doctor and patient

Self-funding and Voluntary Benefits: The Dynamic Insurance Duo

Did you know that self-funded health insurance and voluntary benefits can be a dream team when used in conjunction with each other? Check out this great article by Steve Horvath and Dan Johnson from Benefits Pro and find out how you can make the most of this dynamic insurance duo.

In an era of health care reform, double-digit rising health care costs, and plenty of “unknowns,” many employers view their benefit plans as a challenging blend of cost containment strategies and employee retention.

But perhaps they need to better understand the value of a little caped crusader named voluntary benefits.

Employers of all sizes share common goals when it comes to their benefits. They seek affordable, and quality benefits for their employees.

Some companies achieve these goals by cutting costs and going with a high-deductible, self-funded approach. While many associate self-funding with larger employers, in the current marketplace, it has become a viable option for companies across the board.

Especially when paired with a voluntary benefits offering supported by one-on-one communication or a call center, employers are able to cut costs and offer additional insurance options tailored to their employees’ needs. But there’s more.

Voluntary enrollments can help employers meet many different challenges, all of which tie back to cost-containment, streamlined processes and employee understanding and engagement. But before we explore solutions, let’s first understand why so many employers are going the self-funded route.

For most large and small employers, the costs of providing health care to employees and their families are significant and rising.

For companies who may be tight on money and are seeing their fully-insured premiums increase every year with little justification, self-funding serves as a great solution to keep their medical expenses down.

Self-funding: An overview

Self-funding allows employers to:

  1. Control health plan costs with pre-determined claims funding amounts to a medical plan account, without paying the profit margin of the insurance company.
  2. Protect their plan from catastrophic claims with stop-loss insurance that helps to pay for claims that exceed the amount set by their self-funded plan.
  3. Pay for medical claims the plan actually incurs, not the margin a fully insured plan underwrites into their premium, while protecting the plan with catastrophic loss coverage when large expenses are incurred. Plans may offer to share favorable savings with their employees through programs like premium holidays. These programs allow employee contributions to be waived for a period of time selected by the employer to reward employees for low utilization and adequate funding of their claims accounts and reserves.
  4. Take advantage of current and future year plan management guidance.
  5. Save on plan costs by using predictive analysis for health and wellness offered by the third-party administrator (TPA).

Beyond these advantages,self-funded plans may not be subject to all of the Affordable Care Act regulations as fully-insured plans, which is one of the reasons they provide a solution for controlling costs. Without these requirements, the plans can be tailored much more precisely to meet the needs of a specific employee group.

Boosting value: Advantages of adding voluntary benefits to a self-funded plan

Based on an employer’s specific benefit plan, and what it offers, employers are able to select voluntary benefits that can complement the plan and properly meet employees’ needs without adding extra costs to the plan.

Employees are then able to customize their own, personal benefit options even further based on their unique needs and available voluntary benefits.

This provides employees a myriad of benefits while also allowing them to account for out-of-pocket costs due to high-deductibles or plan changes, as well as provide long-term protection if the product is portable.

Voluntary solutions are about more than the products

Aside from the common falsehood that voluntary benefits are only about adding ‘gap fillers’ to your plan, you may be pleasantly surprised to learn that conducting a voluntary benefits enrollment can actually offer a number of services, solutions, and products, many of which may be currently unfamiliar to you.

Finding, and funding, a ben-admin solution

Some carriers offer the added bonus of helping employers install a benefits administration system in return for conducting a one-on-one or mandatory call center voluntary benefits enrollment.

The right benefits administration systems can help remove manual processes and allow HR to do what they do best—focus on employees and improving employee programs. No more headaches around changing coverage, change files to carriers, changing payroll-deductions or premiums.

Finding the benefits administration system that works best for your situation can make a big difference for your HR team.

Communication and engagement

Many employees are frustrated and scared about how changes to the insurance landscape will impact them. And with a recent survey noting that 95 percent of employees need someone to talk to for benefits information,1 they clearly are seeking ongoing communications and resources.

During the enrollment process, some carriers work with enrollment and communications companies who understand the employees’ benefit plan options and help guide them to the offerings that are best for them and their families.

At the same time, employers can enhance the communication and engagement efforts on other important corporate initiatives. For example, a client of ours increased employee participation in their high-deductible health plan (HDHP) via pre-communication.

Of the 90 percent of employees that went to the enrollment, nearly 70 percent said they were either likely or very likely to select the HDHP. Just a little bit of communication can go a long way toward employee understanding.

Providing education and engagement about both benefits and workplace initiatives increases the effectiveness of these programs and contributes to keeping costs down for employers. The more engagement employers generate, the healthier and better protected the employees.

Prioritizing health and wellness

Employers can also use the enrollment time with employees to remind them to get their annual exams. Many voluntary plans offer a wellness benefit (e.g. $50 or $100) to incentivize the employee and dependents.

The ROI for an employer’s health plan provides value as regular screenings can help detect health issues in the beginning stages so that proper health care management can begin and medical spend can be minimized.

Employers have also seized the opportunity of a benefits enrollment to implement a full-scale wellness program at reduced costs by aligning it with a voluntary benefits enrollment.

An effective wellness program will approach employee health from a whole-person view, recognizing its physical, social, emotional, financial and environmental dimensions. A properly implemented wellness program can ultimately make healthy actions possible for more of an employee population.

A formidable combination

What employers are seeking is simple -- quality benefits and a way to lower costs. With that in mind, offering a self-funded plan with complementary voluntary benefit products and solutions allows employers to take advantage of multiple opportunities while, at the same time, providing more options for their employees.

In today’s constantly changing landscape, self-funded plans paired with voluntary benefits is a formidable combination – a dynamic insurance duo.

See the original article Here.

Source:

Horvath S., Johnson D.  (2016 November 23). Self-funding and voluntary benefits: the dynamic insurance duo [Web blog post]. Retrieved from address https://www.benefitspro.com/2016/11/23/self-funding-and-voluntary-benefits-the-dynamic-in?page_all=1

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Closing the execution continuum on employee benefit cost savings

Are you using big data to reduce your employee benefits costs? As more employers switch their employee benefits to a digital platform, big data can be a great tool for employers looking to reduce the costs associated with their benefits program. Check out this great article by Eric Helman from Employee Benefit Advisor and found out how you can leverage your data to reduce to cost of an employee benefit program.

A revolution in employee benefits is on the horizon, and 21st century analytics is at the core. Big data holds the promise to scan huge amounts of information in a near real-time environment for insights that will impact the current and future trajectory for a given area. The advancement of true cross-vendor analytics, prescription, engagement and measurement brought on by the democratization of big data is enabling employers, brokers and consultants to improve the performance of their employee benefits plans like never before.

Two decades ago, I had the opportunity to hear Chris Sullivan, one of the founders of Outback Steakhouse, speak to a group of executives about customer research. His sentiments: “We don’t do focus groups. People don’t know what they want. Who would say they would like to stand in line for 30 minutes to eat salty food in a very loud restaurant? But that is exactly what they wanted. And that is what made Outback a success. Instead of focus groups, we place very talented and engaged proprietors in our stores and teach them to observe what people want. Then, we replicate that experience.”

In the realm of employee benefits, surveys, focus groups and anecdotes about specific employee encounters with the benefits program typically drive the discussions about how that program should evolve in the future. Unlike the situation at Outback, it is difficult to “observe” how people actually consume benefits and tailor a program that is attractive to them.

Analytics drive strategy 
Fortunately, recent developments in data analytics have unlocked the potential of using consumer behavior insights to drive employee benefits strategy. Leading practitioners are beginning to leverage these developments to change the annual renewal process. The technologies that support data aggregation, normalization and reporting have been aggressively developed to support the provider and payer communities. Only now have these advancements been made available to employers and their advisers.

The most successful practitioners point to the value of standardized claims reporting based upon credible data. By combining current claims data with industry benchmarks and predictive analytics, employers gain insight into the ongoing performance of their benefit plans. They “see” for themselves what industry professionals have been telling them for years. Plan performance is based upon claims, both in terms of the number of units of healthcare consumed and the price of those units. In recent surveys, benefit professionals report the difficulty they have in convincing CFOs and CEOs to make the necessary changes to benefit programs. Standardized reporting from a credible analytics platform can greatly enhance the ability for benefit professionals to communicate their agenda.

But standardized reporting is not the panacea. Benefits are complex. And the relationship between risk and consumption of healthcare add to the complexity. Even in the best reporting environments where executives are well informed about the performance of their plans and how the key metrics compare to industry norms, they are often perplexed about what to do with the information. Advancements in the realm of “actionable analytics” are beginning to address this problem as well.

While artificial intelligence or AI is all the rage, the underlying concept of having a computer suggest a course of action based upon data is not a new idea. The new application to employee benefits is the ability to provide “suggestions” in the context of standardized financial reporting. The number of ideas to bend the cost curve are numerous. The challenge is matching these ideas with the appropriate populations, convincing decision makers to invest and engaging the appropriate cohorts of employees to take specific actions necessary to realize the return on investment for these initiatives.

New systems are now available to close the gaps on this execution continuum. The foundation for these new systems is a robust analytics platform. But actionable analytics build upon this foundation by evaluating the employer’s data to discern whether a specific cost-saving initiative might generate savings worthy of the investment. These new systems present the output of that analysis in an easy to understand graphical format for benefit consultants and HR professionals to effectively communicate the potential of cost savings initiatives to decision makers.

Targeted engagement maximizes compliance and ROI
Getting executives to commit to intentional actions to affect the rising costs of benefits solves one half of the problem. The second half of the problem is one of focus. Rather than attempting to engage all employees with generalized messaging, these new systems use analytics to focus their engagement on a specific cohort of individuals in order to drive the greatest impact. This focus allows for a concentration of resources on the targeted populations, resulting in increased compliance and larger return on investment. The best implementations are integrated with benefits administration platforms and can incorporate multiple initiatives simultaneously. Point solutions, from an engagement perspective, have been proven to result in single-digit compliance. The power of an integrated engagement solution allows for initiatives that, because they are both focused and automated, can be executed simultaneously.

Advancements in technology have created a new era in which the democratization of big data allows for non-technical professionals to access detailed information and convert that information into intelligence. According to a recent survey, more than 65% of employers confess they are not strategic when it comes to benefits cost management. In spite of the many cost savings ideas available, more than 40% say they are not engaging in any new initiatives in the upcoming year. While the future of healthcare reform is in doubt, the potential for actionable analytics to significantly change the trajectory of the employer’s benefits costs is certain.

See the original article Here.

Source:

Helman E. (2017 September 5). Closing the execution continuum on employee benefit cost savings [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/closing-the-execution-continuum-on-employee-benefit-cost-savings?brief=00000152-146e-d1cc-a5fa-7cff8fee0000

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Why Employee Engagement Matters – and 4 Ways to Build It Up

An engaged employee is a productive employee. Employee engagement is a very important piece of a company's operations. They are some of the best assets a company can have and without engaged employees, your company's operations could be negatively impacted. Take a look at this great article by Joe Wedgewood from The Happiness Index and check out some of the helpful tips on how you can boost engagement across your organization.

Organizations with high employee engagement levels outperform their low engagement counterparts in total shareholder returns and higher annual net income.” — Kenexa.

Your people are undoubtedly your greatest asset. You may have the best product in the world, but if you can’t keep them engaged and motivated — then it counts for very little.

By making efforts to keep your people engaged, you will maximize your human capital investment and witness your efforts being repaid exponentially.

The benefits of an engaged workforce

Increase in profitability: 

“Increasing employee engagement investments by 10% can increase profits by $2,400 per employee, per year.” — Workplace Research Foundation.

 There is a wealth of research to suggest that companies that focus on employee engagement will have an emotionally invested and committed workforce. This tends to result in higher profitability rates and shareholder returns. The more engaged your employees are the more efficient and productive they become. This will help lower operating costs and increase profit margins.

An engaged workforce will be more committed and driven to help your business succeed. By focusing on engagement and investing in your people’s future, you will create a workforce that will generate more income for your business.

Improved retention and recruitment rates:

“Replacing employees who leave can cost up to 150% of the departing employee’s salary. Highly engaged organizations have the potential to reduce staff turnover by 87%; the disengaged are four times more likely to leave the organization than the average employee.” — Corporate Leadership Council

Retaining good employees is vital for organizational success. Engaged employees are much less likely to leave, as they will be committed to their work and invested in the success of the company. They will have an increased chance of attracting more qualified people.

Ultimately the more engaged your people are, the higher their productivity and workplace satisfaction will be. This will significantly reduce costs around absences, recruitment, training and time lost for interviews and onboarding.

Boost in workplace happiness:

“Happy employees are 12%t more productive than the norm, and 22% more productive than their unhappy peers. Creating a pleasant workplace full of happy people contributes directly to the bottom line.” – Inc.

Engaged employees are happy employees, and happy employees are productive employees. A clear focus on workplace happiness, will help you to unlock everyone’s true potential. On top of this, an engaged and happy workforce can also become loyal advocates for your company. This is evidenced by the Corporate Leadership Council, “67% of engaged employees were happy to advocate their organizations compared to only 3% of the disengaged.”

Higher levels of productivity:

“Employees with the highest levels of commitment perform 20% better than employees with lower levels of commitment.” — The Society for Human Resource Management (SHRM).

Often your most engaged people will be the most dedicated and productive, which will give your bottom line a positive boost. Employees who are engaged with their role and align with the culture are more productive as they are looking beyond personal benefits. Put simply, they will work with the overall success of the organization in mind and performance will increase.

More innovation:

“Employee engagement plays a central role in translating additional job resources into innovative work behaviour.” — J.J. Hakanen.

Employee engagement and innovation are closely linked. Disengaged employees will not have the desire to work innovatively and think of new ways to improve your business; whereas an engaged workforce will perform at a higher level, due to increased levels of satisfaction and interest in their role. This often breeds creativity and innovation.

If your people are highly engaged they will be emotionally invested in your business. This can result in them making efforts to share ideas and innovations with you that can lead to the creation of new services and products — thus improving employee profitability.

Strategies to increase employee engagement

Communicate regularly:

Every member of your team will have valuable insights, feedback and suggestions. Many will have concerns and frustrations too. Failure to effectively listen and respond to everyone will lower their engagement and negatively affect the company culture.

Create open lines of communication and ensure everyone knows how to contact you. This will create a platform for your people to share ideas, innovations and concerns with you. It will also bridge gaps between senior management and the rest of the team.

An effective way to communicate and respond to everyone in real-time is by introducing pulse surveys — which will allow you to gather instant intelligence on your people to help you understand the sentiment of your organization. You can use this feedback to create relevant action plans to boost engagement and make smarter business decisions.

Take the time to respond and share action plans with everyone. This will ensure your people know that their feedback is being heard and can really make a difference.

Recognize achievements:

“The engagement level of employees who receive recognition is almost three times higher than the engagement level of those who do not.” — IBM Smarter Workforce Institute.

If your people feel undervalued or unappreciated then their performance and profitability will decrease. According to a survey conducted by technology company Badgeville, only 31% of employees are most motivated by monetary awards. The remaining 69% of employees are motivated by job satisfaction, recognition and learning opportunities.

Make efforts to celebrate good work and recognize everyone’s input. Take the time to personally congratulate people and honor their achievements and hard work. You will likely be rewarded with an engaged and energized workforce, that will make efforts to impress you and have their efforts recognized.

Provide opportunities for growth:

Career development is key for employee engagement. If your people feel like their careers are stagnating, or their hard work and emotional investment aren’t being reciprocated — then you can be certain that engagement will drop.

By meeting with your people regularly, discussing agreed targets and time frames, and clearly highlighting how they fit into the organizations wider plans, you can build a “road map” for their future. This will show that their efforts and hard work aren’t going unnoticed.

Improve company culture:

“Customers will never love a company until the employees love it first.” — Simon Sinek.

Building a culture that reflects your brand and creates a fun and productive working environment is one of the most effective ways to keep your employees engaged. It’ll also boost retention and help recruitment efforts. If your culture motivates everyone to work hard, help each other, become brand ambassadors, and even keep the place clean — then you have won the battle.

An engaged and committed workforce is a huge contributor to any organization’s bottom line. The rightculture will be a catalyst to help you achieve this.

Here’s how you can improve the company culture within your organization:

  • Empower your people: Empowered employees will take ownership of their responsibilities, solve problems and do whatever it takes to help your company succeed. This will drive your company culture forward. Demonstrate you have faith in your people and trust them to fulfill their duties to their best of their abilities. This will ensure they feel valued, which can lead to empowerment.
  • Manage and communicate expectations: Your people may struggle to understand your cultural vision. By setting clear and regular expectations and communicating your vision via posters, emails, discussions and leading by example, you will prevent confusion and limit deviation from your desired vision.
  • Be consistent: To sustain a consistent culture, you must show uniformity with your actions and communications. Make efforts to have consistent expectations and standards for all your workers, and communicate everything in the same way.

By focusing on employee engagement and investing in your people, they will repay your efforts with an increase in performance, productivity and — ultimately — profit.

See the original article Here.

Source:

Wedgewood J. (2017 June 8). Why employee engagement matters - and 4 ways to build it up [Web blog post]. Retrieved from address https://www.hrmorning.com/employee-engagement-ways-to-build-it-up/

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5 tips to make this the best open enrollment ever

Open enrollment season is right around the corner. Did you know that most people find open enrollment season more burdensome than tax season? As employers begin engaging their employees on healthcare offerings, check out these great tips by Kim Buckey from Benefits Pro on how you can make this year the best open enrollment yet.

Learn from last year’s enrollment

Look back on how your company fared during last year’s open enrollment period.

What were the most time-consuming tasks, and how can they be streamlined this year? What were the top questions asked by employees? Did you achieve your enrollment goals?

Hold a meeting with key internal and external stakeholders on the team and review what worked and what didn’t work last year. Knowing where you are, what your challenges are and will be, and where you’re on the right track will enable you to create a meaningful plan for this year.

Start with strategy

Once you know where you are, figure out where you want to be, how you’re going to get there, and how you’ll determine if you’ve achieved your goals. Make sure your strategy includes:

  • An assessment of all of your audiences. Remember, you’re not just communicating to employees, you’re reaching out to family members and to managers as well. Keep in mind that not every audience member has the same education level or understanding of even the most basic benefits concepts.
  • What’s changing. Are you adding or eliminating plans? Is cost-sharing changing? Is there a new vendor? Having a thorough understanding of what’s changing will help determine what your messaging should be.
  • Defining your corporate objectives. Are you looking to increase participation in a particular plan option, or shift a percentage of your population to a new plan offering? Increase participation in a wellness plan? What percentage? Define your objectives and how you plan on measuring success.
  • Your overall messages — and any specific messages targeted to your audiences. You may communicate differently to people already in the plan in which you want to increase participation, for example.
  • A schedule. People need to hear messages multiple times before they “register.” Make sure you’re communicating regularly — and thoughtfully — in the weeks leading up to, and during, the enrollment period.
  • Media. What messages will you deliver in print (newsletters, posters, postcards, enrollment guides)? What should be communicated in person, through managers or one-on-one enrollment support?

Make this year’s enrollment more active

Eighty percent of Americans spend less than an hour researching benefit options, and 90 percent keep the same plan from year to year. Yet for most employees, their circumstances change annually — whether it be the number of their dependents, their overall health and health care usage or their pay.

Active enrollment — where an employee must proactively choose a plan or go without coverage — can be an important step in getting employees more engaged in their benefits.

Active enrollment has benefits for the employer as well — it provides an opportunity to collect key data (such as current dependent information) and to direct employees to the most cost-effective plans for them.

But helping employees choose the “right” plan requires a robust communication plan, combining basic information about plan options, decision-making tools that address the total cost of coverage (both premium and point-of-service costs) and even one-one-one enrollment support.

Many employees don’t have the information they need to make good decisions, and aren’t likely to seek it out on their own — it must be ‘pushed’ to them.

Take demographics into consideration

When engaging employees around their benefits options, consider the wants, needs, and communication preferences of each demographic. Employees just starting their careers are the most underinsured (and generally least informed) group, often seeing student debt rather than health coverage as a more pressing priority.

A Harris/Accolade poll reveals that when results are broken out by age cohort, workers under 30 are having the greatest difficulty finding their way through the healthcare labyrinth.

Only 56 percent say they are comfortable doing so, compared to 76 percent of retirees. They also report more challenges in making the best care decisions, including understanding cost, coordinating care, choosing and understanding benefits, and finding a doctor they can relate to.

Understand the limitations of decision support tools

Decision support tools enable people to take an active role in managing their health care. While they can certainly help, remember that employees must seek them out and use them, and these tools often assume a level of benefits knowledge your employees might not have.

And, these tools recently have come under scrutiny for their ultimate lack of measurable results. To see the return on investment and value, you must also provide education and communications to provide some context for, and drive usage of, these tools.

By applying these five steps along with setting your team up with designated roles, responsibilities, and deadlines, you’re well on your way toward a more seamless, efficient and effective open enrollment period and to saving both your organization and your coworkers time and money.

But remember, benefits communication isn’t “one and done” at enrollment. You’ll need a year-round plan to help employees make good decisions about their care once they’ve chosen their coverage.

See the original article Here.

Source:

Buckey K. (2017 Aug 25). 5 tips to make this the best open enrollment ever [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/08/25/5-tips-to-make-this-the-best-open-enrollment-ever?page_all=1

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4 Reasons Employers Should Offer Supplemental Life Insurance

Is life insurance included in your employee benefits program? For many employees, their only form of life insurance they have is the basic group life plan provided by an employer. This standard version of life insurance is usually not enough to maintain most employees financial wellness. Supplemental life insurance plans can enhance the standard coverage provided by most employers by providing employee financial security for their futures. While these plans can be a great way to boost an employees financial wellness only about one-half of employers across the nation offer supplemental life insurance with their employee benefits. Take a look at this great list put together by Mike Wozny from Think Advisor and find out the top 4 reasons why you should be offering your employees supplemental life insurance.

Depending on an individual family’s needs, supplemental life insurance can build on the employer-provided life insurance benefit, and helps employers give their employees the future financial security their employees need. For those employers who are not currently offering supplemental life, here are four key reasons they should start:

  • Many employers can offer employees the financial security of supplemental life insurance without increasing their benefits budget. Because supplemental life insurance is opt-in and chosen by individual employees as appropriate for their situations, employers can offer supplemental life insurance as an option at no additional cost to the employer. Employees can then customize their coverage to their needs depending on their financial responsibilities.
  • Many group carriers offer employers help in enrolling employees in supplemental life. Employers can host on-site enrollment sessions lead by a life insurance expert or hold a webinar led by the carrier followed by online enrollment. Many carriers even offer customized enrollment materials for each employee — all without adding to the employer’s human resources teams’ workload.
  • Financial security is tied to employees' productivity. The Consumer Financial Protection Bureau has found that when employees have to spend time and energy worrying about providing for their families, they are more productive. Appropriate life insurance is a key factor in overall financial health, and provides employees with the peace of mind that lets them focus their energy elsewhere.
  • Comprehensive benefits packages contribute to higher employee satisfaction and retention.The Society for Human Resource Management has also found that benefits offerings are important to employees’ decisions about what companies to work for and how long to stay. Offering a benefits package that includes supplemental life insurance coverage allows employees to customize benefits to their own needs.

With the loss of a loved one, many families also lose their income, which can be not only emotionally devastating, but financially devastating as well. When employers offer a complete benefits package, including one that promotes financial wellness, it gives their employees peace of mind, and helps attract and retain top workers.

Though life insurance is rarely a topic that families want to think about, employers can help employees obtain the right amount of insurance to protect their finances by offering supplemental life insurance options. For those employers who are not currently offering these benefits, in many cases they can be added at no expense, with little additional time required to administer them, and at great potential benefit to both the company and its employees.

See the original article Here.

Source:

Wozny M. (2016 October 19). 4 reasons employers should offer supplemental life insurance [Web blog post]. Retrieved from address https://www.thinkadvisor.com/2016/10/19/4-reasons-employers-should-offer-supplemental-life

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SELF-INSURED GROUP HEALTH PLANS

Are you looking to switch your company's healthcare plan to a self-funded option? Take a look at this informative column by the Self-Insurance Institute of America and find out everything you need know when researching the best self-funded plan for your company.

Q. What is a self-insured health plan?

A. A self-insured group health plan (or a 'self-funded' plan as it is also called) is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, self-insured employers pay for each out of pocket claim as they are incurred instead of paying a fixed premium to an insurance carrier, which is known as a fully-insured plan. Typically, a self-insured employer will set up a special trust fund to earmark money (corporate and employee contributions) to pay incurred claims.

Q. How many people receive coverage through self-insured health plans?

A. According to a 2000 report by the Employee Benefit Research Institute (EBRI), approximately 50 million workers and their dependents receive benefits through self-insured group health plans sponsored by their employers. This represents 33% of the 150 million total participants in private employment-based plans nationwide.

Q. Why do employers self fund their health plans?

A. There are several reasons why employers choose the self-insurance option. The following are the most common reasons:

  1. The employer can customize the plan to meet the specific health care needs of its workforce, as opposed to purchasing a 'one-size-fits-all' insurance policy.
  2. The employer maintains control over the health plan reserves, enabling maximization of interest income - income that would be otherwise generated by an insurance carrier through the investment of premium dollars.
  3. The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
  4. The employer is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are regulated under federal law (ERISA).
  5. The employer is not subject to state health insurance premium taxes, which are generally 2-3 percent of the premium's dollar value.
  6. The employer is free to contract with the providers or provider network best suited to meet the health care needs of its employees.

Q. Is self-insurance the best option for every employer?

A. No. Since a self-insured employer assumes the risk for paying the health care claim costs for its employees, it must have the financial resources (cash flow) to meet this obligation, which can be unpredictable. Therefore, small employers and other employers with poor cash flow may find that self-insurance is not a viable option. It should be noted, however, that there are companies with as few as 25 employees that do maintain viable self-insured health plans.

Q. Can self-insured employers protect themselves against unpredicted or catastrophic claims?

A. Yes. While the largest employers have sufficient financial reserves to cover virtually any amount of health care costs, most self-insured employers purchase what is known as stop-loss insurance to reimburse them for claims above a specified dollar level. This is an insurance contract between the stop-loss carrier and the employer, and is not deemed to be a health insurance policy covering individual plan participants.

Q. Who administers claims for self-insured group health plans?

A. Self-insured employers can either administer the claims in-house, or subcontract this service to a third party administrator (TPA). TPAs can also help employers set up their self-insured group health plans and coordinate stop-loss insurance coverage, provider network contracts and utilization review services.

Q. What about payroll deductions?

A. Any payments made by employees for their coverage are still handled through the employer' s payroll department. However, instead of being sent to an insurance company for premiums, the contributions are held by the employer until such time as claims become due and payable; or, if being used as reserves, put in a tax-free trust that is controlled by the employer.

Q. With what laws must self-insured group health plans comply?

A. Self-insured group health plans come under all applicable federal laws, including the Employee Retirement Income Security Act (ERISA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), the Americans with Disabilities Act (ADA), the Pregnancy Discrimination Act, the Age Discrimination in Employment Act, the Civil Rights Act, and various budget reconciliation acts such as Tax Equity and Fiscal Responsibility Act (TEFRA), Deficit Reduction Act (DEFRA), and Economic Recovery Tax Act (ERTA).

See the original article Here.

Source:

Self-Insurance Institute of America (Date). Self-insured group health plans [Web blog post]. Retrieved from address https://www.siia.org/i4a/pages/index.cfm?pageID=4546

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Preparing for 2018 Open Enrollment

As open enrollment season nears, make sure you are staying compliant and up-to-date with everything that is happening in ACA. Here are some great tips by Carl C. Lammers from Benefit News on what you need to know to prepare yourself for open enrollment this upcoming year.

Open enrollment for employer-sponsored health and welfare benefits comes every year; usually with little fanfare as employers generally have a system in place to seamlessly handle enrollments.

This changed with the passage of the Affordable Care Act in 2010, but now seven years later, employers again mostly have open enrollment standardized. This year brings a new challenge – the Summary of Benefits and Coverage document that was created by the ACA has undergone its first major restructuring since 2012 when employers were first required to provide the SBC.

The new SBC template must be used for open enrollments that occur on or after April 1, 2017. For calendar year plans, the upcoming 2018 open enrollment is the first open enrollment where the new SBC templates must be used.

If you need a quick refresher, the SBC summarizes group health plan coverage for employees, describing many important plan features, such as deductibles, co-pays, co-insurance, and services covered, so that employees can better understand and make more informed choices about the available coverage options.

SBCs have a required uniform format and must contain certain information and examples, so that employees can compare an employer’s coverage options and options from more than one employer.

The uniform standard definitions of medical and health coverage terms and the required SBC template are distributed by the IRS, DOL, and HHS.

While the insurance carrier or third party administrator normally provides the SBC to an employer for distribution with open enrollment materials, employers are ultimately responsible for the SBC’s accuracy and distribution and for the recently increased penalties – of $1,087 per failure – for failure to distribute the SBC.

Employers should review the SBC’s provided for the upcoming open enrollment to be sure they have changed to reflect the new rules. Employers should also distribute the Section 1557 nondiscrimination notice with the SBC to avoid potential penalties.

The new finalized guidance on SBCs was issued by the Departments in April of 2016. The guidance states that while all prior formatting must still generally be complied with; SBCs can now have certain language and formatting alterations, such as differing font styles and margins in order to maintain the four page requirement. Definitions were also added to the Uniform Glossary, and the Departments state that SBCs may hyperlink the terms to a micro-site that HHS will maintain.

The required content of the SBC has also changed, with some of the most significant changes being:
A description of what an SBC is and where consumers can find more information, located at the beginning of the SBC.

A description of how family members must meet their own individual deductibles before the overall family deductible is met, and what services are covered.

  • Changing of the term "person" to "individual."
  • A statement that copays may not be included in out-of-pocket limits.
  • The removal of the definitions of copayments and coinsurance.
  • Change of the "Limitations & Exceptions" column to "Limitations, Exceptions, & Other Important Information" which must now include:
  • When the plan does not cover a certain service category, or a substantial portion of a service category.
  • When cost sharing for covered in-network services does not factor into the out-of-pocket limit.
  • Visit and/or dollar limits.
  • When services require preauthorization.
  • Note: cross-referencing is allowed if including all information in this section would cause the SBC to exceed four pages.
  • New language about minimum essential coverage, minimum value, and language access services.
  • The addition of a third Coverage Example about costs for a fracture, and slightly altered formatting to the Coverage Examples section.
  • A statement regarding whether abortions are covered by the plan.

One thing that is not part of the new SBC guidance is also important for employers: SBCs are likely considered "significant communications" for purposes of the nondiscrimination rules found in Section 1557 of the ACA, and the notice required by Section 1557 should be included with the SBC.

The Section 1557 notice must be included with all “significant communications” involving the medical plan. It is not clear whether the Departments have considered the addition of the Section 1557 language and its impact on the four page SBC limit.

We suggest including the 1557 notice with the new SBCs, but not as part of the new SBCs, in order to maintain the four-page length. Be sure to review any draft SBCs prepared by your insurer or TPA before distribution to ensure they meet the new formatting requirements.

See the original article Here.

Source:

Lammers C. (2017 July 31). Preparing for 2018 open enrollment [Web blog post]. Retrieved from address https://www.benefitnews.com/opinion/preparing-for-2018-open-enrollment

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How Voluntary Benefits Options are Changing

The market for voluntary benefits has seen substantial growth over the last few years with the rise of health care cost. Find out how you can prepare for the changes coming to the voluntary benefits market thanks to this great article by Keith Franklin from Benefits Pro.

As health care insurance deductibles continue to rise, interest in voluntary benefits are growing. This trend supports another growth area that we’re seeing: companies are looking for innovative, cost-effective ways to enhance their compensation packages and are finding that voluntary health benefits are the solution. We’ve seen a significant rise in sales for dental discount plans that offer additional benefits over the past six months.

The most popular dental plans that we offer to groups and individuals now include telemedicine, medical bill negotiation and health advocacy services — along with our more typical dental care, vision, hearing, and prescription savings plans.

But, no matter how popular they are, these plans still do not sell themselves. The key to success in the group voluntary benefits marketplace is clearly communicating the business return on investment that can be expected from offering voluntary benefits to employees.

Voluntary benefits refresher

Of course, you know employers use voluntary programs to offer ancillary benefits, or supplementary benefits, that help fill in the holes in major medical coverage.

If you have not had much direct involvement in voluntary benefits, you may be surprised by how much the menus have grown.

Many of the newest voluntary benefits provide discounted or free access to services that were not typically associated with health care plans. These offerings tend to address concerns related to security, financial management, health care that may not covered by primary insurance (such as dental) and personal improvement.

Today, voluntary benefits may include:

  • Automobile, homeowners, or pet insurance
  • Concierge services
  • Critical illness
  • Cybersecurity/Identify theft protection
  • Dental
  • Education
  • Financial counseling
  • Financial planning
  • Fitness
  • Healthcare advocacy
  • Life insurance
  • Medical bill negotiation
  • Telemedicine/Telehealth
  • Vision

Voluntary benefits are typically offered to employees as an optional add-on to their benefits package. While the benefits may be paid for in part by the employer, these are more typically payroll-deducted benefits.

When sold directly to individuals, voluntary benefit offerings are often described as “discount,” or “additional benefit” plans. Target markets in the business-to-consumer space would include self-employed people and owners of very small businesses. Typically, businesses can qualify as a “group” for voluntary benefits purposes if the business employs three to five people.

When sold to groups, these plans offer savings by tapping into discounts for group rates, and discounts pre-negotiated by the plans’ providers. The savings are passed on to plan members, giving the cost-savings of group coverage to individuals. Brokers and agents can tap into this market effectively by working with trade groups, chambers of commerce, and other associations that serve small businesses, contactors and the self-employed.

It is important to note that many voluntary benefits offerings are not insurance. They are intended to complement existing insurance coverage, make health care such as dental and vision more affordable, or provide discounted access to a broad variety of supplementary services.

There are exceptions, of course. Some voluntary plans offer supplementary health coverage, or other types of insurance.

How to communicate advantages

Financial benefits are the most obvious advantage to businesses. Adding desirable benefits at no additional (or low) cost to the company is obviously an appealing proposition. But that’s not the whole picture.

Businesses considering offering voluntary benefits plans to their employees will also want to ensure that any solution that they buy into fully delivers on its promises and doesn’t add new complications.

Provider reliability: Who is offering the benefit, who is the provider or underwriter? Voluntary benefits can be backed by a provider, such as a health insurance company that offers both dental insurance and dental discount plans. The benefit may be offered directly by the providing company or by another company that they have partnered with. Look for a proven track record of trustworthiness and experience within the voluntary benefits space by all companies involved in providing the benefit.

Easy deployment and administration: What is involved in offering the benefit to employees? What information will be required, how long will it take to on-board people? Will proprietary software need to be installed, or are benefits managed through a platform-generic, online portal? Is there an automatic payroll deduction feature? Obviously, the easier a solution is to set up and use, the more attractive it is. Know the back-end as well as you know the benefits.

Data security: Securing information is an ever-growing concern. Not all companies will ask about data security when evaluating a benefits plan, but an increasing number are vitally concerned about protecting personnel information – both as a service to employees and as a way of warding off digital crime. Cyber criminals can use information about employees to impersonate them and gain access to company networks and data. It is best to be prepared with answers to these questions: How is sensitive information on employees kept secure and private when it is captured, in use, and in storage? If data is stored in the cloud, does the storage solution used meet the organization’s compliance and regulatory obligations?

Education/engagement: Well-designed, informative, and customizable materials that help employees get excited, understand, and use their voluntary benefits are a highly valuable add-on to any offering. Companies expect to see quantifiable results from their benefits packages, and limited adoption reduces return on investment. Keeping employees engaged is central to a company’s happiness with their voluntary benefits plan. Get samples of the employee training material from providers.

Metrics: While many companies will rely on their own data-led decision making tools to measure a program’s success, it’s helpful to point out the ROI voluntary benefits can deliver. Overall, the data points that can be used to gauge the success of a voluntary benefits offering will include an ability to attract and retain top talent, reduced medical absenteeism/presenteeism, increased productivity, and employee interest and usage of the benefits.

Customer care: If employees have problems using their benefits, who provides support? The provider or service partner should offer a single-point-of-contact tasked with solving problems, and a dedicated customer support team that employees can access with questions or concerns.

Interest in voluntary growing

Voluntary benefits aren’t new, but the interest in these offerings is strong – particularly for money-and-time saving services such as telemedicine. As the marketplace grows, businesses and brokers need to understand how to evaluate these offerings and select the best options.

There are advantages to offering a tightly curated bundle of benefits, or providing a broad variety of options that businesses can mix and match. When offering the latter, it’s important to ensure that administration and access are streamlined as much as possible. What seems simple in isolation – you manage and access your benefits though this app or portal – can quickly become wildly complex when the burden grows to a dozen or more apps and portals. Partnering with service providers who focus on delivering a quality experience end-to-end provides significant advantages to brokers and businesses.

See the original article Here.

Source:

Franklin K. (2017 July 13). How voluntary benefits options are changing [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/07/13/how-voluntary-benefits-options-are-changing?t=innovation&page_all=1

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Employers Broadening Health Programs

Employers are starting to change their approach on how they look at their employee benefits program. Take a look at this great article by Nick Otto from Employee Benefit Adviser and find out how employers are reclassifying their employee benefits program in order to expand their employees' well-being.

The siloed approach to retirement, healthcare and wellness is a thing of the past as employers are increasingly taking a holistic approach to addressing their employees’ health and wealth.

Employers are expanding their view of employee overall well-being, according to a new report from Optum, a technology-enabled health services company. That means that, while employers are still offering traditional wellness programs, there has been a significant shift in the last three years to those programs addressing workers’ financial, behavioral and social health.

“For example, we see increased interest among companies in developing new programs around mindfulness, positivity and creativity, which can reduce stress, improve eating and sleeping habits, and stimulate innovative thinking,” says Seth Serxner, Optum’s chief health officer.

While physical health still remains a significant focus for employee wellness programs, other dimensions are tracking with higher importance among large employers:

· 51% of such programs now address financial health, up from 38% in 2015;
· 47% address employees’ social health by using strategies like team-based activities to increase feelings of connectedness and a sense of belonging, compared to 37% in 2015; and
· 68% address behavioral health, up from 65% in 2015

And technology is helping employers to better engage these programs to workers. Since 2014, there has been a significant increase in the use of a variety of innovations, including online competitions, activity tracking devices, social networks, mobile apps and mobile messaging to help engage employees, the study notes.

Additionally, incentive strategies are helping to get workers in the wellness game.

Use of incentives is at an all-time high, Optum notes, with 95% of employer respondents offering incentives to their employees. Recognizing that workers can be highly influenced by their family members, 74% of employers also are offering incentives to family members. According to Optum, average incentives per participant per year equate to $532.

See the original article Here.

Source:

Otto N. (2017 August 15). Employers broadening health programs [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/employers-broadening-health-programs

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Why Self-funded Healthcare is a Great Option for 2017

Have your health care options left you at a competitive disadvantage when it comes to attracting new talent? Switching to a self-funded healthcare plan can be a great way to reduce your healthcare cost while increasing your ability to attract new employees to your workforce. Take a look at this interesting article by Paul Johnson from Employee Benefits News and find out why you should switch to a self-funded healthcare plan.

Small- and mid-sized companies using traditional major medical plans are at a competitive disadvantage: either they are paying more in loaded costs than competitors that use smarter healthcare options, or they are finding it more difficult to hire employees because their competitors offer better plans.

With the new year and a new healthcare landscape, HR executives and benefits directors are now reconsidering their options, taking a much harder look at out how they can stop struggling to offer competitive benefits, and actually use their healthcare plans to recruit and retain the best talent, which will ultimately boost employee morale and profitability.

Annual premiums for employer-sponsored family health coverage reached $18,142, with workers paying $5,277 toward their plan in 2016, according to the Kaiser Family Foundation.

While companies still shoulder the lion’s share, worker contributions increased about 80% over the last 10 years; this cost doesn’t even include the employee’s co-pay or deductible.

To balance the scales and create a competitive advantage, more companies are turning to healthcare plans based on a self-funding model that offer more flexibility, customization and cost-savings while still improving the quality of care. Self-funded plans have been almost universal among large employers for quite some time, yet only in recent years have more HR departments at small- and mid-sized companies started to realize the benefits.

Customizing a self-funded model

Federal and state laws incorporate exceptions that enable companies to self-fund healthcare. This move provides for more flexibility while limiting risk for the employer. Companies can also choose to pay their claims directly, or work with third-party administrators to handle claims and administrative responsibilities.

Benefits can include medical, dental, vision, prescription medications and workers’ compensation. Unlike more rigid traditional insurance, companies can customize their offerings to address specific needs, such as investing in injury and chiropractic care in industries that require physical labor to robust maternity benefits for those with younger workforces.

Customized plans offer a win-win scenario — the company saves money while increasing productivity, and employees get access to the most pertinent care at an affordable cost.

To further increase convenience and cost efficiencies, companies can use third-party healthcare concierge services to help employees navigate the system, access the right level of care, and steer them away from needlessly expensive services and facilities. Also, businesses have the option to purchase stop-loss insurance to increase the type of healthcare provided to employees and limit the company’s liability in case of catastrophic illnesses and accidents.

Saving money

Self-funding is generally less expensive — 10% to 25% less, according to the Self Insurance Educational Foundation — than fully funded insurance because it doesn’t include marketing costs or profit margins associated with traditional insurance. As an added benefit, companies that self-insure are exempt from state insurance regulations and premium taxes, and are not subject to many government provisions.

Managing care delivery also has a dramatic impact on costs. For example, many medical services are needlessly performed in hospitals, where costs are higher. A third-party partner can direct employees to comparable lower-cost sites of service. Similarly, while costs of prescription medications can vary widely among pharmacies, understanding cost differentials and making decisions accordingly can bring costs down.

While advantageous for all types of employers, the ability to closely manage care delivery and place of service is especially important for companies with low-wage and young workers who have previously relied on high-cost emergency rooms for basic care or are unaccustomed to navigating the system.

Lowering workers’ comp

Employees often use workers’ comp for minor injuries requiring only first aid or for injuries sustained outside the workplace because they don’t have other options. With a self-funded plan – and with the assistance of a third-party partner to help employees access care through the right channels – businesses can cut such claims.

Likewise, organizations with an Experience Modifier Rate may lower their E-Mod score through a self-funded plan.

Owning healthcare data

Before the Patient Protection and Affordable Care Act, health insurance underwriters reviewed the medical data of a specified group of employees. Now, carriers must look at an entire community — often hundreds of businesses — and calculate a community rating based only on age, zip code and smoker status.

Because the ACA requires guaranteed-issue medical insurance, does not allow denial based on preexisting conditions, and precludes annual or lifetime limits, insurers must account for added risks when setting rates that are often detriment to the company and result in higher premiums.

Companies that self-fund have access to every claim, allowing them to benchmark their utilization against industry norms and address red flags, ultimately using insights garnered to better manage benefits and control costs.

Insurance isn’t a one-size-fits-all proposition, despite what the industry leads business owners to believe. Providing quality healthcare and maintaining profitability should not be mutually exclusive. For many companies, a self-funded plan becomes the gateway to managing skyrocketing healthcare costs while offering competitive benefits.

See the original article Here.

Source:

Johnson P.  (2017 January 9). Why self-funded healthcare is a great option for 2017 [Web blog post]. Retrieved from address https://www.benefitnews.com/opinion/why-self-funded-healthcare-is-a-great-option-for-2017

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