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Employment Benefits for Registered Nurses in the US

Hi everybody, welcome. It's Friday so it must be Connetics USA show our live show onwards and upwards. Everything that a global nurse needs to know about coming to live and work in the United States. I am your host, Tanya Freedman. And we are excited today to bring to you a new topic, which is dealing with employment benefits. What are the kinds of benefits that you might expect to get from a healthcare facility in the United States, many nurses come to the United States in order to grow their careers, meet up with family and friends, enhance the lives of their own families, also for the money. So it's really important to understand what employment benefits are all about. As this were all part of your total compensation. Today, we are joined by a panel of guests. We are joined by nurse Kaye Hi, Kaye, how are you? Hi, Tanya. Good morning.

Hello, everybody. Good. Good morning, or good evening, wherever you are in the world. And we excited to have Kay back. She's no stranger to the show. So we are excited to have her back and she'll be sharing her viewpoint. We're also joined by Angie, hi, Angie, welcome. Good morning. Morning, Angie. Welcome. And also Katie. Katie, I don't see you. Are you able to see me now? Nope. We can hear you but we don't see you.

I am not sure let me try some things. You go this Katie. Welcome, everybody. So if you're joining us now please put your name into the chat and where you're watching from. It's so fun to see all the all the health care workers around the world who join onwards and upwards every Friday. And it's so fun to see where you are in the world. Please put your name in the chat and where you're watching from. So we've got James who's tagging Mel rose. James is also tagging jam Fernandez, thank you for tagging your friends James. Our lien is watching from Jamaica and James is tanking. And she Denise is watching from Turkey. So to share it to hear sorry, is saying hi everybody. So welcome to everybody who's joining us around the world. And when it's from Malaysia, Albert from Toronto, James from Saudi Arabia, Cheryl from Dubai, Erin from Germany, Germany, Tracy from Georgia, US and Albert from Toronto. Wow are coming fast and furious Muhammad from net from Nigeria. Welcome, everybody. We're excited to bring this new topic to you today. And we're going to start off with introductions. I think it starts with Kaye. Kay, do you want to introduce yourself and tell everybody a little bit about you?

Hi, good. Good morning, again, afternoon. Good evening. So again, my name is Kaye. I'm a nurse here in the United States for the past 17 years. I arrived here in New York City as an ER nurse also petitioned by my agency in and after that, I just became a traveling nurse for many, many years.

So that's me. I've been all over mostly north east coast. Thank you. Okay, so we can't dig, can't wait to dig into your experience and your journey in terms of employment benefits. And because you've traveled around, I think you're going to actually bring an interesting perspective, because you haven't just been in one hospital in one place, all the time that you've been in the United States. So thank you for joining us, Kaye. And Angie, do you want to go ahead and introduce yourself and give a little bit of your background? Sure. Good morning, everyone.

I'm Angie free, and I serve as Senior Director of total rewards, which includes employee benefits at Methodist Levana Hospital in Memphis, Tennessee. It's a large hospital. I spent about 25 years administering benefits, so I have lots of good information to share. Thank you, Angie, and thank you for joining us. And Methodist. Levana is one of Connetics partners. In fact, we are in the UAE with the Methodist team right now.

So if you're interested in coming to Methodist, please apply online to ConneticsUSA.com/Application and our team are on standby to help you with your explore where you want to go to in the United States. And last but not least Katie, do you want to go ahead and introduce yourself? Give us a bit of background. Of course.

My name is Katie Abbey, I'm the director for recruitment and retention here at coxhealth. In Springfield, Missouri. We have an international recruiting program, where we gain a lot of really great employees from other areas, primarily the UAE and also the Philippines and Puerto Rico. I have been in my director role and recruitment for about a month now. But I had about 12 years in our employee benefits department before that. So hoping to bring a lot of great benefits knowledge to everyone today. Thank you, Katie.

So um Katie also work with one of Connetics partners Cox healthcare in Springfield, Missouri and both Methodist and Cox actually have hundreds of international nurses. And we're really proud and honored to be part of your and their and the nurses journey. So we're going to dig now into the topic employment benefits. If you have a question, please put it into the chat. And I will try and get through as many questions as I can. I actually have some questions that were sent to me already from viewers who knew this topic was coming up. And I will be trying to get through as many of those questions in the next hour. The one thing just to say, before we begin, and Katie and Andrew, this is maybe for you, is most Americans are not that familiar with employment benefits and find them very confusing. Am I right? That's correct.

So everybody, as you listen to all of us, don't feel too overwhelmed, we're going to break it down for you and help you to try and understand how employment work benefits work in the United States. Because it really is a very complicated topic. And as I said, for most Americans, it's very confusing as well. Okay, so let's start off. Okay, let's start with you. Did you know that employment benefits packages were going to be added to your salary when you apply to a nurse as a nurse in the United States? Yes, I know, some benefits that I'm familiar with. So when they gave me a job offer, back then, I highlighted those things that I don't understand. And probably 80%, I don't understand. The only thing that I understood from there was, they will give me housing, they will give me free housing for  certain months. And there will be like a shuttle from the hospital to the to my home. And then there will be also health insurance and retirement. But I have no clue about health insurance and retirement. So those were like I just ignored them. Okay. And thank you for sharing that.

Because it's very common for most international healthcare workers. It's like, I don't really know what that means. But you know, it sounds good. And I'll probably find out in time. And I think it's interesting that you, you know, you said you, you looked at the salary, you looked at the package that was going to be offered to you, but not really understanding the employment benefits part of it. And you can you give us a definition, or just kind of a very brief basic overview of what are employment benefits. Sure. It there's a wide range of things that can be included. But mostly, it just means all of those things that your employer will offer you in addition to the salary that you're going to receive. So it could be health insurance, it could be time off, it could be a bonus, it could be fitness memberships there, lots of different things, but all those things that are not part of your regular salary. Okay, thank you, Angie. And so again, a lot to learn here. Kenny, why is it so important for an international healthcare worker to understand about employment benefits?

That's a great question. So when we talk with international employees and domestic employees alike, the amount that they may be required to pay for certain benefits is really something that they want to consider in their overall total compensation. So when we say total compensation, we're not just talking about the amount that you are earning in your salary that gets deposited into your bank account. But it's also the benefits that your organization is paying for you to be able to afford certain things like health insurance, like housing and other things that you would otherwise have to pay for on your own. So if you have a couple of employment opportunities, and one maybe is providing you with a very robust benefits package, and the other one is not, that's really something that you want to consider. Because if you opt to go with the one that's not for maybe a higher salary, a portion of that salary that you're earning, will still in turn wind up going towards benefits if you need to prepare those independently. Okay, so that's a great answer to why it's important, and also to why it's important to try and break it down and understand all of it. Because if you don't even understand the basics, it's really difficult to be able to determine if one offer is better than another in terms of the employment benefits. I see everybody's nodding their heads.

And Angie, can you maybe give us and I think we have a slide on this. Can you tell us just a little bit about the basic components? I think I'm gonna ask Katie about some of the perks or some of the extras but just kind of the basics that are what an international healthcare worker might expect from an employer. Sure, most employers are going to provide some level of health insurance. And so that would look like maybe medical insurance, dental coverage vision. Usually there's life insurance provided. Also, too, there'll be retirement of some sort of the other where you're, you know, saving for the future. And, you know, certainly that can look different based on the employer. But those basic ones are usually going to be the medical, dental, vision, life insurance, and maybe a disability plan. Okay, so those are the basics. And I think we have a slide now just about all the different kinds of benefits. So Katie, can you maybe take us through what the perks or the additional benefits might be?

Absolutely. So typically, when designing a benefits package, it's available, you're going to reach out to our employee group and get feedback from them over time. So a lot of these are ones that employees themselves have asked for. So just to kind of go around the graphic here, obviously, we talked about health, dental, life insurance, retirement and vision. So I think those are pretty typical to be offered. Other advantages may be an onsite Fitness Center for which employees get a discounted rate, versus what you would normally pay if you were part of the public and wanting to work out at that facility, paid vacation leave. So obviously, it's very important for our employees have a work life balance, to be able to go and visit family members, maybe for an extended period of time. So we want you to be able to accumulate time off as well, and still be able to gain your paycheck while you're doing that. Personal leave options are going to be if you have an illness, or a family emergency, maybe you have some sort of other things going on in your life. There are times and protections that are available for most employees to be able to do that without risking losing their jobs. Sick leave, this could be combined with paid vacation leave or PTO or it could be a separate bank of time.

That's specifically for you to be able to utilize if you or possibly even a family member is ill and needing care, childcare advantages. So obviously, we all know if we are a working parent, that somebody to care for your child while you are at work is very important. So many of us have organized childcare options, either on our employment campuses, or through a voucher system where you can seek your own childcare options outside of what may be available on campus to make sure that kids are cared for while we're at work. Okay, thank you. So that's a very, very detailed and good answer on the whole kind of package that might one might expect from an employment benefits perspective. Let's put that slide back up, back up, and K maybe you can share with us. In your experience. I know that you've worked as a travel nurse, but before if you were working in long term care, I think you've worked in hospitals as well.

Can you share what it's what benefits and perks you have received in the past? So for my first job here in New York City, I was hired by a government hospital. It's a city hospitals so everybody knows here in America that when you work for a government, the benefits are very, very good. In exchange our salaries, one of the lowest among all the surrounding hospitals, which didn't really bother me. The main thing that I really helped me with there, when I became pregnant, I paid zero for my health insurance, and all of my delivery hospital expenses, were all zero, even the doctors and after having the baby, everything was zero, not even a penny was asked from me. And that was very important for me for people who have, you know, high costs of medical expenses then, of course, health care insurance, very important for me, and, and also the retirement plan was really good.

Okay, good. So you've experienced a lot of those basic benefits. Did you experience any of the perks? The perks? Yes. Since it was a government hospital, we observed more federal and some smaller holidays whereas whenever I go to my traveling assignment and I asked for the benefits of the hospital just in case I want to stay there, I only see that they offer some of them like minimal holidays, you know, Federal holiday major holidays, but this hospital, even smaller holidays were off. So that was very good as well. On top of the, again, the free membership for the gym, they provided us with that as well. Okay, good. So different hospitals and different systems can also provide different things. Right, Angie and Kate.

Yeah. And so, um, if you look at those benefits, Angie, and I'm just I'm looking at I'm trying to, there's so many questions coming at me. I'm trying to see which one comes first. And it's for what, and this can be a little confusing to international nurses. I think we have a graphic that kind of shows that Can you talk us through? Who pays for sure. And of course, this will vary among employers. And, you know, I think we can say that most employers would contribute, maybe at least 50% for health insurance. But many employers will pay for all of it. Methodist Lavon er, health pays for roughly about 80% of the health insurance. So if you were to try to buy that on your own, certainly it would be much more expensive. We generally will make a contribution also to dental insurance, and then provide life insurance at no cost. And the average for that is usually maybe one times your annual salary is provided at no cost.

And then additional amounts are available for the nurse to purchase. Long and short term disability a Methodist Levana provides those to employees at no cost. But you know, there may be a small premium for that at some hospitals, depending on where you're working, or, you know, whether it's for profit or nonprofit or government, I mentioned for sure. And then when we talk about retirement, so this one shows 401k, there's going to be a contribution by the associate, but then usually the employer will match that in some way also. And then of course, the federal law requires that we pay Social Security and Medicare tax and this one listens to this tuition reimbursement. So that's a part that Methodist Levana provides, and many employers are doing that to help you further your education. Okay, and we can see, um, in the in the right hand side, that was the nurse pace key when you came to the United States, did you realize that benefits would be taken out of your paycheck that you would be paying for some of those benefits or perks? Um, I'll be honest, I did not know how to read my paycheck. When I got started to my bank, I get something and I call it a day.

And I'm pretty sure a lot of foreign nurses who will be coming here will be on the same situation I am that we've never looked into the paycheck, we just look at their bank account. Okay, so that's where onwards and upwards is so important. Because, yes, he has a place where it's free information for you to educate yourself and empower yourself about what you can expect and what but also what you're going to be contributing. Katie, what are some of the common mistakes you see people especially into new work at cost with so many international nurses? What do you see some of the mistakes that you see international nurses making when they sign up for benefits. Um, so it's usually going to depend on what their previous experiences with benefits have been. So especially if they're coming from an area where maybe you have more socialized medicine or state provided benefits, they may be shocked to know that in addition to the amount that's being deducted from their paycheck for benefits, they may also have some costs associated with their care. So like, hey, discuss what was really great about her coverage when she had her baby is that she didn't owe anything. But on average, depending on the health plan that you're enrolled in, if you were to have a baby, even with really good health insurance, you still may owe hundreds if not 1000s of dollars for your care throughout that maternity episode.

Okay, so those are the pitfalls the things to watch out for. So everybody watching I see we've got OB from the UAE or your dela from Nigeria, in Europe Bunty from Uganda Marie from Saudi oven saying Miss Kaye you got a fan there he was Kaye the baby from the Philippines grace from Divine density can't see but I hope you can now patients from Divine Ricky from Turkey, Jeff from Saudi Arabia, Ronnie saying hi. So Ethan has a question. by federal law, what are the minimum benefits and an orange should be given by the employer and your case you want to maybe both give your viewpoint on that question. Sure. Minimum benefits are going to be a medical plan where the employer makes a large contribution generally dental and vision and then that one times your annual salary for life insurance as well as a contribution to a retirement plan and then disability either. both long and short term disability plans are generally also offered either at no cost or at a small premium for the for the nurse Okay, so there you go Adnan and I

All the viewers who are watching around the world, please put your questions in the chat. If you're joining us now and are curious about employment benefits and how they work, put your questions in the chat. And I'm going to be asking the expert panel on your behalf. And Katie, anything to add on evidence? Question, or did we pretty much cover that? No, I would say it's important to ask those questions, because it can vary wildly by your employer. But yes, everything that Angie said is pretty typical as an offering. Okay, thank you, Katie. And Beth, she has a question on the 401 K. So best, stay tuned, because we're going to be asking that question when we move now to some of the other topics that we're speaking about and look at them in a little bit more depth. So the next one, our brains is also asking about the 401 K. So quite a few questions there on 401 K. Tim is asking about vacation PTO. So we're going to get to your questions as well. Tim. And

Denise is asking do hospitals provide support for postgraduate studies? And J&K? I can say that Methodist Levana certainly does. So we have an annual contribution for graduate studies. So there's a higher amount that we pay for that tuition assistance when it's for graduate program. And of course, it does vary by employer, but it is something that we offer. And I believe where it's $4,500 contribution to that per year. Okay, Katie, anything to add to that? Yes, so Cox health. And Springfield does also provide educational assistance and tuition reimbursement. Depending on the program that you are interested in, you can get up to the IRS federally maximum rate of $5,250 per calendar year. And the reason that that limit is said is because if we were to contribute above and beyond that, then the employee would be taxed on that additional amount. So we try to keep it to that limit, just so there are fewer tax implications for the rest of the end. Okay, thank you, Katie.

So for those of you who are watching around the world, I think it's probably clear already, that they are the basic benefits, but different hospitals or different health care systems might have variations on that. And again, as everybody has said, that's the importance of asking questions to empower yourself. So that you know more what to expect. So I see lots of people from all over the world. And just a shout out to my teeny who's from the city that's close to my home country, South Africa, I'm just thinking as I'm speaking, and I came to the United States as a, from South Africa twice this year, it was 22 years ago. And I can tell you, when I came from South Africa, I knew absolutely nothing about employment benefits. Like I wouldn't even know what questions to employment benefits. So hopefully, this is helpful for everybody watching around the world. Okay, so for the purposes of today's show, we're going to be taking tackling the health insurance and retirement benefits first, if we have time, we're going to get to the paid time off. But we're going to talk a little bit deeper now about health insurance, and the differences. Or, you know, what might one might expect in terms of health insurance? So okay, were you aware that the US has health insurance has a health insurance system? And how is that different from your home country?

So from in the Philippines, we I used to work with a small private organization that was paying us only about $150 a month. So we are actually Where are you, we used to work, they take out a chunk of our pay and goes to that kind of like their charity division. So if we ever get sick, as an employee, we go to the charity division of that hospital. But if we decide to go to the private, we will have to pay out of our pocket. But when you say charity division, this is the place where we buy all our supplies and materials. If we need surgery, we have to buy our own sutures into the operating room. It's like that the health the health insurance in the Philippines is very, very poor. And it's not affordable for everybody. And you want to really want to stick with your employer. And there are so many things to go around before you see a doctor in there. But when I got to the United States, and I just want to see a doctor, there's the variety of doctors that I can see it's just in my fingertips and you know, it's just a phone call away and it's not as hard and it's affordable because the hospital will pay, you know, majority of the cost of it. So it was for me the first time that I really saw a physician to do my annual checkup in my whole life. It was my first

We're starting to do, you know, in a consistent basis, my dental visits, which I never did in the Philippines, because it's expensive. Okay, so a lot of differences, and I'm sure I am there going to be differences. And you know, we've got people watching from all over the world, the health care, insurance or benefits would be different in different parts of the world. And Angie, can you give us maybe just a brief definition of what does healthcare insurance mean in the United States? Sure. So insurance, health insurance just means that you're paying a premium, generally on a per paycheck basis, so that you get that health coverage that might otherwise cost you upwards of maybe $500 a month. Whereas if you're purchasing that from your employer through the Employee Benefits plan, you're going to pay much less than that some employers will cover all of that, and then others will cover a percentage. And again, Methodist is paying about 80% of that coverage. So you might look at a premium, each biweekly paycheck of maybe 40 or $50, for the coverage just for the nurse. And then the organization is paying the rest of that. And you know, the benefit of that is so that when you do go and things like have a baby like Kate mentioned, then you've already paid your premium, you may have a small copay, which is part of your share of paying for that care ongoing, and then maybe some coinsurance. So some plans will share that and an 80% 20%, where the nurses paying 20% of that cost of care and the organization is paying 80%. So having that insurance means that you're going to spend much less than if you were trying to pay for things out of pocket. Okay, so, first of all, it's going to be available for you.

And second of all, and you're going to be paying less and it will depend on the hospital, Katie and Kaye mentioned when she was giving her experience of health care insurance. And she mentioned dental and vision, how does how should an international nurse think of that under the kind of the umbrella of health benefits or health insurance? Sure. So the choice on whether or not to enroll in dental and vision plans is up to each individual. Really, for those it is more of a cost value analysis. So if you were to have some sort of dental emergency, like needing a tooth pulled or needing a crown, for you to pay for those services on your own, would be pretty expensive. So most dental plans will have a maximum amount that they will pay for you to help you cover the costs of those services. Also, with dental most plans will provide you with preventative services like mostly most commonly by annual cleaning. So you can go in and get your teeth checked and clean, usually twice a year, at no or very little cost to yourself, which I think we all can value as important to keeping us from having those potential more major dental costs in the future with us not maybe staying on top of on top of routine care for vision insurance. Common misconception this usually does not cover any sort of injuries to your eye, or any eye infections. Really vision insurance is there to help discount the cost of contacts, glasses and eye exams. Sometimes it can be very helpful. Other times you may be able to pay for those services out of your own pocket and have it be about the same or even less cost than what you're getting with vision insurance.

So you really want to ask those important questions. weigh your options, work with your hospitals benefit teams, to help you make the right decision for yourself. Okay, so good advice. Katie is asked the right questions. And I'm looking in the chat. She knows saying this is very helpful, because I have no idea what questions to ask. So that's the difficulty for international nurses is sometimes it's just so overwhelming, and they don't even know what to ask, Kaye, what would you suggest an international nurse ask what are some of the typical questions that you think in your experience would be helpful, wish you what you wish maybe you'd known at the beginning when you came to the United States. So I think based on my experience in here and base for my as a nurse, and also based some experience as a consultant to this nurses who are coming in here. So yeah, that is true. They don't know what to ask. And without knowing under understanding the topic, they're just clueless on how to navigate it. The best thing that I was able to, to help them with is really connecting it with a nursing knowledge. And I asked them, How often do you do you need to see this kind of doctor? How do you how often you think you're going to visit this dentist in the next one year, and if they will tell me just for preventive, so that's where I guide them, then you don't need a very comprehensive Dental Plan are very, very comprehensive health care insurance, if you're going to see the doctor to do this for just preventive for annual checkup, then you don't need to pay the most expensive health insurance. So I go down on how they're going to use it. That's the first thing I have to guide them with.

Okay, so a great place to start. And, and I think that that's, you know, really important and very helpful for many international healthcare workers, and is saying, watching from New York, this is a great topic. Hi, Anna, nice to see you here. And we have lots of people that are asking questions, I think we're going to finish off with health care insurance. And then I'm going to go through some of the questions that we have in the chat. And so one of the one of the things that is confusing for an international nurse Angie is the difference between what the different types of plans like an HMO and a PPO, can you explain what the difference is? First of all, say it's just not international health care workers who are confused by that all of our employees

are confused by that. So you are not alone. But an HMO that you mentioned, that's a plan where you're going to be required to pick a doctor. So a PCP or you know, a specific doctor that's going to manage your care. And then for when you're in that plan, once you've picked that PCP, that doctor is going to guide your care and make referrals to you to other doctors and approve those before you're going to see somebody else for additional types of care. But that one HMO provider is going to basically, you know, guide all of your care. Then there's a PPO Preferred Provider Organization. And that's a plan where you can really see any doctor that you choose. So you're not going to have to pick one PCP to, you know, guide all of your care, you can go to one doctor for heart issues, and another doctor for God, ecology and another. And you can just do that without a referral. And just see anyone that you would like to see within the network. There are lots of other types of health care plans, one that's become very popular in the US to help control the increasing cost of medical care is a high deductible health plan. And so a High Deductible Health Plan is one where you may pay a much lower premium out of your paycheck each pay period.

But you're going to be asked to contribute more in terms of a deduct, excuse me a deductible or how much you contribute to your care before the plan begins to pay. And I think it's really important for international workers and everyone to understand just how much you would have to contribute for those high deductible health care plans. Those are generally paired with a health savings account. And that's it, that's an account that you can use for health care expenses, where your employer may make a contribution to that to help you pay for expenses. And then you also can make a contribution to that to help pay for your health care expenses. And it's just a way to manage the increasing cost of health care. But it's very important to understand what you might have to pay out of pocket for that high deductible health care plan, if that's the plan that you choose to enroll in. Okay, so the options, Katie, how to how does an international healthcare worker choose which option is going to be best for them or for their family?

So again, to Andrew's point, this is not unique to international nurses, we actually have a team of benefits specialists who work at coxhealth that meet with every new employee to the system. And really, each employee has the same questions of what plan option is going to be the best for me or me and my family. So the things that we try to do to help them evaluate that is we try to gauge a balance of what is going to be your appetite for how much you have coming out of your paycheck, versus your appetite for when something happens. And you need to seek medical care, how much are you able to bear the brunt of the financial obligation at that point in time. So typically, to Andrew's point, if you have a lower deductible, meaning you may owe less for your medical care, you're probably going to be paying more out of each paycheck for that type of coverage. And conversely, if you have less coming out of each paycheck, and then you do have a medical event, then you may have some greater financial obligation there. So we really talked to people about their traditional use of medical insurance. Any other factors regarding their preference for what network they may want to be in? So do you think that you would be able to use kind of our tier one or primary network of providers? That can be a big difference maker in that HMO versus PPO

option, where the HMO is really going to keep you captive to a more concise list of providers. Whereas the PPO would give you options if you were traveling or wanted to seek services outside of that primary network. Okay, so lots of choices there lots of decisions to be made by the International healthcare worker. And the thing to remember everybody is you know, you don't need to get too stressed out about this because as both Angie and Kenyan affair, his help for you, when you arrive at the hospital, there's a lot of nervousness, a lot of support, to look at your individual case, your individual family, and make the best decision in terms of health insurance that's going to work for you and your family. Hey, how did you make that decision in terms of the difference with an HMO and a PPO?

So our for me, I just picked HMO initially, because it looks like it sounds great.

Foreigners are coming here, I have no idea. So BPO, that seemed sound to me fine. I like the age, it's like, kind of like that. So I just picked it without really understanding as well. And it says there that if we go see that these are the doctors that we can see only

for me coming from a different country, I really don't have an any preference with the doctor. So I think the HMO sounds okay with me. But for for now, as a person who is a traveling nurse, I have specific doctors that I know already. And I do travel as Katie said, I travel so for me a PPO can be very helpful as well. Okay, so and so that brings up a good point that your needs might change, you know, you might when you come to the US, you might be a single person don't have kids and a family. Or you might be at a specific hospital, you might in time travel or then go back to a hospital. So as things evolve in your life, there might be different choices. It's not like you're stuck with the one choice forever, as your situation might change. And so I see there quite a few questions in the chat about family, and can merely is saying can we include our dependence on the health insurance benefit? If yes, how and what does it change on the pay? Or what benefits would be available for both? Angie?

Could you repeat the first part of that again, please? Committee is saying can we include our dependence on the health insurance benefit? And if yes, how and what does it change on the pay or what benefits would be available for both? Sure, so I think most employers have an option for adding dependents to the plan, generally speaking, they're going to make less of a contribution, the employer will to paying for that dependent coverage. So whereas you might pay, you know, contribute maybe 80%, to the cost for just the employee, you may make maybe, you know, 50%, or 60, or 75%, towards the cost per dependent, but dependent coverage is available.

Another thing that's quite common is in the past few years, and the US is people who have a spouse who have access to coverage on their employer plan, the employer may ask that you pay an additional fee or a spouse surcharge to add the spouse to your plan if they have access to coverage elsewhere. And so that's something to be on the lookout for. There are also employers who have what they referred to as spouse exclusions, where if they do have that access at another employer, then they can't enroll on that plan. And so you really want to make sure you understand, but generally speaking, you can add dependents, especially children, and there's an additional cost for that, and generally speaking, less of a cost share.

Okay, thank you, Angie. And I see we've got quite a few questions about from people worried are they dependents included in healthcare and insurance or NT? Thank you for answering that question. She now has a question and I'm not 100% Sure she know what you mean. But the thing is health insurance offered by employers on non negotiable and sometimes not just insurance, but the offer in general. So what do we do? And Katie, can you answer that question? Are health insurance not negotiable for employees? So the plans are set as they are for everyone at the employee site. So when we started a new plan year, we have already negotiated, you know, what your co pays are going to be, what your deductible is going to be what your premiums are going to be. And regardless of what happens with your personal situation, or even the financial situations of the insurance company and the hospital that you work at, all of those are going to stay the same. So we don't, you know, ever have the opportunity to go in and say, Hey, I know my plan says that I have a $25 copay for this doctor's visit, but how about I give you 50

And, and kind of Varner with that system, we don't have those kinds of options available. The choice that you do have them where you do have negotiating power is being able to design your benefits package in the way that makes the most sense for you. So you may get hired on the exact same time as another nurse, who maybe has a very similar situation to you as far as dependents, financial risks, things like that. But you may design a completely different benefits package, given the offering from your employer, based on you wanting to meet your needs, versus that other nurse wanting to meet their and their family's needs. So again, what we've kind of been saying is, please utilize us in HR to be able to help guide you in making those decisions. And then please do look at your benefits each year. Because as your life changes, and as your family situation changes on an annual or at least any annual basis, you do have the opportunity to come back and make those adjustments to hopefully get you closest to that best fit for you and your family. Okay, so a great advice by Katie. Kaye, how has your approach to health insurance changed as your family has evolved?

So again, I started from things zero as a single person. And then when I had a child, it was zero. And then when I started traveling, this is the funny part, I'm paying my insurance privately and it's costing me and my family 1500 a month, for a family of four versus zero. And this is a high deductible plan already, it means that we will have to pay more if we have to, you know, get sick. And the maximum amount of pocket we will have to take out for per year is about $6,000. So again, because I'm a private, private insurance that I bought it in a marketplace, it's gonna cost me a lot. That's why I tell people insurance from your employers are very, very, very important. You might pick a company that pays you more, but you have to pay attention about the health insurance. Because if your pay your hourly wages are way high or high, but you have a family, and it will cost you know, an arm and a leg for the coop for a deduction on your paycheck, then it doesn't make Mike's it makes sense to be going with that higher paying company. If your family are very sick, then like my daughter, she ended up in the ICU at one time when she was two years old. For us having a very good protection of health insurance, even though the pay was on the lower side was very important because otherwise we will be drained out of money paying that ICU for her. Okay, so it's evolved over time over I have way too much involved.

Yes, they will pay about $18,000 a year for health insurance. Okay, so that gives everyone an idea of how it might change and evolve over time. And Albert has a question is Medicaid health insurance? And gee, I know some people might hear the term how does that fit in? So in the United States, Medicaid is insurance for the poor actually. And so that's something that you have to qualify for based on income, and it is provided by the federal government if you qualify. Okay, so. So there you go, Elbert, and all right, you know, the one thing that when we talk about health insurance that I think is makes it even a whole other layer of confusion is some of the terminology. Like some of the words that we you know, that we speak about, like, what is a premium? What is the deductible? You know, all of those different kinds of terms. And I'm just curious if anybody in the chat has put that slide back up? Does anybody in the chat know what a what a premium is?

Anybody know what a premium is? Put that into the chat? Because that's like one of the first things to know when you're talking about health care, insurance. What is a premium? I don't see anybody putting a definition into the chat. Everybody's googling on their phones right now. And you what is a premium? Sure. So that's the amount that you're going to pay to have that insurance coverage that will generally be deducted out of your paycheck every pay period. Okay, did you get that everybody? Okay, so let's put that slide back up. And let's look at some of the other terms for health insurance. What is a co-pay? So each time you seek care, so if you go to see a doctor, you're going to pay a small amount, so at Methodist Levana to go and see your primary doctor a regular visit would be $10 copay. If you wanted to see a specialist provider, you might pay a $50 copay for that visit. So it's a portion that you pay each time you see care. Okay, thank you Angie. So and I see we've got some comments in in the chat from JR and Basha good one premium is the standard amount up out of your check to team is saying clueless I know to Team people are. And Rommel is saying monthly contribution Mohamad amount of pay for service. Okay, thank you everybody, let's put that slide back up. This is like Wheel of Fortune. And let's see what some of the other topics are.

Deductible Katie, what is the deductible so, so A deductible is the amount that you typically have to pay for more major services, depending on your plan type. So if I have a PPO plan, and I need to have a surgery, typically there's not a copay associated with that. But those charges for the surgery would be my responsibility up to a certain amount that's communicated to you when you sign up for the plan. So you may have a $500 deductible, meaning that even if you have a surgery that costs $1,000, you would need to pay the first 500 of that yourself. And then after that deductible has been satisfied for the year, the plan here, then the remaining portion of that more major service is usually going to be shared, which I think we have this on the list as well as coinsurance, meaning that the remaining 500 typically would be like an 8020 split, where 80% of that remaining 500, after the deductible has been satisfied, would be the responsibility of the plan, the insurance would pay for that. And then the other 20% we would pay for as the person seeking services. Okay, thank you, Katie. So that clarifies that term.

I'm not going to go through all of the different terms here in the show, because I'm just looking at the clock, and we still want to talk about retirement benefits. But everybody keeps watching in the chat, because we will put a list of definitions of those terms. I see. Sheena has a follow up question. You say nope, no idea. When I get an offer, I also get a benefit guy, but I don't even understand. So don't panic, and everybody else who gets that benefit guide. You know, that's really where the hospitals are here. And the benefits departments are here to help you to understand that. And I really strongly encourage everybody, don't be shy to ask if you understand, ask, Kaye, what would you say about that? Because you know, many international was taught to be shy, humble, not all questions.

What is your advice? Yeah, so my advice for you guys is, of course, indicating yourself is very important. This, Katie did not only mentioned that this applies for health insurance. But this applies to car insurance, as well. When you buy your car insurance, it's the same thing you will see the deductible, you will see, you know, the coverage is in there. So you really have to understand the  topic or the meaning of it, because you're the one who's going to be paying for it. For me, the easiest way for me to remember deductible, the deductible is something how much can I afford to bring out right now, if something happens right now? How much can I afford? For me when I started a $500? Could? Sorry, deductible is something that I put out like that out of pocket is something that how much can I take out for a year without really hurting my finances? It's like that. So that's where I kind of really start. Okay, good. That's a good way of thinking about it.

Okay, I think that's really helpful. And before we move on to the retirement benefits, I'm going to just take a few questions in the chat that were just about more general benefits. And so Christiana is saying, Please is UFL tuition free education for staff also included the international nurses working for them? So Christiana, I know you Avallon is one of Connetics and partners and employers of international nurses and yes, the International nurses coming will are coming on a green card, which is permanent residency, so you get the same benefits, whether it's education or anything else, as any American nurse, Mohammed is asking what percentage of the pay is taxed, learns that taxes are higher in the US, Angie. Um, so that's going to depend on how much you earn. So the federal government, the IRS, they publish a tax table every year that tells what percentage of your pay is going to go to pay taxes, but that goes up as your income goes up. So it does depend on how much you actually earn for the year. Okay, and please make sure and Muhammad to watch we have done a show on taxes and how that differs.

We also did a show I think was last week on Yes, it was last week reeks of blending on Cost of living in fact, Kaye was on that show. So please watch those shows because that will also give you a lot more insight into taxes and cost of living and how they relate. And Sam has a question, what's the difference between an HSA and FSA? Katie? Yes, so the primary difference with an HSA and an FSA is portability. So if you are contributing to an HSA, you have the option to be able to roll that over from year to year. And you also have the option to be able to take it with you to a subsequent employer, if you decide to leave your organization. And the FSA, sometimes you'll hear referred to as use it or lose it, meaning that if you do not utilize the funds that you have allocated for the FSA for that year, then you do forfeit those funds at the end of your plan year after a short run out period. Or if you were to leave your employer. The other big difference. And this kind of goes to Kay's point with the deductible and kind of asking yourself how much you have available to pay right away if something happens. An FSA is generally front loaded for you. So if you start your plan year on January 1, and you promise $500, into your FSA, that $500 is available to you right away.

So if you have an injury or some other medical need, and you need to pay that $500, it's available to you before you start to pay anything out of your paycheck towards that. So incrementally throughout the year, you are paying that back to yourself. But the advantage of putting money into an FSA or an HSA versus a traditional bank account is that you then get to contribute on a tax free basis. So to Andy's point about the tax tables, when you pay premiums towards your health insurance, or you put money aside into an FSA or an FSA, you are lowering your overall remaining income that could be taxed by the federal and state governments. Okay, that's a great explanation. Thank you, Katie. And Thea has a question. Is it true the more children the less the tax, Angie?

That is basically true, yes. Because the government makes us certain allowance for each dependent. So as an individual, you would have a certain amount that you can earn tax free, and then for each dependent that you add to your family, that amount increases so that you can earn more before you're taxed on it. Okay, thank you, Angie for clarifying. Okay, so in the last few minutes, we're going to talk a little bit more about the retirement benefits. I know we had some questions in the chat about a 401. K. And how that works. I think there was another one, but definitely some questions about the retirement benefits. So and, Kaye, had you heard about retirement benefits at all before you came to the United States? And how is that different in your home country?

Oh, retirement benefits in my country will be funny because they say the more kids you have, the better retirement plan you have. So that's how it is it majority I would say in my what people would say my country, but I do not have money for my retirement. So I never contributed and I have no idea how to either because of our very low income there. When I got here, I saw the job offer and I have I'm clueless what it is like everybody is in the chat right now. I'm very clueless What the 401k I put a big question mark on my job offer. And then when I got here, they gave me a whole packet that I do not understand at all. And I'm just blessed that an aunt who lives here and she's actually a bookkeeper, she actually guided me on what it is. She just explained to me. But mind you 80% of what she told me I still didn't understand.

Okay, it takes time to kind of wrap your head around it. And Angie, can you give us an overview what our retirement benefits, what is the definition of that? Sure. And of course, this is another one that's going to vary by employer. But I would say the thing that is most commonly offered is as a defined contribution plan that could be in the form of a 401 K if you work for a for profit organization, or a 403 b if you work for a nonprofit or for school, but the designs are generally the same. So the employee is going to contribute a certain amount that the government defines how much you can contribute in a year. And then the employer will usually match some of that I'm so proud to say Methodists matches up $1 for dollar up to 6% of your income which is a very generous contribution to a 403 B. There are some other

traditional types of plans that are becoming less common a pension plan that you might have heard about is a defined benefit plan. And that is where the organization decides how much they're going to set aside for each employee, generally based on how many hours they work and how many years of service that they have. And so there's a calculation that's done in retirement that says, because you worked here this long and earned this much, then we're going to pay you either this much in a lump sum benefit at retirement or in an annuity or monthly amount that you're going to get over time throughout your retirement. Those are becoming less common, because they're very expensive to fund. And so generally speaking, employers are not offering those defined contribution plans like the 401k or the for 3d. Okay, Kaye, did you know what a match meant?

Yes, when I got here, I do not know what it is. It took me a long time, really like more than five years before I figured it out. And when I figured it out, I actually started putting more money into my retirement, because my employer that time did not only provide us 403401, but they also have a certain thing called 457, which is a government plan for city government. And there's also a thrift savings plan for a federal government employee. And on top of that, there's a pension. So the pension, I really put all my salary in there, because they were matching that 100% like $1 to dollar. As mentioned earlier, okay, so the match very important concept for international health workers. Because I mean, essentially, Katie, and correct me if I'm wrong, this is like, almost like free money that's coming from your employer, right. And so how does what are the any benefits, tax benefits, Katie, in terms of retirement benefits, and the penalties for cashing in early if you retire early?

Yes. So typically, you're able to contribute on a pre or post tax basis. So if you're contributing on a pre tax basis, that means that as you're paying in money to your retirement, when you're working, you are not being taxed on those funds. So it's just like your health insurance premiums or your FSA contributions, they lower than your overall taxable income. However, when you go to retire, that is typically when you will have some tax implications, the amount that you contribute on a post tax basis, sometimes it's called a Roth IRA or a Roth contribution, that would help you avoid some of the tax implications when you do go to retire. Because it's money that's being taken out on a post tax basis while you're working. So taxes have already been assessed, we do occasionally have people that need to borrow from the money that they have put in for their retirement, or they do need to take that money out, you can do those options, you really just want to work closely with your retirement administrator so that you understand how much more you may be taxed on an early withdrawal.

Okay, thank you, Katie. So there's a lot to unpack and a lot to learn in terms of retirement benefits. And I'm just looking at the clock, we are like, almost out of time. So I think we're gonna have to come back and revisit this topic and dig a little deeper. And Kaye, in your experience, what do you think are the biggest mistakes that an international nurse might make in terms of retirement benefits. So the biggest mistake that I've seen in almost all of my clients and my colleagues are, they never contributed on to these things, and they never open, they were more busy on adjusting number one adjusting when they get here getting their family settled. And they forgot about this. And then second is they forgot about putting money in their retirement plan, which eventually, you know, could have grown already. They sometimes a lot of them come to me, Mom, I want to, you know, Miss Kaye, I like to learn about stocks. And I put a pause and a break with them. Hold on, have you contributed with your 401k first with matching, because that's really what you want to start from? Okay. So, um, so that's really important. It's just to actually understand the importance. And Angie, I know, well, actually, both of Angie and Katie, you both work with international nurse just to finish up what is your best piece of advice for an international nurse who's going to be coming to the United States? who's listening to all of this and thinking, Oh, my gosh, okay, I think I know a little bit more, but it's all seems very confusing. What would you say ng is your final words of wisdom for an international. We've said ask questions, but I can tell you that every HR department and every benefits department is just waiting for you to come and let them know

Are you how much they know about the plans and explain them to you, and they are happy to do that. So please don't be shy about it. Because that's what we're here for. Okay, so Angie's advice. Don't be shy. Katie, what would you like one of your final words of advice, pearls of wisdom, Katie, finish it off. The exact same thing. We saw very much appreciate everyone who is coming to work for us as an organization, we want to make that transition as easy as possible. So do not hesitate to reach out to us and HR and utilize your resources there. Don't ever feel like you require more time to understand what your options are, and that you're at all negatively impacting us, we really want to make sure that you understand. So keep those lines of communication open, and let us help you make the right decision for you and your family members. Okay, thank you, Katie, that's a great place for us to end off. And I think that everybody watching can really feel the passion and the energy coming from everybody on the panel here that we just they just, you know, everybody just wants to help, wants to help. This is an important topic. It's not an easy topic to understand. But there is support and there is help.

So with that we're going to finish up for today. And I'm sorry, I wasn't able to get to all the questions that everybody into the chat but thank you for sharing those questions. And we are just going to finish off now with our upcoming shows just to remind everybody of what you can expect. And so upcoming shows for onwards and upwards next week we're going to be talking about renting an apartment. How does one go about that? What is renting insurance and all the topics you need to know about renting on the 16th we have our expert legal battle panel back for the immigration Q&A. On the 20th of September we have the foreign talk show. And this came from our poll, what do people want to hear about so we breaking down the clinical differences in the IDI between working outside of the United States as well as working in the ER. And on the 23rd we have stateside is North Carolina. We have a lot of people asking about North Carolina. So we're going to be talking about what it's like to live in North Carolina. And then on the 30th of September, we have our client showcase. So excited to be able to showcase one of our clients.

Also don't forget every Monday at 5am Pacific Time, check the time in your location, we have Connetics College. This is free information if you don't know where to start on the success path. In terms of coming to the United States, we have NCLEX classes, IELTS, OET, and PTE classes are lots of classes coming to you from our wonderful partners Aspire Swoosh, I, pos and nynas. And so please feel free to watch those. This is free information. And last but not least, the Connetics initiatives. And we have a free eye English scholarship for all Connetics USA nurses can ex pay for your English course. We have a free NCLEX scholarship for selected global nurses. Don't forget our $1,000 referral fee. This was extended to September 30. Check out our website for details. listen to our podcast nursing in America, we also have a direct hire nurse aide program, watch our onwards and upwards every Friday Connetics college every Monday. And if you are an elliptic medical lab technician, respiratory therapist or cardiology test, please also apply to Connetics USA, we'd be happy to help you. So I'd like to finish off to thank the panel for joining us today. And it was a fun discussion. I know I'm just looking at the chat. And we have a lot of people saying thank you, Tanya learned so much I learned so much today. Thank you so much. This was a very helpful topic. So thank you, everybody for joining us. We'll see you next week. Onwards and Upwards everybody. Thank you. Bye