30 employee handbook do’s and don’ts from the NLRB

Recently, the National Labor Relations Board (NLRB) released a list of rules to help employers comply with the National Labor Relations Act. Read this blog post to learn more.


To help employers craft handbooks that don’t violate the National Labor Relations Act, the National Labor Relations Board has issued a compilation of rules it has found to be illegal — and rewritten them to illustrate how they can comply with the law.

It was issued as a memorandum by NLRB General Counsel Richard F. Griffin, Jr. to “help employers to review their handbooks and other rules, and conform them, if necessary, to ensure they are lawful.”

Specifically, the memorandum points out employer policies found to violate and conform to Section 7 of the NLRA.

The main area of concern

Section 7 mandates that employees be allowed to participate in “concerted activity” to help improve the terms and conditions of their work.

The NLRB has made it abundantly clear recently that it’s on the lookout for rules that:

  • explicitly restrict protected concerted activity, and/or
  • could be construed to restrict protected Section 7 activity.

One thing the memorandum makes very clear: extremely subtle variations in language could be the difference between having a legal policy in the NLRB’s eyes and having one that’s viewed as violating the NLRA.

What to say, what not to say

Here are many of the dos and don’ts highlighted by the memorandum, separated by topic:

Rules regarding confidentiality

  • Illegal: “Do not discuss ‘customer or employee information’ outside of work, including ‘phone numbers [and] addresses.'” The NLRB said, in addition to the overbroad reference to “employee information,” the blanket ban on discussing employee contact info, without regard for how employees obtain that info, is facially illegal.
  • Illegal: “Never publish or disclose [the Employer’s] or another’s confidential or other proprietary information. Never publish or report on conversations that are meant to be private or internal to [the Employer].” The NLRB said a broad reference to “another’s” information, without clarification, would reasonably be interpreted to include other employees’ wages and other terms and conditions of employment.
  • Illegal: Prohibiting employees from “[d]isclosing … details about the [Employer].” The NLRB said this is a broad restriction that failed to clarify that it doesn’t restrict Section 7 activity.
  • Legal: “No unauthorized disclosure of ‘business “secrets” or other confidential information.'”
  • Legal: “Misuse or unauthorized disclosure of confidential information not otherwise available to persons or firms outside [Employer] is cause for disciplinary action, including termination.”
  • Legal: “Do not disclose confidential financial data, or other non-public proprietary company information. Do not share confidential information regarding business partners, vendors or customers.”

The NLRB said the last three rules above were legal because: “1) they do not reference information regarding employees or employee terms and conditions of employment, 2) although they use the general term “confidential,” they do not define it in an overbroad manner, and 3) they do not otherwise contain language that would reasonably be construed to prohibit Section 7 communications.”

Rules regarding conduct toward the company and supervisors

  • Illegal: “[B]e respectful to the company, other employees, customers, partners, and competitors.”
  • Illegal: “Do ‘not make fun of, denigrate, or defame your co-workers, customers, franchisees, suppliers, the Company, or our competitors.'”
  • Illegal: “Be respectful of others and the Company.”
  • Illegal: “No ‘[d]efamatory, libelous, slanderous or discriminatory comments about [the Company], its customers and/or competitors, its employees or management.'”

The NLRB said the rules above were unlawfully overbroad because: “employees reasonably would construe them to ban protected criticism or protests regarding their supervisors, management, or the employer in general.”

  • Illegal: “Disrespectful conduct or insubordination, including, but not limited to, refusing to follow orders from a supervisor or a designated representative.”
  • Illegal: “‘Chronic resistance to proper work-related orders or discipline, even though not overt insubordination’ will result in discipline.”

The NLRB said the rules above, while banning “insubordination,” also ban “conduct that does not rise to the level of insubordination, which reasonably would be understood as including protected concerted activity.”

  • Illegal: “Refrain from any action that would harm persons or property or cause damage to the Company’s business or reputation.”
  • Illegal: “[I]t is important that employees practice caution and discretion when posting content [on social media] that could affect [the Employer’s] business operation or reputation.”
  • Illegal: “Do not make ‘[s]tatements “that damage the company or the company’s reputation or that disrupt or damage the company’s business relationships.”‘”
  • Illegal: “Never engage in behavior that would undermine the reputation of [the Employer], your peers or yourself.”

The NLRB said the rules above “were unlawfully overbroad because they reasonably would be read to require employees to refrain from criticizing the employer in public.

  • Legal: “No ‘rudeness or unprofessional behavior toward a customer, or anyone in contact with’ the company.”
  • Legal: “Employees will not be discourteous or disrespectful to a customer or any member of the public while in the course and scope of [company] business.”

The NLRB said the rules above are legal because they wouldn’t lead an employee to believe they restrict criticism of the company.

  • Legal: “Each employee is expected to work in a cooperative manner with management/supervision, coworkers, customers and vendors.” The NLRB says employees would reasonably understand that this states the employer’s legitimate expectation that employees work together in an atmosphere of civility.
  • Legal: “Each employee is expected to abide by Company policies and to cooperate fully in any investigation that the Company may undertake.” The NLRB said this rule is legal because “employees would reasonably interpret it to apply to employer investigations of workplace misconduct rather than investigations of unfair labor practices or preparations for arbitration.”
  • Legal: “‘Being insubordinate, threatening, intimidating, disrespectful or assaulting a manager/supervisor, coworker, customer or vendor will result in’ discipline.” The NLRB said: “Although a ban on being  disrespectful’ to management, by itself, would ordinarily be found to unlawfully chill Section 7 criticism of the employer, the term here is contained in a larger provision that is clearly focused on serious misconduct, like insubordination, threats, and assault. Viewed in that context, we concluded that employees would not reasonably believe this rule to ban protected criticism.”

Rules regarding conduct between employees

  • Illegal: “‘[D]on’t pick fights’ online.”
  • Illegal: “Do not make ‘insulting, embarrassing, hurtful or abusive comments about other company employees online,’ and ‘avoid the use of offensive, derogatory, or prejudicial comments.'”
  • Illegal: “[S]how proper consideration for others’ privacy and for topics that may be considered objectionable or inflammatory, such as politics and religion.”
  • Illegal: “Do not send ‘unwanted, offensive, or inappropriate’ e-mails.”

The NLRB said the rules above were unlawfully overbroad because employees would reasonably construe them to restrict protected discussions with their co-workers.

  • Legal: “[No] ‘Making inappropriate gestures, including visual staring.'”
  • Legal: “Any logos or graphics worn by employees ‘must not reflect any form of violent, discriminatory, abusive, offensive, demeaning, or otherwise unprofessional message.'”
  • Legal: “[No] ‘[T]hreatening, intimidating, coercing, or otherwise interfering with the job performance of fellow employees or visitors.'”
  • Legal: “No ‘harassment of employees, patients or facility visitors.'”
  • Legal: “No ‘use of racial slurs, derogatory comments, or insults.'”

The NLRB said the rules above were legal because: “when an employer’s professionalism rule simply requires employees to be respectful to customers or competitors, or directs employees not to engage in unprofessional conduct, and does not mention the company or its management, employees would not reasonably believe that such a rule prohibits Section 7-protected criticism of the company.

SOURCE: Schappel, C. (18 July 2018) "30 employee handbook do’s and don’ts from the NLRB" (Web Blog Post). Retrieved from http://www.hrmorning.com/employee-handbook-dos-and-donts-from-the-nlrb/


Checklist: Updating your employee handbook

Employee handbooks can be confusing to prepare and revise. Ensure you don't miss any information when preparing or revising your company's employee handbook with this simple checklist:


When you are preparing or revising an employee handbook, this checklist may be helpful.

Acknowledgment

  • Do employees sign a signature page, confirming they received the handbook?
  • On the signature page, do employees agree to follow the policies in the handbook?
  • Does the signature page state that this handbook replaces any previous versions?
  • On the signature page, do employees agree that they will be “at-will” employees?
  • Do employees agree that the employer may change its policies in the future?

Wage and hour issues

  • Does the employer confirm that it will pay employees for all hours worked?
  • Before employees work overtime, are they required to obtain a supervisor’s approval?
  • During unpaid breaks, are employees completely relieved of all duties? (For example, while a receptionist takes an unpaid lunch break, this person shouldn’t be required to greet visitors or answer phone calls.)
  • Are employees paid when they attend a business meeting during lunch?
  • Are employees paid for attending in-service trainings?
  • Are employees paid while they take short breaks?

Paid Time Off

  • Has the employer considered combining vacation time, sick time, and personal time into one “bucket” of paid time off?
  • Does the paid time off policy line up with the employer’s business objectives? (For example, does it provide incentives for employees to use paid time off during seasons when business is slower?)
  • Does the handbook say what will happen to paid time off when employment ends? (In Pennsylvania, employers are not required to pay terminated employees for the value of their paid time off. Some employers choose to do this, as an incentive for employees to give at least two weeks’ notice.)
  • If the Family and Medical Leave Act (FMLA) applies to the employer, does the handbook inform employees of their rights?
  • Does the handbook list all types of leave that are available? (For example, does the employer offer bereavement leave? How about leave while an employee serves as a juror or witness? What about municipal laws that provide certain types of leave, such as paid sick leave?)

Reasonable accommodations

  • How should employees request a reasonable accommodation?
  • Does the employer permit employees with disabilities to bring service animals to work (Employers should avoid blanket policies that ban all animals.)
  • May employees deviate from grooming and uniform requirements for a religious reason, or a medical reason? (For example, an employee may have a religious reason to wear a headscarf, even if the employer has a blanket policy that would otherwise prohibit this.)

Discrimination and retaliation

  • Does the employer inform employees that they are protected against discrimination and retaliation?
  • Is there an accurate list of protected categories? (Confirm all locations where the employer does business. Some states or municipalities may provide employees with greater protection than federal law. Are there any categories, such as sexual orientation, that the employer should add?)
  • Do employees have a clear way to report discrimination and retaliation?
  • Is there more than one way to report discrimination and retaliation? (In other words, employees shouldn’t be required to make a report to the same person who they believe is committing acts of discrimination.)

Restrictive covenants/trade secrets

  • Are employees required to keep the employer’s information confidential?
  • Do employees confirm they are not subject to any restrictive covenants (such as non-compete agreements) that would limit their ability to work for the employer?
  • Are employees prohibited from giving the employer confidential information that belongs to a previous employer?

Labor law issues

  • If employees belong to a union, does the employer state that it doesn’t intend for the handbook to conflict with any collective bargaining agreement?
  • Does the employer have a content-neutral policy on soliciting and distributing materials in the workplace? (In general, if an employer wants to limit union-related communications, the employer must apply the same rules to solicitations which don’t involve a union.)
  • Does the handbook accurately reflect whether employees may wear union-related apparel, such as hats, buttons, T-shirts and lanyards?
  • Are employees permitted to discuss their wages with each other? (Some employers try to prohibit this, but the National Labor Relations Act entitles employees to discuss their wages with each other. This rule applies to all employers—whether or not they have a union.)

Other

  • If the employer has a progressive discipline policy, does the employer reserve the right to deviate from this policy?
  • Does the employer reserve the right to inspect company computers and email accounts?
  • Does the employer have a social media policy, or a medical marijuana policy?
  • If the employer has other policies, how do they fit together with the handbook? (Does it make sense to incorporate the policies into the handbook? Or, should the handbook clarify which other policies will remain in effect?)
  • Does the handbook contain any provisions that the employer is unlikely to enforce? (For example, does the handbook prohibit employees from using all social media? Does it prohibit employees from talking on the phone while driving?)

SOURCE: Lipkin, B (20 August 2018) "Checklist: Updating your employee handbook" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/08/20/is-your-employee-handbook-up-to-date-compare-it-wi/


4 actions HR departments should take to prepare for GDPR

In this article from Benefits Pro, we are going to take a look at the top four actions HR departments should take to prepare for GDPR. Continue reading:

A few years ago, Mark Cuban famously advised that data is the new gold. However, things have changed since the Cambridge Analytica and Facebook scandal as the public has become increasingly concerned with how companies are using their personal information.

As businesses prepare for the arrival of the General Data Protection Regulation (GDPR), leaders could be forgiven for thinking that data can become more of a liability than an asset – depending on its handling.

GDPR is a much-needed update to data protection that aims to strengthen and unify security for everyone in Europe. The legislation goes live on May 25, 2018 and will enforce all businesses to secure and manage the personal data of all individuals living within the European Union.

After years of gathering data, we are now entering a new era where trust and transparency are the new global currency. GDPR will affect all businesses that store any aspect of personally identifiable information of all individuals, both customer and employee, living in the EU, whether or not that business has an office there.

The scope of GDPR includes employee data, so it directly affects HR departments. As a result, companies need to update processes around the lifecycle of basic employee personal data such as health information and family details.There are many resources surrounding the topic; some on which include free, user-friendly materials published by the EU governments in addition to those that act as “scaremongers” seeking to try to trick companies into paying for compliance help. What makes it most difficult for HR professionals is interpreting the rule, which was written broadly to address any type of personal data and applying it to employee data and HR practices, specifically. Compliance cannot be achieved overnight or ready for the big “go live” in May either. An entirely new way of working to understand where every aspect of data is obtained, how it is used, and where it is stored needs to be put in place. In short, this is not a job for the IT department alone, but rather requires a highly collaborative effort across the company. Silos will need to be broken down to efficiently unify all departments such as sales, marketing, finance, IT, and legal to understand the scale of how much data businesses are actively storing. But what do HR professionals need to know?

1. Create new or updated privacy policies
New privacy policies likely need to be created and implemented to reflect the new rights of employees. Equally, all existing policies should to be reviewed to determine which ones require updating to fall in line with GDPR’s transparency and accountability requirements.

In addition, a key difference between the current EU data rules and the GDPR is the emphasis on individual rights. Employees can now request that their data be completely erased at any time or request a copy of their data thats on file. HR teams need to be prepared to uphold these demands.

2. Revisit outdated processes
Reviewing HR processes, like onboarding a new employee, will help reveal what data you’re collecting that you don’t necessarily have a need for. Minimization is key to successful GDPR compliance; less is more. Implementing minimization will likely require you to update protocols and rethink processes that include the requesting of personal data from employees. For example, the onboarding and transfer of employees will need to be revisited to ensure that data collection practices meet GDPR requirements. You may also need to revisit your record retention policies and processes for ex-employees.

Ask your partners and vendors for their GDPR and compliance plan as risk is shared when they handle employee data on your behalf…

3. Allow data access only to those who really need it
The rise of shadow IT and sensitive data being increasingly stored in the public cloud combined with malware in cloud SaaS applications are the more significant concerns. CIOs and IT leaders now have the power to implement stronger cybersecurity and secure data-management policies that will protect personal data now and in the future. Security elements of the legislation demand that appropriate technical and organizational measures are taken to ensure all employee data is kept safe. HR’s responsibility is to ensure that only those who need access to personal data to do their job have access to it. Making sure that the right people have the appropriate access levels within a digital HR platform – or keys to the file cabinet – is the secret to successful compliance.

4. Centralize your employee file management
Learning about and documenting every element of employee data, where it is stored, and who has access is a process made much easier with centralized digital files. Going forward, a digital system makes it possible for HR to implement and internally audit procedures that will ultimately provide them with the visibility into compliance as well as potential vulnerabilities. GDPR and employee expectations means companies need to shift from a reactive to a proactive approach. A digital system is necessary to enable HR with visibility across their data, securely manage access to the data and implement at scale and policy changes.. With GDPR, the stakes are increasing yet again for companies; HR now must think about collecting the least amount of data they need to get the job done and being completely transparent around its usage, rather than burying this information in complicated terms and conditions. Sure, this will dramatically change the way companies globally deal with EU citizens’ data, but it’s something to be embraced rather than feared. By showcasing implementation of these new data protection practices, a brand can actually build its reputation. While board members might fear the ramifications of the GDPR, we all know that the breach of company data is something far worse. For these reasons alone, GDPR should be seen as an opportunity for every employee to focus on protecting their personal data or at least understanding their responsibilities. And for employers, take this opportunity to become more open to a review of outdated practices and investing in and building technology that can complement this forward thinking approach. Data protection compliance is now an on-going priority and its beneficial for all to take seriously.

Source:
Gouchan A. (4 May 2018). "4 actions HR departments should take to prepare for GDPR" [web blog post]. Retrieved from address http://bit.ly/2wl6ZwU


CenterStage: Traditional IRA, Roth IRA, 401(k), 403(b): What’s the Difference?

In this month’s CenterStage article, we are going to take a look at the difference between traditional IRA, Roth IRA, 401(k), 403(b), curtesy of Kevin Hagerty, a Financial Advisor at Saxon.

The earlier you begin planning for retirement, the better off you will be. However, the problem is that most people don’t know how to get started or which product is the best vehicle to get you there.

A good retirement plan usually involves more than one type of savings account for your retirement funds. This may include both an IRA and a 401(k) allowing you to maximize your planning efforts.

If you haven’t begun saving for retirement yet, don’t be discouraged. Whether you begin through an employer sponsored plan like a 401(k) or 403(b) or you begin a Traditional or Roth IRA that will allow you to grow earnings from investments through tax deferral, it is never too late or too early to begin planning.

This article discusses the four main retirement savings accounts, the differences between them and how Saxon can help you grow your nest egg.

“A major trend we see is that if people don’t have an advisor to meet with, they tend to invest too conservatively because they are afraid of making a mistake,” said Kevin. “Then the problem is that they don’t revisit it and if you’re not taking on enough risk you’re not giving yourself enough opportunity for growth. Then you run the risk that your nest egg might not grow to what it should be.”

“Saxon is here to help people make the best decision on how to invest based upon their risk tolerance. We have questionnaires to determine an individual’s risk factors, whether it be conservative, moderate or aggressive and we make sure to revisit these things on an ongoing basis.”

Traditional IRA vs. Roth IRA

Who offers the plans?

Both Traditional and Roth IRAs are offered through credit unions, banks, brokerage and mutual fund companies. These plans offer endless options to invest, including individual stocks, mutual funds, etc.

 

Eligibility

Anyone with earned, W-2 income from an employer can contribute to Traditional or Roth IRAs as long as you do not exceed the maximum contribution limits.

With Traditional and Roth IRAs, you can contribute while you have earned, W-2 income from an employer. However, any retirement or pension income doesn’t count.

Tax Treatment

With a Traditional IRA, typically contributions are fully tax-deductible and grow tax deferred so when you take the money out at retirement it is taxable. With a Roth IRA, the money is not tax deductible but grows tax deferred so when the money is taken out at retirement it will be tax free.

“The trouble is that nobody knows where tax brackets are going to be down the road in retirement. Nobody can predict with any kind of certainty because they change,” explained Kevin. “That’s why I’m a big fan of a Roth.”

“A Roth IRA can be a win-win situation from a tax standpoint. Whether the tax brackets are high or low when you retire, who cares? Because your money is going to be tax free when you withdraw it. Another advantage is that at 70 ½ you are not required to start taking money out. So, we’ve seen Roth IRA’s used as an estate planning tool, as you can pass it down to your children as a part of your estate plan and they’ll be able to take that money out tax free. It’s an immense gift,” Kevin finished.

Maximum Contribution Limits

Contribution limits between the Traditional and Roth IRAs are the same; the maximum contribution is $5,500, or $6,500 for participants 50 and older.

However, if your earned income is less than $5,500 in a year, say $4,000, that is all you would be eligible to contribute.

“People always tell me ‘Wow, $5,500, I wish I could do that. I can only do $2,000.’ Great, do $2,000,” explained Kevin. “I always tell people to do what they can and then keep revisiting it and contributing more when you can. If you increase a little each year, you will be contributing $5,500 eventually and not even notice.”

Withdrawal Rules

With a Traditional IRA, withdrawals can begin at age 59 ½ without a 10% early withdrawal penalty but still with Federal and State taxes. The Federal and State government will mandate that you begin withdrawing at age 70 ½.

Even though most withdrawals are scheduled for after the age of 59 ½, a Roth IRA has no required minimum distribution age and will allow you to withdraw contributions at any time. So, if you have contributed $15,000 to a Roth IRA but the actual value of it is $20,000 due to interest growth, then the contributed $15,000 could be withdrawn with no penalty.

 

 

Employer Related Plans – 401(k) & 403(b)

A 401(k) and a 403(b) are theoretically the same thing; they share a lot of similar characteristics with a Traditional IRA as well.

Typically, with these plans, employers match employee contributions .50 on the dollar up to 6%. The key to this is to make sure you are contributing anything you can to receive a full employer match.

Who offers the plans?

The key difference with these two plans lies in if the employer is a for-profit or non-profit entity. These plans will have set options of where to invest, often a collection of investment options selected by the employer.

Eligibility

401(k)’s and 403(b)’s are open to all employees of the company for as long as they are employed there. If an employee leaves the company they are no longer eligible for these plans since 401(k) or 403(b) contributions can only be made through pay roll deductions. However, you can roll it over into an IRA and then continue to contribute on your own.

Only if you take possession of these funds would you pay taxes on them. If you have a check sent to you and deposit it into your checking account – you don’t want to do that. Then they take out federal and state taxes and tack on a 10% early withdrawal penalty if you are not age 59 ½. It may be beneficial to roll a 401(k) or 403(b) left behind at a previous employer over to an IRA so it is in your control.

Tax Treatment

Similar to a Traditional IRA, contributions are made into your account on a pretax basis through payroll deduction.

Maximum Contribution Limits

The maximum contribution is $18,000, or $24,000 for participants 50 and older.

Depending on the employer, some 401(k) and 403(b) plans provide loan privileges, providing the employee the ability to borrow money from the employer without being penalized.

Withdrawal Rules

In most instances, comparable to a Traditional IRA, withdrawals can begin at age 59 ½ without a 10% early withdrawal penalty. Federal and State government will mandate that you begin withdrawing at age 70 ½. Contributions and earnings from these accounts will be taxable as ordinary income. There are certain circumstances when one can have penalty free withdrawals at age 55, check with your financial or tax advisor.

In Conclusion…

“It is important to make sure you are contributing to any employer sponsored plan available to you so that you are receiving the full employer match. If you have extra money in your budget and are looking to save additional money towards retirement, that’s where I would look at beginning a Roth IRA. Then you can say that you are deriving the benefits of both plans – contributing some money on a pretax basis, lowering federal and state taxes right now, getting the full employer contribution match and then saving some money additionally in a Roth that can provide tax free funds/distributions down the road,” finished Kevin.

 

Editor’s Note: This article was originally published in June 2017 and was updated in January 2018 for accuracy.


FREE ACA RESOURCES FOR SMALL BUSINESSES

From The ACA Times, we've pulled this article that lists out some helpful resources for small businesses.


The federal government provides free online resources to help small businesses better understand the requirements of the Affordable Care Act (ACA) and how they might be able to offer health insurance to their employees. Here are some we thought might be helpful.

How the Affordable Care Act affects small businesses: This web page hosted by HealthCare.gov explains how the ACA can impact a small business with 1 to 50 full-time equivalent employees.

SHOP Guide: This web page on Healthcare.gov provides information for small businesses on how they can offer a Small Business Health Options Program (SHOP) insurance to their employees. The web page has links to help businesses learn more about SHOP and whether they qualify to offer such coverage to employees.

The Small Business Health Care Tax Credit: Healthcare.gov, the Taxpayer Advocate Service and the IRS both provide web pages that provide information that helps small businesses determine if they are eligible to take advantage of tax credits if they offer SHOP to their employees.

The Future of SHOP: The Centers for Medicare and Medicaid Services (CMS) is providing information on how CMS will be exploring a more efficient implementation of the Federally-facilitated SHOP Marketplaces in order to promote insurance company and agent/broker participation and make it easier for small employers to offer SHOP plans to their employees, while maintaining access to the Small Business Health Care Tax Credit.

 

Read the original article here.

Source:
Sheen R. (21 November 2017). "FREE ACA RESOURCES FOR SMALL BUSINESSES" [Web blog post]. Retrieved from address https://acatimes.com/free-aca-resources-for-small-businesses/


5 ways digital tools can help build a better benefits package

"...digital tools can be excellent motivators and are a popular option for keeping employees to their wellness objectives..." In this article from Employee Benefit Advisor, we get a fantastic look at some statistics and digital tools to create better employee engagement.


The American workforce has an employee engagement problem: Half of U.S. workers are disengaged, according to a recent Gallup poll. That not only has a detrimental effect on individual wellness, but on company culture and the bottom line. According to The Engagement Institute, disengaged employees cost organizations between $450 and $550 billion every year. In addition to being less productive, they’re also more likely to quit.

One of the most effective ways to improve employee engagement is to offer better benefits. In fact, research conducted by Willis Towers Watson found 75% of employees said they were more likely to stay with their employer because of their benefit program. This demonstrates the value of designing an employee benefits package that really works for your staff. And to even better engage workers with benefits, employers should utilize HR apps and employee wellness software.

They vary in functionality, device compatibility, and of course price, but they all share five considerable advantages:

They’re highly adaptable. Unlike programs that rely on in-person use or resources that are primarily stored in binders, digital content can be updated on the fly. This flexibility makes it very easy to keep the information current and relevant, and it even opens the door to personalized benefits. For instance, if each employee has their own login, they can bookmark the resources they find most useful and receive suggestions based on those picks. Seventy-two percent of employees in a MetLife survey say being able to customize their benefits would increase their loyalty to their current employer, which makes this perk doubly advantageous.

They’re fully integrative. One major complaint employees have is that their health information is so disjointed. Dental, physical, psychological and nutritional data is siloed, creating a cumbersome situation for employees when it comes to accessing and updating their records. Digital tools neatly solve this problem by collecting all these resources in one place. All employees have to do is sign into one account to view all their health-related resources, benefits, emergency phone numbers, enrolment information, health savings account balance and so on.

They’re constantly accessible. Have you noticed your staff using fewer and fewer benefits over time? It’s easy to assume they’ve lost interest, but chances are they’ve simply forgotten what’s available to them. Digital tools are a fantastic way of combating that attrition for a couple of reasons. First, they’re super easy to access because they can be used essentially anytime, anywhere. The second reason your staff is more likely to continue using their benefits with a digital platform is because it can serve them with notifications and reminders. They no longer have the excuse of being unaware when fresh content is added, or missing medical appointments.

They encourage employee goals. To add to the previous point, digital tools can be excellent motivators and are a popular option for keeping employees to their wellness objectives. Two of the most common goals are weight loss and smoking cessation, but your employees can use calendar, reminders, notes, fitness trackers and other features to push them toward any goal they like.

They’re easily scalable. Finally, digital tools are the most efficient way of reaching a large employee base, especially if they’re spread over a large geographical distance. It’s impossible to expect a thousand employees located in different states to attend a stress management seminar, for example, but it’s not unreasonable to ask them to watch a five minute video or listen to a podcast. Digital resources are changing the game when it comes to reaching all employees equally so that no one gets left behind.

Some things to keep in mind

Now that you’ve been convinced to digitize your employee wellness program, there are a couple of assurances you should make. The first is confidentiality. Your employees need to feel safe accessing your health resources, so guaranteeing the security and privacy of their information is a must. You should also make accommodations for various accessibility concerns. In other words, having all your resources in video format isn’t helpful for employees who are visually impaired. Also be aware of the different situations in which your staff might need access (at home, on the go, with or without an internet connection, etc) to ensure maximum ease of use.

Why is this all so important? As cool and cutting-edge as many of these digital tools are, at the end of the day your goal is to promote employee well-being and engagement. Anything that encourages your staff to come into work with a smile on their faces is worthwhile. Gallup studies have shown highly engaged organizations are 21% more profitable, 17% more productive, and achieve a 41% reduction in absenteeism. No matter how effective your current benefits package is, you can — and should — take it to the next level with a digital program.

 

Read the original article.

Source:
Mittag A. (17 November 2017). "5 ways digital tools can help build a better benefits package" [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/5-ways-digital-tools-can-help-build-a-better-benefits-package?feed=00000152-1387-d1cc-a5fa-7fffaf8f0000

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I Have Life Insurance Through My Employer. Why Do I Need Another Policy?

Life Happens in a Heartbeat - Stay Prepared With Saxon Life Insurance.

Although it is a subject no one wants to talk about, Life Insurance may be one of the best purchases you ever make.

Have you considered what would happen if you were not there to take care of your loved ones?  Life insurance plans are about preparing for the unexpected. While nothing can replace you, having Life Insurance helps ensure that your family and loved ones would be financially stable if anything was to ever happen to you. Check out this article from Life Happens on the importance of obtaining Life Insurance - even if it's already offered through your employer.

 


One of the perks of having a full-time job with a good company is the benefits package that comes with it. Often, those benefits include life insurance coverage, which is great. And everyone who can get life insurance at work should definitely take it, as there are many advantages to company-funded life insurance, also known as group life insurance. These advantages include:

1. Easy qualification. Often, enrollment into group life insurance is automatic. That means everyone qualifies, as there is no medical exam required. So people who have preexisting health conditions, like diabetes or previous heart attack, can get life insurance at work, and may get a better rate compared with what an individual life insurance policy might cost them.

2. Lower costs. Employers’ insurance plans tend to be paid for or subsidized by the company, giving you life insurance at a low cost or even free. You may even have the option to buy additional coverage at low rates. Costs tend to be lower for many people because with group plans, the cost per individual goes down as the plan enlarges.

3. Convenience. It’s easy to subscribe to an employer’s life insurance plan without much effort on your part and if a payment is required, it’s easily deducted from your paycheck in much the same way as your medical costs are deducted.

These are all great advantages, but are these the only considerations that matter when it comes to life insurance? The answer, of course, is no.

Life insurance should first and foremost fit the purpose—it should meet your needs.

Life insurance should first and foremost fit the purpose—it should meet your needs. And the primary purpose of life insurance is to care for those left behind in the event of your death. With group life insurance, it’s often set at one or two times your annual salary, or a default amount such as $25,000 or $50,000. While this sounds like a lot of money, just think of how long that would last your loved ones. What would they do once that ran out?

There are several other disadvantages to relying on group insurance alone:

1. If your job situation changes, you’ll lose your coverage. Whether the change results from being laid off, moving from full-time to part-time status or leaving the job, in most cases, an employee can’t retain their policy when they leave their job.

2. Coverage may end when you retire or reach a specific age. Many people tend to lose their insurance coverage when they continue working past a specified age or when they retire. This means losing your insurance when you need it most.

3. Your employer can change or terminate the coverage. And that can be without your consent, since the contract is between your employer and the insurer.

4. Your options are limited. This type of coverage is not tailored to your specific needs. Furthermore, you may not be able to buy as much coverage as you need, leaving you exposed.

Importance of Buying a Separate Life Insurance Policy
It’s for these reasons you should get an individual life insurance policy that you personally own, in addition to any group life insurance you have. Individual life insurance plans offer superior benefits, and regardless of your employer or employment status, they remain in place and can be tailored to meet your needs and circumstances.

Most importantly, an individual life insurance policy will fit the purpose for which you purchase it—to ensure your dependents continue to have the financial means to keep their home and lifestyle in the unfortunate event that you’re no longer there to care for them.

Don't wait to protect your livelihood. Set up an appointment with one of our life insurance specialists here at Saxon by clicking this link.

Source:

Medina F. (19 June 2017). "I Have Life Insurance Through My Employer. Why Do I Need Another Policy?" [Web blog post]. Retrieved from address http://www.lifehappens.org/blog/i-have-life-insurance-through-my-employer-why-do-i-need-another-policy/


CenterStage: Fee-Based vs Commission-Based Advisors: What You Should Know

“After almost 30 years of working in the business, the most important question to ask,” Garry Rutledge, AIF®, a Fee Based Advisor with Saxon, explained, “is do you trust that person to make decisions in your best interest or in theirs?”

In this month’s CenterStage article, we sat down with Garry to get the lowdown on what to expect from both fee-based financial advisors and commission-based advisors.

When Is a Commission-Based Advisor a Better Choice than a Fee-Based Advisor?

A commission-based advisor receives compensation for transactional business, usually at the point of sale, with a small annual fee to encourage advisor engagement. A client rarely knows the commission amount until the transaction is completed.

Garry mentioned, “those who purchase investments for the long term are better off choosing a commission-based advisor, who won’t pursue the client for information and bombard you with advice.”

Also, if you are a do-it-yourselfer when it comes to investing, a commission-based advisor is a great fit for you.

When Is a Fee-Based Advisor a Better Choice than a Commission-Based Advisor?

A fee-based advisor tends to value relationship’s over transactions. This results in, typically, a more involved and hands on process, because positive results increase the value of client’s portfolio.  A fee-based advisor takes a consultative approach to managing client’s assets and is more likely to offer a broader scope of advice than compared to a commission based advisor.

A fee-based advisor works for the relationship resulting in little or no bias to an investment or its sponsor, as it relates to compensation, vs a commission-based advisor who may consider the compensation when making a decision when weighing similar products.

What Are You Paying Your Financial Advisor?

There are three means of advisor compensation:

  1. Commission for products or transactions
  2. A percentage of assets an advisor manages
  3. A hybrid between method 1 and 2

 

It’s imperative to know which method your advisor utilizes.  This knowledge allows you to determine if you are receiving advice commensurate with the value provided.  A Commissioned advisor, after making a sale, generally has no interest in what the outcome is because they have received compensation vs a fee based advisor who must build trust with clients to maintain a meaningful relationship.

Garry very rarely utilizes the hybrid model when working with clients.  However, in keeping with his philosophy of doing right by his clients, there are times when he must employ this model.  Garry points out, “at times, an alternative investment that is a complimentary piece of a client’s portfolio is not available on a fee basis, in which circumstance dictates that I receive a commission.  In full disclosure, my clients realize when this happens and exactly what their charge will be.”

 

As a means of building relationships, Garry has and is focused on sustaining the fee based practice he has built and continues to build through client referrals.  Garry’s fees range from 1% to .5%, depending on the assets and complexity of a client case.  With this knowledge, clients know what their expenses will be up front.

 

The length of his client relationships is a testament that fee based advising is successful in building a solid financial advisory firm.

 

In the end, the client must determine what works for them, as far as how they will compensate the advisor. If a client wants to be transactional, commission is the way to proceed; but if an ongoing relationship is a requirement, a fee-based advisor is the best path for them.

 

More About Garry

 

Garry joined Saxon in August of 2006 and his focus has been the strategic management of client assets with tax minimization and capital preservation as the foundation of his planning strategy.

Since graduating from Wright State University in 1988 with a degree in Finance, Garry has worked for two respected firms.  Garry holds Series 7 & 63 securities licenses, and his Life & Health license, along with achieving the professional AIF (Accredited Independent Fiduciary) designation.

 

You can contact Garry via email, phone, or connect with him on LinkedIn.

 

These are the opinions of Garry Rutledge and not necessarily those of Cambridge; they are for informal purposes only, and should not be construed or acted upon as individualized investment advice. All investing involves risk. Depending on the types of investments, there may be varying degrees of risk. Investors should be prepared to bear loss, including total loss of principal.

 

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Health Care Sector Earnings: Major Companies Open The Books On Q3 Results In Weeks Ahead

In the weeks ahead, some major companies begin to showcase their Q3 results. Check out this article for some insight on the situation written by JJ Kinahan of Forbes.
You can read the original article here.

Photo Credit: Shutterstock

The health care sector has been one of the better-performing sectors in 2017, bouncing back after being the only sector in the S&P 500 to finish last year in the red. So far this year, the S&P Health Care Select Sector Index is outperforming the S&P 500 by 5.75% as of October 6.

The sector got a bump recently when Republicans’ released an initial framework for tax reform, with CNBC pointing out that some of the largest companies in the health care sector could be primary beneficiaries of the proposed repatriation tax break. For the sector’s upcoming earnings, analyst estimates are calling for low to mid-single-digit growth for both earnings and revenue.

Within the S&P 500, the health care sector is expected to report year-over-year revenue growth of 4.8% and earnings growth of 2.5%, according to FactSetwith profit margins estimated to decline from 10.3% to 10.1% across the sector. Those estimates are slightly below the sector’s estimated revenue and earnings growth rates expected for the full year.

Beyond the proposed tax reform, below we’ll take a look at what’s been happening in the sector as companies prepare to report earnings in the upcoming weeks.

S&P Health Care Sector Index compared to S&P 500 and Nasdaq Biotechnology Indexthinkorswim

After underperforming by a large margin in 2016, the health care sector has been recovering in 2017. The S&P Health Care Select Sector Index, charted above, is up 18.49% year-to-date, compared to a 12.74% increase in the S&P 500, the teal line. The Nasdaq Biotechnology Index, the purple line, has outperformed both and climbed 25.6% year-to-date. Chart source: thinkorswim® by TD Ameritrade. Data source: Standard & Poor’s. Not a recommendation. For illustrative purposes only. Past performance does not guarantee future results.

Biotech Industry Outperforming

So far this year, the biotechnology industry has outpaced the broader health care sector, with the Nasdaq Biotechnology Index up 25.6% versus a 18.49% increase in the S&P Health Care Select Sector Index. However, looking at 2016, the Nasdaq Biotechnology Index fared far worse than the S&P Health Care Select Sector Index, declining 22.01% when the latter only declined 4.37%.

Stocks in the biotech industry are notoriously volatile and it can take many years, even decades, for a company to undergo research and development, and the clinical trial process. A 2014 study by Tufts University’s Center for the Study of Drug Development found that only 11.8% of drugs that enter clinical trials end up being approved by the FDA.

Washington on Health Care

Drug pricing scrutiny has been an ongoing focus in Congress, but there’s yet to be concrete legislation pushed forward to address the issue. Dr. Scott Gottlieb, the head of the Food and Drug Administration (FDA), recently said high drug prices are a “public health concern” and in a post on the FDA’s official blog, outlined several steps the agency is taking to make the generic approval process for complex drugs easier.

On October 17, the Senate Health Committee is scheduled to hold a second hearing as part of its investigation into high drug prices. Representatives from drug company and pharmacy benefit managers—essentially middle men between pharmacies and drug companies—have been invited to speak before the panel. Depending on how that hearing goes, there could be heightened volatility in healthcare stocks.

Due to the costly process of developing drugs, companies often go to great lengths to protect patents. Those practices have also started to come into scrutiny in Congress as well. Allergan announced last month it had transferred the patent rights for its drug Restasis to the St. Regis Mohawk Indian Nation, which would license them back to Allergan in exchange for ongoing payments to the tribe.

The tribe’s sovereign immunity would potentially shield the drug from certain patent reviews. “Allergan has argued that the legal maneuver is aimed at removing administrative patent challenges through inter partes review by the U.S. Patent Trial and Appeal Board, and not challenges in federal court”, according to Reuters.Shortly after Allergan transferred the patent rights, U.S. Senator Claire McCaskill quickly announced she had drafted a bill to prevent tribal sovereign immunity from being used to block U.S. Patent and Trademark Office review of a patent in response to the move.

Aging Demographics and More Disease as Population Grows

There are some trends that analysts anticipate to be tailwinds for the sector for years to come. One of them is aging demographics and the other is growth of certain diseases. Approximately 10,000 baby boomers turn 65 every day, according to Pew Research, and that trend is expected to continue until 2030, when the last of the boomers reach retirement age and roughly 18% of the U.S. population is projected to be 65 and older.

As world populations grow and age, certain diseases are expected to have a greater prevalence than others and a large portion of health care spending is likely to go towards them. By 2020, Deloitte projects that 50% of global health care expenditures, about $4 trillion, will be spent on cardiovascular diseases, cancer and respiratory diseases.

These trends could be a tailwind for healthcare companies, but at the same time a lot could change in the regulatory environment as well as with the treatments available in the years ahead.

Looking Ahead to Earnings

The first major company in the sector to report earnings is Johnson & Johnson, which will release results before market open on Tuesday, October 17. The following companies report later in the month: Eli Lilly & Co. before market open on Tuesday, October 24, Gilead Sciences after market close on Thursday, October 26, Merck before market open on Friday, October 27 and Pfizer before market open on Tuesday, October 31.

 

You can read the original article here.

Source:

Kinahan J. (10 October 2017). "Health Care Sector Earnings: Major Companies Open The Books On Q3 Results In Weeks Ahead" [Web Blog Post]. Retrieved from address https://www.forbes.com/sites/jjkinahan/2017/10/10/health-care-sector-earnings-major-companies-open-the-books-on-q3-results-in-weeks-ahead/#417bef6a44bb


The Medicare Part D Prescription Drug Benefit

Below we have an article from the Kaiser Family Foundation providing detailed information and graphics on the benefit of the Medicare Prescription Drug Plan.

You can read the original article here.


Medicare Part D is a voluntary outpatient prescription drug benefit for people on Medicare that went into effect in 2006. All 59 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Part D drug benefit through private plans approved by the federal government; in 2017, more than 42 million Medicare beneficiaries are enrolled in Medicare Part D plans. During the Medicare Part D open enrollment period, which runs from October 15 to December 7 each year, beneficiaries can choose to enroll in either stand-alone prescription drug plans (PDPs) to supplement traditional Medicare or Medicare Advantage prescription drug (MA-PD) plans (mainly HMOs and PPOs) that cover all Medicare benefits including drugs. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. This fact sheet provides an overview of the Medicare Part D program and information about 2018 plan offerings, based on data from the Centers for Medicare & Medicaid Services (CMS) and other sources.

Medicare Prescription Drug Plan Availability in 2018

In 2018, 782 PDPs will be offered across the 34 PDP regions nationwide (excluding the territories). This represents an increase of 36 PDPs, or 5%, since 2017, but a reduction of 104 plans, or 12%, since 2016 (Figure 1).

Beneficiaries in each state will continue to have a choice of multiple stand-alone PDPs in 2018, ranging from 19 PDPs in Alaska to 26 PDPs in Pennsylvania/West Virginia (in addition to multiple MA-PD plans offered at the local level) (Figure 2).

Low-Income Subsidy Plan Availability in 2018

Through the Part D Low-Income Subsidy (LIS) program, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes (less than 150% of poverty, or $18,090 for individuals/$24,360 for married couples in 2017) and modest assets (less than $13,820 for individuals/$27,600 for couples in 2017).1

In 2018, 216 plans will be available for enrollment of LIS beneficiaries for no premium, a 6% decrease in premium-free (“benchmark”) plans from 2017 and the lowest number of benchmark plans available since the start of the Part D program in 2006. Roughly 3 in 10 PDPs in 2018 (28%) are benchmark plans (Figure 3).

Low-Income Subsidy Plan Availability in 2018

Through the Part D Low-Income Subsidy (LIS) program, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes (less than 150% of poverty, or $18,090 for individuals/$24,360 for married couples in 2017) and modest assets (less than $13,820 for individuals/$27,600 for couples in 2017).1

In 2018, 216 plans will be available for enrollment of LIS beneficiaries for no premium, a 6% decrease in premium-free (“benchmark”) plans from 2017 and the lowest number of benchmark plans available since the start of the Part D program in 2006. Roughly 3 in 10 PDPs in 2018 (28%) are benchmark plans (Figure 3).

Benchmark plan availability varies at the Part D region level, with most regions seeing a reduction of 1 benchmark plan for 2018 (Figure 4). The number of premium-free plans in 2018 ranges from a low of 2 plans in Florida to 10 plans in Arizona and Delaware/Maryland/Washington D.C.

Part D Plan Premiums and Benefits in 2018

Premiums. According to CMS, the 2018 Part D base beneficiary premium is $35.02, a modest decline of 2% from 2017.2 Actual (unweighted) PDP monthly premiums for 2018 vary across plans and regions, ranging from a low of $12.60 for a PDP available in 12 out of 34 regions to a high of $197 for a PDP in Texas.

Part D enrollees with higher incomes ($85,000/individual; $170,000/couple) pay an income-related monthly premium surcharge, ranging from $13.00 to $74.80 in 2018 (depending on their income level), in addition to the monthly premium for their specific plan.3 According to CMS projections, an estimated 3.3 million Part D enrollees (7%) will pay income-related Part D premiums in 2018.

Benefits. In 2018, the Part D standard benefit has a $405 deductible and 25% coinsurance up to an initial coverage limit of $3,750 in total drug costs, followed by a coverage gap. During the gap, enrollees are responsible for a larger share of their total drug costs than in the initial coverage period, until their total out-of-pocket spending in 2018 reaches $5,000 (Figure 5).

After enrollees reach the catastrophic coverage threshold, Medicare pays for most (80%) of their drug costs, plans pay 15%, and enrollees pay either 5% of total drug costs or $3.35/$8.35 for each generic and brand-name drug, respectively.

The standard benefit amounts are indexed to change annually by rate of Part D per capita spending growth, and, with the exception of 2014, have increased each year since 2006 (Figure 6).

Part D plans must offer either the defined standard benefit or an alternative equal in value (“actuarially equivalent”), and can also provide enhanced benefits. But plans can (and do) vary in terms of their specific benefit design, cost-sharing amounts, utilization management tools (i.e., prior authorization, quantity limits, and step therapy), and formularies (i.e., covered drugs). Plan formularies must include drug classes covering all disease states, and a minimum of two chemically distinct drugs in each class. Part D plans are required to cover all drugs in six so-called “protected” classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics.

In 2018, almost half (46%) of plans will offer basic Part D benefits (although no plans will offer the defined standard benefit), while 54% will offer enhanced benefits, similar to 2017. Most PDPs (63%) will charge a deductible, with 52% of all PDPs charging the full amount ($405). Most plans have shifted to charging tiered copayments or varying coinsurance amounts for covered drugs rather than a uniform 25% coinsurance rate, and a substantial majority of PDPs use specialty tiers for high-cost medications. Two-thirds of PDPs (65%) will not offer additional gap coverage in 2018 beyond what is required under the standard benefit. Additional gap coverage, when offered, has been typically limited to generic drugs only (not brands).

The 2010 Affordable Care Act gradually lowers out-of-pocket costs in the coverage gap by providing enrollees with a 50% manufacturer discount on the total cost of their brand-name drugs filled in the gap and additional plan payments for brands and generics. In 2018, Part D enrollees in plans with no additional gap coverage will pay 35% of the total cost of brands and 44% of the total cost of generics in the gap until they reach the catastrophic coverage threshold. Medicare will phase in additional subsidies for brands and generic drugs, ultimately reducing the beneficiary coinsurance rate in the gap to 25% by 2020.

Part D and Low-Income Subsidy Enrollment

Enrollment in Medicare drug plans is voluntary, with the exception of beneficiaries who are dually eligible for both Medicare and Medicaid and certain other low-income beneficiaries who are automatically enrolled in a PDP if they do not choose a plan on their own. Unless beneficiaries have drug coverage from another source that is at least as good as standard Part D coverage (“creditable coverage”), they face a penalty equal to 1% of the national average premium for each month they delay enrollment.

In 2017, more than 42 million Medicare beneficiaries are enrolled in Medicare Part D plans, including employer-only group plans.4 Of this total, 6 in 10 (60%) are enrolled in stand-alone PDPs and 4 in 10 (40%) are enrolled in Medicare Advantage drug plans. Medicare’s actuaries estimate that around 2 million other beneficiaries in 2017 have drug coverage through employer-sponsored retiree plans where the employer receives subsidies equal to 28% of drug expenses between $405 and $8,350 per retiree in 2018 (up from $400 and $8,250 in 2017).5 Several million beneficiaries are estimated to have other sources of drug coverage, including employer plans for active workers, FEHBP, TRICARE, and Veterans Affairs (VA). Yet an estimated 12% of Medicare beneficiaries lack creditable drug coverage.

Twelve million Part D enrollees are currently receiving the Low-Income Subsidy. Beneficiaries who are dually eligible, QMBs, SLMBs, QIs, and SSI-onlys automatically qualify for the additional assistance, and Medicare automatically enrolls them into PDPs with premiums at or below the regional average (the Low-Income Subsidy benchmark) if they do not choose a plan on their own. Other beneficiaries are subject to both an income and asset test and need to apply for the Low-Income Subsidy through either the Social Security Administration or Medicaid.

Part D Spending and Financing in 2018

The Congressional Budget Office (CBO) estimates that spending on Part D benefits will total $92 billion in 2018, representing 15.5% of net Medicare outlays in 2018 (net of offsetting receipts from premiums and state transfers). Part D spending depends on several factors, including the number of Part D enrollees, their health status and drug use, the number of enrollees receiving the Low-Income Subsidy, and plans’ ability to negotiate discounts (rebates) with drug companies and preferred pricing arrangements with pharmacies, and manage use (e.g., promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order). Federal law prohibits the Secretary of Health and Human Services from interfering in drug price negotiations between Part D plan sponsors and drug manufacturers.6

Financing for Part D comes from general revenues (78%), beneficiary premiums (13%), and state contributions (9%). The monthly premium paid by enrollees is set to cover 25.5% of the cost of standard drug coverage. Medicare subsidizes the remaining 74.5%, based on bids submitted by plans for their expected benefit payments. Part D enrollees with higher incomes ($85,000/individual; $170,000/couple) pay a greater share of standard Part D costs, ranging from 35% to 80%, depending on income.

According to Medicare’s actuaries, in 2018, Part D plans are projected to receive average annual direct subsidy payments of $353 per enrollee overall and $2,353 for enrollees receiving the LIS; employers are expected to receive, on average, $623 for retirees in employer-subsidy plans.7 Part D plans’ potential total losses or gains are limited by risk-sharing arrangements with the federal government (“risk corridors”). Plans also receive additional risk-adjusted payments based on the health status of their enrollees and reinsurance payments for very high-cost enrollees.

Under reinsurance, Medicare subsidizes 80% of drug spending incurred by Part D enrollees above the catastrophic coverage threshold. In 2018, average reinsurance payments per enrollee are estimated to be $941; this represents a 7% increase from 2017. Medicare’s reinsurance payments to plans have represented a growing share of total Part D spending, increasing from 16% in 2007 to an estimated 41% in 2018.8 This is due in part to a growing number of Part D enrollees with spending above the catastrophic threshold, resulting from several factors, including the introduction of high-cost specialty drugs, increases in the cost of prescriptions, and a change made by the ACA to count the 50% manufacturer discount in enrollees’ out-of-pocket spending that qualifies them for catastrophic coverage. Analysis from MedPAC also suggests that in recent years, plans have underestimated their enrollees’ expected costs above the catastrophic coverage threshold, resulting in higher reinsurance payments from Medicare to plans over time.

Issues for the Future

After several years of relatively low growth in prescription drug spending, spending has risen more steeply since 2013. The average annual rate of growth in Part D costs per beneficiary was 2.4% between 2007 and 2013, but it increased to 4.4% between 2013 and 2016, and is projected to increase by 4.7% between 2016 and 2026
(Figure 7).9

Medicare’s actuaries have projected that the Part D per capita growth rate will be comparatively higher in the coming years than in the program’s initial years due to higher costs associated with expensive specialty drugs, which is expected to be reflected in higher reinsurance payments to plans. Between 2017 and 2027, spending on Part D benefits is projected to increase from 15.9% to 17.5% of total Medicare spending (net of offsetting receipts).10 Understanding whether and to what extent private plans are able to negotiate price discounts and rebates will be an important part of ongoing efforts to assess how well plans are able to contain rising drug costs. However, drug-specific rebate information is not disclosed by CMS.

The Medicare drug benefit helps to reduce out-of-pocket drug spending for enrollees, which is especially important to those with modest incomes or very high drug costs. Closing the coverage gap by 2020 will bring additional relief to millions of enrollees with high costs. But with drug spending on the rise and more plans charging coinsurance rather than flat copayments for covered brand-name drugs, enrollees could face higher out-of-pocket costs for their Part D coverage. These trends highlight the importance of comparing plans during the annual enrollment period. Research shows, however, that relatively few people on Medicare have used the annual opportunity to switch Part D plans voluntarily—even though those who do switch often lower their out-of-pocket costs as a result of changing plans.

Understanding how well Part D is working and how well it is meeting the needs of people on Medicare will be informed by ongoing monitoring of the Part D plan marketplace and plan enrollment; assessing coverage and costs for high-cost biologics and other specialty drugs; exploring the relationship between Part D spending and spending on other Medicare-covered services; and evaluating the impact of the drug benefit on Medicare beneficiaries’ out-of-pocket spending and health outcomes.

Endnotes
  1. Poverty and resource levels for 2018 are not yet available (as of September 2017).

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  2. The base beneficiary premium is equal to the product of the beneficiary premium percentage and the national average monthly bid amount (which is an enrollment-weighted average of bids submitted by both PDPs and MA-PD plans). Centers for Medicare & Medicaid Services, “Annual Release of Part D National Average Bid Amount and Other Part C & D Bid Information,” July 31, 2017, available at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/PartDandMABenchmarks2018.pdf.

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  3. Higher-income Part D enrollees also pay higher monthly Part B premiums.

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  4. Centers for Medicare & Medicaid Services, Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report – Monthly Summary Report (Data as of August 2017).

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  5. Board of Trustees, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table IV.B7, available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2017.pdf.

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  6. Social Security Act, Section 1860D-11(i).

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  7. 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds; Table IV.B9.

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  8. Kaiser Family Foundation analysis of aggregate Part D reimbursement amounts from Table IV.B10, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

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  9. Kaiser Family Foundation analysis of Part D average per beneficiary costs from Table V.D1, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

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  10. Kaiser Family Foundation analysis of Part D benefits spending as a share of net Medicare outlays (total mandatory and discretionary outlays minus offsetting receipts) from CBO, Medicare-Congressional Budget Office’s June 2017 Baseline.

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Read the full article here.

Source:

Kaiser Family Foundation (2 October 2017). “The Medicare Part D Prescription Drug Benefit” [Web Blog Post]. Retrieved from address https://www.kff.org/medicare/fact-sheet/the-medicare-prescription-drug-benefit-fact-sheet/#26740