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4 ways to help employees master their HDHPs in 2019

Now is a great time to help your employees better understand their High Deductible Health Plans (HDHP) for 2019. Continue reading this blog post for steps HR can take to help employees stay on the right track.


As 2018 draws to a close, it’s a great time to give HDHP veterans and newbies at your company some help understanding — and squeezing more value out of — their plans in 2019.

Here are four simple steps your HR t­eam can take over the next few months to put employees on the right track.

1. Post a jargon-free FAQ page on your intranet

When: Two weeks before your new plan year begins

Keep your FAQ at ten questions (and answers!), maximum. Otherwise, your employees can get overwhelmed by their health plans and by the FAQ.

When writing up the answers, pretend you’re talking directly to an employee who doesn’t know any of the insurance jargon you do. Keep it simple, straightforward, and free of insurance gobbledegook.

[Image credit: Bloomberg]

Make sure your questions reflect the concerns of different employee types: Millennials who haven’t had insurance before, older employees behind on retirement, employees about to have a new kid, etc. To get a clear sense of these concerns, invite a diverse group of 5-7 employees out for coffee and ask them.

Some sample questions for your FAQ might be:
• Is an HSA different from an FSA?
• Do I have to open an HSA?
• How much money should I put in my HSA?
• This plan looks way more expensive than my PPO. What gives?

2. Send a reminder email about setting up an HSA and/or choosing a monthly contribution amount

When: The first week of the new plan year

When your employees don’t take advantage of their HSA not only do they miss out on low-hanging tax savings, your company misses out on payroll tax savings, too.

So right at the start of the new year, send an email that explains why it’s important to set up a contribution amount right away.

A few reasons why it’s really important to do this:

  • You can’t use any HSA funds until your account is fully set up and you’ve chosen how much you’re going to contribute.
  • If you pay for any healthcare at all next year, and don’t contribute to your HSA, you’re doing it wrong. Why? You don’t pay taxes on any of the money you put into your HSA and then spend on eligible health care…which puts real money back in your pocket. (Last year, the average HSA user contributed about $70 every two weeks and saved $267 in taxes as a result!)
  • There’s no “use it or lose it” rule! Any money you put into your HSA this year is yours to use for medical expenses the rest of your life. And once you turn 65, you can use it for anything at all. A Mediterranean cruise. A life-size Build-a-Bear. You name it!

3. Give your HDHP newbies tips on navigating their first visit to the doctor and pharmacy

When: The week insurance cards are mailed out

When employees who are used to PPO-style co-pays realize they have to pay more upfront with their HDHP, they can get…cranky. And start to doubt their plan choice — or worse, you as their employer choice.

So set expectations ahead of time to avoid employee sticker shock and to prevent you from getting an earful. Specifically, remind employees which types of visits are considered preventative care (and likely free) and which aren’t. Then explain their options when it comes to paying for — and getting reimbursed for — the visit.

4. Share tips on saving money on care with all your HDHP users

When: Any time before the end of the first quarter of the year

Specifically, you might recommend that your employees:

  • Check prescription prices on a site like Goodrx.com before they buy their meds
  • Visit an urgent care center instead of the ER, if they’re sick or hurt but it’s not life-threatening
  • Use a telemedicine tool (if your company offers one) to get free online medical advice without having to leave their Kleenex-riddled beds

Sure, following this communication schedule requires extra elbow grease. But if you defuse your employees’ stress and confusion early, they’ll feel more prepared to take control of their healthcare and get the most out of their plans. And as a bonus, you and your team get to spend less time answering panicked questions the rest of the year.

SOURCE: Calvin, H. (17 December 2018) "4 ways to help employees master their HDHPs in 2019" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/4-ways-to-help-employees-master-their-hdhps-in-2019?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001


More part-time workers getting access to benefits

A new study by the International Foundation of Employee Benefit Plans found that more employers are moving toward extending more benefits to part-time workers. Continue reading this blog post to learn more.


Gone are the days that new talent might come to work for a company part-time in exchange for some extra cash and the promise of discounted merchandise.

Employers are moving toward extending more benefits to part-time workers, according to a new study by the International Foundation of Employee Benefit Plans. The Flexible Work Arrangements: 2017 Survey Report found that 78% of organizations employ part-time workers, and 90% of those organizations define part-time work as fewer than 30 hours a week.

And part-time workers can thank the tight labor market for the increase in benefit offerings.

“In order to attract and retain key talent, employers are seeing the need to broaden the scope of work from the traditional ‘40-hour per week model,” says Julie Stich, CEBS, associate vice president of content at IFEBP. “They’re also seeing that benefit offerings and other workplace perks are essential for growing any talented organization, regardless of the number of hours employees work per week.”

The most favorable medical benefits among employees working fewer than 30 hours a week were healthcare coverage (54%), prescription drug coverage (53%), dental and vision care (52%), flexible spending accounts (47%) and health savings accounts (33%), according to the report.

In addition, paid leave benefits offered to part-timers saw an uptick to include holidays, bereavement leave, sick pay, short-term disability, maternity leave, parental/family leave and personal leave.

Clothing retailer H&M recently announced its plan to offer six weeks of paid leave to the company’s 18,000 employees — including part-timers.

In addition, Eataly, said in September its new paid parental leave policy — eight weeks of time off for both mothers and fathers following the birth or adoption of a child — is available to all employees who have been working at the company for at least a year, regardless of hours worked per week. Dollar General also introduced a new paid parental leave benefit in March, offering two weeks of paid time off for all eligible full-time and part-time employees, and eight weeks of paid time off for birth mothers.

“U.S. organizations are not required to provide paid leave to part-time workers, but many do for several reasons: to retain high-performing workers, attract high-quality applicants, build worker loyalty and provide work-life balance,” Stich adds.

Paid time off and healthcare were also key benefits identified in the Society for Human Resource Management’s annual survey, with a 10% increase in companies offering healthcare benefits and more than half saying they offer some sort of paid time off to part-time workers.

More employers will likely offer benefits to part-time workers as the workforce shifts toward more flexible work options, Stich says. “Certainly, each organization is structured differently, and company cultures vary, but if offering part-time work arrangements and benefits is appropriate, they can be a vehicle for attracting top-tier talent while providing additional flexibility for current employees.”

SOURCE: Otto, N. (12 December 2018) "More part-time workers getting access to benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/more-part-time-workers-getting-access-to-benefits?brief=00000152-14a7-d1cc-a5fa-7cffccf00000


The case for self-funded health benefit plans and reference-based pricing

Small businesses are starting to explore self-funded plan designs that use reference-based pricing. Continue reading for more about self-funding and reference-based pricing.


Self-funding and reference-based pricing are hot topics with small businesses. They are so popular, in fact, that a recent survey shows an overall increase in their 2019 projection of small employer clients having a reference-based pricing health benefit plan design. Small businesses are seeing these savings, and they’re starting to explore how reference-based pricing can help them, too.

Before we get to why self-funded plan designs that use reference-based pricing are becoming more popular for small businesses, let’s review the basics.

Reference-based pricing is a methodology of calculating payment to providers for covered treatments and services using a “reasonable fee” based on a reference point. A common reference point is the Medicare fee schedule. Some self-funded health benefit plans calculate the reasonable fee as a percentage of the Medicare fee schedule to determine reimbursement for services rendered.

Bottom line: Self-funded health benefit plan designs that use reference-based pricing can allow for a great deal of flexibility with a variety of arrangements and overall cost-savings.

So, what’s behind the recent trend toward reference-based pricing for smaller employers? A few key factors.

First, a self-funded health benefit plan design that uses referenced-based pricing can mean less expensive coverage for employees and employers.

When coupling a self-funded health benefit plan with stop-loss insurance, reference-based pricing provides an affordable way to extend coverage to employees through lower employee contributions. So, employees are happy because they’re saving money.

And employers are happy, too, because they’re allowing for more coverage to more employees. There’s a refund potential for employers if claims dollars are less than funded. There’s also a premium tax savings of around 2% since self-funded claim dollars are not subject to state health insurance premium taxes.

Moreover, self-funded health benefit plan designs that utilize reference-based pricing may also include transparency reports with aggregate health claims data and demographic information, which allow employers to better manage costs. Overall, anytime you can design a plan that’s beneficial for employees and employers, it’s a win.
Second, reference-based pricing can provide employees more flexibility when it comes to choosing a provider. Typically, an important feature of any health benefit plan design for employees is the ability to choose the provider they want. Some self-funded plan designs that use reference-based pricing give employees the chance to pick the provider that’s right for them. And, when employees are happy with their health plan, employers are usually pretty happy, too.

Finally, self-funded plan designs that use reference-based pricing can help employees become smarter healthcare consumers because of all the transparency and choice involved. When employees better understand the healthcare processes and system, costs come down for both the employee and employer. In fact, just understanding their coverage better may help employees better use their health benefit plans.

For example, using telemedicine when appropriate, establishing a relationship with a primary care doctor and using client advocacy services can all help employees better utilize their health benefit plans. In the end, employees get smarter about how they manage their care, and employers win with reduced costs.

These factors are driving more small businesses to consider reference-based pricing self-funded health benefit plan designs with stop-loss insurance. And, for good reason. These plan designs can give employers the opportunity to offer their employees affordable health benefits, provide more choice in their health plans and providers, and encourage more employee engagement. While moving to reference-based pricing may be too big of a leap for some employers, self-funding continues to provide a means for employers to offer comprehensive major medical health benefits at lower costs.

SOURCE: MacLeod, D. (6 December 2018) "The case for self-funded health benefit plans and reference-based pricing" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/the-case-for-self-funded-health-benefit-plans-and-reference-based-pricing


New resource offers guidance on digital tools for diabetes management

The market for digital diabetes management tools is continuing to mature. Read this blog post for the Northeast Business Group on Health’s updated guide on diabetes management tools.


The Northeast Business Group on Health has updated its “Digital Tools and Solutions for Diabetes: An Employer’s Guide,” to include both enhanced and new solutions—and promising future innovations—to help employers help their workers better manage their diabetes, lower costs and ultimately save more lives.

“Employers are well aware of the costs associated with diabetes in their employee and dependent populations—they continue to indicate this is a top concern and are increasingly aware of the links between diabetes and other chronic and debilitating health conditions, including cardiovascular disease,” says Candice Sherman, CEO of NEBGH.

The market for digital diabetes prevention and management solutions continues to mature since the group published its first guide in 2016, Sherman says. The updated guide provides a detailed checklist of the features and functionalities of the digital tools available now to manage diabetes, as well as information on several unique and innovative digital diabetes solutions that are being targeted to employers but were not part of NEBGH’s research, including Proteus Discover, BlueLoop and do-it-yourself programs.

“Proteus Discover is comprised of ingestible sensors, a small wearable sensor patch, an application on a mobile device and a provider portal,” the guide cites the provider. “Once activated, Proteus Discover unlocks never-before-seen insight into patient health patterns and medication treatment effectiveness, leading to more informed healthcare decisions for everyone involved.”

“BlueLoop is the one and only tool that allows kids and their caregivers to log and share diabetes information—both online and with the app—in real time, via instant e-mail and text message, giving peace of mind to parents,more class time for students and fewer phone calls and paper logs for school nurses,” the provider tells NEBGH. “Online, parents can share real-time BG logs with their clinicians, who can see logs (in the format they prefer), current dosages and reports, all in one place.”

The guide also hints at promising future innovations:

“Technology is constantly evolving: by connecting sensors, wearables and apps, it is increasingly possible to pool and leverage data in innovative ways to provide timely interventions so that people with diabetes can be truly independent and effectively self-manage their care,” the authors write.

The guide lists a hypothetical scenario: A person with diabetes enters a restaurant where a GPS sensor identifies the location, reviews the menu and proposes the best choices based on caloric and carbohydrate content. The technology also proposes and delivers a rapidly acting insulin bolus dose based on the person’s exercise level that day and prior experiences when eating similar meals.

Also included are key questions for employers considering implementing digital diabetes tools or solutions, including:

  • What does the company want to achieve with a digital tool?
  • How much is the company willing to pay?
  • How will success be measured?
  • How will digital solutions and tools be marketed to employees and their families?
  • What privacy issues need to be addressed when tools or solutions are implemented?

“Digital health tools hold the promise of improved health outcomes and reduced health care expenses through improved engagement, better collaboration and sustained behavior change,” says Mark Cunningham-Hill, NEBGH’s medical director. “However, digital diabetes solutions are not a panacea. Employers will need to address several obstacles such as the difficulty of recruitment and enrollment, lack of sustained employee engagement and the cost of deployment of digital solutions. This can be accomplished through careful planning and learning from other employers that have successfully implemented these tools.”

SOURCE: Kuehner-Hebert, K. (4 December 2018) "New resource offers guidance on digital tools for diabetes management" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/12/04/new-resource-digital-tools-for-diabetes-management/


4 trends in employee wellness programs for 2019

Employee wellness programs will be impacted by intelligent personalization, social recognition, virtual wellness and smarter analytics, according to a white paper by MediKeeper. Read on to learn more.


Employee wellness programs will likely be transformed in the coming year by intelligent personalization, social recognition, virtual wellness and smarter analytics, according to MediKeeper’s white paper, “Four Emerging Employee Wellness Trends for 2019.”

“Embracing change and knowing what organizations need to keep driving wellness offerings forward in the next few years will help them lay the groundwork for building stronger employee wellness programs and increasing employee engagement,” says MediKeeper’s CEO David Ashworth. “With health care costs on the rise, companies that pay attention to these key trends will have the greatest success investing in their employees’ overall well-being.”

Intelligent Personalization

Intelligent personalization allows companies to make more informed decisions based on understanding risks and their causes and identifying what is driving present and future cost, according to the white paper.

“Every person is different, so it only makes sense that everyone’s wellness portal experience should also be different — this includes personalization, targeted messages and offerings.,” the authors write. “Adding business intelligence/data mining capabilities delivers the ability to take data captured within the portal, manipulate it, segment it and merge with other sets of data to perform complex associations all within each population groups’ administration portal will be the key to truly managing the population’s health.”

Social Recognition

In the coming year, workplace wellness programs will also implement a multitude of ways to include social recognition that fosters a team-oriented atmosphere intended to encourage people to perform to the best of their abilities, according to the white paper.

“Through social recognition, which can include posting, sharing, commenting and other virtual interactions, employees can help motivate each other to reach their goals,” the authors write. “These interactions foster both a competitive and team-oriented atmosphere that encourages people to perform to the best of their abilities.”

In addition to support from coworkers, managers can also promote their employees’ achievements by offering praise in an online public forum or even further boost morale by handing out incentive points that can be redeemed for tangible rewards.

Virtual Wellness Programming

In 2019, the importance of offering virtual wellness programming will grow as more employees work remotely or set flexible hours, according to the white paper.

“Since employees may work variable hours or work in several locations around the world, it simply doesn’t make sense to solely rely on lunchtime health seminars that may not be accessible to much of the workforce,” the authors write. “Instead of providing physical classes, consider hosting virtual programs that can be viewed at any time or any place. By making your wellness program available online, you’re able to reach a broader audience and make more of an impact within the entire working population.”

Smarter Analytics

Smarter analytics will also be at the forefront in 2019, according to the white paper.

“Now you can generate reports targeted specifically to the information that you are seeking, as well as layering various reports including biometrics, incentives, health risk assessments and challenges, to see what is working and what is not,” the authors write. “You can use these results to inform and better customize the intelligent personalization side of your wellness program. You’ll also be able to send messages from the reports, making them actionable instead of just informative.”

As employers continue to evaluate the effectiveness of their wellness programs, they should keep these four emerging trends in mind in order to ensure that their business is providing all the tools necessary to keep their employees both happy and healthy, according to the white paper.

“Remember that just because you’ve seen success in the past, you can’t just sit back and relax now,” the authors write. “Continual advances in wellness technology mean that you need to stay on top of the trends and adjust frequently in order to remain relevant in an increasingly competitive workplace environment.”

SOURCE: Kuehner-Hebert, K. (28 November 2018) "4 trends in employee wellness programs for 2019" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/11/28/4-trends-in-employee-wellness-programs-for-2019/


The benefits issue that costs employers big: Ineligible dependents on company plans

Frequently, roughly 10 percent of enrolled dependents are ineligible for the healthcare programs. Continue reading this blog post to learn more.


Are you paying insurance premiums for people who aren’t qualified to be on your company plan?

For some employers, too often the answer is “yes.”

In our experience, we find that nearly 10% of dependents enrolled in employee health and welfare plans are not eligible to be in the program. And for a company with a couple of hundred employees that spends around $2 million a year on benefits, ineligible dependents can become a significant financial issue.

When employers pay for ineligible dependents, costs increase for them and employees. Unfortunately, it’s an all-too-common issue that employers need a solid strategy to combat.

So how do ineligible dependents get enrolled in the first place? There are a couple of common ways that employers end up paying health insurance premiums for ineligible dependents. The most basic factor is a change in a person’s situation — children pass the age of 26, spouses get jobs, people get divorced, etc. — and the employee is unaware of the need to notify the plan sponsor. Most often, these situations arise because the employer doesn’t have a process in place.

But some situations are more nefarious: An employee mischaracterizes someone as a dependent. They may claim that a nephew is a son, or that they’re still married to an ex-spouse. In either of these situations, the employer loses.

Prevent ineligible dependents with best practices

Prevent paying for ineligible dependents by putting into place best practices that begin when a new employee joins the company.

During onboarding, investigate each potential plan member when the employee applies for insurance coverage. That means seeking documentation — such as marriage certificates and birth certificates — to verify that a person is, in fact, married, or that their kids are their kids and not someone else’s. Following these processes at the outset prevents the awkwardness of having to question employees about their various family relationships. Nobody wants to ask a colleague if the divorce is final yet.

To make it easy for employees to verify everyone’s eligibility, provide access to a portal where they can upload scans or images of relevant documents. This will also make it easier to track—and keep track of—onboarding documents and dependent audits when the time comes.

Once this best practice is established, it’s important to conduct periodic dependent eligibility audits, as required by ERISA. The employer can conduct an audit or hire an external auditor. This decision is usually driven by the size of the workforce.

The most logical time to conduct an audit is during benefit enrollment. Employees are already considering options for the next plan year, and they likely won’t be confused by the need to submit verifying documents. (During this exercise, it’s also a good idea to ask plan participants to verify beneficiaries on employer-provided life insurance.)

Some employers — again, depending on the size of the workforce — will conduct random sample audits of 20-25% of their employee population. Obviously, the larger the sample size, the better. Benefits administration platforms typically streamline this process.

What happens when employers identify an ineligible dependent?

Many employers offer workers an amnesty period during which an employee can come forward to say they have someone that should be taken off the plan. If the plan sponsor identifies an ineligible dependent, employees are typically offered a one-time pass. Then, they must sign an affidavit attesting that they can be terminated if it happens again.

If the employer has processed insurance claims for an ineligible dependent, they can declare fraud and seek back payment of claims payouts. Again, most in this situation prefer a more benevolent approach and will ask the employee to make monthly differential payments until the account is even. Conducting regular dependent eligibility audits as part of the benefits administration process needs to be handled with finesse for the good of organizational culture.

Some employers may shy away from conducting audits out of concern for creating awkward situations. But frankly, it’s the plan sponsor’s job to help them navigate the waters, educate them and keep them engaged in the process by becoming their best advocates. This will not only help enhance the efficiency and accuracy of employee benefit offerings, but it will result in a smoother ride for everyone involved.

Ensuring that a health and welfare benefits program follows eligibility best practices is the responsibility of the plan sponsor. But employees have a share in that responsibility, too.

SOURCE: O'Connor, P.(28 November 2018) "The benefits issue that costs employers big: Ineligible dependents on company plans" (Web Blog Post). Retrieved from:


Poor employee health costs employers half trillion dollars a year

According to a recent report from the Integrated Benefits Institute, poor employee health costs employers half a trillion dollars each year and almost 1.4 billion in missed work days. Read on to learn more.


Poor employee health is costing employers in a big way — to the tune of half a trillion dollars and nearly 1.4 billion days of missed work each year.

That’s according to a new report from the Integrated Benefits Institute, which finds that employees miss around 893 million days a year from illness and chronic conditions, and another 527 million days because of impaired performance due to those illnesses. Those days add up to $530 billion in lost productivity.

“To put this in further context, the cost of poor health to employers is greater than the combined revenues of Apple, Amazon, Microsoft, Netflix, eBay and Adobe,” says Thomas Parry, president of Integrated Benefits Institute, an independent nonprofit that serves more than 1,250 employers including Amazon, Kroger, McDonald’s and Walmart.

The $530 billion price tag is on top of what employers already spend on healthcare benefits. Employers pay $880 billion in healthcare benefits for their employees and dependents, which means that poor health costs amount to “60 cents for every dollar employers spend on healthcare benefits,” according to the study.

“There’s not a CEO or CFO that can placidly accept their business expending the equivalent of almost two-thirds of their healthcare dollars on lost productivity,” Perry says. “Illness costs this country hundreds of billions of dollars, and we can no longer afford to ignore the health of our workforce.”

Employers invest in healthcare benefits to maintain a productive workforce. But this new study suggests that more needs to be done to keep employees healthy, or strategies need to be put in place to lower spending. Or both.

“It’s critical that employers understand how strategies for managing healthcare spend — such as cost- shifting to employees or ensuring better access and more cost-effective care — can impact the kinds of conditions that drive illness-related lost productivity,” says Brian Gifford, director of research and analytics at IBI.

The study broke down the estimated costs of poor health into several categories:

Wage and benefits (incidental absence due to illness, workers’ compensation and federal family and medical leave): $178 billion.

Impaired performance (attributed to chronic health conditions): $198 billion.

Medical and pharmacy (workers’ compensation, employee group health medical treatments, employee group health pharmacy treatments): $48 billion.

Workers’ compensation other costs (absence due to illness, reduced performance): $25 billion.

Opportunity costs of absence (missed revenues, costs of hiring substitutes, overtime): $82 billion.

For its study, IBI used 2017 data from the U.S. Bureau of Labor Statistics as well as its own benchmarking data from 66,000 U.S. employers.

SOURCE: Paget, S. (20 November 2018) "Poor employee health costs employers half trillion dollars a year" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/poor-employee-health-costs-employers-half-trillion-dollars-a-year?brief=00000152-14a7-d1cc-a5fa-7cffccf00000


Employers Assess Risk Tolerance with Wellness Program Incentives

Do you offer wellness programs to your employees? Employers are now uncertain to what extent they can use incentives as part of a wellness program. Continue reading to learn more.


Employers designing 2019 wellness programs must decide what approach to take on program incentives without Equal Employment Opportunity Commission (EEOC) guidance on the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).

The commission has a Notice of Proposed Rulemaking tentatively slated for January 2019. Last year, the U.S. District Court for the District of Columbia decided the commission's 2016 ADA and GINA wellness regulations were arbitrary and vacated them, effective Jan. 1, 2019.

Employers again are "in the uncomfortable position of not knowing with certainty whether and to what extent they can use incentives as part of a wellness program that involves medical examinations, disability-related inquiries and/or genetic information," wrote Lynne Wakefield and Emily Zimmer, attorneys with K&L Gates in Charlotte, N.C., in a joint statement.

The Society for Human Resource Management (SHRM) "has long advocated for proposals that will ensure consistency between the wellness rules that the EEOC has jurisdiction over, the ADA and GINA, with those provided under the ACA [Affordable Care Act]," said Nancy Hammer, SHRM vice president, regulatory affairs and judicial counsel. "While EEOC's 2016 rulemaking effort adopted the ACA's 30 percent incentive, it added new requirements that would have discouraged employers from providing wellness options for employees. We are hopeful that the EEOC is able to revisit the rules to ensure both consistency with existing rules and flexibility to encourage employers to adopt innovative programs to improve employee health and reduce costs."

ADA and GINA Requirements

Employers have long sought guidance over whether and when wellness program incentives—rewards or penalties for participating in biometric screenings and health risk assessments connected with the programs—comply with the ADA and GINA.

The ADA prohibits employers from conducting medical examinations and collecting employee medical history as part of an employee health program unless the employee's participation is voluntary, noted Ann Caresani, an attorney with Tucker Ellis in Cleveland and Columbus, Ohio.

GINA prohibits employers from requesting, requiring or purchasing genetic information from employees or their family members, unless the information is provided voluntarily.

The EEOC in 2000 asserted that for a wellness program to be voluntary, employers could not condition the receipt of incentives on the employee's disclosure of ADA- or GINA-protected information.

However, in 2016, the commission issued regulations providing that the use of a penalty or incentive of up to 30 percent of the cost of self-only coverage would not render involuntary a wellness program that seeks the disclosure of ADA-protected information. The regulations also permitted employers to offer incentives of up to 30 percent of the cost of self-only coverage for disclosure of information, in accordance with a wellness program, about the manifestation of a spouse's diseases or disorder, Caresani said.

Wakefield and Zimmer noted that the EEOC's 2016 wellness regulations applied to wellness programs that provided incentives tied to:

  • Biometric screenings for employees and spouses.
  • Disability-related inquiries directed at employees, which might include some questions on health risk assessments.
  • Family medical history questions, such as risk-assessment questions that ask about the manifestation of disease or disorder in an employee's family member and/or such questions about the disease or disorder of an employee's spouse.
  • Any other factors that involve genetic information.

Court Actions

The AARP challenged the 2016 rule, arguing that the 30 percent incentives were inconsistent with the voluntary requirements of the ADA and GINA. Employees who cannot afford to pay a 30 percent increase in premiums would be forced to disclose their protected information when they otherwise would choose not to do so, Caresani explained.

While the 30 percent cap was consistent with the Health Insurance Portability and Accountability Act (HIPAA) as amended by the ACA, the AARP said this was inappropriate, as HIPAA and the ADA have different purposes, noted Erin Sweeney, an attorney with Miller & Chevalier in Washington, D.C..

In addition, the change from prohibiting any penalty to permitting one of 30 percent was not supported by any data, according to the AARP.

In the summer of 2017, the U.S. District Court for the District of Columbia held that the EEOC's rule was arbitrary. The court sent the regulations back to the EEOC for further revisions.

In December 2017, the court vacated the 2016 rule after the EEOC initially said that the new rule would not be ready until 2021.

Conservative to Aggressive Approaches

Wakefield and Zimmer observed that employers may take several different approaches as they design wellness programs for next year:

  • No incentives (most conservative approach). These types of wellness programs can still include biometric screening and health risk assessments that employees and spouses are encouraged to complete, but no rewards or penalties would be provided in connection with their completion.
  • Modest incentives (middle-ground approach). A modest incentive is likely significantly less than 30 percent of the cost of self-only coverage, given the court's finding that the EEOC did not provide adequate justification for an incentive level-up to 30 percent.
  • Up to 30 percent incentives (more aggressive approach). Although the court did not rule that a 30 percent incentive level would definitely cause a wellness program to be considered involuntary, incentives at this level after 2018 likely will expose employers to lawsuits, they wrote.

Multiple-Point Program

One good way to demonstrate compliance, they noted, is a multiple-point program in which participants engage in different activities and earn an incentive by participating in enough activities apart from biometric screenings, risk assessments or providing their spouse's health information.

For example, an employer could let employees take health care literacy quizzes or offer a program that measures a worker's activity as opposed to fitness, Caresani noted. She said, "Programs that are participatory are probably less effective than outcome-based programs, but they are more popular with employees and are less likely to pose litigation risks."

SOURCE: Smith, A. (1 August 2018) "Employers Assess Risk Tolerance with Wellness Program Incentives" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/risk-tolerance-wellness-program-incentives.aspx


Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits

Employers can now use their own data to help fine-tune their employer-sponsored benefits packages. Continue reading to learn how this technology could be used to help fine-tune employee benefits offerings.


Last year’s World Series between the Houston Astros and the Los Angeles Dodgers came down to a seven-game battle based not only on talent, athleticism and coaching but also on data. Just as Sports Illustrated suggested back in 2014 via predictive data, the Astros were the victors.

The publication of Moneyball: The Art of Winning an Unfair Game spurred not only Major League Baseball teams to deploy predictive analytics, but also businesses to take a harder look at what their data means. It's no longer part of the hype cycle: Statista forecasts (paywall) that the predictive analytics market worldwide will reach $6.2 billion in 2018 and $10.95 billion in 2022.

I believe we are also at a transformational point in improving corporate employee benefits and our employees’ lives by embracing predictive analytics. HR is swimming in rich data. Instead of guesstimating needs across multiple generations of employees, employers can turn to their own data to fine-tune what they are offering as benefits solutions. Companies spend 25-40% of an employee’s salary on benefits. It simply makes strategic and financial sense to get it right.

Bring Employee Benefits Out Of The Dark Ages

Hiring and retaining great talent is at the very soul of almost every company’s strategy. Not surprisingly, more companies have turned to predictive analytics to give them a leg up in recruitment. However, HR benefits have lagged behind. As John Greenwood reported to Corporate Adviser, “More than half of reward and employee benefits professionals see predictive analytics as a game-changer, but 90 percent are still using spreadsheets to manage data, research from the Reward & Employee Benefits Association shows.”

One reason for benefits lagging behind recruitment in adopting predictive analytics is that the way companies choose new benefits varies greatly from business to business. Given that the majority of HR departments keep data in disparate spreadsheets, even if some HR departments conduct employee surveys or historical cost analyses, they often do not integrate the data about their workforce. If a new benefit offering is chosen based on a needs analysis, only some know the “why” behind a request from the workforce. Knowing how many employees are logging into a benefits platform is helpful; market standard benefit utilization reports provide this level of information. Yet they do not give insight into the underlying reason for an employee to utilize a benefit. The user of deeper analytics is required to look deeper into employees' behavior.

We have found firsthand that many HR departments do not have a full understanding of how their employees are utilizing their benefits across the entire offering suite. A one-size-fits-all or a one-off strategy no longer is effective. Companies must understand not only their employees’ needs but also the underlying data related to these needs to provide a valuable benefits offering.

Put Your Existing Data To Use

For the past five years, I have watched our clients glean valuable insights into what the real underlying issues are for their employees and what must be done to address these pressing needs. I also have been watching companies realize that what they thought were the core problems at hand sometimes were not.

For example, one of our national high-tech clients, with over 50,000 benefit-eligible employees, believed that a high number of their employees had children struggling with autism. This belief was initially based on input from some of their employees. After approximately 16 months, the client reviewed the masked utilization data from their benefit platform. The data illustrated that the overwhelming majority of employee families (tenfold) in fact faced challenges associated with youth anxiety, a concern that had never been expressed to HR previously. Once they reviewed what employees were doing within our platform, their results mirrored the National Institute of Mental Health’s report that approximately 31.9% of U.S. children ages 13-18 struggle with anxiety disorders.

Their own data helped them understand much more specifically where their employees’ stress lay, and their HR department was able to focus communications around it.

Getting Started

Mining and viewing use data across all benefits is ideal. This enables an employer to determine if the benefit suite is serving employees effectively. We have found that as quickly as year over year, users' behaviors shift. If a company solely chooses a benefit based on what they saw as most heavily utilized the previous year, they are not being strategic.

For that reason, HR should utilize past and current data to better predict future patterns of need for a truly strategic approach to benefit choice. With this insight, they can make better choices and serve their workforce more effectively.

Given the limitations across many employee benefit vendors today, to start initially:

1. Embrace KPIs. Agree upon them internally, and measure benefit vendors on them.

2. Work with your current vendors to determine what data they provide to support your internal analysis. Ensure you have access to all the data you need, and if not, consider a vendor change.

3. Hold possible new vendors to similar data standards, and create a transparent relationship from the start.

4. Collect current and historical data. Existing vendors can provide this history, so make sure to collect at least 2-3 years of information.

These analytics need to go deeper than basic demographics to show patterns of activity. In order to understand the benefit needs of your workforce, you'll want to analyze trends across multiple data sets: medical, pharmacy, worker's compensation, biometric screenings, utilization patterns, FMLA requests and demographic trends. From there, you can start to pinpoint what your employees need -- and the “whys” behind the needs -- in order to make a measurable impact.

While predictive analytics is still in the nascent phase in the benefits and vendor worlds, the easiest and most proactive thing any employer can do is to focus on other insights vendors can provide related to the workforce and benefit use beyond simple utilization. In doing so, you will be able to support your employees both in their work lives and their personal lives by providing them with the benefits they need to be at their best.

SOURCE: Goldberg, A. (2 October 2018) "Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits" (Web Blog Post). Retrieved from: https://www.forbes.com/sites/forbestechcouncil/2018/10/02/predictive-analytics-will-be-the-silent-game-changer-in-employee-benefits/#26648166e182


HR’s recurring headache: Convincing employees to get a flu shot

According to The National Institute for Occupational Safety and Health, the flu cost U.S. companies billions of dollars in medical fees and lost earnings. Read this blog post to learn how HR departments are convincing their employees to get a flu shot.


Elizabeth Frenzel and her team are the Ford assembly line of flu shots: They can administer about 1,800 flu shots in four hours.

Frenzel is the director of employee health and wellbeing at the University of Texas MD Anderson Cancer Center, and with 20,000 employees, she is no stranger to spearheading large flu shot programs. The center where Frenzel administers flu shots has roughly a 96% employee vaccination rate. Back in 2006, only about 56% of employees got their shots.

“When you run these large clinics, safety is critically important,” she says.

Problems like Frenzel’s are not unique. Every fall, HR departments send mass emails encouraging employees to get vaccinated. The flu affects workforces across the country, costing U.S. companies billions of dollars in medical fees and lost earnings, according toThe National Institute for Occupational Safety and Health. It is not only a cause of absenteeism but a sick employee can put their coworkers at risk. Last year the flu killed roughly 80,000 people, according to the Centers for Disease Control.

Even if an employer offers a flu shot benefit, the push to get employees to sign up for the vaccine can be a two-month slough, with reminder emails going unanswered. Moreover, companies often contend with misconceptions about the shot, such as the popular fallacy that shots will make you sick, running out of the vaccine, and sometimes just plain employee laziness.

In Frenzel’s case, increasing the number of employees who got flu shots weren’t just a good idea, but it was needed to protect the lives of the cancer patients they interact with every day. The most startling fact, she says, was that healthcare workers who interact with patients daily were less likely to get vaccinated.

“So that’s how we started down the path,” she says. “Really targeting these people who had the closest patient contact.”

Frenzel credits the significant increase in employee participation in the flu shot program to several factors. They made the program mandatory — a common move in the healthcare industry — but Frenzel says their improvement also was related to flu shot education. The center made it a priority to explain to staff members exactly why they should get vaccinated. Frenzel made it more convenient, offering the vaccine at different hours of the day, so all employees could fit it into their schedule. They also made it fun, offering stickers for employees to put on their badge once they got a shot. Every year, she says, they pick a new color.

Employers outside of the medical industry are focused on improving their flu shot programs, including Edward Yost, manager of employee relations and development at the Society for Human Resource Management, who helped organize a health fair and flu shot program for 380 employees.

Yost says onsite flu shot programs are more effective than vouchers that allow employees to get vaccinated at a primary care doctor or pharmacy. The more convenient you make the program, he says, the more likely employees will use it.

“There’s no guarantee that those vouchers are going to be used,” he says. “Most people aren’t running out to a Walgreens or a CVS saying, please stab me in the arm.”

Besides the convenience, employees are more likely to sign up for a shot when they see co-workers getting vaccinated, Yost says. If a company decides to offer an onsite program, planning ahead is key. Sometimes employees will not sign up in advance for the vaccine but then decide they want to get one once the vendor arrives onsite. Yost recommends companies order extra vaccines.

“Make sure that you’re building in the expectation that there's going to be at least a handful of folks who are more or less what you call walk-ins in that circumstance,” he says.

Incentivizing employees to get the flu shot is also important, Yost says. Some firms will offer a gym membership or discounted medical premiums if they attend regular checkups and get a biometric screening in addition to a flu shot. He recommends explaining to employees how a vaccine can help reduce the number of sick days they may use.

“Employees need to see that there’s something in it for them,” Yost says. “And quite honestly, being sick is a miserable thing to experience.”

Affiliated Physicians is one of the vendors that can come in and administer flu shots in the office. The company has provided various employers with vaccines for more than 30 years, including SourceMedia, the parent company of Employee Benefit News andEmployee Benefit Adviser. In the past 15 years, Ari Cukier, chief operating officer of the company, says there’s been an increase in the amount of smaller companies signing up for onsite vaccines. HR executives should be aware of the number of employees signing up for vaccinations when scheduling an onsite visit.

“We can’t go onsite for five shots, but 20-25 shots and up, we’ll go,” Cukier says.

Cukier agrees communication between human resources departments and employees is crucial in getting people to sign up for shots. Over the years, he’s noticed that more people tend to sign up for shots based on the severity of the previous flu season.

“Last year, as bad as it was, we have seen a higher participation this year,” he says.

Brett Perkisonassistant professor of occupational medicine at the University of Texas School of Public Health in Houston, says providing a good flu shot program starts from the top down. The company executives, including the CEO and HR executives, should set an example by getting and promoting the shots themselves, he says.

It’s also important to listen to employee concerns. Before implementing a program, if workers are taking issue with the shot, it’s best to hold focus groups to alleviate any worries before the shots are even being administered, he says.

Some employees may even believe misconceptions like the flu shot will make one sick or lead to long-term illnesses, he says. Others may question the effectiveness of the shot. Having open lines of communication with employees to address these concerns will ensure that more will sign up, Perkison says.

Regardless of the type of flu shot program, the most important part is preventing illness, SHRM’s Yost says. While missing work and losing money are important consequences of a flu outbreak, having long-term health issues is even more serious, he says. Plus, no one likes being sick.

“Who’s going to argue about that?” he says.

This article originally appeared in Employee Benefit News.

SOURCE: Hroncich, C (24 October 2018) "HR’s recurring headache: Convincing employees to get a flu shot" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/hrs-recurring-headache-convincing-employees-to-get-a-flu-shot