or follow someone elses argument for their existence and to do that they’ve used the gift given to them to be used as they choose to explain away the giver and the gift given.

A Backhoe Analogy

Let’s use an analogy, let’s say you’re giving your son a ridiculous gift, you make no strings attached to the gift and you tell him he has complete freedom to use the gift anyway he wants. No matter how old your son is he is capable of using the gift anyway he wants. You give him a man-size big backhoe, now that’s a cool guy gift. Right? This gift represents a tool your son can use, it represents a tool he could use to benefit himself, you, your family, the community. Right? He could use tool anyway he wants and he could use it for good or not.

This gift represents a special tool your son can use, it represents a tool he could use to benefit himself, you, your family, the community. Right? He could use tool anyway he wants and he could use it for good or not. He can choose to not use it at all, he could go to classes to become the best at using it. You get the idea right the tool is not your son it is just a tool?

Guess what, he uses the tool to tear down your house. The house built by you and your spouse for the family including your son, it’s a house that friends and the community have enjoyed together. He brings the backhoe up to the side of the house and says, to himself, this is silly siding, I’m going to remove it. He doesn’t like the front door, shingles, driveway, landscaping and removes or destroys your home or parts of it. He elects himself arbiter over the good and not good. He uses the tool you gave him to tear down the house you also gave him, the house that is also a gift to him.

The point?

The point is you your gift that could have been used for good was used instead to tear down your home. Do you see the irony in that? Like the backhoe gift, God is so generous that the gift of the mind he uniquely gives you and the gift of freedom to use the gift is often used to tear down your relationship with God.

How do you use your gift?

Atheists or simply skeptics of the Church use the gift to reduce God’s relationship with them to something they understand. They don’t use the gift God gave them for good or to understand and build a relationship with God. Just like the backhoe analogy, the irony is intellect is often abused by skeptics because the very gift or tool called intellect is used not for their good, or the communities good but to destroy the relationship they could enjoy.

The backhoe could have been used for example to build a community pool, work with the parents to build an addition to the house, construct food plots to feed others. Likewise, the intellect of atheists could be used to build up the spirit of God, articulate the beauty God provides to all of us, or simply used to help others.

Do you use your gift to build or tear down?

The Joke

But, it’s a fools joke, as a good Catholic boy who is learning the faith more deeply each day, searching the mystery of God more each day, I sense God’s humor in so many places. Consider that for me Atheists or skeptics of the Church are among the brightest minds I know. Really, in having a conversation with skeptics I find most often these are quite bright individuals.

This makes the irony even more humorous to me. That God’s best intellectual gifts are given to those who use it to tear down the relationship they could have with God.

God Can’t be Figured Out By The Mind

God in the old and new testament often points out that a profit or wise person doesn’t come to faith without God willing it. Often God writes words like the following.

"Blessed are you, Simon son of Jonah.
For flesh and blood has not revealed this to you, but my heavenly Father." 

MT 16:13-20

He says, flesh and blood have not revealed this to you, and what does that mean? It means, the mind or intellect can not perceive what God has hidden from it. This means God doesn’t live in the mind or intellect but somewhere else in the human person. When God is ready he will reveal himself. In the mean time, you’re stuck with what your mind creates by way of an explanation.

Again, LOL.

I Didn’t Meet Him Until I Was in My 30’s

You might ask how do I know this? Well, I’ve been Catholic my entire life, I wandered away and questioned the faith when I was young. He didn’t reveal himself to me until I sought him in earnest. When I put my ego aside and got on my knees, I allowed God to show himself to me, then he invited me in.

The Intellect Fabricates God

Atheists/skeptics use their mind to fabricate a limited human view of God using the very intellect God provided. Atheists can not define God who they do not know.

By design, ironically, God reveals himself when you invite him in. The intellect or mind is not capable of understanding God but the soul reaches for God, yearns for the God of the Universe to reveal himself again and again. God’s grace is what brings Christians to their knees. God’s grace is what Atheists have never experienced because their mind limits them. That limit is by design, they push God away and insert their own self-importance. The spirit God gives animates the mind and intellect, the soul understands what the mind can not.

How Ironic Is That?

I’m often sad, that bright and learned well educated are most often victims of their education. They create in their own mind a small, small world that doesn’t have God as its center. For another topic, our Universities have moved our youth away from God at our brightest institutions. They limit their teaching to what the mind can know only and do not discuss God’s presence and omnipotence.

All the ages have included God until this present age that ironically considers itself “enlightened”. The truth is, if what I see Universities teaching is what’s available by way of “enlightened” then I’m not interested.

The Soulless Work Place Is A Problem

We are a country that places a great importance on the intellect or mind. We reward intellect at home, school, work and honor it by paying wages for it, we acknowledge it on social media and display it in the news and politics. We value the intellect more than the soul and in the process, the intellect has trampled the soul.

You Can See This Truth At Work

At work the human character is overlooked, employees are reduced to solely an economic value. The workplace values only intellect and mind but the soul and whole person should be recognized in the workplace. If we value every employee no matter their role or intellect, and even in the context of the economics, how much better companies would be.

Recently I learned the Japanese produced much better cars after they used LEAN as a way to listen to employees who knew best what to improve. This change started in the 50’s and continues today. LEAN is a process to engage ideas for improvement at the employee level. Meanwhile, back here in America, LEAN won’t stick because American employees can’t admit they and their jobs could improve.

America A Prideful Culture

We are a very prideful culture where no one is wrong because Universties teach that whatever individuals tell themselves by way of their intellect is okay. The idea that anything your intellect or mind thinks up is okay permeates our culture. It is difficult to examine an employee job to make improvements when everyone thinks what they are doing is perfect because they thought it up.

Virtue of Humility Is The Fix For Pride

The intellect or mind is a prideful tool that rarely finds humility on its own. The absence of the soul in the workplace means we reduce the human endeavor of work to only economics. Economics is a reality like gravity that can not be ignored and has its place to be sure. But, like LEAN suggests listening to employees and engaging employees to reach for perfection is a very soulful endeavor.

If you talk with employees and ask them about their contribution at work you will often hear them say the employer doesn’t use all of their abilities. Why? Because in a purely economic sense employees efforts are reduced to tasks and not thinking or collaboration. The human person has so much more to offer by way of solving complicated business problems but this requires employees to collaborate and problem solve together.

The Soul Connects Humans

The soul, unlike the intellect, can find and embrace the virtues, the virtues animate the soulful person allowing them to laugh at mistakes, yet take economics seriously. Allows a person to listen and understand different points of view because they’re not tied up in their own intellect. The soul is connected to God as is each other soul.

No matter how hard atheists try, the human person can not at work or in the public square be reduced to an economic value alone. The human connection is needed more now than ever as we enter a new era of collaboration. The workplace needs individuals to work together to become the best versions of themselves and groups. In this way, their companies improve bottom lines.

Do You Know Someone Who Can’t Admit A Mistake?

Pride is everywhere today, as evidenced by no one taking responsibility for mistakes. Have you noticed how rare it is to ask how a problem occurred in the workplace and get an honest answer? Can you think of a time when you knew something was not right and you asked someone for information about what happened? Think of a time you asked someone about something broken in the workplace. Was the answer, “I didn’t do it.” Or, any variation of that kind of language?

What is your example, were you in a leadership role and do you wish for a day when it would be easy to discuss problems and resolutions constructively? Are you an employee stuck in a work group where there’s a lot of dancing around a truth everyone knows but no one will admit?

Collaborating can not begin in a work group until everyone is aligned to something bigger, a work group can not work if the group is dominated by people who dominate a meeting. A dominant person in a work group can be quite unproductive for the group dynamic, typically this is the know-it-all, they dominate because they don’t view anyone else’s input as valuable.

Virtue Is Not An Intellectual Endeavor

In a work context a meeting without ego’s helps a group reveal the best method to move ahead, but to get to this the virtue of humility is needed. It takes a heroic effort for an individual to choose a Virtue, and to choose humility is to combat pride. Let’s call it selfish pride, this is the pride that keeps an atheist from acknowledging God, it pushes a know-it-all to dominate a meeting. Selfish pride makes it difficult for a person to work with others.

For a person to choose humility, that is to put themselves second to the work group, second to God, second to their spouse is to make a conscious choice influenced by the divine. All the virtues animate the human condition and in a moment of God’s grace, all the virtues are available.

Choosing virtue comes from God’s grace but God’s grace is only available when we are connected heart, mind, and soul to God. Then, choosing humility is easily done. All the virtues work the same way. Choosing a virtue is asking the divine to influence your actions, to rise above the human condition and be heroic. It’s available in every moment of every day.

You can’t take the human out of the work place, at least not yet, so making more of the employee value than simply an economic event can reveal much more value to companies. Pretty cool how our faith reveals so much about people and interactions including economics.

Can you see selfish pride at work in your everyday life? What do you think?

Work, Money (economics) and Mission

Try to separate your work, money, and mission?

They all weave together in your everyday. In fact, they work toward the same end all day. The question is do you see each in your day, all day?

Struggle and conflict occur often because we think work, money, and mission don’t belong together. I’m curious what you think? Have you ever been at work and asked yourself “what am I doing here?”

Have you been at Church and found yourself distracted thinking about work?

As different as we all are, we are very much the same.

What do you do when you have time on your hands but no job? Do you worry about getting a better job? Do you worry about bills? We all have that conversation with ourselves that influences us. How often does your conversation include money, work, and mission? How much time do you spend thinking about these things and having that conversation? Why do you occupy yourself with these topics?

Of course, there are many other topics; family, sex, chores, kids, homework, school, and many others. But, on the whole, the conversation between your ears, I’m guessing, includes the three; work, money and mission. Is that true for you? Maybe I’ve got it wrong so share your thoughts below in the comments.

It occurred to me recently to pray for all three at once; work, money, and mission.

Quickly, my reason for my prayer: employee handbooks don’t say you can’t talk about God at work. Right? But, there’s a cultural taboo, “don’t talk about God at work,” right? But people are soulful, your fellow employee is seeking the joy God offers just as much as you. They are having the conversation you have with yourself; if I get more money, better work and fulfill my mission then I’ll be happy, joyful. Right?

Chasing money doesn’t make you happy, doing more work doesn’t make you happy, being focused on your mission but unable to pay your bills doesn’t make you happy. So, I decided I would pray for a job where I could have the full life God promises me (you too).

So, first, of the year I asked God for a job that; utilized my skills and experience (work), was at a place where I could be in a community that accepted my faith (mission) and paid enough to meet my bills (money).

Today, I read the quote from the Gospel of John (today’s reading) and realized my prayer that offered to God the best version of myself and organized my work to him was a prayer he answered.

whatever you ask the Father in my name he will give you.
Until now you have not asked anything in my name;
ask and you will receive, so that your joy may be complete. John 16:23-28

This new role is helping the owners of a small business. It uses my prior experience owner, economics, LEAN, HR, benefits (work), is set for 30 hours of work per week (money), and directs my efforts toward God (mission). Quite an answer to a prayer to do his will. LOL.

God’s sense of humor is not giving this gift when I was young, of course, I didn’t pray for this gift when I was young because I followed cultural norms (no God in the workplace). LOL.

mission: listening and validating employees through lean/six sigma.

Work grinds down employees who, as a result, feel disengaged, ignored, overlooked and unappreciated. In the LEAN role, I am connecting employees to the customer value in a way that’s meaningful to each employee in their own way.

Simply put, I validate each employee by listening to them. This work makes me think of the virtue of subsidiarity. That is putting decisions closest to the worker who is doing the work; this is totally LEAN and totally Catholic social teaching. Pretty cool, I am helping employees and the employer and doing mission work.

God should not be absent from the workplace; where people are there God is too. With eyes of faith we can see Jesus in each person. How often do we give others their due in this regard? As a business owner, I know all too well how the economic realities will push aside the value of the people. If HR is doing its job they should find the “human” in the resource.

I’ve always thought of work, money, and mission as together but never have I had the opportunity I have today.

I love economics because, like gravity, forces that affect economics are immovable. People have to work to pay bills. Companies need employees to be more productive than their competitor to survive. I like the reality economics imposes and I like helping employees and companies be more competitive.

So, this new role I prayed for has me in the middle of making people, productive and happier and improves customer value and profitability. Pretty cool, and an answer to a prayer. Thank you Lord.

Do you think it makes sense to merge mission, work and economics together for you? What’s your workplace like?

I’d love to hear what you think? Comment or share below.

Wondering Why Trump Was Elected?

I’ve been silent since the Donald Trump election because I’ve been shocked at how many people haven’t a clue about why Donald Trump was elected by people like me. My apologies to anyone who might be upset, please provide your comments here so I can learn about you. My hope is to offer, in This Linkedin repost, one explanation long before election day why I voted for Trump.

I’d love to stir up a discussion so I might learn if my post is new information if I’m miss informed or if this is not relevant and why. Continue reading “Wondering Why Trump Was Elected?”

UHC and Obamacare; More of Your Money

My Answer to a customer who asked,

“This caught my eye over the weekend. Does this change our decision matrix at all?”

This customer is in the middle of making decisions today for their employees. I wrote the  email that follows to help them understand what this article is really about. The customer can move ahead as planned but should know more changes are coming for Obamacare. More importantly I explain how this article is an example of how the government and insurers do not care about your health.

If that’s important to you read on.


Screen Shot 2015-11-23 at 9.17.05 AM

The article includes this CEO quote,

“We cannot sustain these losses,” Chief Executive Officer Stephen Hemsley told analysts on a conference call. “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”



My email to my business customer asking about how this UHC article may affect their present decisions for their employees.

Short answer to your question about UHC:

No, what they’re deciding makes no difference for your decision today. Your decision today will only be good until they make more changes and they do that everyday. What you decide today could change tomorrow, that’s not a joke, that’s real.

Long answer to your question about UHC:

Still, the answer is no, this won’t affect you in the short term and you can’t plan long term.

I’ve been using the words, “shifting sands” for 5 years now. The Obamacare law is 5 years old, March 23rd, 2010. Shifting sands means continuous course corrections by all system stake holders that affects more than $2-3 Trillion of the American economy. This means, today UHC is saying they’re out. But, what it actually means is they’re lobbying for more money. What we have going on here is “lobbying for position.” In the halls of congress, the industry exerts leverage in order to get more money from the government. Welcome to modern politics.

Our elected officials didn’t read the law; they had no idea what they approved and now it’s obvious. People like me have been calling attention to the cost problem for 5 years or more (my blog: but the American public won’t listen to someone like me over articles like this. The evidence and problem is documented in my white paper posts.

Sad, but true, I can confidently say, I’ve never seen a bigger mess. Before Obamacare, Healthcare needed a fix because the insurance industry wouldn’t police itself. But, this isn’t a fix and national healthcare won’t fix it any better either (watch my video on, “US healthcare system in crisis”).

My guess about UHC? UHC and the feds will make up; the feds will give UHC more money (this will drag on over the next few months) and in order to give them money they have to make the fix look like they didn’t. In the end, just more rules, overhead, confusion and frustration; and cost.

Summary: The government is making massive changes everyday while the plane is flying. Thoughtless unread regulations created this mess and their fix is a daily stream of thousands of new patches, regulations, paperwork and confusion. I’ve been living in the trenches for 5 years trying to help employers understand and navigate. The reality and size of this law is starting to impact small employers like you.

 There has been NO improvement in health or cost because your health doesn’t matter to them (any of them). What are we going to get if we keep doing what we’ve been doing? Do you expect a different result?

My frustration is clear, we’re in an awful mess and no one cares. There’s a different voice that’s needed; here’s my hope (



Read Don’s Huffington Post Article for Owners


P.S. I will add below related articles;

“Insurers say Obamacare changes needed soon to protect companies from losses” USA Today, 11-24-2015.

“New research out this week from Commonwealth Fund shows far fewer people think their insurance premiums and deductibles — from employer-provided or exchange plans — are affordable than the government does when it defines affordability. About 40% of 2,700 people surveyed said they delay care and prescription refills when they were sick because of high deductibles, Commonwealth found.”

Hard Working Americans Trust Their Leaders

Do You Think Leaders are Making the Same Decisions You’d Make?

Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

Obamacare is not “affordable” because it wasn’t intended to lower costs, only increase them (see video why). Obamacare created a way to give an insurance card to 16 million Americans. The lie was that it would save money.

As a medical economist, a veteran of rating and pricing, of more than 28 years, it’s time to consider real reforms before we leave more decisions to poor leadership. The direction we’re headed will guarantee us a healthcare system that looks like our struggling cities and schools.

Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

“ObamaCare may cost the feds less than anticipated, but it’s extracting far more from consumers’ wallets than they bargained for.  …

Meanwhile, overall health-care spending has increased drastically under ObamaCare.”

Source: Pacific Research Institute, quoting Investors’ Business Daily, April 7th, 2015, Author Sally C. Pipes. It can be found at this link: Pacific Research Institu…r ObamaCare’s ‘Savings’ 4-7-15  and from the original web source at:

When Obamacare was conceived it threatened the existence of many players in the “healthcare system.” These players gathered together to stop Obamacare from becoming law. To get the law passed and accepted by the healthcare system stakeholders, Obamacare authors provided access to all these parties to participate in Obamacare in a way that helped their position. Maybe you’d call this “bellying up to the bar.” They were afforded the opportunity to lobby their position and were offered incentives to accept Obamcare, or at a minimum not fight it. All the Stake holders got something except the American public. They were not represented and as a result they are now paying the tab in these higher rates.

Are you suspect of that this is true? If you want proof, read the law and you will find revenue that is earmarked for every stakeholder in the system who “bellied up to the bar.” If you unravel what was signed into law five years ago you will find only a token measure or two that helps Americans. And, at that, they’re only there because they made good sound bites for the public.

It’s amazing that with the intellect of so many, that so little was done.

Making the systematic changes that will make healthcare more affordable are not pie-in-the-sky ideas but ideas that will work. They will require hard work, if you want to help out, call me.

5 Reasons to Avoid Self Funding Your Health Plan

Bring balance to your decision making with an independent evaluation.
Bring balance to your decision making with independent evaluation.,

Small Businesses are putting their businesses at serious risk

In talking with prospective employers seeking our “Decoder”, one of the most popular topics that arises is self funding. It is being sold like it is the magic solution for employers. The fact is, it’s being sold because it’s an expedient way for carriers and group agents to “stay in the group market.” This means, by offering self funding as the preferred option to “save money” the agent can keep an employer in a “group” policy.

A group policy is much better for a group agent because they can maintain the employer relationship and write greater premium with one policy, the commission is greater too. It is much easier to sell the “popular” fad solution to healthcare than to dig into the specific details of your plan. There is a large investment of time needed to do the best job comparing all the possible options. Normal commissions can not by themselves support this deeper analysis. As a result, for a sales agent, it’s much easier to sell self funding.

Unfortunately, in the process to “win” the sale important information about self funding is left out. There are pitfalls to self funding no matter what your agent, consultant, carrier, TPA or administrator say. Employers must consider the small print about self funding before jumping into this type of plan.

For larger employers, there are benefits to self funding, but self funding for a group of 25, 40 or 75 is a bad idea because the proposed gains can easily be outweighed by an unexpected $1,000,000 unpaid claim.

Here’s a short list of reasons that should give a small business owner pause before self funding.

1 – Being an Insurance Company Isn’t On Your Bucket List

Being self funded means you move out from under the safety of having an insurance company paying claims. There’s the potential that you may have to pay claims when the TPA/administrator/insurer decides not to pay.

Not to mention, all the new rules and obligations.

2 – You Want to Buy Coverage, Not Be the Coverage

Here is a quote that most people would call the “small print.” You won’t find it in the typical sales material or presentation. You will find it when you’re asked to defend the non-payment in court.

“The participating employer agrees to be solely responsible for compliance with all laws, including the payment of any required benefits that are not covered as illustrated in the Summary Plan Description or the stop loss policy.”

Administrator Actual Policy Language

3 – You Become The Expert In Making This Decision

This quote is a warning found in the sales material of a TPA, it’s terrific to see but rare to find sales material like this, with the truth, in sales promotional propaganda. At least, this carrier is being honest when they say, you should have experts telling you what to expect before you choose self funding.

“While many employers can benefit from a self-funded plan, it may not be the right choice for every business. The biggest question a small group employer has to consider is if the additional risk will jeopardize their business.”

Administrator Advertising Materials

If you go the route of self funded, you will need someone qualified to evaluate your risk before making the decision. Your sales agent, consultant, insurer, CFO, HR person are not qualified to make this assessment for you. Of course, this is a skill we have and put to work everyday, the BenStaff team can bring our independent evaluation skills to your team to balance all the noise and help you make an informed decision.

This service is built into every Decoder where an employer is giving this option consideration.

4 – You Didn’t Have Time to Read the Small Print

"If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim."
“If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim.”

The Big Print makes promises but the small print takes those promises away. When your self funded administrator,TPA,insurer decides not to pay a claim, you’re on the hook. You as a business owner become the checkbook employees and courts will rely upon.

Hard to believe, why would a sales person you “trust” let this happen. It’s true, in today’s sophisticated and complicated healthcare world it’s becoming more necessary to independently evaluate your options.


This is just one example of the big print:

“Your maximum self-funding cost for the plan year is determined up front – and it’s guaranteed not to change, …

And here’s one example of the corresponding small print written into the policy of the carrier who published the “big print” quote above. There are many more statements like this in every self funded agreement or stop loss policy.

  1. “We issued this coverage in reliance upon the accuracy and completeness of the information provided in the application form and during the enrollment process. If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim, rescind the coverage and/or modify the terms of the coverage or the premium amount.”

Actual policy language, page 1.

5 – You Didn’t Make a Benefit Plan to Tell Employees They Aren’t Covered

It happens, google the topic of “self funded plans that couldn’t pay claims” and you will find 42 million website hits. See the graphic of the google search done on that topic. That’s a few more sites than can be covered in this short note. The point is, there’s plenty of reading available on the many problems with self funding.

Google search on self funded plans that couldn't pay claims.
Google search on self funded plans that couldn’t pay claims.


Do you Still Need Convincing? I’ll Review Your Options for Free.

If you are still questioning it’s viability for your organization, and you’ve read this entire post, send any quote you have received and the comparisons you have from agents consultants insurers or your internal staff and I’ll give you my two cents for free.

This offer is available to owners only. Send them to my email without PHI,

Have a great weekend.

Source: Actual administrator and carrier language from marketing promotions and specimen policy.

A Real Life Story of Accepting ACA Changes for a Small Business; Part II

Part II – a Small Business Looking to Do Better

The story starts with a business who engaged us for our Decoder because they asked the simple question, “we know it’s different than it use to be, and we perceive we could do better but we don’t know how to make the right decision.” In the first post, a couple days ago, you learned about the background a little bit. Feel free to review that post below.

Today, we’ll begin to cover details about who is being covered and who is not. It’s very common to have employers who cover individuals that should not be covered. Would you be surprised to know that employers have been known to cover deceased employees, or family members? When we visit with employers we never expect problems but we’re never surprised to find them either.

Job One, Research

Our first job is to research the details about all those covered and all those who are, or were, working for a company. We ask for lists that would show us this information. For instance, tax statements that provide lists of employees and payroll reports that show hours worked plus HR rosters of employees and former employees and other data. The research starts almost immediately and it usually entails asking questions about documentation that’s available that an insurance company would ask to prove the status of an employee or dependent. Identifying problems can be as easy as doing this research.

Our research immediately draws our attention to questions about a former board president who is still covered. In asking questions, it’s obvious there is no current relationship with the former executive. They had been involved and were made promises by the company. As we discuss this with current ownership, no one wants to address the issue with the board or the former executive. We helped solve the problem by including a proper commentary about the liability to both parties for covering someone who should not be covered.

But the former executive had an agreement?

Insurance companies can audit large claims any time, that’s in the small print. If they audit a claim on a former executive, like in our story, and they discover this person is covered it would be bad for both the employer and former employee. Coverage for groups means employees of the group must be covered and individuals who are not employees can not be covered. This is why it’s called group coverage.

So what actually would happen?

If an audit were to occur by the insurance company they would deny the claim of the former employee stating they’re not an employee of the company and not eligible for “group” coverage.  This is bad because the former employee and covered individual could use promises by the government to impose upon the employer the need to pay the claim. To keep the story simple, I’ve eliminated all the details and possibilities for how this could happen. The point is, there’s a chance the employer would be stuck paying the claims of the employee without insurance coverage. This is bad for everyone.

When we arrived the former employee had been on the plan more than 10 years. Why this had been left to linger is anyone’s guess.

What was the outcome?

The employer and former employee understood the risk to both employer and former employee. We introduced an agent who could help with individual coverage. We directed them to seek individual coverage immediately. This was completed within a week. As a note about how this worked, ACA makes transition from group to individual possible because it eliminated pre-existing conditions and medical underwriting. In the old days, these two rules made doing what we did much more difficult.

This small adjustment to the rules gave us the understanding to help the employer. Because the Decoder puts all of these facts in writing, it made it much easier for the employer to make the change with confidence. They just had to see it in writing and be able to show the former employee as well. This is the purpose of the Decoder.

If you enjoyed the story, or learned something from it, please let me know in the comment below. Do you have your own insurance story?