5 Crucial Wellness Strategies for Self-Funded Companies
Original post careatc.com
Instead of paying pricey premiums to insurers, self-insured companies pay claims filed by employees and health care providers directly and assume most of the financial risk of providing health benefits to employees. To mitigate significant losses, self-funded companies often sign up for a special “stop loss” insurance, hedging against very large or unexpected claims. The result? A stronger position to stabilize health care costs in the long-term. No wonder self-funded plans are on the rise with nearly 81% of employees at large companies covered.
Despite the rise in self-insured companies, employers are uncertain as to whether they’ll even be able to afford coverage in the long-term given ACA regulations. Now more than ever, employers (self-insured or not) must understand that wellness is a business strategy. High-performing companies are able to manage costs by implementing the most effective tactics for improving workforce health.
Here are five wellness strategies for self-insured companies:
Strategy 1: Focus on Disease Management Programs
Corporate wellness offerings generally consist of two types of programs: lifestyle management and disease management. The first focuses on employees with health risks, like smoking or obesity, and supports them in reducing those risks to ultimately prevent the development of chronic conditions. Disease management programs, on the other hand, are designed to help employees who already have chronic disease, encouraging them to take better care of themselves through increased access to low-cost generic prescriptions or closing communication gaps in care through periodic visits to providers who leverage electronic medical records.
According to a 2012 Rand Corporation study, both program types collectively reduced the employer’s average health care costs by about $30 per member per month (PMPM) with disease management responsible for 87% of those savings. You read that right – 87%! Looking deeper into the study, employees participating in the disease management program generated savings of $136 PMPM, driven in large part by a nearly 30% reduction in hospital admissions. Additionally, only 13% of employees participated in the disease management program, compared with 87% for the lifestyle management program. In other words, higher participation in lifestyle management programs marginally contributes to overall short-term savings; ROI was $3.80 for disease management but only $0.50 for lifestyle management for every dollar invested.
This isn’t to say that lifestyle management isn’t a worthy cause – employers still benefit from its long-term savings, reduced absenteeism, and improved retention rates – but it cannot be ignored that short-term ROI is markedly achieved through a robust disease management program.
Strategy 2: Beef Up Value-Based Benefits
Value-Based Benefit Design (VBD) strategies focus on key facets of the health care continuum, including prevention and chronic disease management. Often paired with wellness programs, VBD strategies aim to maximize opportunities for employees make positive changes. The result? Improved employee health and curbed health care costs for both employee and employer. Types of value-based benefits outlined by theNational Business Coalition on Health include:
Individual health competency where incentives are presented most often through cash equivalent or premium differential:
- Health Risk Assessment
- Biometric testing
- Wellness programs
Condition management where incentives are presented most often through co-pay/coinsurance differential or cash equivalent:
- Adherence to evidence-based guidelines
- Adherence to chronic medications
- Participation in a disease management program
Provider Guidance
- Utilization of a retail clinic versus an emergency room
- Care through a “center of excellence”
- Tier one high quality physician
There is no silver bullet when it comes to VBD strategies. The first step is to assess your company’s health care utilization and compare it with other benchmarks in your industry or region. The ultimate goal is to provide benefits that meet employee needs and coincide with your company culture.
Strategy 3: Adopt Comprehensive Biometric Screenings
Think Health Risk Assessments (HRAs) and Biometric Screenings are one and the same? Think again. While HRAs include self-reported questions about medical history, health status, and lifestyle, biometric screenings measure objective risk factors, such as body weight, cholesterol, blood pressure, stress, and nutrition. This means that by adopting a comprehensive annual biometric screening, employees can review results with their physician, create an action plan, and see their personal progress year after year. For employers, being able to determine potentially catastrophic claims and quantitatively assess employee health on an aggregate level is gold. With such valuable metrics, its no surprise that nearly 51% of large companies offer biometric screenings to their employees.
Strategy 4: Open or Join an Employer-Sponsored Clinic
Despite a moderate health care cost trend of 4.1% after ACA changes in 2013, costs continue to rise above the rate of inflation, amplifying concerns about the long-term ability for employers to provide health care benefits. In spite of this climate, there are still high-performing companies managing costs by implementing the most effective tactics for improving health. One key tactic? Offer at least one onsite health service to your population.
I know what you’re thinking: employer-sponsored clinics are expensive and only make sense for large companies, right? Not anymore. There are a few innovative models out there tailored to small and mid-size businesses that are self-funded, including multi-employer, multi-site sponsored clinics. Typically a large company anchors the clinic and smaller employers can join or a group of small employers can launch their very own clinic. There are a number of advantages to employer-sponsored clinics and it is worthwhile to explore if this strategy is right for your company.
Strategy 5: Leverage Mobile Technology
With thousands health and wellness apps currently available through iOS and Android, consumers are presented with an array of digital tools to achieve personal goals. So how can self-insured companies possibly leverage this range of mobile technology? From health gamification and digital health coaching, to wearables and apps, employers are inundated with a wealth of digital means that delivering a variation of virtually the same thing: measurable data.
These companies curate available consumer health and wellness technology to empower employers by simplifying the process of selecting and managing various app and device partners, and even connecting with tools employees are already be using.
Conclusion:
Self-insured companies have a vested interest in improving employee health and understand that wellness is indeed a business strategy. High-performing companies are able to manage costs by implementing the most effective tactics for improving workforce health including an increased focus on Chronic Disease Management programs; strengthening value-based benefit design; adopting comprehensive biometric screening; exploring the option of opening or joining an employer-sponsored clinic; and leveraging mobile technology.
5 Strategies to Cut Healthcare Costs without Cutting Benefits
Original post benefitsnews.com
For employers, it’s been an ongoing battle to keep health insurance costs down without cutting employee health benefits. According to a PwC report, healthcare costs will remain a challenge in 2016 as costs are expected to outpace general economic inflation with a 4.5% growth rate.
There is no single culprit in the battle against rising healthcare costs; rather, there are many drivers contributing to the increase. Soaring prices for medical services, new costly prescription drugs and medical technologies, paying for volume over value, unhealthy lifestyles and a lack of transparency concerning prices and quality are all factors contributing to the spike in premiums.
So what can you do?
It can be a difficult juggling act to keep your health insurance premiums from financially squeezing your business, while also providing a robust benefits package for your employees. However, you may have more options for controlling your company’s healthcare costs than you realize. With the right knowledge and planning, there are ways to keep health insurance costs from derailing your company’s profits while also providing your workforce with the benefits they need.
Here are five strategies to cut costs without minimizing the benefits offered to employees:
1. Level-funding company healthcare costs.
In between a traditional fully insured plan and a traditional self-funded plan lies an innovative solution known as level-funding.
Traditional fully insured plans are contracts between the employer and the insurer where the employer pays a predetermined and fixed amount per employee per month (PEPM) and the insurer assumes the financial (claims) risk, net of employee co-pays and deductibles.
Traditional self-funded plans are one in which the employer assumes the financial (claims) risk for providing healthcare benefits to its employees. In practical terms, self-insured employers pay for each out-of-pocket claim as they are incurred, and the model is almost always is packaged with stop-loss insurance in case of large claims.
Level-funding is a hybrid of the two aforementioned plans, whereby the plan is filed as a self-funded plan, but the employer is billed each month a fixed and unchanging premium per employee per month, and after a year or two may qualify for a refund of premium if claims were lower than expected, or receive a proposed increase to premiums at renewal if claims were higher than expected. Since these plans are filed as self-funded, they are typically exempt from state taxes and many of the federal healthcare law’s health insurance taxes, but subject to a modest annual transitional reinsurance fee.
Additionally, according to data from the U.S. Department of Health and Human Services, nearly 30% of employers with between 100 and 499 employees self-insures their benefits, and over 80% of employers with 500 or more employees self-insure their benefits.
2. Provide a proactive wellness initiative.
Health and wellness programs have become popular ways for employers to manage healthcare costs — and some companies are finding that employees are more engaged in these programs when they’re offered incentives, rewards or even disincentives for participating or attaining certain health-related goals. Some companies are also seeing an impact of incentives on their program ROI.
For wellness programs to be effective, they need to be robust and allow for individual needs and interests. Wellness programs need to be comprehensive and tailored to individuals; meeting them where they are and helping them keep their healthy goals and ambitions in check with robust resources.
One other important aspect of having an effective wellness program is measuring employee engagement. By determining their level of inclusion, employers can understand how to implement incentive-based initiatives for the future. And remember, leading by example is important to make your employees feel comfortable.
3. Implement tax-advantaged programs.
Tax-Advantage benefits programs allow for a reduced cost of living for employees by handling expenses using pre-tax dollars. This method ensures the use of money that is valued at 100% of a wage or salary, instead of paying with funds that are devalued due to taxation.
There are four major types of programs that utilize this method: flexible spending accounts (FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs) and premium offset lans (POPs). Each program offers a different process for healthcare payments that involves both employers and employees, and can lighten the burden of rising medical expenses.
4. Use a flexible contribution arrangement (FSA).
Elaborating further on the aforementioned benefit programs, FSAs enable employees to collect and store money that can be used for medical expenses tax-free. FSAs may be funded by voluntary salary reductions with an employer, and there is no employment or income tax enforced.
Another benefit of FSAs stems from the ability of employers to make contributions towards an account that can be excluded from an employee’s gross income. From an employee’s mindset, an FSA allows for flexibility and a metaphorical safety net in case of a medical emergency.
5. Use deductible exposure mitigation vehicles (HRAs).
A health reimbursement arrangement is another tax-advantaged employer health benefit plan that can trim your tax bill and reduce the cost of medical services.
HRAs are an employer funded medical expensed reimbursement plan for qualifying medical expenses. These plans reimburse employees for individual health insurance premiums and out-of-pocket medical expenses. They allow the employer to make contributions to an employee's account and provide reimbursement for eligible expenses. All employer contributions are 100% tax deductible when paid to the participant to reimburse an expense. They are also tax-free to the employee.
Based on the plan design, HRAs can be an excellent way to supplement health insurance benefits and allow employees to pay for a wide range of medical expenses not covered by insurance.
What works, what doesn’t
It’s crucial to educate employees on available tools and programs — by doing so you can control costs, while simultaneously providing appropriate benefits and employee engagement. To make the most out of a conscientious business decision, take the time to understand what is and isn’t working for you on your current plan, and what your other options are.
By adopting these new healthcare benefit strategies, you are engaging your workforce and enabling them to have an active role in determining an appropriate course of action.
A proper benefits partner maintains track of legislation and regulatory changes, advocates for small to mid-sized businesses and has the expertise to prevent violations from unforeseen rules and laws. By enabling these programs and using the right benefits partner, you can see your company’s healthcare costs lower substantially.
10 things to check when planning 2016 health benefit packages
The clock is ticking down to 2016 which means time is running out to dot the 'i' and cross the 't' for your health benefit packages. Employee Benefit Adviser has these tips.
1) Employer shared-responsibility (ESR) strategy: Ensure the intended goal of avoiding or paying ESR assessments for 2016 coverage is supported by coverage offers, administrative and recordkeeping processes, and benefit documents.
2) ESR reporting: Arrange data sources, systems and administrative processes to collect all information about enrollees with minimum essential coverage (MEC), full-time employees, and coverage offers needed for reporting on 2016 coverage. Create a process for correcting any erroneous IRS filings and personal statements.
3) Preventative care: Ensure “non-grandfathered” group health plans comply with the final ACA rules and recent guidance on cost-free preventive services.
4) Other ACA reporting and disclosure requirements: Review delivery operations for summaries of benefits and coverage (SBCs) and watch for revised SBC templates. Prepare for round two of online submission and payment of ACA’s reinsurance fee.
5) Mid-year changes to cafeteria plan elections: Decide whether to permit mid-year changes to cafeteria plan elections for either or both of the status-change events in IRS Notice 2014-55.
6) ACA’s out-of-pocket maximum: Verify that self-only and other (e.g., family) coverage tiers in “non-grandfathered” plans meet ACA’s 2016 out-of-pocket (OOP) limits for in-network care. Confirm that family coverage also satisfies ACA’s self-only OOP limit for each enrollee.
7) Same-sex marriages and domestic partnerships: Assess how the U.S. Supreme Court’s Obergefell v. Hodges ruling that legalizes same-sex marriage nationwide affects your benefit programs and employment policies. Also, consider the decision’s indirect implications for domestic partner coverage.
8) Mental health parity: Check that plan designs and operations provide parity between medical/surgical and mental health/substance use disorder (MH/SUD) coverage. Federal audits of health plans now evaluate compliance with the final Mental Health Parity and Addiction Equity Act (MHPAEA) rules that took effect in 2015. In addition, state legislative activity and litigation around parity issues continue.
9) Wellness: Review employee wellness programs against the proposed Equal Employment Opportunity Commission (EEOC) rules requiring voluntary participation and restricting incentives for completing health risk assessments and/or biomedical screenings. Be prepared to make changes after EEOC finalizes these rules for nondiscriminatory wellness plans under the Americans with Disabilities Act.
10) Fixed-indemnity and supplemental health insurance: Review fixed-indemnity and supplemental health insurance policies to ensure they qualify as excepted benefits under the ACA and the Health Insurance Portability and Accountability Act (HIPAA).
CDHP cost advantages extend for years
Originally posted March 30, 2015 by Alan Goforth on www.benefitspro.com.
Consumer-directed health plans can help contain health care spending for years after they're put into place, according to the first major study of its type.
“Do ‘Consumer-Directed’ Health Plans Bend the Cost Curve over Time?" released by the National Bureau of Economic Research, analyzes the three-year effects of CDHPs.
“We estimated spending trends for three years across … the country in an analysis estimating CDHP impacts, without the threat of individual level selection bias,” the authors of the study wrote. “We find that health-care cost growth among firms offering a CDHP is significantly lower in each of the first three years after offer. This result suggests that, at least at large employers, the impact of CDHPs persists and is not just a one-time reduction in spending.”
An unrelated study by the Society for Human Resource Management found that 19 percent of respondents that offer employee coverage said consumer-driven plans were the most-effective means of controlling the rising cost of health coverage.
Annual health care spending, according to the research bureau's findings, was 6.6 percent, 4.3 percent and 3.4 percent lower on average for the first three years, respectively, for companies with CDHPs when compared to companies without them.
CDHPs, which combine high deductibles with personal medical accounts, were designed to reduce health-care spending through greater patient cost-sharing. Several studies have shown that they reduce spending during the first year, but little research had been conducted into the longer-term economic impact. One concern was that CDHP enrollees would decrease their use of necessary care, which would lead to increased spending in the long term due to greater complications.
The National Bureau of Economic Research analyzed data from 13 million individuals in 54 large U.S. firms.
“We find that spending is reduced for those in firms offering CDHPs in all three years,” the report said. “The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care.”
Researchers found that the CDHP savings effect varied considerably across spending category:
- Prescription drugs. Compared with firms not offering CDHPs, annualized spending growth on pharmaceuticals was 5 to 9.5 percentage points lower in the three years after firms offered CDHPs.
- Outpatient services. Spending growth on outpatient care was 3 to 6.8 percentage points lower in the first three years relative to non-offering firms.
- Emergency room use. No differences were detected in cost growth for emergency room care in any of the first three years after a CDHP was offered.
Researchers caution against drawing implications for populations other than the ones studied.
"The results presented here are limited to large employers," the report said, "and therefore may not extend to Medicaid beneficiaries, the individual or small group market, or to the health insurance exchanges where, on average, deductibles and out-of-pocket maximums are higher and/or enrollees have fewer financial resources."
However, the longer-term study should alleviate some previous concerns.
“These findings do not support either the concern that decreases in spending will be a one-time occurrence or that short-term decreases in spending with a CDHP will result in increases in spending in the long term due to complications of foregone care,” it said.
'Cadillac' Tax Could Diminish Union Health Plans
Originally posted by Bob Herman on March 3, 2015 on businessinsider.com.
Health plans obtained through union collective bargaining agreements often include much more generous benefits than other employer-sponsored plans. But such benefits are likely to be pared down as the Affordable Care Act's excise tax nears, a new study in Health Affairs contends.
That excise tax, often called the “Cadillac” tax, will go into effect Jan. 1, 2018. A 40% tax will be levied on every dollar of total premiums paid above $10,200 for individual health plans and $27,500 for family plans.
Policymakers included the Cadillac tax in the ACA as a way to raise revenue to fund the law. The Congressional Budget Office estimates it will bring in $120 billion between 2018 and 2024. Most of that will come from higher taxes on employees' taxable wages instead of the tax-exempt insurance benefits.
But the tax also was viewed as a way to reduce the number of health plans that have little cost-sharing and premium contributions, which some argue contribute to the overuse of healthcare. President Barack Obama has been quoted as saying the excise tax will discourage “these really fancy plans that end up driving up costs.” Lavish executive-level health plans and collegiate benefit packages, like Harvard University's, have been oft-cited targets. However, many collectively bargained policies fall into the Cadillac bracket as well.
The Health Affairs study, published Monday, sought specifics about what kind of health benefit packages unions provide for employees. People with union plans have lesser out-of-pocket obligations and don't pay as much per month toward their premium as others with employer-based insurance, but the surprise was “the magnitude of the differences for certain things,” said Jon Gabel, a healthcare fellow at NORC at the University of Chicago and one of the study's authors.
For instance, families in collectively bargained plans paid about $828 per year toward their premium, or about $69 per month, according to the study's surveyed data. That compared to $4,565 for the average employer-sponsored family plan, or about $380 per month, according to 2013 data from the Kaiser Family Foundation.
Cost-sharing requirements also were less onerous in union health plans, the study found. The average annual in-network deductible for an individual in a collectively bargained plan was $203. The average deductible at other employer-based plans was almost six times higher at $1,135.
Although the federal government is considering some flexibility for “high risk” unionized occupations such as miners and construction workers, many employers are looking to get ahead of the excise tax by slimming down benefits.
“For those who are fortunate to have a Cadillac plan right now, it's probably not going to be so comprehensive in the future,” Mr. Gabel said. However, he said, reduced benefits should lead to increased wages to offset higher cost-sharing.
Tom Leibfried, a health care lobbyist for the AFL-CIO, a federation of 56 unions, calls the Cadillac tax “a misnomer” because union plans apply to middle-class Americans with modest wages. The issue should not be about the generosity of health coverage, but rather whether the coverage is appropriate for people based on the health care costs in their geography, he said.
“Trying to control utilization in that way really does amount to a cost-shift,” Mr. Leibfried said. “This is really a middle-class problem.”
Higher compensation supplanting lost benefits is not a sure thing either, Mr. Leibfried said. Indeed, wages and salaries have been mostly stagnant the past decade, barely edging out inflation even as health benefits shrink.
Reducing benefit costs while still valuing employees
Originally posted August 26, 2014 by Steve Grossi on https://ebn.benefitnews.com.
As part of valuing our employees, benefits are viewed as a direct extension of pay and considered to be a vital part of an employee’s total compensation package. Benefits represent a sizeable investment for BOK Financial as well as for each employee. It’s our corporate culture to place a great deal of attention on benefits, and helping employees understand all of the value of their benefits package is a key focus for our HR team.
People who work for us are independent thinkers. It’s important to make our own decisions, and that’s especially true when it comes to health benefits. This is the reason our company is committed to a program that offers employees the flexibility to choose their coverage in most major benefit areas. Each employee can put together a personal package to suit their needs, and I believe that this flexibility shows the company’s commitment to each and every member of our staff as well as their families.
But this level of commitment to our employees – although vital – is expensive. After payroll, benefits costs were our No. 1 company expense, and as a result we found ourselves coming to terms with the impending Cadillac Tax, a penalty against companies over a particular threshold in terms of premiums resulting from the Affordable Care Act.
We added a consumer-directed health plan to our benefits offering, along with a health savings account, hoping to bring overall benefits costs down and reduce our exposure to the Cadillac Tax. Our belief was that the CDHP would suit the needs of many employees, and premiums would be lower for both the company and the employee. But explaining the benefit of a CDHP to employees is challenging – people are confused by the options, and most simply choose to do nothing and remain in their current plan. Others assume that the most expensive plan is the best, and default to that choice.
After one year with the CDHP, adoption was well short of our company goal, at only 5%. We went looking for help, and ended up with a solution from Tango, a company that helps organizations save money by optimizing health benefits, while keeping employees happy.
The first step was to educate our employees, and Tango explained the differences between each plan in simple, relevant terms. A plan optimizer tool allowed employees to walk through a series of questions and decide which plan was the best based on their individual needs. Since the tool is online, employees can log in from home and walk through the steps with their spouse, and discuss their options. Our CEO and his wife went online at home to use the plan optimizer, and they ended up choosing the CDHP. In all, over a thousand of our employees logged on to the online tool, with most spending at least 20 minutes reviewing and comparing their options.
For even more employee awareness, Tango put a communication plan in place that included email-based updates and information. Weekly and monthly communications continue to go out to the employees explaining how to open and use their HSA, and other helpful tips on topics like reimbursements and tax filing. The emails were very specific and targeted, so employees were more likely to open and read them. Tango also provided videos and webinars specifically created for our employees with a direct comparison between the CDHP and the traditional PPO plan – helping to demystify the choice between the plans. Normally this kind of information would come from the HR team, but Tango’s level of service meant that our HR team could focus on other critical employee needs.
Reviewing our results at the end of the first enrollment period with Tango, we saw adoption of the CDHP and HSA go from 5% of the employee base up to 30%. Our employees were pleased with the plan changes and with the amount of information they were getting about the growth of their HSAs. And it was a huge win for the company: BOK Financial saved over $880,000 in premiums and avoided an additional $190,000 in taxes.
BOK Financial continues to work with Tango to boost further adoption of the CDHP, and to retain existing plan members and ensure that employees are getting the maximum benefit out of their HSAs. As a chief human resource officer, the ability to increase adoption of the CDHP while maintaining our relationships with employees was very important to me. I’m thrilled that we’re able to retain our commitment to value our employees, even as we make changes that benefit the company’s bottom line.
Play or Pay in 2015 — so many requirements, so little time
Originally posted August 6, 2014 by Dorothy Summers on https://ebn.benefitnews.com
2015 is getting close and the Employer Shared Responsibility Mandate (“Play or Pay”) under the Affordable Care Act (ACA) is almost here. So what does this mean for your organization? Play or Pay requires certain employers to offer affordable and adequate health insurance to full-time employees and their dependents, or they may be liable for a penalty for any month coverage is not offered.
Play or Pay goes into effect in the calendar year of 2015 for large employers only. However, mid-size employers aren’t entirely off the hook. They’ll have to report on insurance coverage even though they won’t be liable for penalties in 2015. By January 1, 2015, businesses with 100 or more full-time or full-time-equivalent employees must ensure they are offering health benefits to all of those working an average of 30 hours per week, or 130 hours per month. If an employer has a non-calendar year plan and can meet certain transitional rules, they can delay offering employee health benefits until the start date of their non-calendar year plan in 2015. Mid-sized employers will have to comply beginning in 2016.
Here are important questions that employers need to answer today:
- Do you know which category your business fits into?
- How do you classify who is a full-time employee?
- What do you need to do to comply with Play or Pay requirements?
Let’s take an in-depth look at each of these questions.
Which category do you fit into?
Whether you are a small, mid-sized, or large employer is determined by the number of full-time and full-time equivalent employees (FTEs). It sounds simple on the surface:
- Small employers have 1-49 full-time or FTE employees
- Mid-sized employers have 50-99 full-time or FTE employees
- Large employers have 100+ full-time or FTE employees
However, it’s important to remember that these numbers can be affected by several factors, including whether the employer is a part of a control group, seasonal employees and variable-hour employees. That brings us to our next question:
Who is a full-time employee?
The law defines a “full-time employee” for penalty purposes as an employee who, for any month, works an average of at least 30 hours per week, or 130 hours. This includes any of the following paid hours: vacation, holiday, sick time, paid layoff, jury duty, military duty and paid leave of absence under the Family and Medical Leave Act.
Employees who aren’t considered full-time include non W-2 leased workers, sole proprietors, partners in partnerships, real estate agents, and direct sellers.
Variable-hour employees—those who don’t work a set amount of hours each week—fall into a gray area. That is, they don’t need to be counted as full-time employees until and unless it becomes an established practice for them to work more than 30 hours per week.
To assist employers in determining whether variable hour workers will meet the definition of full-time employees (and therefore need to be offered health insurance), employers may use various “look back” and “look forward” periods. Here is a summary of terms used for measuring variable-hour employees:
- Measurement Period: A period from three to 12 months in which the employer would track hours to determine whether the employee worked an average of more than 30 hours per week.
- Stability Period: A period from six to 12 consecutive months in which the employer must provide health insurance coverage to employees who worked more than 30 hours per week in the Measurement Period. Note: must be at least six months and cannot be shorter than the Measurement Period.
- Administrative Period: A period not to exceed 90 days, which falls between the Measurement Period and Stability Period, and/or a short period after a new employee’s date of hire. Using this waiting period allows employers to analyze eligibility of full-time employees and provide enrollment information to enroll them in a plan before penalties could be assessed.
Does your plan meet the Play or Pay requirements?
To avoid penalties, you’ll need to make sure your plan meets certain requirements. First, coverage must be offered to full-time employees and their dependents. Under the ACA, dependents are defined as children under age 26. Spouses are not considered dependents.
Include health care cost in plans
Originally posted August 3, 2014 by Redding Edition on https://www.ifebp.org
The possibility of having to pay major health care costs in the future is a primary concern of planning for retirement these days. Is there some way to plan for these expenses years in advance?
Just how great might those expenses be? There’s no rote answer, but recent surveys from AARP and Fidelity Investments reveal that too many baby boomers might be taking this subject too lightly.
For the last eight years, Fidelity has projected average retirement health care expenses for a couple — assuming that retirement begins at age 65 and that one spouse or partner lives about seven years longer than the other. In 2013, Fidelity estimated that a couple retiring at age 65 would require about $220,000 just to absorb those future health care costs.
When it asked Americans ages 55 to 64 how much money they thought they would spend on health care in retirement, 48 percent of the respondents figured they would only need about $50,000 each, or about $100,000 per couple. That pales next to Fidelity’s projection and it also falls short of the estimates made in 2010 by the Employee Benefit Research Institute. EBRI figured that a couple with median prescription drug expenses would pay $151,000 of their own retirement health care costs.
AARP posed this question to Americans ages 50 to 64 in the fall of 2013. The results were 16 percent of those polled thought their out-of-pocket retirement health care expenses would run less than $50,000 and 42 percent figured needing less than $100,000.
Another 15 percent admitted they had no idea how much they might eventually spend for health care. Not surprising, just 52 percent of those surveyed felt confident that they could financially handle such expenses.
Prescription drugs may be your No. 1 cost. EBRI currently says that a 65-year-old couple with median drug costs would need $227,000 to have a 75 percent probability of paying off 100 percent of their medical bills in retirement. That figure is in line with Fidelity’s big-picture estimate.
What might happen if you don’t save enough for these expenses? As Medicare premiums come out of Social Security benefits, your monthly Social Security payments could grow smaller. The greater your reliance on Social Security, the bigger the ensuing financial strain.
The main message is save more and save now. Do you have about $200,000 after tax saved for future health care costs? If you don’t, you have yet another compelling reason to save more money for retirement.
Medicare, after all, will not pay for everything. In 2010, EBRI analyzed how much it did pay for, and it found that Medicare only covered about 62 percent of retiree health care expenses. While private insurance picked up another 13 percent and military benefits or similar programs another 13 percent, that still left retirees on the hook for 12 percent out of pocket.
Consider what Medicare doesn’t cover, and budget accordingly. Medicare pays for much, but it doesn’t cover things like glasses and contacts, dentures and hearing aids — and it certainly doesn’t pay for extended long-term care.
Medicare’s yearly Part B deductible is $147 for 2014. Once you exceed it, you will have to pick up 20 percent of the Medicare-approved amount for most medical services. That’s a good argument for a Medigap or Medicare Advantage plan, even considering the potentially high premiums. The standard monthly Part B premium is at $104.90 this year, which comes out of your Social Security. If you are retired and earn income of more than $85,000, your monthly Part B premium will be larger. The threshold for a couple is $170,000. Part D premiums for drug coverage can also vary greatly. The greater your income, the larger they get. Reviewing your Part D coverage vis-à-vis your premiums each year is only wise.
Takeaway: Staying healthy may save you a good deal of money. EBRI projects that someone retiring from an $80,000 job in poor health may need to live on as much as 96 percent of that end salary annually, or roughly $76,800. If that retiree is in excellent health instead, EBRI estimates that he or she may need only 77 percent of that end salary — about $61,600 — to cover 100 percent of annual retirement expenses.
Open enrollment checklist for employers
Originally posted July 23, 2014 by Alan Goforth on https://www.benefitspro.com
Wrestling with the implications of the Patient Protection and Affordable Care Act could make the upcoming open enrollment period one of the most challenging in memory. Mercer, a human resources and benefits company in New York City, encourages companies to approach the fall season with a plan.
Mercer’s proposed checklist includes:
- Consider offering a consumer-driven health plan. The momentum behind this type of plan continues to grow, with 39 percent of large of large employers offering one last year and 64 percent expected to do so within two years.
- Communicate early and often to the newly eligible. Mercer’s research indicates that one-third of employers still need to make changes to comply with the requirement to extend coverage to all employees working 30 or more hours per week. Start communicating right away with newly eligible employees about who is eligible, why they are eligible, how eligibility was determined, what this means and what they have to now consider. Information should also be delivered to those who still remain ineligible and the options these employees may have in the public exchange arena.
- Make voluntary benefits a big part of the message. Voluntary benefits can deliver significant value to employees and are an important element of a thoughtfully designed benefits program. They can also be used to overcome misperceptions and confusion around other benefit offerings. These offerings also can assist employees who remain ineligible for the employer-sponsored medical plan.
- Use open enrollment as an opportunity to reinforce wellness campaigns. This is particularly important if any perceived compliance penalties are going to be introduced next year, such as increased premiums for those who do not participate in health screenings.
- Deploy decision support and mobile technology to support the accountability theme. Participants are being asked like never before to take accountability for their health benefit decisions and cost outlays. For example, some employers are providing digital “wallet cards” for smart phones and other devices that contain benefit information and contacts needed at the point of service or anywhere else a participant needs this information and/or advice.