Should virtual patients worry about the side effects of telemedicine?
Although telemedicine is expected to become more prevalent, there are many boundaries this new technology still has to cross. Jay Horton gives more insight in the article below.
Original Post from BenefitsPro.com on June 28, 2016
As technological advancements heighten the accuracy and immediacy of medical consultations conducted remotely, the practice of telemedicine has blossomed alongside.
A Research and Markets study released this week announced the worldwide virtual health care market should jump from last year's estimated $17.9 billion to more than $40 billion by 2021.
Driven by the steadily-increasing capabilities of digital communication, medical professionals are now only a click away from even the furthest reaches of the globe, and the widening access has opened up avenues for diagnoses and treatment once unimaginable.
However, while the availability of far-flung examinations has aided the work of rural practitioners and Doctors Without Borders volunteers, the growth of telemedicine as a practical variant to traditional hospital visits has brought to light thorny regulatory issues and widespread concerns over such programs' inherent limitations.
Although the most technologically adept remote-care facilities may obtain real-time vital signs data and control precision optics able to convey the smallest visual detail, critics fear the physical absence of diagnosticians will necessarily raise the risk that less-obvious symptoms only recognizable through physical presence (clammy skin, eye tremors, sweetened scents) would be ignored.
At this point, telemedicine remains a relatively niche alternative largely undertaken by only those prospective patients within the United States otherwise unable to easily obtain traditional care. A recent HealthMine poll found nearly a third of web-friendly consumers had yet to take advantage of the services primarily because of questions about when they would be most appropriate.
These numbers are widely expected to leap in the coming years, however. As long as telemedicine consults cut the costs of face-to-face visits so dramatically — estimates range from 50 percent to 5000 percent depending upon the nature of the meeting — health insurance companies and the large firms that subsidize the majority of their policies will aggressively urge consumers to choose the cheaper option.
Further complicating matters, state licensing boards have so zealously guarded their dominion that many doctors are forbidden from even offering an opinion when expressly requested by a regular patient vacationing elsewhere.
Literally hundreds of legislative remedies have been introduced on the local level this year as state governments attempt to streamline the process of virtual care. Still, with no clear federal rulings to outline the boundaries of telemedicine, there's an ocean of gray area separating the proposed measures.
The sheer novelty of the practice has also stymied efforts to ensure remote treatment will be reimbursed under Medicaid. While most officials agree some aspects of telemedicine should deserve full compensation, the varying degrees of aid currently in use range from the occasional scan of vital signs to exhaustive video interviews and analyses.
Defending the necessity of immediate legislation last week, Pennsylvania state Rep. Marguerite Quinn stated her case bluntly: "We're trying to put down some basic guidelines here to match policy with technology and make sure we're not thwarting the growth of this in the meantime.”
Read the original article at: https://www.benefitspro.com/2016/06/28/should-virtual-patients-worry-about-the-side-effec?ref=hp-news&slreturn=1468614391
Source:
Horton, J. (2016, June 28). Should virtual patients worry about the side effects of telemedicine? [Web log post]. Retrieved from https://www.benefitspro.com/2016/06/28/should-virtual-patients-worry-about-the-side-effec?ref=hp-news&slreturn=1468614391
Study quantifies skyrocketing copays for the insured
Dan Cook provides insight on reasons for the Skyrocketing copays in the article below.
Original Post fro BenefitsPro.com on June 28, 2016
There’s been considerable focus on health insurance cost-shifting to covered individuals and families since the passage of the Affordable Care Act. But much of the shift occurred before Americans started looking to insurance exchanges for less costly coverage.
That’s what a research team composed primarily of University of Michigan scholars found when insurance records for 2009 to 2013 were examined. The study found that inpatient hospitalization costs paid by patients rose 37 percent from 2009 to 2013, to the point that the average insured individual was paying more than $1,000 annually in shared costs.
The biggest driver of the increase were deductibles, which rose a staggering 86 percent during that period. Coinsurance was the second largest factor, rising 33 percent during that time.
Individuals bore a greater share of the cost increase than did those with family coverage, the study said.
“In 2013, total cost sharing was highest for enrollees in individual market plans ($1875 per hospitalization) and consumer-directed health plans ($1219). Cost sharing varied substantially across regions, diagnoses, and procedures,” the researchers reported.
But it wasn’t just the average amount that the research team found troubling. Some among the insured were hit much harder than others by out-of-pocket costs, and that bears further investigation.
“Wide variability in out-of-pocket spending merits greater attention from policymakers,” the report concluded.
Additionally, more attention should be paid to cost-sharing trends among those with insurance rather than focusing just on the uninsured, the study’s lead author Emily Adrion told Fortune.
“There have been so many stories about how much hospital costs are for the uninsured and underinsured, but what’s lost is how much people with insurance are paying,” she said.
Read the full article at: https://www.benefitspro.com/2016/06/28/study-quantifies-skyrocketing-copays-for-the-insur?ref=hp-news&slreturn=1468802076
Source:
Cook, D. (2016, June 28). Study quantifies skyrocketing copays for the insured [Web log post]. Retrieved from https://www.benefitspro.com/2016/06/28/study-quantifies-skyrocketing-copays-for-the-insur?ref=hp-news&slreturn=1468802076
IRS Update on Filing ACA Forms After June 30, 2016
The IRS is giving a pass this year but encourages those who missed the deadline to file ACA Forms to still complete filing returns. See the article below from ThinkHR.com for more information.
Original Post from ThinkHR.com on July 1, 2016
If you are an applicable large employer, self-insured employer, or other health coverage provider, the deadline to electronically file ACA information returns (e.g., Forms 1094-B, 1095-B, 1094-C and 1095-C) with the IRS was June 30, 2016. The ACA Information Returns (AIR) system will remain up and running after the deadline. If you were not able to submit all required ACA information returns by June 30, 2016, you are advised to complete the filing of your returns after the deadline.
It is important to note the following:
- The AIR system will continue to accept information returns filed after June 30, 2016. In addition, you can still complete required system testing after June 30, 2016.
- If any of your transmissions or submissions was rejected by the AIR system, you have 60 days from the date of rejection to submit a replacement and have the rejected submission treated as timely filed.
- If you submitted and received “Accepted with Errors” messages, you may continue to submit corrections after June 30, 2016.
The IRS is aware that some filers are still in the process of completing their 2015 tax year filings. As is the case for other information returns, penalties may be associated with the submission of the ACA information returns for failure to timely file required returns. As the IRS has publicly stated in various forums in recent months, filers of Forms 1094-B, 1095-B, 1094-C and 1095-C that miss the June 30, 2016 due date will not generally be assessed late filing penalties under section 6721 if the reporting entity has made legitimate efforts to register with the AIR system and to file its information returns, and it continues to make such efforts and completes the process as soon as possible. In addition, consistent with existing information reporting rules, filers that are assessed penalties may still meet the criteria for a reasonable cause waiver from the penalties.
If you are not an electronic filer and you missed the May 31, 2016 paper filing deadline for ACA information returns, you should also complete the filing of your paper returns as soon as possible.
For more information, the IRS provides helpful questions and answers on the ACA reporting requirements for applicable large employers here.
Read the original article here.
Source:
Unknown (2016, July 1). IRS Update on Filing ACA Forms After June 30, 2016 [Web log post]. Retrieved from https://www.thinkhr.com/blog/hr/irs-update-on-filing-aca-forms-after-june-30-2016/
Civil Penalties Adjusted with Interim Final Rule for ERISA Violations
Released by the United States Department of Labor through The Federal Register on July 1, 2016.
Effective August 1, 2016, the amounts for civil penalties will be adjusted as required by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015.
- The maximum penalty for failure/refusal to properly file a plan annual report (Form 5500) increased from $1,100 per day to $2,063 per day the Form 5500 is late.
- The maximum penalty for failure to provide a Summary of Benefits Coverage under the Public Health Services Act increased from $1,000 per failure to $1,087 per failure.
- The maximum penalty for failure to provide an automatic contribution arrangement notice under ERISA increased from $1,000 per day to $1,632 per day.
- The penalty for providing required CHIP notices under ERISA is increased from $100 per day to $110 per day
- The maximum penalty for failure of a multiple employer welfare arrangement (MEWA) to file a report required by regulations issued under ERISA increased from $1,100 per day to $1,502 per day.
- The maximum penalty for failure to furnish reports (e.g., pension benefit statements) to former participants and beneficiaries or maintain records increased from $11 per employee to $28 per employee.
- The maximum penalty for failure to comply with ERISA requirements relating to genetic information increased from $100 per day to $110 per day.
To read the full release from The Federal Register, click here.
U.S. Department of Labor Proposes Improvements to Form 5500
Released by the United States Department of Labor on July 11, 2016.
Form 5500 affects us all and the Department of Labor is looking for your input on the proposed revisions to the form. Below you will find the proposed revisions and some details about them.
The Form 5500 is the primary source of information about the operations, funding and investments of private-sector, employment-based pension and welfare benefit plans in the U.S. There are an estimated 2.3 million health plans, a similar number of other welfare plans and nearly 681,000 pension plans. Covering roughly 143 million private-sector workers, retirees and dependents, these plans have an estimated $8.7 trillion in assets.
The proposed revisions are intended to:
- Modernize the financial statements and investment information filed about employee benefit plans.
- Update the reporting requirements for service provider fee and expense information.
- Enhance accessibility and usability of data filed on the forms.
- Require reporting by all group health plans covered by Title I of ERISA.
- Improve compliance under ERISA and the Internal Revenue Code through new questions regarding plan operations, service provider relationships, and financial management of the plan.
The proposed regulations also would make improvements to the certification requirements for the limited scope audit requirements under 29 CFR 2520.103-8, and allow group health plans to use the Form 5500 to satisfy certain reporting requirements in the Affordable Care Act. The proposed changes to the DOL regulations are also needed to implement the form revisions.
“The proposed form changes and related regulatory amendments are important steps toward improving this critical enforcement, research and public disclosure tool,” said Assistant Secretary for the Employee Benefits Security Administration Phyllis C. Borzi. “The 5500 is in serious need of updates to continue to keep pace with changing conditions in the employee benefit plan and financial market sectors. We must also remedy the form’s current gaps in collecting data from ERISA group health plans.”
To read the full article from the Department of Labor, click here.
5 rules for engaging millennials in wellness
As wellness programs become increasingly popular, it is important to understand how to get your employees engaged. Dr. Rajiv Kumar lends 6 tips to engaging millennials in your wellness program in the article below.
Original Post from BenefitsPro.com on June 27, 2016
These days, you can’t pick up a newspaper or turn on the TV without hearing a new indictment of millennials.
You know the stereotype: this newest generation of employees is selfish, narcissistic, entitled, and impatient.
I understand where this portrayal comes from — no one admires the guy with the selfie stick — but it’s an inaccurate generalization of my generation.
In fact, a growing body of data has revealed that the millennial generation is more altruistic, socially engaged, and health-minded than our predecessors, making us perfect consumers for employee well-being programs.
The trick is to speak the language of millennials, and as a millennial myself, I’ve got some advice to share.
Here are my five rules for engaging millennial employees in employee well-being programs.
Rule 1: Be legit.
The key to earning the trust of millennial employees is authenticity. Mine is a generation that has grown up with the internet, and thus has a very keen eye for public relations spin, marketing jargon, and advertising. Millennials have grown up truly surrounded by marketing, and they’re a bit immune.
Research has shown authenticity is of utmost value to millennials. 70 percent of millennials will stay loyal to a brand that has earned their trust. And 75 percent view themselves as authentic, meaning that being legit is the truest way to earn that trust.
When you’re considering your well-being benefits, create a brand that resonates and accurately represents your workforce. Use images of real people instead of photo-shopped models. Offer programs that allow people to set their own goals, rather than impose parameters and benchmarks.
Avoid jargon and long detailed benefits explanations. Instead, be straightforward. You’ll telegraph authenticity and your employees will connect with your brand.
Rule 2: Cut to the chase.
The millennial preference for all things direct and convenient is unsurprising given our obsession with authenticity. A marketplace devoid of middle men, where consumers are empowered to make their own informed decisions, is a millennial touchstone. Some of the country’s most impressive consumer companies have tapped into this preference. Consider Uber, Roku, and Airbnb.
The attributes that define the millennial marketplace — speed, convenience, transparency — are the ones that will also shape the future of well-being benefits.
45 percent of millennials say they’re more likely to participate in health and wellness programs if they’re easy or convenient to do. This means that we need to make enrolling in well-being programs straightforward and easy if we’re going to attract the next generation.
Seek out vendors that offer Single Sign On (SSO) integrations to relieve your employees of additional accounts, usernames, and passwords. When possible, offer programs that are flexible — that employees can tackle in their own time, on their own schedule.
This flexibility means programs can easily be accommodated and adopted within an existing or preferred schedule, and your engagement rates will climb.
Rule 3: There’s gotta be an app for that.
An appropriate motto for the millennial generation is “all mobile, all the time.” It may astonish older generations to hear that even a PC is passé to a millennial. Instead, we rely on our phones, tablets, and even our watches for all of the information we need.
Wellness and benefits cannot expect to be an exception to this rule. To remain relevant to millennials, you must allow them to enroll, participate, and access resources from their phone. This is absolutely critical, as millennials have little tolerance for anything else.
The good news is the industry is catching up to these preferences. Many well-being vendors have native apps that employees can download and access through their phones and smartwatches.
When selecting your wellbeing program, find a vendor that is committed to mobile innovation — this trend is advancing rapidly, and you’re going to want a partner that keeps up with the swift pace of mobile invention.
Rule 4: Sharing is caring.
For a generation that is constantly in touch, frequently checking in online, and publicly voicing our opinions, sharing is an important part of millennial life — professional and otherwise. Contrary to the stereotypes, this tendency to “overshare” isn’t just about self-involvement or grandstanding. In fact, sharing opinions, publicly voicing feedback, and reaching out to others serve an important purpose.
More than any other generational cohort, millennials rely on our friends, family, and peers for recommendations and suggestions. This is particularly true in the consumer arena — consider sites like Yelp and Amazon — but it has important implications for well-being benefits as well.
If you’re able to get an enthusiastic group of early adopters to enroll in your benefits program, you’ll likely enjoy a successful ripple effect with millennials. That’s because word-of-mouth is the most effective form of marketing for my generation. This ties back directly to our obsession with authenticity — we trust the recommendations and views of our friends and peers more than the promotional efforts of a corporate department.
When you’re implementing a well-being program, devote time and resources to building a champions network that will get the word out, share updates, and encourage others to join.
This will attract hard-to-engage populations and keep them invested throughout the program duration. Find a well-being vendor that has experience creating champion networks and your program will benefit immensely.
Rule 5: Offer well-being, not wellness.
Unlike previous generations who have used traditional milestones to measure success — climbing the corporate ladder, getting married, buying a house — millennials aspire towards balance, in life and in work. In fact, 97 percent of millennials named happiness as a primary interest. It’s nearly unanimous.
This focus on balance extends to the way millennials conceptualize health, which is much more focused on well-being than previous generations. 72 percent of millennials say they exercise once a week or more, and 95 percent say they care deeply about their health.
For wellness benefits to be relevant to millennials they can’t merely focus on the physical realm of health — clearly, millennials are already on that bandwagon.
Instead, they’ll be drawn to a range of programs that address other ways to find balance and achieve happiness. For example, financial wellness is of great interest to a generation that’s shouldering record levels of debt. My generation would also benefit greatly from emotional resiliency programs, since we are incredibly stressed.
To engage millennials in wellness, you have to extend the definition to embrace holistic wellbeing, incorporating programs that address the multiple factors that contribute to work/life balance, including mental, social, and emotional variables. Companies that adopt this millennial view of well-being will be much more successful in attracting, retaining, and engaging the most powerful generation in the workforce today.
Read the full article at: https://www.benefitspro.com/2016/06/27/5-rules-for-engaging-millennials-in-wellness?ref=hp-blogs&page_all=1
Source:
Kumar, R. (2016, June 27). 5 rules for engaging millennials in wellness [Web log post]. Retrieved from https://www.benefitspro.com/2016/06/27/5-rules-for-engaging-millennials-in-wellness?ref=hp-blogs&page_all=1
States Offer Privacy Protections To Young Adults On Their Parents’ Health Plan
Michelle Andrews gives insight on how the ACA is impacting HIPPA and privacy for young adults. See her article below.
Original Post from Kaisher Health News on June 28, 2016.
The health law opened the door for millions of young adults to stay on their parents’ health insurance until they turn 26. But there’s a downside to remaining on the family plan. Chances are that mom or dad, as policyholder, will get a notice from the insurer every time the grown-up kid gets medical care, a breach of privacy that many young people may find unwelcome.
With this in mind, in recent years a handful of states have adopted laws or regulations that make it easier for dependents to keep medical communications confidential.
The privacy issue has long been recognized as important, particularly in the case of a woman who might fear reprisal if, for example, her husband learned she was using birth control against his wishes. But now the needs of adult children are also getting attention.
“There’s a longstanding awareness that disclosures by insurers could create dangers for individuals,” said Abigail English, director of the advocacy group Center for Adolescent Health and the Law, who has examined these laws. “But there was an added impetus to concerns about the confidentiality of insurance information with the dramatic increase in the number of young adults staying on their parents’ plan until age 26” under the health law.
Federal law does offer some protections, but they are incomplete, privacy advocates say. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a key federal privacy law that established rules for when insurers, doctors, hospitals and others may disclose individuals’ personal health information. It contains a privacy rule that allows people to request that their providers or health plan restrict the disclosure of information about their health or treatment. They can ask that their insurer not send the ubiquitous “explanation of benefits” form describing care received or denied to their parents, for example. But an insurer isn’t obligated to honor that request.
In addition, HIPAA’s privacy rule says that people can ask that their health plan communicate with them at an alternate location or using a method other than the one it usually employs. Someone might ask that EOBs be sent by email rather than by mail, for example, or to a different address than that of the policyholder. The insurer has to accommodate those requests if the person says that disclosing the information would endanger them.
A number of states, including California, Colorado, Washington, Oregon and Maryland, have taken steps to clarify and strengthen the health insurance confidentiality protections in HIPAA or ensure their implementation.
In California, for example, all insurers have to honor a request by members that their information not be shared with a policyholder if they are receiving sensitive services such as reproductive health or drug treatment or if the patient believes that sharing the health information could lead to harm or harassment.
“There was concern that the lack of detail in HIPAA inhibited its use,” said Rebecca Gudeman, senior attorney at the National Center for Youth Law, a California nonprofit group that helps provide resources to attorneys and groups representing the legal interests of poor children. She noted that HIPAA doesn’t define endangerment, for example, and doesn’t include details about how to implement confidentiality requests.
Concerns by young people that their parents may find out about their medical care leads some to forgo the care altogether, while others go to free or low-cost clinics for reproductive and sexual health services, for example, and skip using their insurance. In 2014, 14 percent of people who received family planning services funded under the federal government’s Title X program for low-income individuals had private health insurance coverage, according to the National Family Planning and Reproductive Health Association.
Even though most states don’t require it, some insurers may accommodate confidentiality requests, said Dania Palanker, senior counsel for health and reproductive rights at the National Women’s Law Center, a research and advocacy group.
“Inquire whether there will be information sent and whether there’s a way to have it sent elsewhere,” Palanker said. “It may be possible that the insurer has a process even if state doesn’t have a law.”
Insurers’ perspective on these types of rules vary. In California, after some initial concerns about how the law would be administered, insurers in the state worked with advocates on the bill, Gudeman said. “I give them a lot of credit,” she said.
Restricting access to EOBs can be challenging to administer, said Clare Krusing, a spokesperson for America’s Health Insurance Plans, a trade group. A health plan may mask or filter out a diagnosis or service code on the EOB, but provider credentials or pharmacy information may still hint at the services provided.
There’s also good reason in many instances for insurers and policyholders to know the details about when a policy is used, experts say. Policyholders also may have difficulty tracking cost-sharing details such as how much remains on the deductible for their plan.
In addition, “if a consumer receives a filtered or masked EOB, he or she has no way of knowing whether their account has been compromised or used as part of fraudulent activity,” Krusing said.
Read the full article and learn more at: https://khn.org/news/states-offer-privacy-protections-to-young-adults-on-their-parents-health-plan/
Source:
Adnrews, M. (2016, June 27). States offer privacy protections to young adults on their parents’ health plan [Web log post] Retrieved from https://khn.org/news/states-offer-privacy-protections-to-young-adults-on-their-parents-health-plan/
When it Comes to Employee Engagement, ‘One-Size-Fits-All’ Isn’t Working
Is employee engagement becoming an issue within your organization? Allen Smith, J.D. brings to light some statistics on why the "one-size fits all" strategy may not be working.
Original Post from HrMorning.com on May 18, 2016
There’s bad news for organizations working hard to improve employee engagement: Overall, it’s still declining.
With so much time and energy being focused on this issue, what is still going wrong? In order to get some answers, Quantum Workplace — a company that offers an employee feedback platform — conducted an in-depth survey to see the macro and micro trends in employee engagement.
Their infographic below delves into how different types of employees’ engagement are driven by different factors.
The takeaway? It’s time to stop approaching engagement with “one-size-fits-all” strategies.
Some highlights include:
- In 2013, 68% of employees were engaged. That fell to 65.3% in 2015.
- Having leaders who are committed to making the organization a great place to work is the number one factor driving engagement.
- For employees between the ages of 26 and 35, having a job that allows them to use their strengths became more important. That factor jumped up 5 ranking spots as an influencer of engagement.
- While 72% of men and 67.9% of women are engaged, just 40.9% of employees of another gender identity are.
See the article and infographic at https://www.hrmorning.com/when-it-comes-to-employee-engagement-one-size-fits-all-isnt-working/
Source:
Smith, A. (2016, May 18). When it comes to employee engagement, 'one-size-fits-all' isn't working [Web log post]. Retrieved from https://www.hrmorning.com/when-it-comes-to-employee-engagement-one-size-fits-all-isnt-working/
5 Top Employee Benefits Questions and How to Answer Them
Original Post from BenfitsPro.com
By: Monica Majors
Legislative changes continue to markedly affect the health benefits marketplace. Employers and their workers face challenges on a number of fronts. Along with those challenges come questions that range from current and future requirements of health care reform, to providing adequate plan coverage that serves employees well.
By understanding the top-of-mind employer benefit issues and responding to them appropriately and effectively, brokers and advisors can better serve existing clients, attract new ones, and help employees protect themselves and their families going forward.
1. How can I meet my employees’ needs?
A key concern of today’s employers is making sure benefits they offer for both prospective and current employees are competitive. Businesses recognize the role a solid benefit program plays in attracting and keeping good talent, and they want to know what is included in plans offered by their competitors.
Brokers serving the health benefits marketplace can best serve customers by knowing the current market landscape well, speaking confidently about it and sharing that knowledge with customers. Key to this knowledge is understanding what the employer currently offers, what types of employees make up its workforce, what their needs are, and what gaps may currently exist.
Then, talk with insurers and learn what industry and market insight they may possess based on geographic and industry-specific factors. Search out findings made available from insurance- and customer-specific industry research organizations and trade associations. You can also mine data from within your own office, such as aggregated customer information by industry.
Integrate all of this information with comprehensive benefit offerings available from the carriers you represent, and show employers how they can gain a competitive market advantage with the right benefit plan.
2. How can I control my costs?
The question of controlling costs is common for obvious reasons. Small groups, in particular, are looking for creative ways to keep their health benefit expenses down. Brokers can address this question by understanding current offerings and combining that with knowledge of the plans available through the carriers they represent.
Understanding the various coverage tiers available and sharing that knowledge with employers is key. Often, implementing a health benefit program that meets the minimum required coverage levels brings the lowest cost.
Other cost-reduction strategies include addressing coverage for dependents or part-time employees. Some employers may consider eliminating dependent coverage or reducing contributions for this coverage. Also, determine with the employer the cost versus the benefit of including part-time staff in the plan. Employers may need to make tough decisions to maintain viable programs for employees.
Employers need to consider other costs that may come into play. For example, new IRS and ACA reporting requirements for employers to notify employees about new mandates bring with them administrative expenses. While they may not be able to eliminate these costs, brokers can help provide guidance and increase awareness around the changing requirements. They can also recommend approaches that might help employers streamline the process to reduce the impact of the requirements.
3. What about exchanges?
Employer questions about health benefit exchanges are prevalent. How do the exchanges align with the employer’s desire to deliver benefits in a cost-effective manner? What advantages do they offer? What are the drawbacks? Brokers need to be familiar with individual and group exchanges — both private and public.
Brokers working with some employers may find that certain tax advantages come along with using a public exchange. Private exchanges offer other benefits, from cost-management tools to a broader set of administrative support options and a choice of benefit options that extend beyond basic medical coverage. Group or employer-focused exchanges are becoming increasingly popular as a way to efficiently manage health benefits. Brokers should become familiar with the pros and cons, as well as processes involved.
It’s important to understand the advantages for different employer groups, as well as the reputation and satisfaction levels of exchanges, and use that knowledge to help employers select the right option.
4. What’s on the horizon?
Large employers are concerned about looming changes. They wonder how new regulations—for example, the Cadillac tax —may affect them in the future. Brokers need to be knowledgeable about what is coming down the pike, and how to minimize negative resulting impacts.
Preparing for the Cadillac tax, for example, may require a strategy shift. While the tax is primarily levied against health plans for coverage deemed “too rich,” it will ultimately affect employers and workers. Health plans are likely to pass off at least some of the costs to employers in the form of higher premiums. Employers may then pass costs off to workers in the form of higher cost-sharing arrangements. Of course, employers will have to consider how this will impact employee retention and recruitment.
The Internal Revenue Service posts helpful information about the ACA’s requirements on employers on its website: irs.gov/affordable-care-act. The Centers for Medicare & Medicaid Services website is another valuable resource: cms.gov/cciio/.
5. Why you?
The final top question may be one employers don’t explicitly ask; but it’s one you need to answer: “Why should I use you as a broker?” How is it that you set yourself apart from other brokers — industry knowledge, market strategy or customer service? Brokers need to carefully and clearly explain benefit plan designs, educate employers, guide them through the maze of changes in the benefits arena, and explain all the implications.
Building knowledge is the first part of the answer. Learn about laws, regulations and your employers’ workforce attributes. Learn more about the products offered by carriers and through the exchanges. Combine that knowledge with employer and employee data you capture to design programs that can help employers attract and retain good workers. Work with financially strong carrier partners to find and deliver the right benefit plans, and consider offering your clients a multi-year strategy where appropriate. And leverage administrative, technology, client portals and other resources your carrier partners offer.
Be sure to document and explain the advantages you can bring to the employer. Also, encourage satisfied customers to provide testimonials, directly and on social platforms, and then share these testimonials and references to help differentiate yourself and your shop from your competitors.
By understanding the needs of your clients, offering cost control solutions and keeping businesses apprised of changes on the horizon, you set yourself apart from other brokers and demonstrate your value as a trusted adviser. New and existing clients will come to you year after year for help in designing affordable health benefit plans that will attract and hold onto good workers.
How to Avoid Penalties Under the Affordable Care Act
Original Post from SHRM.org
By: Lisa Nagele-Piazza
2016 is expected to be the most expensive year for businesses complying with the Affordable Care Act (ACA), said David Lindgren, senior manager of compliance and public affairs for Flexible Benefit Service Corporation, a benefit administrator headquartered in Rosemont, Ill.
It’s the first year for dealing with ACA reporting, which many employers will have to complete by the end of June, Lindgren said during a concurrent session at the Society for Human Resource Management 2016 Annual Conference & Exposition.
There are more than 30,000 pages of guidance about the law, but Lindgren said the ACA is fairly easy to comprehend. “Of course, many people would disagree with me,” he noted.
“It’s not necessarily easy to comply with the ACA, and it’s not financially inexpensive, but most of the rules aren’t overly complicated,” he said.
The federal agencies that regulate the ACA have said they intend to monitor all businesses for compliance. This may not be realistic, but employers should keep in mind that more auditing can be expected.
Lindgren identified 30 penalties associated with noncompliance and provided insight on how to avoid them.
Employers can choose to pay the penalties for noncompliance, but steep fines are often attached, he said. For example, market reform violations carry a penalty of $100 per participant per day, up to $500,000 for each violation.
Employees Must Receive Notices
Some noteworthy penalties to avoid are those associated with the failure to provide required notices to plan participants, including a written notice of patient protections.
Lindgren said sometimes employers aren’t clear about who has been designated to provide this notice. “A lot of times the insurance company thinks the employer provided it and the employer thinks the insurance company did,” he said. “So it’s important to double check who is in fact giving the notice.”
Participants must also be provided with a summary of benefits and coverage in a standardized format. Lindgren likened this format to a nutrition label on a can of soup.
A participant should be able to easily compare the benefits to other plans, such as a spouse’s plan, just as the nutrition facts for two cans of soup can be easily compared.
There is a standardized template for the summary of benefits and coverage on the Department of Labor website.
The requirement to provide a summary of benefits and coverage applies to medical plans, but not to dental or vision plans.
The summary should be distributed at the time of open enrollment and special enrollments related to qualifying events, as well as at the request of participants and when a material modification has been made to the plan.
Although there is no penalty attached for noncompliance, employers must also provide written notice about the health insurance marketplace to new hires within 14 days of their start date.
This applies even for organizations that don’t offer benefits and even to those employees who aren’t eligible for benefits, Lindgren said.
There are some exceptions. For example, if an employer isn’t subject to the Fair Labor Standards Act, then it doesn’t have to provide the marketplace notice.
Exceptions for Grandfathered Plans
Grandfathered plans aren’t subject to some of the requirements under the ACA. This includes plans purchased on or before March 23, 2010, that haven’t made certain material changes.
Lindgren noted that employers with grandfathered plans must provide written notice to participants notifying them that it is a grandfathered plan and describing what that means for participants.
If participants aren’t provided this information, the plan will lose its grandfathered status, Lindgren said.
HR Takes the Lead
Benefits compliance isn’t just a human resources issue anymore, but HR often takes the lead in compliance efforts, according to Lindgren.
However, other departments, such as finance, legal and information technology, are increasingly getting more involved.