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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The IRS Is Still Enforcing The Individual Mandate, Despite What Many Taxpayers Believe

Did you know that there are many people who still don't believe that they will be hit by tax penalty if they do not have health insurance? Here is an informative article by Timothy Jost from Health Affairs on why everyone should be keeping up with their health insurance in-order to avoid a tax penalty by the IRS.

There has been considerable speculation since President Trump’s Inauguration Day Affordable Care Act Executive Order as to whether the Internal Revenue Service is in fact enforcing the individual and employer mandates. The IRS website has insisted that the mandates are still in force, despite the Executive Order and despite the fact that the IRS decided not to implement for 2016 tax filings a program rejecting “silent returns” that did not indicate compliance with individual mandate requirements.

There is evidence, however, that many taxpayers do not believe it. An April report from the Treasury Inspector General for Taxpayer Services found that as of March 31, a third fewer taxpayers were paying the penalty than had been the case a year earlier. More importantly, insurers seem to believe that the IRS is not enforcing the mandate, or at least that taxpayers do not believe the IRS is enforcing the mandate, and are raising their rates for 2018 to account for the deteriorating of the risk pool that nonenforcement of the mandate will cause.

It is of note, therefore, that Robert Sheen at the ACA Times has identified several letters from the IRS reaffirming that it is still in fact enforcing the individual, and employer, mandates.

One is a letter reportedly sent in April by the IRS General Counsel to Congressman Bill Huizenga (R-MI) in response to an inquiry as to whether the IRS could waive the employer mandate with respect to a particular employer. The IRS replied that there was no provision in the ACA for waiver of the mandate penalty when it applied and that: “The Executive Order does not change the law; the legislative provisions of the ACA are still in force until changed by the Congress, and taxpayers remain required to follow the law and pay what they may owe.”

In a second letter in June, responding to an individual who had written to President Trump, the IRS similarly responded:

The Executive Order does not change the law; the legislative provisions of the ACA are still in force until changed by the Congress, and taxpayers remain required to follow the law, including the requirement to have minimum essential coverage for each month, qualify for a coverage exemption for the month, or make a shared responsibility payment.

Of course, whether taxpayers believe it, and whether insurers believe taxpayers believe it, is another question.

See the original article Here.

Source:

Jost T. (2017 August 21). The IRS is still enforcing the individual mandate, despite what many taxpayers believe [Web blog post]. Retrieved from address https://healthaffairs.org/blog/2017/08/21/the-irs-is-still-enforcing-the-individual-mandate-despite-what-many-taxpayers-believe/

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ACA Revamp Odds Slip as Senate Gets New Expiration Date

Timeframe to repeal and replace has just shortened. Find out how this new timeline for the repeal of ACA will impact Senate and their plan for healthcare in this informative column by Laura Litvan from Think Advisor.

The Senate parliamentarian told lawmakers that Republicans’ ability to pass an Affordable Care Act change bill with just 51 votes expires at the end of this month, Sen. Bernie Sanders said Friday.

The preliminary finding complicates any further efforts by Republican leaders in Congress to pass a comprehensive GOP-only overhaul of the health care law.

Sanders, a Vermont independent, in a statement called the determination a "major victory" for those who oppose Affordable Care Act de-funding.

Senate Republicans, who control the chamber 52-48, failed to win enough support for their ACA de-funding and change bill in July as three GOP lawmakers joined Democrats to oppose the measure. Republican leaders haven’t ruled out reviving their effort, and some party members — including Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Ted Cruz of Texas — say they’re talking to colleagues about a possible broad-based bill.

At the same time, some senators are discussing a scaled-back, bipartisan health measure. It takes 60 votes to overcome a Democratic filibuster, and Democrats are united against de-funding of the Affordable Care Act, or the kinds of Affordable Care Act program changes proposed in the bills that have reached the House or Senate floor.

The Senate Health, Education, Labor and Pensions Committee has scheduled four hearings this month to examine bolstering the Affordable Care Act public health insurance exchange system.

Committee Chairman Lamar Alexander, a Tennessee Republican, and the panel’s top Democrat, Patty Murray of Washington, have pledged a bipartisan effort to shore up the exchanges, which provide consumers a place to purchase individual coverage with help from Affordable Care Act subsidies.

Earlier guidance from Senate Parliamentarian Elizabeth MacDonough dogged Republicans in their Affordable Care Act change effort throughout the summer. In late July, she issued a preliminary finding that key parts of a proposal drafted by Senate Majority Leader Mitch McConnell didn’t qualify for consideration under the budget reconciliation rules, dramatically complicating the already slimming prospects of passing a bill.

Republicans can still try to use the budget reconciliation process to get an Affordable Care Act change bill through the Senate with just a 51-vote majority, rather than a 60-vote majority, during the fiscal year that starts Oct. 1.

The House Budget Committee has drafted a fiscal 2018 budget that could be used for both de-funding the Affordable Care Act and tax reform. That budget may come to the floor in mid-September, and the Senate Budget Committee hopes to release its version of the budget in the coming weeks. Still, putting a tax overhaul and Affordable Care Act de-funding in the same legislation would be time-consuming and unlikely.

See the original article Here.

Source:

Litvan L. (2017 September 1). ACA revamp odds slip as senate gets new expiration date [Web blog post]. Retrieved from address https://www.thinkadvisor.com/2017/09/01/aca-revamp-odds-slip-as-senate-gets-new-expiration?t=health-insurance?ref=channel-top-news

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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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New House Healthcare Proposal a Mixed Bag for Employers

The House of Representatives has just introduced their new bipartiasn plan for healthcare reform. Find out how this new healthcare legislation will impact your employers' healthcare in this great article by Victoria Finkle from Employee Benefit News.

A new bipartisan healthcare plan in the House contains potential positives and negatives alike for employers.

The plan could provide much-sought relief to small and medium-sized businesses with respect to the employer mandate, but it could also institutionalize the mandate for larger firms and does little to reduce employer-reporting headaches. Critics say it also fails to endorse other employer-friendly reforms to the Affordable Care Act.

The Problem Solvers Caucus, a group of more than 40 Republicans and Democrats led by Reps. Tom Reed, R-N.Y., and Josh Gottheimer, D-N.J., unveiled their new plan last week to stabilize the individual markets, following the collapse of Senate talks that were focused on efforts to repeal and replace the Affordable Care Act last month. The proposal would be separate from an earlier bill that passed the House to overhaul large swaths of the ACA. Congress is now on recess until after Labor Day, but talks around efforts to shore up the individual markets are likely to resume when lawmakers return to Washington this fall.

PaulThe House lawmakers introduced a broad set of bipartisan principles that they hope will guide future legislation, including several key tweaks to the employer mandate. This plan includes raising the threshold for when the mandate kicks in from firms with 50 or more employees to those with at least 500 workers. It also would up the definition of full-time work from those putting in 30 hours to those working 40 hours per week. Among changes focused on the individual markets, the proposal would bring cost-sharing reduction payments under the congressional appropriations process and ensure they have mandatory funding as well as establish a stability fund that states could tap to reduce premiums and other costs for some patients with expensive health needs.

Legislative talks focused on maintaining the Obamacare markets remain in early stages and it’s unclear whether the provisions targeting the employer mandate will gain long-term traction, though lawmakers in support of the plan said that their proposed measure would help unburden smaller companies.

“The current employer mandate places a regulatory burden on smaller employers and acts as a disincentive for many small businesses to grow past 50 employees,” the Problem Solvers Caucus said in their July 31 release.

Observers note that raising the mandate’s threshold would likely have few dramatic effects on coverage rates. But critics argued that while the plan would eliminate coverage requirements for mid-size employers — a boon for smaller companies — it could ultimately make it more difficult to restructure or remove the mandate altogether.

“It would provide relief to some people — however, it will enshrine the employer mandate forever,” says James Gelfand, senior vice president of health policy at the ERISA Industry Committee. “You are exempting the most sympathetic characters and ensuring that large businesses will forever be subject to the mandate and its obscene reporting.”

The real-world impact of the change would likely be limited when it comes to coverage rates, as mid-sized and larger employers tend to use health benefits to help attract and retain their workforce. Nearly all firms with 50 or more full-time employees — about 96% — offered at least one plan that would meet the ACA’s minimum value and affordability requirements, according to the Kaiser Family Foundation/Health Research & Education Trust employer health benefits survey for 2016. Participation was even higher — 99% — among firms with at least 200 workers.

“At the 500 bar, realistically, virtually every employer is offering coverage to at least some employees,” says Matthew Rae, a senior policy analyst with Kaiser Family Foundation.

Gelfand notes that under the proposed measure, big businesses would still have to comply with time-consuming and costly reporting requirements under the ACA and would continue to face restrictions in plan design, because of requirements in place that, for example, mandate plans have an actuarial value of at least 60%.

“Prior to the ACA, big business already offered benefits — and they were good benefits that people liked and that were designed to keep people healthy and to make them productive workers,” he says. “[The ACA] forces us to waste a boatload of time and money proving that we offer the benefits that we offer and it constrains our ability to be flexible in designing those benefits.”

Susan Combs, founder of insurance brokerage Combs & Co., says that changing the definition of full-time employment from 30 to 40 hours per week could have a bigger impact than raising the mandate threshold, because it would free up resources for employers who had laid off workers or cut back their hours when they began having to cover benefits for people working 30 or more hours.

“Some employers had to lay off employees or had they to cut back on different things, because they had to now cover benefits for people that were in essence really part-time people, not full-time people,” she says. “If you shifted from 30 to 40 hours, that might give employers additional remedies so they can expand their companies and employ more people eventually.”

Two percent of firms with 50-plus full-time workers surveyed by Kaiser in 2016 said that they changed or planned to change the job classifications of some employees from full-time to part-time so that the workers would not be eligible for health benefits under the mandate. Another 4% said that they reduced the number of full-time employees they intended to hire because of the cost of providing health benefits.

Gelfand calls the provision to raise the definition from 30 to 40 hours per week “an improvement,” though he said a better solution would be to remove the employer mandate entirely.

He added that he would like to see any market stabilization plan include more items employers had backed as part of the earlier repeal and replace debate. While the House plan would remove a tax on medical devices, it does not address the Cadillac tax on high-cost plans, one of the highest priority items that employer groups have been working to delay or repeal. It also doesn’t include language expanding the use of tax-advantaged health savings accounts detailed in earlier House and Senate proposals.

“There’s not likely to be another healthcare vehicle that’s focused on ACA reform, so if you have a reform vehicle that goes through and it doesn’t do anything to give us tax relief and it doesn’t do anything to improve consumer-driven health options, like HSAs, and it doesn’t do anything to improve healthcare costs — wow, what a missed opportunity,” he says.

See the original article Here.

Source:

Finkle V. (2017 August 10). New house healthcare proposal a mixed bag for employers [Web blog post]. Retrieved from address https://www.benefitnews.com/news/new-house-healthcare-proposal-a-mixed-bag-for-employers

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doctor and patient

How Health Coaching can Revitalize a Workforce

Do you need help revitalizing your workforce? Check out this great column by Paul Turner from Employee Benefit Advisor and see how health coaching can be a great way to increase engagement and productivity among your employees.

Nearly 50% of Americans live with at least one chronic illness, and millions more have lifestyle habits that increase their risk of health problems in the future, according to the Centers for Disease Control and Prevention. Type 2 diabetes, cardiovascular disease, cancer, pulmonary disease and other conditions account for more than 75% of the $2 trillion spent annually on medical care in the U.S.

Employers have a stake in improving on these discouraging statistics. People spend a good portion of their lives at work, where good health habits can be cultivated and then integrated into their personal lives. While chronic diseases often can’t be cured, many risk factors can be mitigated with good health behaviors, positive and consistent lifestyle habits and adherence to medication and treatment plans. Moreover, healthy behaviors — like smoking cessation, weight management, and exercise — can help prevent people from developing a chronic disease in the first place.

Companies that sponsor well-being programs realize the benefits of a healthier and more vital employee population, with lower rates of absenteeism and improved productivity. Investing in such programs can yield a significant return — particularly from condition management programs for costly chronic diseases.

Digitally-based well-being programs in particular are powerful motivators to adopt healthy behaviors. Yet for many employees, dealing with difficult health challenges can be daunting and digital wellness tools may not offer them sufficient support. Combining these health technologies with the skill and support of a health coach, however, can be a winning approach for greater workplace well-being. The benefits of coaching can also extend to employees that are currently healthy. People without a known condition may still struggle with stress, sleep issues, and lack of exercise, and the guidance of a coach can address risk factors and help prevent future health problems.

Choosing a health coach

Coaching is an investment, and the more rigor that employers put into the selection of a coaching team, the better the results. Coaches should be a credentialed Certified Health Education Specialist or a healthcare professional, such as a registered nurse or dietician, who is extensively trained in motivational interviewing. It also helps when a coach has a specialty accreditation in an area such as nutrition, exercise physiology, mental health or diabetes management. Such training allows the coach to respond effectively to highly individualized needs.

This sort of personalization is essential. A good coach will recognize that each wellness program participant is motivated by a different set of desires and rewards and is undermined by their own unique combination of doubts, fears and temptations. They build trust and confidence by helping employees identify the emotional triggers that may lead them to overeat, smoke or fail to stick with their treatment plans and healthy lifestyle behaviors.

What works for one employee, does not work for another. A 50-year-old trying to quit smoking may need the personal touch of a meeting or phone conversation to connect with her coach; a 30-year-old focused on stress management might prefer email or texting. It’s important for the coaching team to accommodate these preferences.

Working with our employer clients, WebMD has seen what rigorous coaching can achieve:
· A 54% quit rate for participants in a 12-week smoking-cessation program
· Successful weight loss for 68% of those who joined a weight-management program
· A nearly 33% reduction in known health risks for relatively healthy employees in a lifestyle coaching program
· A corresponding 28% health risk reduction for employees with a known condition who received condition management coaching.

Coaching is more likely to succeed when it is part of a comprehensive wellness program carried out in an environment where employee well-being is clearly emphasized by the employer and its managers. WebMD popularizes the saying that ‘When the coach is in, everybody wins.’ Qualified health coaching may be the missing ingredient that helps an employer achieve its well-being goals and energize its workforce.

See the original article Here.

Source:

Turner P. (2017 July 27). How health coaching can revitalize a workforce [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/opinion/how-health-coaching-can-revitalize-a-workforce?feed=00000152-1387-d1cc-a5fa-7fffaf8f0000

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How to Explain HSAs to Employees Who Don’t Understand Them

HSAs can be a very effective tool for employees looking to save for their healthcare and retirement. But many employees are not knowledgeable enough to fully utilize their HSAs. Here is an interesting column by Eric Brewer from Employee Benefit News on what you can do to help educate your employees on the impartance of HSAs.

High-deductible health plans with health savings accounts are becoming more popular as benefits consumerism increases throughout the country. Enrolling your employees in HDHPs is one way to educate them on the true cost of healthcare. And if they use an HSA correctly, it can help them better manage their healthcare costs, and yours.

But understanding how an HDHP works and ensuring your employees will get the most out of an HSA can be tricky. In fact, a recent survey by employee communication software company Jellyvision found that half of employees don’t understand their insurance benefits. And choosing a benefits plan is stressful for employees because it’s a decision that will impact them for a long time. This is further complicated by the trend toward rising employee contributions and the issue of escalating healthcare costs. Employees are taking on more cost share — and that means plan sponsors have a greater responsibility to do a better job of educating them to make the best decision at open enrollment.

HSAs benefit the employee in a number of ways:
· Just like a retirement plan, HSAs can be funded with pre-tax money.
· Employees can choose how much they want to contribute each pay period and it’s automatically deducted.
· Employers can contribute funds to an HSA until the limit is met.

These are important facts to tell employees. But there’s more to it than that. Here are some tips on how to best explain HSAs to your workforce.

The devil is in the details: discuss tax-time changes

Employees using HSAs will see an extra number or two on their W-2s and receive additional tax forms. Here’s what to know:

· The amount deposited into the HSA will appear in Box 12 of the W-2.
· Employees may also receive form 5498-SA if they deposited funds in addition to what has been deducted via payroll.
· Employees must submit form 8889 before deducting contributions to an HSA. On the form they’ll have to include their deductible contributions, calculate the deduction, note what you’ve spend on medical expenses, and figure the tax on non-medical expenses you may have also paid for using the HSA.
· Employees will receive a 1099SA that includes distributions from the HSA.

Importantly, most tax software walks employees through these steps.

Dispel myths

A lot of confusion surrounds HSAs because they’re yet another acronym that employees have to remember when dealing with their insurance (more on that later). Here are a few myths you should work to dispel.

· Funds are “use it or lose it.” Unlike a flexible spending account, funds in an HSA never go away. In fact, they belong to an employee. So even if they go to another job, they can still use the HSA to pay for medical expenses tax-free.

· HDHPs with HSAs are risky. There are benefits to choosing an HDHP with an HSA for both healthy people and those with chronic illnesses. Healthy people benefit from low HDHP premiums and can contribute to an HSA at a level they’re comfortable with. On the other hand, people with chronic illnesses will likely hit their deductible each year; after that time, medical expenses are covered in most cases.

Help employees understand they’re in control

High-deductible plans with an HSA might seem intimidating, but they put employees firmly in control of their healthcare. This is increasingly important in today’s insurance landscape. When employees choose an HSA, healthcare becomes more transparent. They can shop around for services and find the best deal for services before they make a decision.

HSAs also give you control and flexibility over how and when employees spend the funds. Users can cover medical costs as they happen or collect receipts and get reimbursed later. Finally, employees don’t have to worry about sending in receipts to be reviewed. This means they must be responsible for using the funds the right way, or face tax penalties.

Resist ‘insurance speak’

As an HR professional, you may not realize how much benefits jargon you use every day. After all, you deal with benefits all the time, so using industry terms is second nature. But jargon, especially the alphabet soup of insurance acronyms that I mentioned earlier, is confusing to employees.

One tip is to spell out acronyms on the first reference. Second, simplify the explanation by shortening sentences so that anyone can understand it.

Here’s an example of a way to introduce an HSA:

A health savings account, also called an HSA, is a tax-free savings account. An HSA helps you cover healthcare expenses. You can use the money in your HSA to pay medical, dental and vision costs for yourself, spouse and dependents who are covered by your health plan. You can use HSA funds to pay for non-medical expenses, but you will have to pay taxes on them…

You get the idea.

As responsibility continues to shift to employees, they may need more education in small chunks over time to reinforce their knowledge. As the employer, it’s in your best interest to help employees choose the best plan and use it the right way.

See the original article Here.

Source:

Brewer E. (2017 August 4). How to explain HSAs to employees who don't understand them [Web blog post]. Retrieved from address https://www.benefitnews.com/opinion/how-to-explain-hsas-to-employees-who-dont-understand-them?feed=00000152-18a5-d58e-ad5a-99fd665c0000

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