GOP’s Health Bill Could Undercut Some Coverage In Job-Based Insurance
Thanks to the new legislation passed by Congress health care is on the verge of changing as we know it. Check out this interesting article by Michelle Andrews from Kaiser Health News on how these changes to healthcare will affect Americans who get their healthcare through an employer.
This week, I answer questions about how the Republican proposal to overhaul the health law could affect job-based insurance and what the penalties for not having continuous coverage mean. Perhaps anticipating a spell of uninsurance, another reader wondered if people can rely on the emergency department for routine care.
Q: Will employer-based health care be affected by the new Republican plan?
The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too.
The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care.
Small businesses (generally companies with 50 or fewer employees) in those states would also be affected by the change.
Plans offered by large employers have never been required to cover the essential health benefits, so the bill wouldn’t change their obligations. Many of them, however, provide comprehensive coverage that includes many of these benefits.
But here’s where it gets tricky. The ACA placed caps on how much consumers can be required to pay out-of-pocket in deductibles, copays and coinsurance every year, and they apply to most plans, including large employer plans. In 2017, the spending limit is $7,150 for an individual plan and $14,300 for family coverage. Yet there’s a catch: The spending limits apply only to services covered by the essential health benefits. Insurers could charge people any amount for services deemed nonessential by the states.
Similarly, the law prohibits insurers from imposing lifetime or annual dollar limits on services — but only if those services are related to the essential health benefits.
In addition, if any single state weakened its essential health benefits requirements, it could affect large employer plans in every state, analysts say. That’s because these employers, who often operate in multiple states, are allowed to pick which state’s definition of essential health benefits they want to use in determining what counts toward consumer spending caps and annual and lifetime coverage limits.
“If you eliminate [the federal essential health benefits] requirement you could see a lot of state variation, and there could be an incentive for companies that are looking to save money to pick a state” with skimpier requirements, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.
Q: I keep hearing that nobody in the United States is ever refused medical care — that whether they can afford it or not a hospital can’t refuse them treatment. If this is the case, why couldn’t an uninsured person simply go to the front desk at the hospital and ask for treatment, which by law can’t be denied, such as, “I’m here for my annual physical, or for a screening colonoscopy”?
If you are having chest pains or you just sliced your hand open while carving a chicken, you can go to nearly any hospital with an emergency department, and — under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) — the staff is obligated to conduct a medical exam to see if you need emergency care. If so, they must try to stabilize your condition, whether or not you have insurance.
The key word here is “emergency.” If you’re due for a colonoscopy to screen for cancer, unless you have symptoms such as severe pain or rectal bleeding, emergency department personnel wouldn’t likely order the exam, said Dr. Jesse Pines, a professor of emergency medicine and health policy at George Washington University, in Washington, D.C.
“It’s not the standard of care to do screening tests in the emergency department,” Pines said, noting in that situation the appropriate next step would be to refer you to a local gastroenterologist who could perform the exam.
Even though the law requires hospitals to evaluate anyone who comes in the door, being uninsured doesn’t let people off the hook financially. You’ll still likely get bills from the hospital and physicians for any care you receive, Pines said.
Q: The Republican proposal says people who don’t maintain “continuous coverage” would have to pay extra for their insurance. What does that mean?
Under the bill passed by the House, people who have a break in their health insurance coverage of more than 63 days in a year would be hit with a 30 percent premium surcharge for a year after buying a new plan on the individual market.
In contrast, under the ACA’s “individual mandate,” people are required to have health insurance or pay a fine equal to the greater of 2.5 percent of their income or $695 per adult. They’re allowed a break of no more than two continuous months every year before the penalty kicks in for the months they were without coverage.
The continuous coverage requirement is the Republicans’ preferred strategy to encourage people to get health insurance. But some analysts have questioned how effective it would be. They point out that, whereas the ACA penalizes people for not having insurance on an ongoing basis, the AHCA penalty kicks in only when people try to buy coverage after a break. It could actually discourage healthy people from getting back into the market unless they’re sick.
In addition, the AHCA penalty, which is based on a plan’s premium, would likely have a greater impact on older people, whose premiums are relatively higher, and those with lower incomes, said Sara Collins, a vice president at the Commonwealth Fund, who authored an analysis of the impact of the penalties.
See the original article Here.
Source:
Andrews M. (2017 May 23). GOP's health bill could undercut some coverage in job-based insurance[Web blog post]. Retrieved from address https://khn.org/news/gops-health-bill-could-undercut-some-coverage-in-job-based-insurance/
The Employer Mandate: Essential or Dispensable?
Have you wondered how the passing of the AHCA will impact employers? Check out this article by David Blumenthal, M.D and David Squires from Commonwealth Fund and see how employers will affect by the passing of the most recent healthcare legislation.
The Commonwealth Fund’s Sara Collins has blogged that, “Employers are at the heart of the U.S. health insurance system and their ongoing commitment to it will be critical to its success and viability over time.” The point is undeniable. More than 150 million Americans under the age of 65 get their coverage through the workplace, and employer-sponsored insurance remains critical to the success of the Affordable Care Act’s (ACA) coverage plans.
Some may therefore be surprised by the growing talk of repealing the ACA’s requirement that employers cover their employees. To unpack this issue, let’s take a look at the ACA provision itself, why it was enacted, and the potential upside and downside of repeal.
The Employer Mandate
The ACA section under discussion is often called an employer mandate, but that’s an oversimplification. The law says that employers with 50 or more employees have a choice. They can offer health insurance that meets minimum standards for affordability and coverage to employees working 30 or more hours a week. Or they can pay the federal government a penalty if at least one of their employees receives a federal subsidy for a private insurance plan sold through one of the new ACA insurance marketplaces.
You can call this a mandate. Or you can call it a requirement that businesses share responsibility for the costs of covering all Americans, either by helping to buy insurance directly for their own employees, or helping the federal government do so.
The language here matters. The concept of shared responsibility reflects a political calculation and a statement of values. It asserts that for the ACA to be fair and politically viable, all Americans have to do their part. All U.S. citizens are required to have health insurance, and many will have to pay a penalty if they go without it (the individual mandate). Employers must cover workers or help the government financially to do so. Taxpayers have to support the expansion in Medicaid eligibility and marketplace subsidies. Hospitals have to take cuts in Medicare payments, medical device makers need to accept additional taxes, and so on. The most successful American social programs—such as Social Security and Medicare—rely on this concept of shared responsibility.
The Rationale
Whatever you label it, the employer coverage requirement has several rationales beyond the concept of shared sacrifice. Policymakers want to deter employers who now provide coverage to their employees from dumping workers into the marketplaces, either by dropping coverage completely or limiting benefits to the point where workers will chose to buy insurance elsewhere. The requirement also attempts to nudge employers who don’t cover employees into offering health insurance. And on the assumption that some businesses will chose to pay rather than offer coverage, the employer provision provides an important source of revenue to cover the ACA’s expenses: an estimated $139 billion over 10 years.
The Rationale for Repeal
Several arguments are fueling the repeal push. First, implementation will be administratively complex and burdensome. For example, employers will have to report many new details about their workers, including what coverage they have been offered and whether they have received coverage elsewhere.
Second, some economists are concerned that the employer requirements will distort hiring decisions, leading companies to bring on fewer low-income employees who might be eligible for subsidized coverage in the marketplaces. Firms with payrolls near 50 workers might hire fewer workers altogether. Economists also believe that if employers incur penalties for not offering coverage, workers might contribute to the costs of insurance through reduced wages. Other economists, however, believe these effects will be modest.
Third, modeling from RAND and the Urban Institute suggests that when fully implemented in 2016, the employer provisions will increase the number of insured Americans by only a few hundred thousand. The overwhelming proportion of U.S. employers already provides insurance to their employees, and would continue to do so without the penalties in the ACA, the analysts contend.
Concerns About Repeal
Supporters of the employer requirement posit that projections that employers would stay in the health insurance business without the ACA requirements are just that—projections. Balanced against employers’ past record of providing coverage is an increasing tendency for businesses to reduce the generosity of coverage. In fact, the law’s requirements that workplace coverage be affordable and meaningful may be as important as the requirement that employers offer coverage at all.
Eliminating the employer provisions would also leave a big hole in funding for the ACA. The likelihood that supporters and opponents could reach agreement on how to raise the missing cash seems low, especially given the recent history of the congressional effort to replace the Medicare physician payment formula known as the SGR. This year, a bipartisan consensus on policy crashed and burned when Republicans and Democrats could not agree on new sources of revenue to pay for the legislation.
Finally, and perhaps most importantly, repealing the employer mandate would undermine the concept of shared responsibility and potentially add momentum—which could grow in a new Congress or under a new president—to the idea of eliminating the individual mandate as well. After all, why should individuals have to buy insurance when businesses don’t? Virtually all disinterested analysts agree that the individual mandate is critical to the stability of the new insurance marketplaces created under the ACA, and to reducing the number of uninsured Americans.
Proceed with Caution
The full effects of repealing the employer provisions of the ACA remain speculative. A repeal seems unlikely in the short term, in part, because a repeal effort would open the floodgates to partisan warfare over undoing the ACA in its entirety, or to changing other elements of the law that could have more far-ranging consequences.
However, if serious bipartisan discussion of ACA improvement becomes possible, expect to see a repeal of employer coverage provisions front and center on the legislative agenda. Under these circumstances, lawmakers should still proceed with caution. It may be wise to experiment with implementing the employer provisions and to reassess their comparative benefits and costs at a later date. The philosophy of shared responsibility is foundational to the law’s political viability, and should not be discarded without compelling evidence that the employer requirements are not essential to the ACA’s success.
See the original article Here.
Source:
Blumenthal D., Squires D. (2017 June 4). The employer mandate: essential or dispensable [Web blog post]. Retrieved from address https://www.commonwealthfund.org/publications/blog/2014/jun/the-employer-mandate
HSAs on the Rise, but Employees Need to Know More About Them
Are your employees aware of the many benefits and features associated with HSAs? Check out this great article by Marlene Y. Satter from Benefits Pro on why it is important employees are knowledgeable about HSAs, so they can prepare for their health care expenses while planning for retirement.
According to Fidelity Investments, health savings accounts — and the assets within them — are rising quickly, as both employers and employees try to find ways to pay for health care. Still, a number of the features of HSAs are still underutilized.
While Fidelity says that assets in its HSAs rose 50 percent in the past year, now topping $2 billion, and the number of individual account holders rose 46 percent during the same period to 657,000, it points out more work still needs to be done on showing employees the advantages of such accounts.
Since it’s estimated that couples retiring today could need $260,000 — perhaps even more — to cover their health care costs during retirement, the need for a way to save just for health care expenses, aside from other retirement expenses, is becoming more urgent.
HSAs offer a tax-advantaged way to set aside more money than a retirement account alone provides — and people who have both tend to save more overall, with 2016 statistics indicating that people who had both defined contribution and HSA accounts saved on average 10.7 percent of their annual income in the retirement account. Those with just a DC account saved on average 8.2 percent in it.
People are mostly satisfied with HSAs — 80 percent say they are, while 76 percent are satisfied with the ease of using it HSA for medical expenses, 77 percent with the quality of their health care coverage and 77 percent with how the plan helps them manage their health care costs.
But that doesn’t mean they’ve got all the ins and outs figured out yet; 39 percent mistakenly believe that they’ll lose unspent HSA contributions at the end of the year. Yet unlike contributions to health flexible spending accounts (FSA), unspent contributions to HSAs roll over from year to year.
Still, employees are learning that HSAs can provide them a means of saving that’s not restricted to cash. While it’s still not common, more people are putting HSA money into investments that can then grow toward covering longer-term health expenses, but employers, says Fidelity, can do more to educate workers on such an option. Nationally, only 15 percent of all HSA assets are invested outside of cash.
See the original article Here.
Source:
Satter M. (2017 May 26). HSAs on the rise, but employees need to know more about them [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/05/26/hsas-on-the-rise-but-employees-need-to-know-more-a?ref=hp-news
Employees Look to Employers for Financial Stability
Do your employees depend on their pay and benefits for their financial security? Find out in this great article by Nick Otto from Employee Benefit News on what employees depend on from their employers to support their financial well-being.
As the American dream of financial security continues to slip out of reach for many U.S. workers, employers — seen as trusted partners by employees — will need to step up to restore faith in retirement readiness.
Only 22% of individuals described themselves as feeling financially secure, Prudential says in its new research paper, and there is growing acceptance among employers that there is significant value in improving employees’ financial wellness.
Aspirations are modest, says Clint Key, a research officer in financial security and mobility at The Pew Charitable Trusts. Between economic mobility or financial stability, an overwhelming 92% of workers say they want stability.
“Four in 10 don’t have the resources to pay for a $2,000 expense,” he said Tuesday, at a joint financial wellness roundtable sponsored by Prudential Financial and the Aspen Institute in Washington, D.C. More alarmingly, employees don’t have the income to last a month if they were to lose their job.
Still, Key adds, it isn’t so much the number of dollars in the bank, but the peace of minds that savings buy them.
And employers are feeling the repercussions of the growing stressors in the workplace.
“People who are stressed about finances are five times more likely to take time off from work to deal with personal finances,” added Diane Winland, a manager with PricewaterhouseCoopers. “Three to four hours every week go to handling personal finances, and these employees are more likely to call out sick from work.”
The security levers once in place, such as home equity, are going away and it’s becoming much more difficult for workers to handle a financial emergency, she added.
The good news, however, is employers get it, she said. “They understand employee financial wellness is tied to the bottom line and it behooves them to invest in their employees,” said Winland. “The conundrum is how to deploy and what to deploy in their programs. Is it counseling? Coaching? Is it a new snazzy app that comes out. The key is there is no silver bullet.”
So, what is there to do?
Each employer has a unique business model and employee base, and, therefore, faces different challenges when implementing a financial wellness approach, Prudential’s paper notes. “Employers should design financial wellness programs that are informed by insights into the unique financial needs of their employees, successfully educate and engage employees, and help employees take concrete actions to improve their financial health. We encourage employers to discuss financial wellness with their benefit consultants or advisers.”
And, added Robert Levy, managing director at the Center for Financial Services Innovation, just talk to your employees. “They’re open to discussing their financial challenges,” he said, and employers can engage these conversations through numerous ways: surveys, one-on-one talks, focus groups.
Prudential stepping up
To try to change the current unease in financial security, Prudential Tuesday also announced its expansion of worksite tools for employers to enable them to analyze the financial needs of their workforce and offer the employees a personalized interactive experience that includes videos, tools, webinars and articles that empower them to manage their financial challenges.
In addition, Prudential has launched a $5 million, three-year program in partnership with the Aspen Institute — a Washington, D.C.-based, non-partisan educational and policy studies organization — to promote employees’ financial security.
“The investment highlights the need to increase the national discourse about greater economic access for employees as they bear increasing risk and responsibility for their short-term and long-term financial security,” said Prudential.
See the original article Here.
Source:
Otto N. (2017 May 18). employees look to employers for financial stability [Web blog post]. Retrieved from address https://www.benefitnews.com/news/employees-look-to-employers-for-financial-stability
Millennials are Saving for 'Financial Freedom,' not Retirement
Did you know that more millennials are skipping saving money for their retirement? Take a look at this interesting article by Marlene Y. Satter from Benefits Pro on how millennials are focusing on saving for their lifestyles instead of retirement.
Well, at least millennials are saving.
According to the Spring Merrill Edge Report from Bank of America Merrill Edge, 63 percent of millennials are socking it away in the name of financial freedom: the amount of savings or income they need to live the lifestyle they want.
GenXers and boomers, on the other hand, are saving up to get out of the workplace—with 55 percent of them working toward that goal.
Younger people are apparently being driven by FOMO—or fear of missing out, with their top goals a dream job ((42 percent, compared with 23 percent of older workers) and traveling the world (37 percent, compared with 21 percent of older workers).
Millennials have also relegated marriage and parenting lower down on the priority list, with just 43 percent looking forward to wedding bells, compared with 51 percent.
Those aren’t the only things they’re focusing on. That FOMO mindset is also driving millennials to spend now on traveling (81 percent), dining out (65 percent) and exercising (55 percent). Interestingly, however, they’re still managing to save more than older generations, with 36 percent stashing more than 20 percent of their annual salary.
Of course, that doesn’t mean that everyone is doing a bang-up job of saving money; overall, 42 percent of respondents are saving less than 10 percent of their salary, and 7 percent don’t save at all.
And many lack confidence in being able to cope with “what-if” scenarios: 71 percent are not very confident they could hit financial goals in the event of a divorce (although just 5 percent are planning for the possibility), 64 percent don’t think raising a family goes hand in hand with financial success, and just 23 percent are saving for a family; and 48 percent are not very confident about achieving their goals if they outlived their significant other.
They’re apparently not all that sanguine about financial wisdom, either with 48 percent believing that financial education should be a requirement. Not a bad idea—particularly since 29 percent of respondents believe that, in the future, 401(k)s will not be the “gold standard” in retirement investing.
See the original article Here.
Source:
Satter M. (2017 May 19). Millennials are saving for " financial freedom" not retirement [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/05/19/millennials-are-saving-for-financial-freedom-not-r?ref=hp-top-stories
Helping Your Employees Protect Against Identity Theft
Are you doing enough to help your employees protect themselves from identity theft? Make sure to take a look at this article by Irene Saccoccio from SHRM on what employers can do to protect their employees from identity theft.
Social Security is committed to securing today and tomorrow for you and your employees. Protecting your identity and information is important to us. Security is part of our name and we take that seriously.
Identity theft is when someone steals your personally identifiable information (PII) and pretends to be you. It happens to millions of Americans every year. Once identity thieves have your personal information they can open bank or credit card accounts, file taxes, or make new purchases in your name. You can help prevent identity theft by:
- Securing your Social Security card and not carrying it in your wallet;
- Not responding to unsolicited requests for personal information (your name, birthdate, social security number, or bank account number) by phone, mail, or online;
- Shredding mail containing PII instead of throwing it in the trash; and
- Reviewing your receipts. Promptly compare receipts with account statements. Watch for unauthorized transactions.
It is important that your employees take the necessary steps to protect their Social Security number. Usually, just knowing the number is enough, so it is important not to carry your Social Security card or other documents unless they are needed for a specific purpose. If someone asks for your employees’ number, they should ask why, how it will be used, and what will happen if they refuse. When hired, your employees should provide you with the correct Social Security number to ensure their records and tax information are accurate.
If your employees suspect someone else is using their Social Security number, they should visit IdentityTheft.gov to report identity theft and get a recovery plan. IdentityTheft.gov guides them through every step of the recovery process. It’s a one-stop resource managed by the Federal Trade Commission, the nation’s consumer protection agency. You can also call 1-877-IDTHEFT (1-877-438-4338); TTY 1-866-653-4261.
Your employee should also contact the Internal Revenue Service (IRS), and file an online complaint with the Internet Crime Complaint Center at www.ic3.gov.
Don’t let your employees fall victim to identity theft. Advise them to read our publication Identity Theft and Your Social Security Number or read our Frequently Asked Questions for more information. If you or an employee suspects that they’re a victim of identity theft, don’t wait, report it right away!
See the original article Here.
Source:
Saccoccio I. (2017 May ). Helping your employees protect against identity theft [Web blog post]. Retrieved from address https://blog.shrm.org/blog/helping-your-employees-protect-against-identity-theft
Why and How to Avoid High-Risk Pools for Americans with Preexisting Conditions
With the passing of the AHCA many people with preexisting conditions can now be put into a high-risk pool by insurers. Here is a great article by Jean P. Hall from Common Wealth Fund on how Americans with preexisting conditions can avoid being put into a high-risk pool.
The American Health Care Act (AHCA)—the U.S. House of Representatives’ bill to repeal and replace the Affordable Care Act (ACA)—would allow states to apply for waivers to reduce existing consumer protections and provide funding for states to set up high-risk pools or other mechanisms for people with preexisting conditions who have lapses in their coverage. In previous posts, I have talked about the high costs and meager coverage associated with high-risk pools that operated before the ACA and the fact that their use did not significantly reduce costs for other people who buy their own health plans in the individual market. Moreover, the Congressional Budget Office analysis of the AHCA finds that the funding it makes available to states for the high-risk pools is inadequate.
In a recent commentary for Annals of Internal Medicine on high-risk pools, I note that people with preexisting conditions constitute roughly 51 percent of Americans. Here, let’s explore who might end up in a high-risk pool, what their experiences might be, and policymakers’ alternative options for stabilizing the marketplaces.
The U.S. Department of Health and Human Services (HHS) estimated that 23 percent of Americans with preexisting conditions had a period of uninsurance in 2014, often because of job changes or periods of financial instability. Young people reaching age 26 who transition off their parents’ coverage also sometimes experienced gaps in coverage—and some of them have preexisting conditions. Should the AHCA become law, individuals with preexisting conditions and lapses in coverage who live in states that obtain waivers to allow insurers to charge people based on their health would likely end up in high-risk pools.
Research has shown that the greater out-of-pocket costs and limited coverage associated with high-risk pools led to enrollees forgoing needed care and experiencing worse outcomes. In fact, before the ACA, high-risk pool enrollees in Kansas were eight times more likely to transition to federal disability programs than members of the general population with these conditions.
Current Medicaid beneficiaries also would be affected. The Congressional Budget Office analysis of the AHCA estimated that 14 million fewer people would have Medicaid coverage as a result of the federal funding cuts. Many of them would be forced to look to the individual insurance market to gain coverage, yet half of these former Medicaid beneficiaries would have serious preexisting conditions. Given the historically very high costs for consumers associated with high-risk pools, the majority of these individuals would likely go uninsured instead. Many would end up using the emergency room to access care once their needs become urgent, and their uncompensated health care costs would be borne by others with insurance. Some would likely suffer serious health consequences, even preventable deaths.
Supporters of the AHCA suggest that the legislation gives states more options to design coverage for their citizens, thereby better meeting their needs. Section 1332 of the ACA, however, already gives states a great deal of flexibility in designing their marketplaces while still providing comprehensive and affordable coverage. Indeed, both Alaska and Minnesota are pursuing 1332 waiver programs to specifically address concerns about high-risk individuals by implementing reinsurance programs, rather than segregating people with preexisting conditions into high-risk pools. These programs would maintain the overall larger pool of insured people in the state while protecting insurers against catastrophic costs. Reinsurance programs, such as the one temporarily instituted under the ACA for its first three years, have historically been proven to bring down premium costs for everyone. Given that reinsurance programs are a more effective and evidence-based mechanism for stabilizing the individual insurance market, state policymakers should strongly consider pursuing these programs under the existing ACA rules instead of establishing high-risk pools. And, federal policymakers should acknowledge and support this mechanism to strengthen the marketplace, bring down costs, and encourage participation by insurers.
See the original article Here.
Source:
Hall J. (2017 June 5). Why and how to avoid high-risk pools for americans with pre-existing conditions [Web blog post]. Retrieved from address https://www.commonwealthfund.org/publications/blog/2017/jun/how-and-why-to-avoid-high-risk-pools
Advisers Seek a Tech Solution to Financial Wellness
Have you been looking for a new solution to increase your client's investment into their financial well-being? Check out this great article by Cort Olsen from Employee Benefits Advisors on how advisers are using technology to help their clients invest in their financial wellness.
With many employers taking advantage of wearable wellness devices such as Fitbits and Apple Watches, advisers and consultants say they would like to see a similar platform that will efficiently monitor a person’s financial wellbeing.
“For physical wellness there are health assessments like biometric screenings to gather information and then there is the wearable data that tells people where they need to be to stay on track with their health goals,” says Craig Schmidt, senior wellness consultant for EPIC Insurance Brokers & Consultants. “The difference with the financial piece is that there isn’t a way to track users’ spending habits or monitoring their retirement funding to make their financial status more budget friendly.”
While Schmidt says he has not been able to find a platform that monitors financial status at such a personal level, John Tabb, chief product officer of Questis, has put together a platform that manages to gather data and make suggestions on what employees should be focusing their investments on such as paying off student loan debt or investing in their Roth IRA.
Tabb estimates that there are roughly 30 companies that call themselves financial wellness firms but adds that none of them are “holisitic.” “Not to say that they are not good, but there are only a handful of companies that can allow advisers at financial institutions to utilize their platform as a tool,” he says.
Saving for retirement vs. paying off student debt
Shane Bartling, retirement consultant for Willis Towers Watson, says they have developed a program with their clients that addresses gaps in the market and increases the value of the overall lineup of financial well-being services offered by employers generally around retirement readiness.
“As a result of requests from clients and the needs we have identified with our consulting work, we have built out a technology solution to compliment the line-up of other resources that clients have available,” Bartling says. “We wanted to find the indicators of poor financial wellbeing in the workforce, how to measure it and then how do we engage the parts of our workforce that are going to see the highest value from the resources we are providing.”
The WTW program offers clients an initial assessment from an adviser to determine where employees are struggling the most with their finances. “There is a way to look at behaviors employees are signaling when they are in a poor financial situation,” Bartling says. “They begin to do things like using loans, taking hardship withdrawals and then ultimately you see issues like wage garnishment tend to pop up on the radar and are opting out of the 401(k).”
SoFi has expanded its business focus from student loan refinancing firms into the workspace by helping employers offer a student loan repayment benefit.
“Looking at the employee benefits space today, student loans are generally a pretty big hole in most employers benefit offerings,” says Catesby Perrin, vice president of business development at SoFi. “The main stays of employee benefit offerings are healthcare and 401(k), which we all know are essential, but in many respects don’t address the most pressing financial concerns of the largest demographic in the workforce, which are millennials.”
Perrin adds that 401(k) and other forms retirement saving is imperative for everyone in the workforce, however retirement is not a top priority for millennials due to other financial stressors that are taking place in their day-to-day lives.
“As great as a 401(k) is and how important it is intrinsically, if you have $500 or $800 a month due in student loan payments, which is totally plausible for somebody coming out of undergrad today, the 401(k) is a total luxury,” Perrin says. “Most employers are not doing much about student loan problem, so we are offering two primary benefits today for employers… a student loan refinancing benefit and a benefit set for employers to help pay down the principle balance of their employee’s loan.”
Alternative tech gaining traction
One option is the increasing popularity of mobile push notifications. Ayana Collins, wellness consultant out of EPIC’s Atlanta office, says she is seeing a greater response from users who utilize these alerts on their smartphones to view wellness tips and strategies that they may not read if they are delivered in the form of an e-mail.
“Employees receive thousands upon thousands of e-mails and one more e-mail coming from HR or from a wellness company may not be opened,” Collins says. “If they receive a push notification from their mobile phone they are more likely to check out what financial wellness tips we are sending to them.”
Privacy invasion?
Meanwhile, new legislation determining how wellness plans are regulated has sparked a renewed interest in finding a streamlined financial wellbeing platform.
Shan Fowler, senior director of employer portfolio and product strategy at Benefitfocus, says legislation such as the Employer Participation in Repayment Act and the Preserving Employee Wellness Programs Act, will help fuel the creation of a financial wellbeing platform.
“Financial regulation is very similar to healthcare regulation,” Fowler says, “due to so many branches that are contingent with legislative support. Seeing bipartisan support for this national epidemic [has me feeling] very optimistic.”
However, employees may not be as enthusiastic. Many workers are concerned about the level of data employers could have access to, seeing it as an invasion of privacy, Fowler adds.
“I think you need to put yourself into the shoes of the employee and ask if I want my company to have access to my personal information,” he says. “That speaks to that very fine line employers have to walk of having their employees’ best interests in mind, but not going too far into a ‘big brother’ mentality.”
Tabb says that while the Questis platform does offer individual advice on financial direction based off an initial assessment, the data collected is stored in an aggregate form that protects employees’ personal information from being viewed by their superiors or colleagues.
“If the employer wants some data, they are going to pay for it to help them make decisions, but it is all on an aggregate level,” Tabb says. “There is certainly a perception that needs to be addressed to ensure employees that their data is safe and that nothing is being shared with their employer that does not need to be shared.”
Both Bartling and Perrin also say their platforms offer data to employers only in an aggregate form to give them an idea of how many employees are utilizing the benefit and also the projected success rates, but when it comes to the personal finances of each individual employee, security is in place to ensure private financial information is protected.
EPIC’s Collins says no matter what branch of wellness an employer invests in, whether it be financial, physical or mental, there needs to be a reason behind the technology that they are using. If there is no payout for the employee, there will be no demand to carry the program.
“There has to be a ‘so what’ behind it,” Collins says. “If the employer is just doing a simple challenge with nothing behind it, people are not going to gravitate toward it, because it doesn’t create a moment where the users discover an improvement to themselves. That is the whole point behind wellness.”
See the original article Here.
Source:
Olsen C. (2017 May 11). Advisers seek a tech solution to financial wellness [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/advisers-seek-a-tech-solution-to-financial-wellness
Gaps in Coverage Among People With Pre-Existing Conditions
The passing of the American Care Act (ACA) in 2010 brought many changes to the healthcare marketplace. One of the most important changes that this legislation brought was coverage for people with pre-existing conditions. This legislation allowed people with pre-existing conditions to gain access to health care without facing higher premiums. But with the passing of the AHCA the market for pre-existing conditions is on the verge of changing. Check out this great article from Kaiser Family Foundation on how the AHCA will effect people with pre-conditions.
The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy.
How the State Waiver Provision Works
Under the provision, insurers in states with community rating waivers could vary premiums by health status for enrollees who have had a gap in insurance of 63 or more consecutive days in the last year. The higher (or lower) premiums due to health status would apply for an entire plan year (or the remainder of the year in case of people signing up during a special enrollment period), at which point enrollees would be eligible for a community-rated premium unrelated to their health.
States waiving community rating would be required to set up a mechanism to subsidize the cost of high-risk enrollees, such as a high-risk pool, or participate in a reinsurance arrangement that makes payments directly to insurers. States are not required to set up an alternative source of coverage for people who face higher premiums based on their health.
The bill makes $100 billion available to all states for a variety of purposes, including high-risk pools, reinsurance programs, and cost-sharing subsidies. An additional $15 billion is made available for a federal invisible risk-sharing program, which would be similar to a reinsurance arrangement. Another $15 billion is earmarked for spending on maternal and newborn care, mental health, and substance abuse services for the year 2020. The AHCA also allocates $8 billion over five years to states that implement community rating waivers; these resources can be used to help reduce premiums or pay out-of-pocket medical expenses for people rated based on their health status.
Premiums varied significantly based on health status in the individual market before the Affordable Care Act (ACA) prohibited that practice beginning in 2014. Insurers in nearly all states were also permitted to decline coverage to people with pre-existing conditions seeking individual market insurance. We estimate that 27% of non-elderly adults have a condition that would have led to a decline in coverage in the pre-ACA market. While insurers would have to offer insurance to everyone under the AHCA, people with declinable pre-existing conditions would likely face very large premium surcharges under an AHCA waiver, since insurers were unwilling to cover them at any price before the ACA.
How Many People Might be Affected by Community Rating Waivers?
The effect of a community rating waiver would depend crucially on how many people with pre-existing conditions have gaps in insurance that would leave them vulnerable to higher premiums.
Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver.1
Among the 21.1 million people who experienced a gap in coverage and did not have a declinable pre-existing condition, some also had pre-existing conditions (such as asthma, depression, or hypertension) that would not have resulted in an automatic denial by individual market health insurers pre-ACA but that nonetheless could also result in a premium surcharge.
In many cases, people uninsured for several months or more in a year have been without coverage for a long period of time. In other cases, people lose insurance and experience a gap as a result of loss of a job with health benefits or a decrease in income that makes coverage less affordable. Young people may have a gap in coverage as they turn 26 and are unable to stay on their parents’ insurance policies. Medicaid beneficiaries can also have a gap if their incomes rise and they are no longer eligible for the program.
Through expanded Medicaid eligibility and refundable tax credits that subsidized premium in insurance marketplaces, the ACA has substantially reduced coverage gaps. In 2013, before the major provisions of the ACA went into effect, 38.6 million people had a gap of several months, including 8.7 million with declinable pre-existing conditions.
Some people with a gap will ultimately regain coverage through an employer-based plan or Medicaid, and would not be subject to premium surcharges based on their health. However, anyone who has been uninsured for 63 days or more who tries to buy individual market insurance in a state with a community rating waiver would be subject to medical underwriting and potential premium surcharges based on their health.
Uncertainty Around the Estimate
There are a variety reasons why our estimates might understate or overstate number of people with pre-existing conditions who could be subject to premium surcharges under the AHCA.
People with health conditions would have a strong incentive under an AHCA waiver to maintain continuous coverage in order to avoid being charged premiums that could potentially price them out of the insurance market altogether. The question is how many would be able to do so, given the fact that the premium tax credits provided for in the AHCA would be 36% lower on average for marketplace enrollees than under the ACA and would grow more slowly over time. In 2013, before tax credits for individual insurance were available and the ACA’s Medicaid expansion took effect, the number of people with pre-existing conditions who experienced a gap in coverage was 41% higher. Among people with individual market insurance in 2015, we estimate that 3.8 million adults (representing 25% of all adult enrollees) had a pre-existing condition that would have led to a decline before the ACA. These individuals would not be subject to premium surcharges under AHCA community rating waivers, so long as they maintain continuous coverage. Because individual market subsidies would be significantly reduced under the AHCA, these individuals could face added challenges remaining continuously covered.
About 49% of people with pre-existing conditions who had a gap in coverage in 2015 had incomes at or below 138% of the poverty level, and some of them could be eligible for Medicaid (depending on whether their state has expanded eligibility under the ACA and what eligibility rules are in states that have not expanded). They would not face any coverage restrictions associated with their health status in Medicaid. However, under the AHCA enhanced federal funding for expanding Medicaid would be repealed, and federal matching funds would be capped. The Congressional Budget Office projects that 14 million fewer people would be enrolled in Medicaid by 2026. So, while some people we identify as having a coverage gap would be eligible for Medicaid under the AHCA, many more people currently enrolled in Medicaid would lose that coverage under the AHCA and be uninsured. They would be eligible for premium tax credits, but the AHCA’s subsidies do not scale by income so individual market insurance would likely be unaffordable for people who are poor, including those with pre-existing conditions.
There is also significant uncertainty surrounding how many states would seek to waive community rating under the AHCA. Some states might do so to roll back what they consider to be excessive regulation of the insurance market initiated by the ACA and preserved under the AHCA. Other states might come under pressure to implement waivers from insurers who believe the market would be unstable, given that the AHCA repeals the ACA’s individual mandate. What states decide to do may ultimately have the greatest effect on how many people with pre-existing conditions face potentially unaffordable insurance premiums.
See the original article Here.
Source:
Levitt L., Damico A., Claxton G., Cox C., Pollitz K. (2017 May 17). Gaps in coverage among people with pre-existing conditions [Web blog post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/gaps-in-coverage-among-people-with-pre-existing-conditions/?utm_campaign=KFF-2017-May-Pre-Ex-AHCA-Coverage-Gap&utm_medium=email&_hsenc=p2ANqtz-927vhm-poW6B4a5Qht6venQyS6-j9mRL1ecYqhgHd3bWp8UT-yBNineOJVRUwxXkUvJ3TalIEo_JBE9QE5o-n_pzrwyA&_hsmi=52007627&utm_content=52007627&utm_source=hs_email&hsCtaTracking=148c8fd6-8ba2-4f02-a508-45b17365a226|3ae33023-7ef1-44a9-a84c-b2a8d055e6bd
3 HSA Facts Employers Need to Know
Take a look at this informative article from Benefits Pro about what changes to HSAs means for employers by Whitney Richard Johnson.
Health Savings Accounts offer employers a way to help employees with health care costs without being as involved as they might be with, say, a Flexible Saving Account. But what are some other advantages?
And what are employers' responsibilities? Although employers will want to research more indepth about HSAs, here is a quick look at some basic HSA questions and answers:
#1: What are the advantages to an employer of offering an HDHP and HSA combination?
The benefits of offering employees an HDHP and HSA vary dramatically depending upon the circumstances. A major strength of offering an HSA program is flexibility.
Employers can be very generous and fully fund an HSA and also pay for the HDHP coverage. Alternatively, employers can also use the flexibility of the HSA to allow for the employer to reduce its involvement in benefits and put more responsibility onto the employee.
Generally, employers switch to HDHPs and HSAs to save money on the health insurance premiums (or to reduce the rate of increase) and to embrace the concept of consumer driven healthcare. The list below elaborates on strengths of HDHPs and HSAs.
Lower Premiums. HDHPs, with their high deductibles, are usually less expensive than traditional insurance.
Consumer-driven health care. Many employers believe in the concept of consumer-driven healthcare. If an employer makes employees responsible for the relatively high deductible, the employees may be more careful and inquisitive into their health care purchases. Combining this with an HSA where employees can keep unused money increases employees’ desire to use health care dollars as if they were their own money – because it is their own money.
Lower administration burden. Given the individual account nature of HSAs, much of the administrative burden for HSAs is switched from the employer (or paid third-party administrator) to the employee and the HSA custodian as compared to health FSAs and HRAs. This increased burden on the employee comes with significant perks: more control over how and when the money is spent, increased privacy, and better ability to add money to the HSA outside of the employer.
Tax deductibility at employee level. The ability of employees to make their own HSA contributions directly and still get a tax deduction is advantageous. Although it is better for employees to contribute through an employer, an employee can make contributions directly. An employer may not offer pretax payroll deferral or it may be too late for an employee to defer. For example, an employee that decides to maximize his prior year HSA contribution in April as he is filing his taxes can still do so by making an HSA contribution directly with the HSA custodian.
HSA eligibility. Becoming eligible for an HSA is a benefit that also stands on its own. Although not all employees will embrace HSAs, savvy employees that understand the benefits of HSAs will value a program that enables them to have an HSA.
#2: What are the employer responsibilities regarding employee HSAs?
If an employer offers pretax employer contributions, then the employer has the following responsibilities:
Make comparable contributions. If the employer is making a pretax employer contribution (nonpayroll deferral), it must do so on a comparable basis.
Maintain Section 125 plan for payroll deferral. If the employer allows pretax payroll deferral, then the employer must adopt and maintain a Section 125 plan that provides for HSA deferrals. This includes collecting employee deferral elections, sending the deferred amount directly to the HSA custodian, and accounting for the money for tax-reporting purposes.
HSA eligibility and contribution limits. Employers should work with employees to determine eligibility for an HSA and the employee’s HSA contribution limit. Although it is legally the employee’s responsibility to determine his or her eligibility and contribution limit, a mistake in these areas generally involves work by both the employer and the employee to correct. Mistakes are best avoided by upfront communication. Also, the employer does have some responsibility not to exceed the known federal limits. An employer may not know if a particular employee is ineligible for an HSA due to other health coverage but an employer is expected to know the current HSA limits for the year and not exceed those limits.
Tax reporting. The employer needs to properly complete employees’ W-2 forms and its own tax-filing regarding HSAs (HSA employer contributions are generally deductible as a benefit under IRC Section 106).
Business owner rules. Business owners generally are not treated as employees and employers need to review HSA contributions for business owners for proper tax reporting.
Detailed rules. There are various detailed rules that fall within the responsibility of the employer that are too numerous to list here but include items such as: (1) holding employer contributions for an employee that fails to open an HSA, (2) not being able to “recoup” money mistakenly made to an employee’s HSA, (3) actually making employer HSA contributions into employees HSAs on a timely basis, and (4) other detailed rules.
#3: How do employers switching from traditional insurance to HDHPs explain the change to employees?
Although there is no certain answer to this question, a straight-forward and honest approach to the change will likely work best.
Changing from traditional insurance to a high deductible plan with an HSA can be significant because employees likely face a higher deductible (although traditional health plan deductibles have been increasing to the point they are close to HDHPs).
Often the largest obstacle to the change is that employees feel something is being taken away from them. An employer that can show that the actual dollars contributed by the employer are level, or increased, versus the previous year helps a lot – especially if the employer makes a substantial HSA contribution for employees.
If the employer is making the change to reduce its health care expenses, then the employer will have to explain and justify that change to employees to get employees’ support for the change (e.g., the business is in a tough spot due to a difficult economy, etc.).
Depending on the facts, the change will likely be an improvement for some employees and HSA eligibility provides benefits to all employees. Some specific benefits include the following:
Saving money. The HDHP is generally significantly less expensive. Depending upon the circumstances, this fact often saves not only the employer money but also the employee. Highlighting the savings will help convince employees the change is positive. Although an actual reduction of the employee’s portion of the premium expense may be unlikely given increasing health insurance premiums, explaining that without the change the employee’s portion of the premium would have increased by more will help reduce tension.
Tax savings. The HSA enables tax savings. For some employees these tax savings are significant.
Control. HSAs give individuals control over their money and accordingly their doctor and treatment choices.
Flexibility. An HSA is very flexible and allows for some employees to put aside a large amount and get a large tax benefit. For those that prefer not to do so, the HSA allows that as well. Plus, even better, the HSA allows employees to change their mind mid-year. If an employee believes they are not going to need any medical services, the employee needs to contribute only a minimum deposit to an HSA. If it turns out that the employee does incur some medical treatment, the employee can contribute at that time and still get the tax benefits. Employees are often frustrated by HSA rules because of some confusion, but when explained that the rules are very flexible they appreciate HSAs more.
Distribution reasons. HSAs allow for more distribution reasons than FSAs: namely to pay for health insurance premiums if unemployed and receiving COBRA, to pay for some health insurance premiums after age sixty-five, to use for any purpose penalty-free after age sixty-five, to carry forward a large balance, and more.
See the original article Here.
Source:
Johnson W. (2017 May 11). 3 HSA facts employers need to know [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/05/11/3-hsa-facts-employers-need-to-know?kw=3+HSA+facts+employers+need+to+know&et=editorial&bu=BenefitsPRO&cn=20170514&src=EMC-Email_editorial&pt=Benefits+Weekend+PRO&page_all=1
