PCORI Fee Is Due by July 31 for Self-Insured Health Plans
The annual fee for the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019. Plans with terms ending after September 30, 2012, and before October 1, 2019, are required to pay an annual PCORI fee. Read this article from SHRM to learn more.
An earlier version of this article was posted on November 6, 2018
The next annual fee that sponsors of self-insured health plans must pay to fund the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019.
The Affordable Care Act mandated payment of an annual PCORI fee by plans with terms ending after Sept. 30, 2012, and before Oct. 1, 2019, to provide initial funding for the Washington, D.C.-based institute, which funds research on the comparative effectiveness of medical treatments. Self-insured plans pay the fee themselves, while insurance companies pay the fee for fully insured plans but may pass the cost along to employers through higher premiums.
The IRS treats the fee like an excise tax.
The PCORI fee is due by the July 31 following the last day of the plan year. The final PCORI payment for sponsors of 2018 calendar-year plans is due by July 31, 2019. The final PCORI fee for plan years ending from Jan. 1, 2019 to Sept. 30, 2019, will be due by July 31, 2020.
In Notice 2018-85, the IRS set the amount used to calculate the PCORI fee at $2.45 per person covered by plan years ending Oct. 1, 2018, through Sept. 30, 2019.
The chart below shows the fees to be paid in 2019, which are slightly higher than the fees owed in 2018. The per-enrollee amount depends on when the plan year ended, as in previous years.
| Fee per Plan Enrollee for Payment Due July 31, 2019 |
|
| Plan years ending from Oct. 1, 2018, through Sept. 30, 2019. | $2.45 |
| Fee per Plan Enrollee for Payment Due July 31, 2018 |
|
| Plan years ending from Oct. 1, 2017, through Dec. 31, 2017, including calendar-year plans. | $2.39 |
| Plan years ending from Jan. 1, 2017, through Sept. 30, 2017 | $2.26 |
| Source: IRS. |
Nearing the End
The PCORI fee will not be assessed for plan years ending after Sept. 30, 2019, "which means that for a calendar-year plan, the last year for assessment is the 2018 calendar year," wrote Richard Stover, a New York City-based principal at HR consultancy Buck Global, and Amy Dunn, a principal in Buck's Knowledge Resource Center.
For noncalendar-year plans that end between Jan. 1, 2019 and Sept. 30, 3019, however, there will be one last PCORI payment due by July 31, 2020.
"There will not be any PCORI fee for plan years that end on October 1, 2019 or later," according to 360 Corporate Benefit Advisors.
The PCORI fee was first assessed for plan years ending after Sept. 30, 2012. The fee for the first plan year was $1 per plan enrollee, which increased to $2 per enrollee in the second year and was then indexed in subsequent years based on the increase in national health expenditures.
FSAs and HRAs
In addition to self-insured medical plans, health flexible spending accounts (health FSAs) and health reimbursement arrangements (HRAs) that fail to qualify as “excepted benefits” would be required to pay the per-enrollee fee, wrote Gary Kushner, president and CEO of Kushner & Co., a benefits advisory firm based in Portage, Mich.
As set forth in the Department of Labor's Technical Release 2013-03:
- A health FSA is an excepted benefit if the employer does not contribute more than $500 a year to any employee accounts and also offers a group health plan with nonexcepted benefits.
- An HRA is an excepted benefit if it only reimburses for limited-scope dental and vision expenses or long-term care coverage and is not integrated with a group health plan.
Kushner explained that:
- If the employer sponsors a fully insured group health plan for which the insurance carrier is filing and paying the PCORI fee and the same employer sponsors an employer-funded health care FSA or an HRA not exempted from the fee, employers should only count the employees participating in the FSA or HRA, and not spouses or dependents, when paying the fee.
- If the employer sponsors a self-funded group health plan, then the employer needs to file the form and pay the PCORI fee only on the number of individuals enrolled in the group health plan, and not in the employer-funded health care FSA or HRA.
An employer that sponsors a self-insured HRA along with a fully insured medical plan "must pay PCORI fees based on the number of employees (dependents are not included in this count) participating in the HRA, while the insurer pays the PCORI fee on the individuals (including dependents) covered under the insured plan," wrote Mark Holloway, senior vice president and director of compliance services at Lockton Companies, a benefits broker and services firm based in Kansas City, Mo. Where an employer maintains an HRA along with a self-funded medical plan and both have the same plan year, "the employer pays a single PCORI fee based on the number of covered lives in the self-funded medical plan (the HRA is disregarded)."
Paying PCORI Fees
Self-insured employers are responsible for submitting the fee and accompanying paperwork to the IRS, as "third-party reporting and payment of the fee is not permitted for self-funded plans," Holloway noted.
For the coming year, self-insured health plan sponsors should use Form 720 for the second calendar quarter to report and pay the PCORI fee by July 31, 2019.
"On p. 2 of Form 720, under Part II, the employer needs to designate the average number of covered lives under its applicable self-insured plan," Holloway explained. The number of covered lives will be multiplied by $2.45 for plan years ending on or after Oct. 1, 2018, to determine the total fee owed to the IRS next July.
To calculate "the average number of lives covered" or plan enrollees, employers should use one of three methods listed on pages 8 and 9 of the Instructions for Form 720. A white paper by Keller Benefit Services describes these methods in greater detail.
Although the fee is paid annually, employers should indicate on the Payment Voucher (720-V), located at the end of Form 720, that the tax period for the fee is the second quarter of the year. "Failure to properly designate 'second quarter' on the voucher will result in the IRS's software generating a tardy filing notice, with all the incumbent aggravation on the employer to correct the matter with the IRS," Holloway warned.
A few other points to keep in mind: "The U.S. Department of Labor believes the fee cannot be paid from plan assets," he said. In other words, for self-insured health plans, "the PCORI fee must be paid by the plan sponsor. It is not a permissible expense of a self-funded plan and cannot be paid in whole or part by participant contributions."
In addition, PCORI fees "should not be included in the plan's cost when computing the plan's COBRA premium," Holloway noted. But "the IRS has indicated the fee is, however, a tax-deductible business expense for employers with self-funded plans," he added, citing a May 2013 IRS memorandum.
SOURCE: Miller, S. (2 July 2019) "PCORI Fee Is Due by July 31 for Self-Insured Health Plans" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2019-pcori-fees.aspx
Top 10 health conditions costing employers the most
Conditions that impact plan costs can be problematic. Here is a look into the top 10 health conditions hitting the hardest on employers wallets.
As healthcare costs continue to rise, more employers are looking at ways to target those costs. One step they are taking is looking at what health conditions are hitting their pocketbooks the hardest.
“About half of employers use disease management programs to help manage the costs of these very expensive chronic conditions,” says Julie Stich, associate vice president of content at the International Foundation of Employee Benefits Plans. “In addition, about three in five employers use health screenings and health risk assessments to help employees identify and monitor these conditions so that they can be managed more effectively. Early identification helps the employer and the employee.”
What conditions are costly for employers to cover? In IFEPB’s Workplace Wellness Trends 2017 Survey, more than 500 employers were asked to select the top three conditions impacting plan costs. The following 10 topped the list.
10. High-risk pregnancy
Although high-risk pregnancies have seen a dip of 1% since 2015, they still bottom out the list in 2017; 5.6% of employers report these costs are a leading cost concern for health plans.
9. Smoking
Smoking has remained a consistent concern of employers over the last several years; 8.6% of employers report smoking has significant impact on health plans.
8. High cholesterol
While high cholesterol still has a major impact on health costs- 11.6% say it's a top cause of raising healthcare costs- that number is significantly lower from where it was in 2015 (19.3%).
7. Depression/ mental illness
For 13.9% of employers, mental health has a big influence on healthcare costs. This is down from 22.8% in 2015.
6. Hypertension/ high blood pressure
This is the first condition in IFEBP's report to have dropped a ranking in the last two years. In 2015, hypertension/ high blood pressure ranked 5th with 28.9% of employers reporting it is a high cost condition. In 2017, the condition dropped to 6th with 27.6% of employers noting high costs associated with the disease.
5. Heart disease
This year's study found that 28.4% of employers reported high costs associated with heart disease. In 2015, heart disease was the second highest cost driver with 37.1% of employers citing high costs from the disease.
4. Arthritis/back/musculoskeletal
Nearly three in 10 employers (28.9%) say these conditions are drivers of their health plan costs, compared to 34.5% in 2015.
3. Obesity
Obesity is still a top concern for employers, but slightly less so than it was two years ago. In 2017, 29% of employers found obesity to be a burden on health plans. In 2015, 32.45 cited obesity as a major cost driver.
2. Cancer (all kinds)
Cancer has become more expensive for employers. Now, 35.4% of employers report cancer increasing the costs of health plans, compared to 32% in 2015.
1. Diabetes
The king of raising health costs, diabetes has topped the list both in 2015 and 2017. In the most recent report, 44.3% of employers say diabetes is among the conditions impacting plan costs.
SOURCE:
Otto. N (18 June 2018) "Top 10 health conditions costing employers the most" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/slideshow/top-10-health-conditions-costing-employers-the-most
Financial shocks could disrupt tomorrow’s retirees
While today’s retirees, dependent as they are on Social Security and traditional pensions rather than 401(k)s, are better able to withstand financial shocks, tomorrow’s retirees won’t have it so easy.
They will be more in danger of being forced to downsize or spend down their assets to meet unexpected expenses such as a spike in medical bills or a loss of income through being widowed.
So says a brief from the Center for Retirement Research at Boston College, which investigated the financial fragility of the elderly to see how well they might be able to deal with financial shocks.
The reason the elderly are seen as financially fragile, the brief says, stems from the fact that, “once retired, they have little ability to increase their income compared to working households.”
And with future retirees becoming ever more dependent on their own retirement savings, and receiving less of their retirement income from Social Security and defined benefit plans, those financial shocks will get harder and harder to deal with.
To see how that will play out, the study looked at the share of expenditures a typical elderly household devotes to basic needs. Next, it looked at how well today’s elderly can absorb those aforementioned major financial shocks. And finally, it examined the increased dependence of tomorrow’s elderly on financial assets, whether those assets are sufficient, and how well those assets do at absorbing shocks.
Nearly 80 percent of the spending of a typical elderly household, the report finds, is used to secure five “basic” needs: housing, health care, food, clothing, and transportation. In lower-income households or the homes of single individuals and in households that rent or have a mortgage, those basic needs make up even more of a household’s spending.
And while there are areas in which a household can cut back—such as entertainment, gifts or perhaps cable TV—as well as potential cutbacks on basic needs, typical retirees can’t cut by more than 20 percent “without experiencing hardship.” And among those lower-income and single households, as well as those with rent or mortgages to pay, the margin is even slimmer.
The need for medical care is so important to those who need it, says the report, that the question becomes whether medical expenditures crowd out spending on other basic items.
And while a widow is estimated by federal poverty thresholds to need 79 percent of the couple’s income to maintain her standard of living, other studies indicate that widows get substantially less than that from Social Security and a pension—estimates, depending on the study, range from 62 percent to 55 percent. And that likely does not leave a widow enough to meet basic expenses.
Among current retirees, only 10 percent report having to cut back on necessary food or medications because of lack of money over the past 2 years.
However, retirees tomorrow, if they have failed to save enough to see them through retirement, are likely to experience income declines of from 6 to 21 percent for GenXers—and that’s assuming that GenXers “annuitize most of their savings at an actuarially fair rate…” despite the fact that very few actually annuitize, and cannot get actuarially fair rates even if they do.
And since the brief also finds that the greater dependency of tomorrow’s retirees on whatever they’ve managed to save in 401(k)s means that they’re exposed to new sources of risk—“that households accumulate too little and draw out too little to cushion shocks and that their finances are increasingly exposed to market downturns”—that means that future retirees will be subjected to a reduced cushion between income and fixed expenses.
To compensate, they will need to downsize and cut their fixed expenses. Neither one bodes well for a comfortable retirement.
Read the article.
Source:
Satter M. (1 March 2018). "Financial shocks could disrupt tomorrow’s retirees" [Web Blog Post]. Retrieved from address https://www.benefitspro.com/2018/03/01/financial-shocks-could-disrupt-tomorrows-retirees/
Personalizing health plans with technology
Technology offers advanced opportunities to make your health plan customized to your employees. Check out this article from Employee Benefit Advisor by Cort Olsen for more information.
Many advisers are using digital monitoring to evaluate the status of wellbeing within a given employer’s employee population.
Craig Schmidt, senior wellness consultant for EPIC, says one of the ways he is able to identify the companies that are offering strong digital wellness plans is through their ability to integrate such programs with claims data. He utilizes a push style notification to a mobile device to inform individual employees about specific plans that can coordinate well with their conditions as a further enhancement.
Samantha Gardiner, director of product management at Health Advocate, says her company has combined wellness, chronic condition management and client outreach all into one program to improve the health of employees and reduce claims and pharmaceutical costs for employer-provided health plans.
“We take the data and provide alerts via our website, email or mobile push notifications to keep employees informed about their personal health conditions,” Gardiner says. “If we have the data, we can really target and personalize the program toward company goals and members’ personal goals.”
In order to identify the best in class among the programs offered by wellness providers, Schmidt says he looks at the number and quality of interfaces and outcomes from the program as well as success stories that employees can share that can flesh out an employer’s return on investment.
“We can look at results six months or even a year after an employee has participated in the program to see if behavior changes have taken place,” Schmidt says. “If the plan integrates and reacts to the systems the employer has in place for his or her employees, then we will know if the program is a right match.”
Integration
Monica Majors, vice president of marketing and communications of health plan products at Sutter Health, says a digital wellness program needs to integrate with a multitude of personal devices.
“The site must be responsive to all technology, such as a mobile device, a tablet, or for those who are deskbound, from their computer,” Majors says. “The flexibility of offering individual trackers as well as key based activity challenges through a wide range of activities will keep retention.”
The program can then offer a health assessment that can be aggregated into an overall employer report, which can then serve as a basis for customization for that specific workforce.
Marcia Otto, vice president of product strategy at Health Advocate, says her company offers biometric screenings that can be done onsite, which can then factor into an employee’s health risk assessment to further customize the personal health program.
“If we get biometric data from our biometric data collection or if the employee sends us the data from a third party, that is another data source we can look at to determine if they need further attention for diabetes, hyper tension or so on,” Otto says. “We can also collect data on what their last blood test reported, right down to how many fruits or vegetables they eat, which is then prioritized based on how sick the employee is.”
Incentivizing
To influence employees to remain on the wellness plan, employers have offered incentives. These incentives can range from gift cards and cash rewards to funding a HSA or a HRA.
Paul Sterling, vice president of emerging products at UnitedHealthcare, says users who are enrolled in the UnitedHealthcare Motion program – an app programmed to encourage employees to remain active throughout the workday using a smart phone or smart watch – rewards employees by funding money into an HSA or HRA as a way to retain users.
“We have three daily walking objectives through our FIT criteria – frequency, intensity and tenacity – that each of our members try to achieve,” Sterling says. “Each one of those objectives is tied to or associated with an incentive amount.”
For each objective the employee completes, UnitedHealthcare deposits $1 into the user’s HSA or HRA, depending what they have.
Each day, the employee can complete each of the objectives. It resets daily, allowing the employee to continue to receive up to $3 per day.
Over the course of one year, Sterling says participation in the Motion program has held at a steady 67%. “If you think about other products in the health and wellness space, that’s arguably 10 times the level of engagement achieved over that period of time others would achieve,” Sterling says.
While Gardiner says she cannot pin point the number of employees engaged in her program for an extended period of time yet, she thinks incentives do drive continued engagement for some employees who need the extra push to be active or engage in a healthier lifestyle.
“An incentive program that provides at least a $300 incentive to participate is where we see our most engagement,” Gardiner says. “It all depends on the goals of the employer.”
Read more.
SOURCE: Olsen C. (4 February 2018). "Personalizing health plans with technology" [Web Blog Post]. Retrieved from address https://www.employeebenefitadviser.com/news/personalizing-health-plans-with-technology?feed=00000152-175f-d933-a573-ff5f3f230000
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Will Amazon-Berkshire-JPMorgan coalition kickstart a benefits revolution?
What will happen if the Amazon-Berkshire-JPMorgan coalition becomes a real thing? Find out in this article from Employee Benefit Advisor.
The announcement that Amazon, Berkshire Hathaway and JPMorgan Chase would form an independent healthcare company for their U.S. employees is just one more move in a growing, albeit relatively quiet, revolution inside the benefits industry: Employers banding together for more control over a health system they see as wasteful and inefficient.
Employee medical expenditures have been the driving factor behind these moves. Last year, premiums for employer-sponsored family coverage hit $18,764, up 3% from the previous year, with employees paying an average $5,714 toward the cost, according to the Kaiser Family Foundation.
Frustration with those costs — and the lack of quality that often goes along with them — has resulted in a number of employer initiatives. But the news of the three corporate behemoths’ coalition may propel even more employers to band together, looking for alternatives on how they provide coverage while driving transparency in an industry notorious for obfuscation.
While it didn’t make the same splash as the big three’s news, two years ago 20 of the country’s biggest companies, including American Express, Berkshire’s BNSF Railway, Caterpillar, Coca-Cola, du Pont, IBM, Ingersoll Rand, Marriott and Verizon, joined together to form the Health Transformation Alliance. The goal of the group is to use data analytics, collective leverage and shared expertise to lower costs for all members. The group has grown to almost 40 members.
And at about the same time, health and financial consulting firm Mercer started running employer collectives to help companies save on pharmacy costs. There also are individual efforts. Intel, notes American Benefits Council president James Klein, has been a leader in direct contracting with healthcare providers.
“When large and successful companies come together in this way, it’s potentially disruptive,” says Frank Easley, senior vice president of Aon’s health and benefits group, about the Amazon, Berkshire and JPMorgan partnership. “The healthcare system is ripe for positive disruption and is in need of new solutions that improve employee satisfaction and reduce costs.”
While the three giants did not detail what their new company would do, they did say in a statement that the entity’s focus will be on technology that will provide employees and their families with “simplified, high-quality and transparent healthcare at a reasonable cost.”
The collaboration will likely pressure profits for middlemen in the healthcare supply chain. Potential ways to bring down costs include providing more transparency in prices for doctor visits and lab tests, and by enabling direct purchasing of some medical items, a person familiar with the companies’ plans said.
Efforts to increase transparency have been an important focus for employers of late and have “enormous potential” when it comes to transforming employer healthcare, says benefits consultant Jack Kwicien. If employers can explain to employees how and where their healthcare dollars are going, it will not only give workers a better understanding of their own money, but it has the potential to build a better relationship between employer and employee.
In addition, Amazon’s e-commerce operation could be used to send medication direct to patient’s homes, saving them trips to a pharmacy. Its cloud-computing division can store patient healthcare records so they can be easily accessed by doctors anywhere. And its payments system could be used to automate payments with healthcare providers.
If Amazon, Berkshire and JPMorgan are successful in lowering costs, the weight of the big three might kick the transformation engine into high gear, leading to a dramatic shift in the benefits delivery as more employers look to use combined leverage to lower their health costs.
“Any time organizations of this caliber — these are world class organizations — say they are going to tackle healthcare, you have to pay attention,” says Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions. The organization advises around 12,000 organizations that buy health plans for millions of employees.
Thompson says that given Amazon and Berkshire’s records, it’s clear “that they have the potential to truly change the consumer experience for their employees, and frankly, that could become a model that could be used by other employers.”
Some benefits insiders, however, express doubts that the three behemoths will spur a widespread industry disruption. Their two biggest doubts: that corporate America can successfully battle the nation’s largest healthcare players and, even if successful, if they can cut costs in a meaningful way.
“Most health costs are incurred by a small percent of the population with chronic conditions,” Klein says. “So if this initiative is just about how health costs are paid for, and does not promote ways to improve health itself, the impact will be minimal.”
Still, business groups say the potential is there for more employer involvement in controlling costs and delivering healthcare, and the need is real.
“New entrants with fresh approaches like these may be just the prescription our ailing healthcare system needs,” says Brian Marcotte, CEO of the National Business Group on Health. “The collective resources of these three companies, emerging technologies and Amazon’s customer obsession and supply-chain savvy gives me optimism that they will pursue a consumer-focused model that will transcend the fragmented, provider-centric delivery system that we have today.”
Read more.
SOURCE: Mayer K. (31 January 2018). "Will Amazon-Berkshire-JPMorgan coalition kickstart a benefitsrevolution?" [Web Blog Post]. Retrieved from address https://www.employeebenefitadviser.com/news/will-amazon-berkshire-jpmorgan-coalition-kickstart-a-benefits-revolution?feed=00000152-175f-d933-a573-ff5f3f230000
Self-funding and Voluntary Benefits: The Dynamic Insurance Duo
Did you know that self-funded health insurance and voluntary benefits can be a dream team when used in conjunction with each other? Check out this great article by Steve Horvath and Dan Johnson from Benefits Pro and find out how you can make the most of this dynamic insurance duo.
In an era of health care reform, double-digit rising health care costs, and plenty of “unknowns,” many employers view their benefit plans as a challenging blend of cost containment strategies and employee retention.
But perhaps they need to better understand the value of a little caped crusader named voluntary benefits.
Employers of all sizes share common goals when it comes to their benefits. They seek affordable, and quality benefits for their employees.
Some companies achieve these goals by cutting costs and going with a high-deductible, self-funded approach. While many associate self-funding with larger employers, in the current marketplace, it has become a viable option for companies across the board.
Especially when paired with a voluntary benefits offering supported by one-on-one communication or a call center, employers are able to cut costs and offer additional insurance options tailored to their employees’ needs. But there’s more.
Voluntary enrollments can help employers meet many different challenges, all of which tie back to cost-containment, streamlined processes and employee understanding and engagement. But before we explore solutions, let’s first understand why so many employers are going the self-funded route.
For most large and small employers, the costs of providing health care to employees and their families are significant and rising.
For companies who may be tight on money and are seeing their fully-insured premiums increase every year with little justification, self-funding serves as a great solution to keep their medical expenses down.
Self-funding: An overview
Self-funding allows employers to:
- Control health plan costs with pre-determined claims funding amounts to a medical plan account, without paying the profit margin of the insurance company.
- Protect their plan from catastrophic claims with stop-loss insurance that helps to pay for claims that exceed the amount set by their self-funded plan.
- Pay for medical claims the plan actually incurs, not the margin a fully insured plan underwrites into their premium, while protecting the plan with catastrophic loss coverage when large expenses are incurred. Plans may offer to share favorable savings with their employees through programs like premium holidays. These programs allow employee contributions to be waived for a period of time selected by the employer to reward employees for low utilization and adequate funding of their claims accounts and reserves.
- Take advantage of current and future year plan management guidance.
- Save on plan costs by using predictive analysis for health and wellness offered by the third-party administrator (TPA).
Beyond these advantages,self-funded plans may not be subject to all of the Affordable Care Act regulations as fully-insured plans, which is one of the reasons they provide a solution for controlling costs. Without these requirements, the plans can be tailored much more precisely to meet the needs of a specific employee group.
Boosting value: Advantages of adding voluntary benefits to a self-funded plan
Based on an employer’s specific benefit plan, and what it offers, employers are able to select voluntary benefits that can complement the plan and properly meet employees’ needs without adding extra costs to the plan.
Employees are then able to customize their own, personal benefit options even further based on their unique needs and available voluntary benefits.
This provides employees a myriad of benefits while also allowing them to account for out-of-pocket costs due to high-deductibles or plan changes, as well as provide long-term protection if the product is portable.
Voluntary solutions are about more than the products
Aside from the common falsehood that voluntary benefits are only about adding ‘gap fillers’ to your plan, you may be pleasantly surprised to learn that conducting a voluntary benefits enrollment can actually offer a number of services, solutions, and products, many of which may be currently unfamiliar to you.
Finding, and funding, a ben-admin solution
Some carriers offer the added bonus of helping employers install a benefits administration system in return for conducting a one-on-one or mandatory call center voluntary benefits enrollment.
The right benefits administration systems can help remove manual processes and allow HR to do what they do best—focus on employees and improving employee programs. No more headaches around changing coverage, change files to carriers, changing payroll-deductions or premiums.
Finding the benefits administration system that works best for your situation can make a big difference for your HR team.
Communication and engagement
Many employees are frustrated and scared about how changes to the insurance landscape will impact them. And with a recent survey noting that 95 percent of employees need someone to talk to for benefits information,1 they clearly are seeking ongoing communications and resources.
During the enrollment process, some carriers work with enrollment and communications companies who understand the employees’ benefit plan options and help guide them to the offerings that are best for them and their families.
At the same time, employers can enhance the communication and engagement efforts on other important corporate initiatives. For example, a client of ours increased employee participation in their high-deductible health plan (HDHP) via pre-communication.
Of the 90 percent of employees that went to the enrollment, nearly 70 percent said they were either likely or very likely to select the HDHP. Just a little bit of communication can go a long way toward employee understanding.
Providing education and engagement about both benefits and workplace initiatives increases the effectiveness of these programs and contributes to keeping costs down for employers. The more engagement employers generate, the healthier and better protected the employees.
Prioritizing health and wellness
Employers can also use the enrollment time with employees to remind them to get their annual exams. Many voluntary plans offer a wellness benefit (e.g. $50 or $100) to incentivize the employee and dependents.
The ROI for an employer’s health plan provides value as regular screenings can help detect health issues in the beginning stages so that proper health care management can begin and medical spend can be minimized.
Employers have also seized the opportunity of a benefits enrollment to implement a full-scale wellness program at reduced costs by aligning it with a voluntary benefits enrollment.
An effective wellness program will approach employee health from a whole-person view, recognizing its physical, social, emotional, financial and environmental dimensions. A properly implemented wellness program can ultimately make healthy actions possible for more of an employee population.
A formidable combination
What employers are seeking is simple -- quality benefits and a way to lower costs. With that in mind, offering a self-funded plan with complementary voluntary benefit products and solutions allows employers to take advantage of multiple opportunities while, at the same time, providing more options for their employees.
In today’s constantly changing landscape, self-funded plans paired with voluntary benefits is a formidable combination – a dynamic insurance duo.
See the original article Here.
Source:
Horvath S., Johnson D. (2016 November 23). Self-funding and voluntary benefits: the dynamic insurance duo [Web blog post]. Retrieved from address https://www.benefitspro.com/2016/11/23/self-funding-and-voluntary-benefits-the-dynamic-in?page_all=1
SELF-INSURED GROUP HEALTH PLANS
Are you looking to switch your company's healthcare plan to a self-funded option? Take a look at this informative column by the Self-Insurance Institute of America and find out everything you need know when researching the best self-funded plan for your company.
Q. What is a self-insured health plan?
A. A self-insured group health plan (or a 'self-funded' plan as it is also called) is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, self-insured employers pay for each out of pocket claim as they are incurred instead of paying a fixed premium to an insurance carrier, which is known as a fully-insured plan. Typically, a self-insured employer will set up a special trust fund to earmark money (corporate and employee contributions) to pay incurred claims.
Q. How many people receive coverage through self-insured health plans?
A. According to a 2000 report by the Employee Benefit Research Institute (EBRI), approximately 50 million workers and their dependents receive benefits through self-insured group health plans sponsored by their employers. This represents 33% of the 150 million total participants in private employment-based plans nationwide.
Q. Why do employers self fund their health plans?
A. There are several reasons why employers choose the self-insurance option. The following are the most common reasons:
- The employer can customize the plan to meet the specific health care needs of its workforce, as opposed to purchasing a 'one-size-fits-all' insurance policy.
- The employer maintains control over the health plan reserves, enabling maximization of interest income - income that would be otherwise generated by an insurance carrier through the investment of premium dollars.
- The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
- The employer is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are regulated under federal law (ERISA).
- The employer is not subject to state health insurance premium taxes, which are generally 2-3 percent of the premium's dollar value.
- The employer is free to contract with the providers or provider network best suited to meet the health care needs of its employees.
Q. Is self-insurance the best option for every employer?
A. No. Since a self-insured employer assumes the risk for paying the health care claim costs for its employees, it must have the financial resources (cash flow) to meet this obligation, which can be unpredictable. Therefore, small employers and other employers with poor cash flow may find that self-insurance is not a viable option. It should be noted, however, that there are companies with as few as 25 employees that do maintain viable self-insured health plans.
Q. Can self-insured employers protect themselves against unpredicted or catastrophic claims?
A. Yes. While the largest employers have sufficient financial reserves to cover virtually any amount of health care costs, most self-insured employers purchase what is known as stop-loss insurance to reimburse them for claims above a specified dollar level. This is an insurance contract between the stop-loss carrier and the employer, and is not deemed to be a health insurance policy covering individual plan participants.
Q. Who administers claims for self-insured group health plans?
A. Self-insured employers can either administer the claims in-house, or subcontract this service to a third party administrator (TPA). TPAs can also help employers set up their self-insured group health plans and coordinate stop-loss insurance coverage, provider network contracts and utilization review services.
Q. What about payroll deductions?
A. Any payments made by employees for their coverage are still handled through the employer' s payroll department. However, instead of being sent to an insurance company for premiums, the contributions are held by the employer until such time as claims become due and payable; or, if being used as reserves, put in a tax-free trust that is controlled by the employer.
Q. With what laws must self-insured group health plans comply?
A. Self-insured group health plans come under all applicable federal laws, including the Employee Retirement Income Security Act (ERISA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), the Americans with Disabilities Act (ADA), the Pregnancy Discrimination Act, the Age Discrimination in Employment Act, the Civil Rights Act, and various budget reconciliation acts such as Tax Equity and Fiscal Responsibility Act (TEFRA), Deficit Reduction Act (DEFRA), and Economic Recovery Tax Act (ERTA).
See the original article Here.
Source:
Self-Insurance Institute of America (Date). Self-insured group health plans [Web blog post]. Retrieved from address https://www.siia.org/i4a/pages/index.cfm?pageID=4546
Why Self-funded Healthcare is a Great Option for 2017
Have your health care options left you at a competitive disadvantage when it comes to attracting new talent? Switching to a self-funded healthcare plan can be a great way to reduce your healthcare cost while increasing your ability to attract new employees to your workforce. Take a look at this interesting article by Paul Johnson from Employee Benefits News and find out why you should switch to a self-funded healthcare plan.
Small- and mid-sized companies using traditional major medical plans are at a competitive disadvantage: either they are paying more in loaded costs than competitors that use smarter healthcare options, or they are finding it more difficult to hire employees because their competitors offer better plans.
With the new year and a new healthcare landscape, HR executives and benefits directors are now reconsidering their options, taking a much harder look at out how they can stop struggling to offer competitive benefits, and actually use their healthcare plans to recruit and retain the best talent, which will ultimately boost employee morale and profitability.
Annual premiums for employer-sponsored family health coverage reached $18,142, with workers paying $5,277 toward their plan in 2016, according to the Kaiser Family Foundation.
While companies still shoulder the lion’s share, worker contributions increased about 80% over the last 10 years; this cost doesn’t even include the employee’s co-pay or deductible.
To balance the scales and create a competitive advantage, more companies are turning to healthcare plans based on a self-funding model that offer more flexibility, customization and cost-savings while still improving the quality of care. Self-funded plans have been almost universal among large employers for quite some time, yet only in recent years have more HR departments at small- and mid-sized companies started to realize the benefits.
Customizing a self-funded model
Federal and state laws incorporate exceptions that enable companies to self-fund healthcare. This move provides for more flexibility while limiting risk for the employer. Companies can also choose to pay their claims directly, or work with third-party administrators to handle claims and administrative responsibilities.
Benefits can include medical, dental, vision, prescription medications and workers’ compensation. Unlike more rigid traditional insurance, companies can customize their offerings to address specific needs, such as investing in injury and chiropractic care in industries that require physical labor to robust maternity benefits for those with younger workforces.
Customized plans offer a win-win scenario — the company saves money while increasing productivity, and employees get access to the most pertinent care at an affordable cost.
To further increase convenience and cost efficiencies, companies can use third-party healthcare concierge services to help employees navigate the system, access the right level of care, and steer them away from needlessly expensive services and facilities. Also, businesses have the option to purchase stop-loss insurance to increase the type of healthcare provided to employees and limit the company’s liability in case of catastrophic illnesses and accidents.
Saving money
Self-funding is generally less expensive — 10% to 25% less, according to the Self Insurance Educational Foundation — than fully funded insurance because it doesn’t include marketing costs or profit margins associated with traditional insurance. As an added benefit, companies that self-insure are exempt from state insurance regulations and premium taxes, and are not subject to many government provisions.
Managing care delivery also has a dramatic impact on costs. For example, many medical services are needlessly performed in hospitals, where costs are higher. A third-party partner can direct employees to comparable lower-cost sites of service. Similarly, while costs of prescription medications can vary widely among pharmacies, understanding cost differentials and making decisions accordingly can bring costs down.
While advantageous for all types of employers, the ability to closely manage care delivery and place of service is especially important for companies with low-wage and young workers who have previously relied on high-cost emergency rooms for basic care or are unaccustomed to navigating the system.
Lowering workers’ comp
Employees often use workers’ comp for minor injuries requiring only first aid or for injuries sustained outside the workplace because they don’t have other options. With a self-funded plan – and with the assistance of a third-party partner to help employees access care through the right channels – businesses can cut such claims.
Likewise, organizations with an Experience Modifier Rate may lower their E-Mod score through a self-funded plan.
Owning healthcare data
Before the Patient Protection and Affordable Care Act, health insurance underwriters reviewed the medical data of a specified group of employees. Now, carriers must look at an entire community — often hundreds of businesses — and calculate a community rating based only on age, zip code and smoker status.
Because the ACA requires guaranteed-issue medical insurance, does not allow denial based on preexisting conditions, and precludes annual or lifetime limits, insurers must account for added risks when setting rates that are often detriment to the company and result in higher premiums.
Companies that self-fund have access to every claim, allowing them to benchmark their utilization against industry norms and address red flags, ultimately using insights garnered to better manage benefits and control costs.
Insurance isn’t a one-size-fits-all proposition, despite what the industry leads business owners to believe. Providing quality healthcare and maintaining profitability should not be mutually exclusive. For many companies, a self-funded plan becomes the gateway to managing skyrocketing healthcare costs while offering competitive benefits.
See the original article Here.
Source:
Johnson P. (2017 January 9). Why self-funded healthcare is a great option for 2017 [Web blog post]. Retrieved from address https://www.benefitnews.com/opinion/why-self-funded-healthcare-is-a-great-option-for-2017
Employer health plans could suffer in ACA repeal
From BenefitsPro by Marlene Satter
Although Congress may feel as if it has the bit in its teeth on repealing the Affordable Care Act, some experts are warning that it might not be all that easy—or even beneficial—particularly for employer-sponsored health plans.
In a Bloomberg report, Greta E. Cowart, a shareholder at Dallas-based Winstead PC, warned that an ACA repeal or major overhaul might put employers in the crosshairs; they could end up having to return money they previously received from the federal government for some initiatives, such as the early retiree reinsurance program, which provided financial assistance to employer-sponsored health plans.
In addition, Cowart said in the report that many of the mandates on what should be included in employer-sponsored health plans that were neither exempted nor grandfathered in will be hard to take out of employers’ plans, because employees would see that as a benefit reduction. And that, of course, would not make the employer look good.
In its report on the matter, HRDive.com warned employers to “keep an eye on” HHS secretary nominee Tom Price, a determined opponent of the ACA. His “empowering patients first” plan calls for complete repeal of the ACA—and that could lead to just such problems for businesses’ health plans.
Employers who have been calling for the repeal of the ACA might want to rethink their strategy, particularly since it could not only cost them money in the form of give-backs but also cost them employee loyalty if they take away health plan features once they’re no longer mandated by the ACA.
HRDive suggested that “employers should be prepared for all outcomes,” and perhaps consider offering their employees high-deductible health plans or health savings plans as cost-saving measures.
In addition, tracking prescription drug prices could help them keep an eye on costs.
See the original article Here.
Source:
Satter M. (2016 December 1). Employer health plans could suffer in ACA repeal[Web blog post]. Retrieved from address https://www.benefitspro.com/2016/12/01/employer-health-plans-could-suffer-in-aca-repeal?ref=mostpopula
Benefit offerings impacted by millennials
Originally posted by Mike Nesper on August 31, 2015 on benefitnews.com.
Generation Y surpassed Generation X this year, to become the largest population of employees in the workforce — more than one in three U.S. workers are between the ages of 18 and 34, according the Pew Research Center. And those 53.5 million millennials are influencing the benefits employers are offering.
Millennials want more customization, says Meredith Ryan-Reid, senior vice president of MetLife’s group, voluntary and worksite benefits. Employers feel the same: 54% rated benefits customization as extremely important, according to MetLife’s 13th annual employee benefits trends study.
Millennials like variety, so employers should offer a broad range of benefits, says Joe Ellis, senior vice president of CBIZ Benefits and Insurance Services. The same isn’t true for networks. Millennials aren’t particularly concerned with narrow networks — they go to whoever is included, Ellis says.
That’s a good thing, especially as more employers are reducing network accessibility as a way to cut costs. This year, 11% of employers introduced narrow network plans as a cost containment tactic, a 7% increase from 2014, according to the Arthur J. Gallagher & Co. recent benefits strategy and benchmarking survey. Cost-sharing and changing carriers were the most frequently used strategies for controlling health care costs.
Both methods have a limited shelf life. Only a certain amount can be pushed onto employees, and recent mergers have reduced the list of major U.S. health insurance companies to just three, says Bill Ziebell, executive vice president of Gallagher Benefit Services.
Employers are also using online enrollment, telemedicine and mandatory specialty pharmacy programs to rein in costs — but premiums are still rising. Six in 10 employers reported increases of 4% or more during their most recent renewal, Gallagher found, and 23% of respondents saw double-digit increases.
Many employers are focused on medical renewals and others are hampered by Affordable Care Act regulations, Ziebell says. “It’s hard to be strategic,” he says, and that’s exactly the help advisers need to give their clients. Advisers and their employer clients should take an all-inclusive look at benefits and have a plan for several years into the future, Ziebell says.
Millennials impacted by the recession
The recession had a big impact on millennials, who entered the job market at a tough time, and many aren’t relying on government safety nets being in place later in life, Ryan-Reid says. In fact, nearly one-quarter of Americans expect no Social Security benefits, a Bankrate.com survey found.
That has spurred millennials to take a greater interest in employer offerings. “They’re craving information,” Ryan-Reid says. However, some employers aren’t delivering.
Just 38.4% of millennials strongly agree that their company is effectively educating them about their benefits, the MetLife study found. When presented with the statement, “I am confident I made the right decisions at my last annual enrollment,” less than half of millennials, 48.5%, strongly agreed, compared to 54% of Gen X employees and 62% of baby boomers.
Access to information that’s easy to understand increases confidence among all generations, MetLife found. For millennails, they prefer education via their provider’s website, a benefits handbook and in-person meetings. “In general, most people prefer to talk to someone,” Ryan-Reid says.