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
Financial Fitness Benefits Take Center Stage as Debt Worries Grow
According to speakers from the Society for Human Resource Management 2019 Annual Conference & Exposition, employees who are taking advantage of financial health benefits have less stress, reduced distraction and lower absenteeism. Read this blog post for more on financial fitness benefits.
LAS VEGAS—Employers that help workers improve their financial health are seeing increased productivity, job satisfaction and retention. Employees taking advantage of these benefits have less stress, reduced distraction and lower absenteeism, according to speakers at the Society for Human Resource Management 2019 Annual Conference & Exposition.
"Your employees are financially stressed, and it's affecting your business," said Dan Macklin, CEO of Salary Finance, a financial technology firm, during a June 24 panel discussion on financial wellness benefits. A survey conducted by his firm, with responses from 10,484 U.S. employees, found that 48 percent were worried or stressed about their finances. Financially stressed employees lost nearly one month of productive workdays per year.
Money management problems exist across all income levels, Macklin noted.
"Financial worries are the No. 1 cause of employee stress," said Kent Allison, national leader for employee financial education and wellness at PwC. The consultancy's 2019 Employee Financial Wellness Survey, with responses from 1,686 full-time employees, showed that 59 percent cited financial or money matters as their chief source of stress, followed by their job (15 percent) and relationships.
Nearly half (49 percent) of all employees said they find it difficult to meet household expenses on time each month, PwC found.
"Employees are seeking personalized financial guidance and coaching," Allison said. "Successful financial wellness programs find the optimal way to combine technology and human interaction" to help employees get back on track financially.
Organizations are more likely to thrive when they help employees "bring their healthiest and happiest self to work," said Felicia Cheng, wellness benefits program manager at HR technology firm SalesForce.
Organizations are more likely to thrive when they help employees 'bring their healthiest and happiest self to work.'
Have meaningful conversations with employees, said Wendy Myers Cambor, Northeast U.S. HR leader at consulting firm Accenture. "Ask what they want, what they need and how we might be in a position to accommodate them."
Accenture, like many companies, has five generations of employees in its workforce, whose concerns range from "managing student debt and affording to have a child and buy a home, to helping to care and provide for aging parents while preparing for their own retirement," Cambor noted.
Physical wellness and financial wellness are deeply interrelated, said Allison, because financial distress can lead to health distress.
Similar to health risk assessments, he said, financial wellness assessments can be helpful because "how can you change behaviors if you don't know what these behaviors are?" He advised, "Assess employees to know where they are financially and what their needs are, and what behaviors they may need to change."
Financial health assessments could be stymied if employees don't feel comfortable revealing their distress—and don't trust their employers with this information, panelists noted. Cheng said it was important to help employees overcome taboos around admitting to money problems, because, if employers don't understand the scope of the challenges their employees face, they can't provide the help that employees need.
Macklin noted that younger workers seem more willing to discuss their financial difficulties and are grateful for the guidance and assistance employers provide.
Younger workers seem more willing to discuss their financial difficulties and are grateful for the assistance employers provide.
"Engage employees at the right time to provide help when needed," Allison suggested.
"People are suffering," Cambor said. "There are opportunities for HR to make a difference in peoples' lives."
"Employees' stories are powerful," Cheng said. HR should "bring them to the leadership team, coupled with data on the positive impact of financial wellness," to make the case for financial wellness benefits.
Student Loan Benefits Are in Demand
Student loan debt affects employees at all stages of their careers, said Kevin Fudge, director of consumer advocacy at American Student Assistance, a nonprofit that helps students manage their education debt, during a June 25 conference session.
He noted that more than 3 million Americans ages 60 and older currently owe more than $86 billion in unpaid student loans, according to the Consumer Financial Protection Bureau.
Employees face different concerns at different career stages, Fudge pointed out, including:
- Early career: Paying off student loans and related debt.
- Mid-career: Supporting a family and saving for children's college education.
- Late career: Helping children and grandchildren by co-signing loans and preparing for retirement.
Fudge pointed to innovative ways employers are helping with student loans. For instance:
- Abbott Laboratories allows employees to save for retirement and pay down their student loans. If an employee is paying off student loans (using 2 percent or more of their pay), Abbott will put the equivalent of 5 percent of the employee's pay into his or her 401(k) account.
Abbott received a private letter ruling from the IRS to allow this practice. The IRS is expected to sanction similar plans with broader guidance. Legislation has also been introduced to allow this practice.
- Unum, a national insurance firm, lets employees transfer carried-over paid time off into debt repayment.
In a June 24 conference session on student loan benefits, Meera Oliva, chief marketing officer at Gradifi, a loan benefits administrator; Jane Fontaine, senior vice president of HR at Digital Federal Credit Union; and Chad Carter, vice president of benefits at Fareway Stores, shared these examples, showing the range of student loan aid employers are providing:
- AECOM, a Fortune 500 engineering firm, offers student loan refinancing along with student loan counseling and financial wellness content.
- Carvana, an e-commerce platform for buying cars, offers up to $1,000 per year to help full-time employees pay off their student loans.
- Connelly Partners, a Boston-based advertising agency, offers a total benefit of $10,000 with contributions starting at $100 a month for the first year and then increasing $25 a month for the next four years. In another effort to retain employees, the firm gives a $1,000 retention bonus at the end of the fifth year of employment.
- Sotheby's, an auction house and private sales firm, offers $150 per month contribution toward student loans indefinitely until employees are no longer in debt, including parents who have taken on debt for their children.
SOURCE: Miller, S. (27 June 2019) "Financial Fitness Benefits Take Center Stage as Debt Worries Grow" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/financial-fitness-benefits-take-center-stage.aspx
Federal Appeals Court Takes Up Case That Could Upend U.S. Health System
A federal appeals court in New Orleans has taken up a case against the Affordable Care Act. If the lower court's ruling in the case, Texas v. United States, is upheld, it has the potential to shake the nation's health care system. Read this article to learn more about this case.
The fate of the Affordable Care Act is again on the line Tuesday, as a federal appeals court in New Orleans takes up a case in which a lower court judge has already ruled the massive health law unconstitutional.
If the lower court ruling is ultimately upheld, the case, Texas v. United States, has the potential to shake the nation’s entire health care system to its core. Not only would such a decision immediately affect the estimated 20 million people who get their health coverage through programs created under the law, ending the ACA would also create chaos in other parts of the health care system that were directly or indirectly changed under the law’s multitude of provisions, such as calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions.
“Billions of dollars of private and public investment — impacting every corner of the American health system — have been made based on the existence of the ACA,” said a friend-of-the-court brief filed by a bipartisan group of economists and other health policy experts to the 5th Circuit Court of Appeals. Upholding the lower court’s ruling, the scholars added, “would upend all of those settled expectations and throw healthcare markets, and 1/5 of the economy, into chaos.”
Here are five important things to know about the case:
It was prompted by the tax bill Republicans passed in 2017.
The big tax cut bill passed by the GOP Congress in December 2017 eliminated the penalty included in the ACA for failure to maintain health insurance coverage. The lawsuit was filed in February 2018 by a group of Republican attorneys general and two governors. They argued that since the Supreme Court had upheld the ACA in 2012 specifically because it was a valid exercise of Congress’ taxing power, taking the tax away makes the entire rest of the law unconstitutional.
Last December, Judge Reed C. O’Connor agreed with the Republicans. “In some ways the question before the court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote in his decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
State and federal Democrats are defending the law.
Arguing that the rest of the law remains valid is a group of Democratic attorneys general, led by California’s Xavier Becerra.
“Our argument is simple,” said Becerra in a statement last Friday. “The health and wellbeing of nearly every American is at risk. Healthcare can mean the difference between life and death, financial stability and bankruptcy. Our families’ wellbeing should not be treated as a political football.”
The Democratic-led House of Representatives has also been granted “intervenor” status in the case.
The Trump administration has taken several positions on the lawsuit.
The defendant in the case is technically the Trump administration. Traditionally, an administration, even one that did not work to pass the law in question, defends existing law in court.
Not this time. And it is still unclear exactly what the administration’s position is on the lawsuit. “They have changed their position several times,” Sen. Chris Murphy (D-Conn.) told reporters on a conference call Monday.
When the administration first weighed in on the case, in June 2018, it said it believed that without the tax penalty only the provisions most closely connected to that penalty — including requiring insurers to sell policies to people with preexisting conditions — should be struck down. The rest of the law should stay, the Justice Department argued.
After O’Connor’s ruling, however, the administration changed its mind. In March, a spokeswoman for the Justice Department said it had “determined that the district court’s comprehensive opinion came to the correct conclusion and will support it on appeal.”
Now it appears the administration is shifting its opinion again. In a filing with the court late last week, Justice Department attorneys argued that perhaps the health law should be invalidated only in the GOP states that are suing, rather than all states. It is unclear how that would work.
Legal scholars — including those who oppose the ACA — consider the case dubious.
In a brief filed with the appeals court, legal scholars from both sides of the fight over the ACA agreed that the lawsuit’s underlying claim makes no sense.
In passing the tax bill that eliminated the ACA’s tax penalty but nothing else, Congress “made the judgment that it wanted the insurance reforms and the rest of the ACA to remain even in the absence of an enforceable insurance mandate,” wrote law professors Jonathan Adler, Nicholas Bagley, Abbe Gluck and Ilya Somin. Bagley and Gluck are supporters of the ACA; Adler and Somin have argued against it in earlier suits. “Congress itself — not a court — eliminated enforcement of the provision in question and left the rest of the statute standing. So congressional intent is clear.”
It could end up in front of the Supreme Court right in the middle of the 2020 election.
Depending on what happens at the appeals court level, the health law could be back in front of the Supreme Court — which has upheld the health law on other grounds in 2012 and 2015 — and land there in the middle of next year’s presidential campaign.
Democrats are already sharpening their rhetoric for that possibility.
“President Trump and Republicans are playing a very dangerous game with people’s lives,” Senate Minority Leader Chuck Schumer told reporters on a conference call Monday.
Murphy said he is most concerned that if the lower court ruling is upheld and the health law struck down, Republicans “won’t be able to come up with a plan” to put the health care system back together.
“Republicans tried to come up with a replacement plan for 10 years, and they couldn’t do it,” he said.
SOURCE: Rovner, J. (9 July 2019) "Federal Appeals Court Takes Up Case That Could Upend U.S. Health System" (Web Blog Post). Retrieved from https://khn.org/news/federal-appeals-court-takes-up-case-that-could-upend-u-s-health-system/
DOL Offers Wage and Hour Compliance Tips in Three Opinion Letters
On July 1, the U.S. Department of Labor (DOL) released three opinion letters that address how to comply with the Fair Labor Standards Act (FLSA) regarding wage and hour issues. Continue reading this blog post to learn how the agency would enforce statutes and regulations specific to these situations.
The U.S. Department of Labor (DOL) issued three new opinion letters addressing how to comply with the Fair Labor Standards Act (FLSA) when rounding employee work hours and other wage and hour issues.
Opinion letters describe how the agency would enforce statutes and regulations in specific circumstances presented by an employer, worker or other party who requests the opinion. Opinion letters are not binding, but there may be a safe harbor for employers that show they relied on one.
The DOL Wage and Hour Division's July 1 letters covered:
- Permissible rounding practices for calculating an employee's hours worked.
- How to apply the "highly compensated employee" exemption from overtime pay to paralegals who are employed by a trade organization.
- How to calculate overtime pay for nondiscretionary bonuses that are paid on a quarterly and annual basis.
Here are the key takeaways for employers.
Rounding Practices
One letter reviewed whether an organization's rounding practices are permissible under the Service Contract Act (SCA), which requires government contractors and subcontractors to pay prevailing wages and benefits and applies FLSA principles to calculate hours worked.
The employer's payroll software extended employees' clocked time to six decimal points and then rounded that number to two decimal points. When the third decimal was less than .005, the second decimal was not adjusted, but when the third decimal was .005 or greater, the second decimal was rounded up by 0.01. Then the software calculated daily pay by multiplying the rounded daily hours by the SCA's prevailing wage.
Employers may round workers' time if doing so "will not result, over a period of time, in failure to compensate the employees properly for all the time they have actually worked," according to the FLSA.
"It has been our policy to accept rounding to the nearest five minutes, one-tenth of an hour, one-quarter of an hour, or one-half hour as long as the rounding averages out so that the employees are compensated for all the time they actually work," the opinion letter said.
Based on the facts provided, the DOL concluded that the employer's rounding practice complied with the FLSA and the SCA. The rounding practice was "neutral on its face" and appeared to average out so that employees were paid for all the hours they actually worked.
For employers, the letter provides two significant details, said Marty Heller, an attorney with Fisher Phillips in Atlanta. First, it confirms that the DOL applies the FLSA's rounding practices to the SCA. Second, it confirms the DOL's position that computer rounding is permissible, at least when the rounding involves a practice that appears to be neutral and does not result in the failure to compensate employees fully over a period of time, he said.
Patrick Hulla, an attorney with Ogletree Deakins in Kansas City, Mo., noted that the employer's rounding practice in this case differed from many employers' application of the principle. Specifically, the employer was rounding time entries to six decimal places. Most employers round using larger periods of time—in as many as 15-minute increments, he said.
"Employers taking advantage of permissible rounding should periodically confirm that their practices are neutral, which can be a costly and time-consuming exercise," he suggested.
Exempt Paralegals
Another letter analyzed whether a trade organization's paralegals were exempt from the FLSA's minimum wage and overtime requirements. Under the FLSA's white-collar exemptions, employees must earn at least $23,660 and perform certain duties. However, employees whose total compensation is at least $100,000 a year are considered highly compensated employees and are eligible for exempt status if they meet a reduced duties test, as follows:
- The employee's primary duty must be office or nonmanual work.
- The employee must "customarily and regularly" perform at least one of the bona fide exempt duties of an executive, administrative or professional employee.
Employers should note that the DOL's proposed changes to the overtime rule would raise the regular salary threshold to $35,308 and the highly compensated salary threshold to $147,414.
Because "a high level of compensation is a strong indicator of an employee's exempt status," the highly compensated employee exemption "eliminates the need for a detailed analysis of the employee's job duties," the opinion letter explained.
The paralegals described in the letter appeared to qualify for the highly compensated employee exemption because all their duties were nonmanual, they were paid at least $100,000 a year, and they "customarily and regularly" perform at least one duty under the administrative exemption.
The letter cited "a litany of the paralegals' job duties and responsibilities—including keeping and maintaining corporate and official records, assisting the finance department with bank account matters, and budgeting—that are directly related to management or general business operations," the DOL said.
The DOL noted that some paralegals don't qualify for the administrative exemption because their primary duties don't include exercising discretion and independent judgment on significant matters. But the "discretion and independent judgment" factor doesn't have to be satisfied under the highly compensated employee exception.
Calculating Bonuses
The third letter discussed whether the FLSA requires an employer to include a nondiscretionary bonus that is a fixed percentage of an employee's straight-time wages received over multiple workweeks in the calculation of the employee's regular rate of pay at the end of each workweek.
Under the FLSA, nonexempt employees must be paid at least 1 1/2 times their regular rate of pay for hours worked beyond 40 in a workweek, unless they are covered by an exemption—but the regular rate is based on more than just the employee's hourly wage. It includes all remuneration for employment unless the compensation falls within one of eight statutory exclusions. Nondiscretionary bonuses count as remuneration and must be included in the calculation.
"An employer may base a nondiscretionary bonus on work performed during multiple workweeks and pay the bonus at the end of the bonus period," according to the opinion letter. "An employer, however, is not required to retrospectively recalculate the regular rate if the employer pays a fixed percentage bonus that simultaneously pays overtime compensation due on the bonus."
The annual bonus, in this case, was not tied to straight-time or overtime hours. Based on the facts provided by an employee, the DOL said that after the employer pays the annual bonus, it must recalculate the regular rate for each workweek in the bonus period and pay any overtime compensation that is due on the annual bonus.
For the quarterly bonuses, the employee received 15 percent of his straight-time and overtime wages so they "simultaneously include all overtime compensation due on the bonus as an arithmetic fact," the DOL said.
SOURCE: Nagele-Piazza, L.(2 July 2019) "DOL Offers Wage and Hour Compliance Tips in Three Opinion Letters" (Web Blog Post). Retrieved from https://www.shrm.org/ResourcesAndTools/legal-and-compliance/employment-law/Pages/DOL-Offers-Wage-and-Hour-Compliance-Tips-in-Three-Opinion-Letters.aspx
Creating an ‘urgent care first’ mindset for employee benefits
With urgent cares continuing to pop up everywhere, it’s important to guide your employees in adopting an "urgent care first" mentality. Continue reading this blog post to learn more.
Urgent care centers are popping up everywhere, which means getting quick healthcare is easier and more convenient for patients. But these centers could also help employers minimize expensive emergency room claims. That’s why it’s important to guide employees to adopt an “urgent care first” mentality.
The concept of urgent care has been around since the 1970s, but rising healthcare costs, especially for ER care, have spurred an increase in centers across the U.S. over the last decade. In fact, from 2014 through June 2017, the number of urgent care centers rose by nearly 20%.
Urgent care centers provide care for health problems that aren’t life-threatening, but can’t wait for an appointment with a primary care provider. No one wants to suffer with a sore throat all weekend. Many urgent care centers are staffed with doctors and nurses, and provide more advanced capabilities than what’s typically available at a primary care doctor’s office. For example, some urgent care centers give stitches, provide X-rays and even MRIs.
Patients can also get treatment at urgent care for conditions they’d typically see a primary care doctor for, such as the flu or a fever, mild to moderate asthma, skin rashes, sprains and strains, and a severe sore throat or cough — illnesses that produce unnecessary high claims if treated in an ER.
Still, when a severe sore throat and high fever strike on a weekend and the doctor’s office is closed, employees may gravitate to the ER because they’re sick and need help right now. That’s where the urgent care first mindset becomes good medicine. It typically costs the employer (and often the employee) far less if that sore throat is treated in an urgent care facility.
The high cost of ER care is enough to make anyone run a high temp. From 2009 to 2016 (the most recent data available), the average amount that hospitals billed insurance carriers for an emergency room visit more than doubled, from $600 to $1,322. By contrast, urgent care typically costs about $150 per visit. Members often pay a lower copay for urgent care visits, too.
The urgent care first mindset is starting to take hold. New data analysis from Aetna shows that as urgent care centers began to proliferate, ER visits for minor health issues dropped 36%, while the use of urgent care and other non-emergency health settings increased 140%.
However, the same study shows that plans only saw a decrease in ER visits if there were several urgent care centers in the geographic region where their employees lived. Awareness is key.
Fostering an urgent care first mentality
Employers can’t just include urgent care in a benefits plan and expect employees to use it. They need to design the plan to encourage use and follow up with plenty of education.
Education about the benefits of primary care versus urgent care versus the ER should take place during open enrollment and throughout the plan year so members understand the medical necessity and financial implications of each option. Including the closest urgent care centers to employees, as well as a list of services they provide, can help encourage them to adopt an urgent care first mentality.
A word of caution: not every nearby urgent care center is actually in-network. It literally pays for employees to keep a list of nearby in-network centers handy when that inevitable weekend sore throat strikes.
Reminders about urgent care before spring allergies, summer vacations, fall school physicals and flu season can also help encourage their use.
The too-low ER copay
Plan design is another important piece of the puzzle to help steer employees to the right level of care for their needs. It’s not that unusual to see a $100 copay for an emergency department visit. While no one wants to discourage ER visits for true emergencies, it makes sense to adjust the plan design to encourage primary and urgent care visits instead. That may mean a $20 copay for primary care, a $40 copay for urgent care and a $200 to $250 copay for ER visits — which is waived if the plan participant is admitted to the hospital.
For high-deductible health plans paired with a health savings account, the savings can be even more drastic; patients may pay $200 for an urgent care visit versus $1,200 for an ER visit.
The combination of education and plan design can help curb unnecessary ER visits, which could help employers control healthcare increases from plan year to plan year. For health issues that crop up during off hours, the urgent care first mindset is good for both employers and employees, who will ultimately save time and money.
SOURCE: O'Conner, P. (5 July 2019) "Creating an ‘urgent care first’ mindset for employee benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/creating-an-urgent-care-first-mindset-for-employees
Here’s how to ensure employees know how to pick the right benefits
Open enrollment is an important time for employees, but it's often a stressful one as well. According to recent research, the average employee spends less than 30 minutes selecting their benefits. Read this blog post for more on communicating benefit options to employees.
Annual enrollment is an important time for employees — but it’s also a stressful one. The choices they make can affect their financial health, yet the average employee spends less than 30 minutes selecting their benefits, according to research from benefits provider Unum.
With annual enrollment planning underway, now is the time for employers to ask themselves, “How can we help employees make the right benefits decisions?” The answers may be more valuable than they think.
See Also: Ideas for Effectively Demonstrating Plan Choices
Today’s workforce is the most diverse in history, with four generations actively working, and a fifth connected through benefits and pensions. A robust benefits package is increasingly important for recruitment and retention, challenging employers to provide choices and options that support diverse needs.
About 80% of employees prefer a job with benefits over one with a higher salary but no benefits, according to the American Institute of CPAs. As such it’s vital that employers ensure their workforce is engaged with their benefits and taking full advantage of what is available. Here are five ways employers can make sure that happens.
See Also: Ideas to Help Employees Find their "Best Fit" Plan
1. Acknowledge that decision support addresses personalized needs. Tools that demystify the benefits selection process can help employees make choices that align with their risk tolerance, financial circumstances and unique needs. The best tools lead employees to a recommended suite of benefits options that fit their individual physical, emotional and financial health.
2. Know that year-round engagement improves benefits literacy. While employees appreciate benefits, they aren’t experts. Indeed, roughly one-third of employees are outright confused about their benefits, according to recent data from Businessolver. Keeping up a cadence of communication about benefits throughout the year can help address this challenge.
3. Recognize the power of a total rewards statement. It empowers employees to maximize the benefits available to them, and these tools can be accessed at any time, not just during enrollment. The most impactful solutions aggregate all employee benefits options in one integrated offering that demonstrates the full value of compensation and benefits investments made by them and their employer.
See Also: Communicating the Value of Employee Benefits
4. Think about different generations. Customizable benefits options are a crucial step in meeting the needs of today’s workforce. For example, our latest data shows that nearly two-thirds of millennials are concerned with managing their monthly budget, while over 50% of boomers are most worried about a large, unexpected cost. Having core medical plan offerings along with complementary voluntary options helps employees address varying financial needs. Likewise, paid parental leave and different health plan options assist families at any stage, and they make it likelier that your employees will engage with their benefits and remain with your organization.
5. Be sure employees know that savings vehicles contribute to financial well-being. Employees of all ages and income levels are facing financial stressors — but they may not be the same ones. Offering different financial benefits, such as student loan assistance and emergency savings accounts, in addition to retirement benefits, enables your employees to address both their immediate and long-term financial needs.
See Also: Avoiding Communication Overload During Open Enrollment
More than ever, employers have a responsibility to help employees make informed decisions when it comes to selecting the right benefits. Otherwise, they risk losing top talent to organizations that are better implementing benefits strategies and technologies.
By meeting the needs of a diverse workforce with an array of benefits options supported by appropriate decision support resources, employers can ensure they’re meeting their workforce’s needs and retaining valuable employees.
See Also: Incorporating Incentives to Create Educated Benefit Consumers
SOURCE: Shanahan, R. (26 June 2019) "Here’s how to ensure employees know how to pick the right benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/educating-employees-to-pick-the-right-benefits
Top 10 Workplace Trends for 2019
During this year's SHRM's Annual Conference & Exposition, Dan Schawbel discussed the importance of looking forward three to six months or even a few years for new and emerging trends. Factors such as technological developments, economic changes, globalization and automation, all affect how companies do business and attract top talent. Read this blog post to learn more.
LAS VEGAS — HR professionals and organization leaders have a lot to keep up with: technological developments, economic changes, globalization and automation. All of these factors affect how companies do business and attract and retain talented workers.
"If we don't keep up with all the changes going on around us in terms of the tasks we do every day, we become obsolete," said Dan Schawbel, partner and research director at New York City-based Future Workplace, an executive development firm dedicated to rethinking and reimagining the workplace.
It's more important now than ever for business professionals to look forward three or six months or even a few years, he said during a mega session at the Society for Human Resource Management 2019 Annual Conference & Exposition.
Conference attendee Jessica Whitney said she hoped to learn about any new trends for the workplace so she could compare what's discussed to what her company is currently doing—to see what it's doing right and if there are any new ideas she can take back to the office. Whitney is a people partner at Unum Therapeutics in Massachusetts.
These are the top 10 trends that will impact HR departments in 2019, according to Schawbel's research.
1. Fostering the relationship between workers and robots.
One of the biggest trends of 2019 is the partnership between robots and humans. "The human element will never go away," Schawbel said. HR will continue to manage the human workforce, and information technology (IT) teams will manage the robots. "The big opportunity moving forward is for HR to partner with IT and even other departments … in order to collaborate and manage the human experience," he said.
2. Creating flexible work schedules.
"Flexibility is something that we want because we're working more hours than ever before," he said. Regardless of age or generation, employees want to have a life outside of work.
3. Taking a stand on social issues.
Younger workers, especially, want to work for companies that are making a positive difference in the world, Schawbel said. Companies that take a stand on social issues will be unpopular with some people, he noted, but if they want to attract the right talent, they have almost no choice.
4. Improving gender diversity.
Compared to men, few women hold executive positions. The New York Times reported that "fewer women run big companies than men named John." That's the bad news. "The great news," Schawbel said, "is that countries are getting involved, companies are getting involved, and it looks like changes are on the horizon."
5. Investing in mental health.
Many people either have mental disorders or interact with someone who does, and mental health is becoming less stigmatized as more people speak publicly on the topic. Britain's Prince Harry, for example, is partnering with Oprah Winfrey and Apple on a series about mental health and has also asked employers in the United Kingdom to sign a pledge to take a stand on this issue. Schawbel noted that employers who sign the pledge signal to employees that they take mental health seriously.
6. Addressing the loneliness of remote workers.
Many employees today can work from wherever they want. Remote work is great—and employers need to promote flexibility—but there is a cost, Schawbel said. The isolation employees feel when they don't interact enough with co-workers may cause them to check out. Investing in offsite and team-building events can help. Connecting with remote workers in person even once a year can make a huge difference and build trust, he noted.
7. Upskilling the workforce.
There are 7.4 million open jobs in the U.S., and the unemployment rate is 3.6 percent. So employers need to find creative ways to close the skills gap. Companies are starting to hire more older workers, workers with disabilities, workers who were formerly incarcerated and veterans. "The [talent] pool is getting wider and wider, which is great," Schawbel said. "It's great because talent can come from anywhere." Companies are less focused on age, gender and other factors and more concerned with whether the person can do the joband work well with others, he added.
8. Focusing on soft skills.
"Soft skills are the new hard skills," Schawbel said. Ninety-one percent of HR professionals surveyed by LinkedIn believe soft skills are very important for the future of recruiting. "You can train for hard skills, but soft skills take a long time to learn," Schawbel noted. "If you hire someone who has a positive attitude, good organizational skills, is able to delegate work … they're going to be incredibly valuable in today's world."
9. Preparing for Generation Z.
Employers need to understand Generation Z, the demographic born between the mid-1990s and mid-2000s. Many in this cohort identify anxiety as a major issue that gets in the way of their workplace success, which relates to addressing mental health, Schawbel said. And even though Generation Z workers self-identify as the digital generation, they say they want more face-to-face interaction at work. Additionally, they tend to expect quick promotions, so employers should set realistic expectations, he noted.
10. Preventing burnout.
Employees must grapple with an "always on" work culture, and many employees leave their companies as a result of being overworked. Employers should recognize what causes burnout and aim to fix it, because it may cost them more over time if they don't, Schawbel said.
"We have to think about work differently," he added. "The future is uncertain … but we can make changes today that will give us a better tomorrow."
SOURCE: Nagele-Piazza, L., J.D., SHRM-SCP (27 June 2019) "Top 10 Workplace Trends for 2019" (Web Blog Post). Retrieved from https://www.shrm.org/hr-today/news/hr-news/Pages/Top-10-Workplace-Trends-for-2019.aspx
No Gym Required for These (Financial) Fitness Tips
While getting "healthy and fit" is important, it's also important to be concerned about your financial fitness. Read this blog post for tips to stay financially fit at any age.
If you’re like me, your social media feeds are jammed with headlines about getting “healthy and fit” in the new year. Of course, they’re referring to diet and exercise and common resolutions to drop pounds and work out more often.
But it’s just as important to be concerned about your financial fitness—where you can also drop some baggage and get some strength training without going near a gym. (In fact, if you have a subscription to a gym membership but aren’t going, that’s one financial fix you can make right now.)
Here are some tips to consider for any age:
IN YOUR 20s:
Workout: Have a portion of each paycheck deposited into your savings account, or take advantage of bank programs that “round up” or have other automated savings features. Trust me, you won’t feel this burn.
Diet: Start making coffee at home or at the office instead of going for expensive lattes. Fewer calories, and more money in your pocket. This is a good time to consider getting life insurance (whether you are single or attached) as it is less expensive the younger and healthier you are.
You also need to consider disability insurance, which pays you a portion of your salary if you are sick or injured and unable to work—because who would pay your bills if you couldn’t? Your work may offer this as an employee benefit, so check with your HR department to find out if you have it and what it covers (short-term, long-term disability, etc.)
IN YOUR 30s:
Workout: You probably have a retirement program at work or some other preliminary retirement planning in place. If you don’t, start.
If you do, why not increase the amount you divert into retirement by a percentage point each year—equaling your company match percentage, if they have it, is a good target.
Diet: You may not have gotten life insurance beyond what you have through your workplace, but now is the time to consider an individual policy that you own. Remember, when you leave a job, you typically lose that life insurance offered through your workplace. And, given that life insurance through the workplace usually equals one or two times you salary (or a set amount like $50,000), it’s no longer going to cut it if you have a growing family.
If money’s tight, as it often is with a growing family, lingering student loans, and perhaps a mortgage, a term life insurance policy can protect you through the lean years. But don’t overlook the long-term benefits of a permanent life insurance policy. The cash value can be tapped later for needs that may arise. Plus, there’s nothing that says you can’t have a combination of both.
Also, consider an individual disability insurance policy that you personally own and follows you throughout your career. If you’re relying on work coverage, know that it goes away when you leave that job, and often these policies have bare-bones coverage.
IN YOUR 40s:
Workout: Do you have a financial professional helping you out? Navigating the ins and outs of a growing investment portfolio can be tricky as you move through your career and want to use traditional or Roth IRAs, and the tax benefits of various planning strategies. This may also be the time that you can add a permanent life insurance policy, if you haven’t before, which allows you to accrue cash value and obtain benefits that extend later into your life.
Diet: If you’re still carrying extra debt at this point, it’s time to get that paid down. Tackle higher-interest debts first, and celebrate each paid-off card or loan with … a bigger payment to the next one on the list.
IN YOUR 50s:
Workout: Max out your retirement contributions, especially once your kids are through college. This is also a good time to start researching things like long-term care insurance, and to make sure that your investment portfolio is built in such a way that you can reach your goals.
Diet: It may be very tempting to take on a new debt now: some folks want a vacation home, or the time may be right to start a business. But beware of any super-risky moves that can spell catastrophe with limited time to recoup losses, or that leave you with unexpected bills.
IN YOUR 60s and beyond:
Workout: Evaluate your Social Security situation against your retirement portfolio to determine the best time to retire. Understand the “living benefits” of your life insurance policies and how annuities may help you create a retirement income stream that you can’t outlive.
Diet: Is it time to downsize? It can be hard letting go of “stuff” so that you can go from that four-bedroom house to a two-bedroom condo. But the financial benefit of doing so may surprise you—plus there is less to clean and take care of (not to mention the ease of jetting off at a moment’s notice with no need for someone to look after your home.)
A lot depends on factors like your relationship status, your career path, whether you have kids or not, and what your long-term goals are, and these can change at any time in our lives.
The long and short of it is that just as when it comes to “health and fitness” goals, you’d get an annual physical. Need to know if you’re financially fit? Talk to an insurance professional or financial advisor today.
SOURCE: Mosher, H. (10 January 2019) "No Gym Required for These (Financial) Fitness Tips" (Web Blog Post). Retrieved from https://lifehappens.org/blog/no-gym-required-for-these-financial-fitness-tips/
It’s time to incorporate cancer screenings into your wellness program
The National Cancer Institute reported that newer FDA-approved novel immunotherapies have shown to be beneficial responses to colorectal cancer but can cost upwards of $400,000 per year. This post from Employee Benefit News discusses incorporating cancer screenings into corporate wellness programs.
Scott Wilson, an employee at brewing company Molson Coors in Denver, was diagnosed with stage four metastatic colorectal cancer in 2016 — a disease that would cost him upward of $1.3 million to date, with significant dollars paid out for non-covered medical expenses.
As a consequence of a later-stage diagnosis, colon and liver resections were necessary coupled with aggressive treatment using chemotherapy and Vectobix — a newer and costly immunotherapy that is priced at $8,000 per week. On average, more than 40,000 people undergo treatment for metastatic colorectal cancer each year and the cost of treatment varies depending on the stage at diagnosis, treatment response and plan.
The availability of newer FDA-approved novel immunotherapies have shown to be beneficial responses to this deadly cancer, but at staggering costs that can be upward of $400,000 per year at market introduction, according to the National Cancer Institute.
Today, about 60% of diagnosed colorectal cases are discovered in later stage disease due to under-screening — a third of the eligible population have never been screened or are not up-to-date with screening guidelines. As a result, about 140,000 Americans are diagnosed with any stage of colorectal cancer and about 51,000 people die of this cancer annually. A recent study examined 1,750 colorectal cancer deaths from 2006 to 2012 in the Kaiser Permanente Health System — 76% of those deaths occurred in patients who were never screened or were not up-to-date with screening.
Cancer screening in the workplace
Last year, the American Cancer Society lowered the colorectal cancer screening age to 45 based on the rising rates of cancer trending in younger age populations — other cancer organization’s recommendations remain at age 50. Employers are in a unique position to reinforce and support these national recommendations among their employees.
Employees between 50 and 65 years of age have the lowest screening rates for colorectal cancer screening, and are typically covered by employer-sponsored health plans. Employers find offering cancer screening programs that reward participation via health and wellness programs are reducing disease risk and financial burdens for themselves and their employees.
The costs for treatment of cancer are more than double the rate of other healthcare expenses. For an employer, the impact of a late versus an early stage diagnosis is significant. National expenditures for treatment and care of colorectal cancer are second only to breast cancer.
In people age 65 and younger, the U.S spends in excess of $7.4 billion for treatment of colorectal cancer. For those employees diagnosed with any stage of colorectal cancer, a large percentage of costs are paid out by company-sponsored health plans despite the implementation of high-deductible health plans.
It would seem prudent to institute a screening initiative to find cancer early in your employee populations, or prevent it altogether by supporting screening for preventable cancers. Employees who test positive are referred by their physician for diagnostic colonoscopy to determine if colorectal cancer is present or to remove precancerous polyps or lesions. The intangible costs associated with cancer is the time off of work for treatment and lost productivity.
Most companies administer a wellness program for employees and families, like Molson Coors, but only about 20% offer colorectal cancer screening. Incorporating a blood test as a preventive cancer screening strategy alongside workplace wellness programs can get employees up-to-date with screening recommendations. Employers who are interested in instituting a colorectal cancer screening program in the office should consider the following suggestions.
Incorporate CRC screening into wellness programs. Screenings provide the opportunity to identify risks early and can bridge the gap between doctor office visits for employees who do not see their providers on a regular or annual basis.
Partner with third-party administrators. Third party administration services can ensure HIPAA regulations are followed for privacy. TPAs also will arrange for the delivery of results.
Create communications campaigns. Target your messaging to those eligible for colorectal cancer screening and make sure to cite the correct statistics for benefits and risk.
Reward participation. Participation is shown to increase when incentives are provided to reward participation. Decide what incentives work for your employees – PTO, financial rewards, gym memberships, coupons or gift cards.
Follow up. Plan for next steps based on employee screenings. Results should be provided in a timely manner to enable employees.
Wilson, the Molson Coors employee, remains in remission for nearly 20 months. He’s since devoted his time to advocate for access to colorectal cancer screening, especially in the workplace. Wilson recently joined the Colorectal Cancer Alliance organization as a board member, a non-profit dedicated to reducing the incidence of colorectal cancer through their many efforts aimed at prevention and awareness. He also wrote a book, “Through the Window: A Photographic Tale of Cancer Recovery” for the alliance. Wilson has been an advocate for the vital need for employee access and employer support for CRC screening in the workplace.
SOURCE: Childers, P. (27 June 2019) "It’s time to incorporate cancer screenings into your wellness program" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/add-cancer-screenings-to-wellness-programs
The Occupational Phenomenon Called Employee Burnout
According to the World Health Organization, "burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed". Unfortunately, workplaces are dismissing burn-out as an employee's issue rather than a workplace issue. Read this blog post to learn more.
Employee burnout is fast becoming prevalent in many workplaces and is also a recurring theme in my day-to-day conversations with people. Unfortunately, many workplaces dismiss the subject and make it more of the employee’s issue than a workplace issue.
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.”
— World Health Organization
An organization’s culture and the work expectations in those organizations can foster employee burnout. Below are examples of situations that make employees prone to burnout:
- Digital Culture: A digital workplace, according to Deloitte, is one where many operational activities are performed over technology devices. These days, you can access your work emails, phone and video conferencing applications, instant messaging tools, and work documents through a single device. It is even more tempting to resist the notifications that continuously nudge you to respond to work-related matters. While I appreciate the digital workplace and understand that it is here to stay, it often implies that we need to be available around-the-clock, even during weekends. You have managers or coworkers sending work requests during early or late hours of the day, leading to a work-life imbalance for the employee. When work begins to encroach into an employee’s personal life, then they are at risk of burnout.
- Excessive Meetings: Collaboration is a skill required in many workplaces, and there’s no doubt that it is essential. However, some organizations tend to go overboard with their expectations from employees. Study shows that the average employee spends approximately six hours in meetings per week, while senior managers spend about 23 hours in meetings per week, and this increases by the size of the organization. Meetings, whether in-person or virtual, provide excellent opportunities for collaboration. When meetings become excessive and leave employees with little to no time to decompress, this can cause stress for employees and eventually lead to burnout.
- Dysfunctional Work Environments: In these work environments, employees face issues such as bullying, micromanagement, gossip, favoritism, or microaggression from coworkers or managers. A workplace that encourages such undermining behaviors can cause undue stress, which can eventually lead to burnout.
- Overworking Top Performers: It is quite easy for managers to overwork the best-performing employees. While the managers have the assurance of quality work, such employees become the victims of burnout because it seems like the reward for top performance is more work. Worse still, burnout is likely to occur when these employees do not receive fair compensation for the work they do.
What are the Signs of Employee Burnout?
The following are some signs of burnout in your employees:
- Reduced drive and work performance
- Increased absences from work
- Frequent tardiness
- Mental health conditions like anxiety and depression
- Poor concentration at work
- Increased sick days
- Visible frustration
- Lack of trust in the company and its leaders
If you or your colleagues are exhibiting any of these signs, you might be burned out.
Some Data
- A 2018 Gallup report states that “two-thirds of full-time workers experience burnout on the job.”
- A Harvard Business School article reports that “the estimated cost of workplace stress is anywhere from $125 to $190 billion a year.”
- An article by The World Economic Forum states that “the annual cost of burnout to the global economy has been estimated to be £255 billion.”
- Research by Stanford Graduate School of Business states that “workplace stress—such as long hours, job insecurity and lack of work-life balance—contributes to at least 120,000 deaths each year and accounts for up to $190 billion in health care costs.”
The data shows that employee burnout is now a workplace epidemic. To prove the seriousness of this issue, the World Health Organization (WHO) recently classified burnout as an “occupational phenomenon” in its latest revision of the International Classification of Diseases (ICD-11).
Ways to Reduce Employee Burnout
- Create and Maintain a Positive Work Environment: You can do this by being aware of your actions and how they impact those around you. Do not bully or micromanage your employees, or gossip about them to other employees you manage. When making decisions about your employees, be fair and consistent to avoid feelings of favoritism. Also, empower your employees to apply their skills by giving them autonomy. These help to increase satisfaction and create trust in the workplace.
- Set Realistic Goals: Plan projects ahead of time with your employees, set realistic deadlines or meetings, and be mindful of their personal commitments when assigning projects with tight deadlines.
- Show Support: Create communication channels for your employees to share their concerns or frustrations with you. Having an open-door policy or weekly check-in meetings where they can share their concerns with you can make your employees feel supported. Listen to them and help to address their issues.
- Show Appreciation: Recognize your employees for their contributions to your team. Recognition makes your employees, especially your top performers, feel like their work is impactful. When employees feel appreciated, they are more likely and willing to do great work.
- Promote Self-Care: Encourage your employees to practice self-care by permitting their requests for personal time off or vacation when they need it. You can also encourage them to fully unplug while they are out of the office by not sending urgent requests. Another way to promote self-care is to remove all expectations that employees need to be reachable around-the-clock. Also, do not encourage employees to stay long hours at work.
Originally published on Osasu Arigbe blog.
SOURCE: Arigbe, O. (13 June 2019) "The Occupational Phenomenon Called Employee Burnout" (Web Blog Post). Retrieved from https://blog.shrm.org/blog/the-occupational-phenomenon-called-employee-burnout