CenterStage...Open Season for Open Enrollment

In this month’s CenterStage, we interviewed Rich Arnold for some in-depth information on Medicare plans and health coverage. Read the full article below.

Open Season for Open Enrollment: What does it mean for you?

There are 10,000 people turning 65 every single day. Medicare has a lot of options, causing the process to be extremely confusing. Rich – a Senior Solutions Advisor – works hard to provide you with the various options available to seniors in Ohio, Kentucky and Indiana and reduce them to an ideal, simple, and easy-to-follow plan.

“For me, this is all about helping people.”
– Rich Arnold, Senior Solutions Advisor

What does this call for?

To provide clients with top-notch Medicare guidance, Rich must analyze their current doctors and drugs for the best plan option and properly educate them to choose the best program for their situation and health. It’s a simple, free process of evaluation, education, and enrollment.

For this month’s CenterStage article, we asked Rich to break down Medicare for the senior population who are in desperate need of a break from the confusion.

Medicare Break Down

Part A. Hospitalization, Skilled Nursing, etc.

If you’ve worked for 40 quarters, you automatically obtain Part A coverage.

Part B. Medical Services: Doctors, Surgeries, Outpatient visits, etc.…

You must enroll and pay a monthly premium.

Part C. Medicare Advantage Plans:

Provides most of your hospital and medical expenses.

Part D.

Prescription drug plans available with Medicare.

Under Parts A & B there are two types of plans…

Supplement Plan or Medigap Plan

A Medicare Supplement Insurance (Medigap) policy can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles, coverage anywhere in the US as well as travel outside of the country, pay a monthly amount, and usually coupled with a prescription drug plan.

Advantage Plan

A type of Medicare health plan that contracts with Medicare to provide you with all your Part A and Part B benefits generally through a HMO or PPO, pay a monthly amount from $0 and up, covers emergency services, and offers prescription drug plans.

How does this effect you?

Medicare starts at 65 years of age, but Rich advises anyone turning 63 or 64 years of age to reach out to an advisor, such as himself, for zero cost, to be put onto their calendar to follow up at the proper time to investigate the Medicare options.  Some confusion exists about Medicare and Social Security which are separate entities.  Social Security does not pay for the Supplement or Advantage plans.

Medicare Open Enrollment: Open Enrollment occurs between October 15th and December 7 – yes, right around the corner! However, don’t panic, Rich and his services can help you if you are turning 65 or if you haven’t reviewed your current plan in over a year – you should seek his guidance.

Your plan needs to be reviewed every year to best fit your needs. If you’re on the verge of 65, turning 65 in the next few months, or over 65, you should consult your Medicare advisor as soon as possible. For a no cost analysis of your needs contact Rich, Saxon Senior Solutions Advisor, rarnold@gosaxon.com, 513-808-4879.

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by 6djina

PIXNIO - Image usage: Image is in public domain, not copyrighted, no rights reserved, free for any use.

Self funded health care – a big business advantage

Check out this article from Business Insurance by one of their staff writers. In this article, Business Insurance dives into the awesome advantages of self-funding for big businesses.

You can read the original article here.

Health insurance benefits are expensive. The rising costs of health care has driven up insurance premiums to levels where many businesses have been forced to reduce these benefits or drop them altogether. There is, however another option that is less regulated, taxed less and typically results in cost savings: self funded health insurance. The problem is, it's not always the best option for all employers, particularly the smaller ones. And there's a number of reasons for this:
What is self funded health care a.k.a. self-insurance?

Self-insurance is a method of providing health care to employees by taking on the financial liabilities of the care instead of paying premiums to an insurance agency to do the same. In other words: when a person covered under a self-funded plan needs medical care, the company is financially responsible for paying the medical bill (minus deductibles). It's an alternative risk transfer strategy that assumes the risk and liability of medical bills for those covered instead of outsourcing it to a third party. It's a surprisingly common practice:

In 2008, 55% of workers with health benefits were covered by a self-insured plan….and 89% of workers in firms of 5,000 or more employees.
Most (but not all) self-insurance plans are administered by a third party, usually a health insurance company, in order to process claims. The bills are simply paid for by the employer. Health insurance companies act as a third party administrators in what are called ASO contracts (Administrative Services Only)

Another common component of self insurance plans is stop-loss insurance. This is a separate insurance plan that the employer can purchase to reduce the overall liability of claims. With this type of insurance, if claims exceed a certain dollar amount, stop-loss kicks in paying the rest. There are two kinds of stop-loss insurance:

Specific – covers the excess costs from larger claims made by individuals in the group
Aggregate – kicks in when total claims by the group exceed a set amount

For example, a company who self-insures their $1000 employees projects $100,000 in medical care claims for the year. If they purchase aggregate stop-loss insurance for claims that exceed 120% of the expected amount or $120,000, the insurance will pick up the bill for the remaining claims. If the company purchases specific stop-loss insurance at 200%, if any single claim exceeds $2,000, the stop-loss pays the remainder.

Typically, self-funded insurance providers will purchase both specific and aggregate stop-loss insurance unless the conditions are such that specific stop-loss provides enough financial protection.
Benefits of self-insurance

There are a number of financial and administrative advantages to using self-funded health insurance plans for employers. According to the Self-Insurance Institute of America (SIIA) these include:

  • 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.
  • 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.
  • The employer does not have to pre-pay for coverage, thereby providing for improved cash flow.
  • The employer is not subject to conflicting state health insurance regulations/benefit mandates, as self-insured health plans are regulated under federal law (ERISA).
  • The employer is not subject to state health insurance premium taxes, which are generally 2-3 percent of the premium's dollar value.
  • The employer is free to contract with the providers or provider network best suited to meet the health care needs of its employees.

There are, however, some drawbacks to self-insurance policies:

Health care can be costly, so heavy claims years can be extremely expensive
Self insurance isn't tax deductible the same way the costs of providing health insurance is.
Financial benefits are long-term, particularly with an investment component.
Small businesses at a disadvantage

Self insurance is much more prevalent for larger companies mostly because it is easier to predict health care costs from a larger group. The more people in the group, the less potentially damaging a single expensive claim will be to the plan overall. That's why less than 10% of companies with less than 50 employees use self-insurance.

Because risk is more difficult to predict with smaller groups, stop-loss insurance is also more expensive for smaller businesses. The practice of “lasering”, or increasing deductibles for specific higher risk employees can also be much tougher on small firms. As a result, self-insurance tends to be a less cost effective option than it is for larger companies.

Another roadblock for small businesses is a lack of cash-flow that is necessary to finance self-insurance. This doesn't mean, however, that small businesses can't benefit from a self-insurance plan. In fact, an increasing number of small businesses still are. But fully understanding the risks and rewards for doing so can sometimes be difficult.
Regulations

Because the only 3rd party administration of insurance (stop-loss) is between the employer and the insurance company directly, it is not subject to state level regulation the way traditional insurance policies are. Instead, they're regulated by the department of labor under the Employee Retirement Income Security Act – ERISA. Benefit administrators must still comply with federal standards despite the lack of state regulation.

California SB 1431

California is considering a proposed legislation to regulate the sale of stop-loss policies to smaller businesses. On the surface, the regulation looks as though it is an attempt to prevent small businesses from taking on too much risk. But the true intentions of the legislation may be to prevent cherry-picking of generally healthier small businesses (effectively removing them from the health insurance pool). This cherry-picking would theoretically cause traditional insurance premiums to become more expensive.

According to the SIIA, SB 1431 would prohibit the sale of stop-loss policies to employers with fewer than 50 employees that does any of the following:

  • Contains a specific attachment point that is lower than $95,000;
  • Contains an aggregate attachment point that is lower than the greater of one of the following:
    • $19,000 times the total number of covered employees and dependents;
    • 120% of expected claims;
    • $95,000

This legislation would effectively limit the options of small businesses as it would force them to purchase a more expensive low deductible stop-loss policies. And according to the SIIA, with this legislation, almost no small business under 50 employees would (nor should they) consider self-insurance as an option.

If the legislation is passed in California, it has been suggested that it is only time before other states follow suit and/or enact even stricter regulations on small businesses. The SIIA even has a facebook page dedicated to defeating the bill they say is:

“…unnecessary and will only exasperate the problem that small employers in California face in being able to afford the rising cost of providing quality health benefits to their employees.”

So while self insurance can be a relatively risky option for small businesses, with legislation like this, it could no longer be a realistic option at all… And, in effect: another competitive advantage big businesses will have over their smaller counterparts.

You can read the original article here.

Source:

Staff Writer. (Date Unlisted). "Self funded health care – a big business advantage" [Web Blog Post]. Retrieved from address https://www.businessinsurance.org/self-funded-health-care-a-big-business-advantage/

by 6djina

Avoid these 12 Common Open Enrollment Mistakes

Open enrollment season is right around the corner. Check out this great column by Alan Goforth from Benefits Pro and find out the top mistakes employers and HR have made during open enrollment and what you can do to avoid them.

Every employer or human resources professional has made mistakes during open enrollment.

Trying to accommodate the diverse needs of the workforce in a short timeframe against the backdrop of increasing options and often bewildering regulations, can be a challenge even in the best-run companies.

Avoiding mistakes is impossible, but learning from them is not. Although the list may be limitless, here are a dozen of the most common pratfalls during open enrollmentand how to avoid tripping over them.

1. Failing to communicate

"What we've got here… is failure to communicate." – Cool Hand Luke

This mistake likely has topped the list since open enrollment first came into existence, and it will probably continue to do so. That's because enrollment is a complex procedure, and few challenges are greater that making sure employers, employees, brokers and carriers are on the same page.

Employers have both a stick and a carrot to encourage them to communicate as well as possible. The stick is the Affordable Care Act, which requires all employers subject to the Fair Labor Standards Act to communicate with employees about their health-care coverage, regardless of whether they offer benefits.

As a carrot, an Aflac study found that 80 percent of employees agree that a well-communicated benefits package would make them less likely to leave their jobs

2. Neglecting technology

The integration of new technology is arguably the most significant innovation in the enrollment process in recent years.

This is especially important as younger people enter the workforce. Millennials repeatedly express a preference for receiving and analyzing benefits information by computer, phone or other electronic devices.

The challenge is to make the use of technology as seamless as possible, both for employees who are tech-savvy and for those who are not.

Carriers and brokers are making this an emphasis, and employers should lean on them for practical advice.

See the original article Here.

3. Over-reliance on technology

At the other end of the spectrum is the temptation to rely on technology to do things it never was meant to do.

"Technology is so prevalent in the enrollment space today, but watch out for relying on technology as the one thing that will make or break enrollment," says Kathy O'Brien, vice president of voluntary benefits and nation client group services for Unum in Chattanooga, Tennessee. "Technology is great for capturing data, but it won't solve every problem and doesn't change the importance of the other work you need to do."

4. Succumbing to inertia

It can be frustrating to invest substantial time and effort into employee benefit education, only to have most of the staff do nothing.

Yet that is what happens most of the time. Just 36 percent of workers make any changes from the previous enrollment, and 53 percent spend less than one hour making their selections, according to a LIMRA study.

One reason may be that employees don’t feel assured they are making the right decisions.

Only 10 percent felt confident in their enrollment choices when they were done, according to a VSP Vision Care study. One good strategy for overcoming inertia is to attach dollar values to their choices and show where their existing selections may be leaving money on the table.

5. Cutting too many corners

One of the most difficult financial decisions employers make each year is deciding how much money to allocate to employee benefits.

Spending too much goes straight to the bottom line and could result in having to lay off the very employees they are trying to help. Spending too little, however, can hurt employee retention and recruiting.

Voluntary benefits offer a win-win solution. Employees, who pick up the costs, have more options to tailor a program that meets their own needs.

In a recent study of small businesses, 85 percent of workers consider voluntary benefits to be part of a comprehensive benefits package, and 62 percent see a need for voluntary benefits.

6. Not taking a holistic approach

"Holistic" is not just a description of an employee wellness program; it also describes how employers should think about employee benefit packages.

The bread-and-butter benefits of life and health insurance now may include such voluntary options as dental, vision and critical illness. Employers and workers alike need to understand how all of the benefits mesh for each individual.

Businesses also need to think broadly about their approach to enrollment

"Overall, we take a holistic approach to the customer’s enrollment program, from benefits communication to personalized benefits education and counseling, as well as ongoing, dedicated service," says Heather Lozynski, assistant vice president of premier client management for Colonial Life in Columbia, South Carolina. "This allows the employer to then focus on other aspects of their benefits process."

7. Unbalanced benefits mix

Employee benefits have evolved from plain vanilla to 31 (or more) flavors.

As the job market rebounds and competition for talented employees increases, workers will demand more from their employers.

Benefits that were once considered add-ons are now considered mandatory.

Round out the benefits package with an appealing mix of standard features and voluntary options with the objective of attracting, retaining and protecting top-tier employees.

8. Incomplete documentation

Employee satisfaction is a worthy objective — and so is keeping government regulators happy.

The Affordable Care Act requires employers who self-fund employee health care to report information about minimum essential coverage to the IRS, at the risk of penalties.

Even if a company is not required by law to offer compliant coverage to part-time employees, it still is responsible for keeping detailed records of their employment status and hours worked.

As the old saying goes, the job is not over until the paperwork is done.

9. Forgetting the family

The Affordable Care Act has affected the options available to employers, workers and their families.

Many businesses are dropping spousal health insurance coverage or adding surcharges for spouses who have access to employer-provided insurance at their own jobs.

Also, adult children can now remain on their parents' health policies until they are 26.

Clearly communicate company policies regarding family coverage, and try to include affected family members in informational meetings.

Get to know more about employees' families — it will pay dividends long after open enrollment.

10. Limiting enrollment options

Carriers make no secret about their emphasis on electronic benefits education and enrollment.

All things considered, it is simpler and less prone to copying and data-entry errors.

It would be a mistake, however, to believe that the high-tech option is the first choice of every employee.

Be sure to offer the options of old-fashioned paper documents, phone registration and face-to-face meetings. One good compromise is an on-site enrollment kiosk where a real person provides electronic enrollment assistance.

11. Letting benefits go unused

A benefit is beneficial only if the employee uses it. Too many employees will sign up for benefits this fall, forget about them and miss out on the advantages they offer.

Periodically remind employees to review and evaluate their available benefits throughout the year so they can take advantage of ones that work and drop those that do not.

In addition to health and wellness benefits, also make sure they are taking advantage of accrued vacation and personal days.

Besides maximizing the return on their benefit investment, it will periodically remind them that the employer is looking out for their best interests.

12. Prematurely closing the 'OODA' loop

Col. John Boyd of the U.S. Air Force was an ace fighter pilot. He summarized his success with the acronym OODA: Observe, Orient, Decide and Act. Many successful businesses are adopting his approach.

After the stress of open enrollment, it's tempting to breathe a sigh of relief and focus on something else until next fall.

However, the close of enrollment is a critical time to observe by soliciting feedback from employees, brokers and carriers.

What worked this year, and what didn't? What types of communications were most effective? And how can the process be improves in 2017?

"Make sure you know what is working and what is not," said Linda Garcia, vice president for human resources at Rooms to Go, a furniture retailer based just outside Tampa. "We are doing a communications survey right now to find out the best way to reach each of our 7,500 employees. We also conduct quarterly benefits surveys and ask for their actual comments instead of just checking a box."

Source:

Goforth A. (2017 Aug 22). Avoid these 12 common open enrollment mistakes [Web blog post]. Retrieved from address https://www.benefitspro.com/2017/08/22/avoid-these-12-common-open-enrollment-mistakes?ref=hp-in-depth&page_all=1

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doctor and patient

Self-funding and Voluntary Benefits: The Dynamic Insurance Duo

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

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

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

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

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

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

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

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

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

Self-funding: An overview

Self-funding allows employers to:

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

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

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

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

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

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

Voluntary solutions are about more than the products

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

Finding, and funding, a ben-admin solution

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

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

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

Communication and engagement

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

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

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

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

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

Prioritizing health and wellness

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

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

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

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

A formidable combination

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

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

See the original article Here.

Source:

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

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5 tips to make this the best open enrollment ever

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

Learn from last year’s enrollment

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

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

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

Start with strategy

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

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

Make this year’s enrollment more active

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

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

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

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

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

Take demographics into consideration

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

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

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

Understand the limitations of decision support tools

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

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

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

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

See the original article Here.

Source:

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

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SELF-INSURED GROUP HEALTH PLANS

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

Q. What is a self-insured health plan?

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

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

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

Q. Why do employers self fund their health plans?

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

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

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

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

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

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

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

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

Q. What about payroll deductions?

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

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

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

See the original article Here.

Source:

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

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Preparing for 2018 Open Enrollment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See the original article Here.

Source:

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

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How Voluntary Benefits Options are Changing

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

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

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

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

Voluntary benefits refresher

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

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

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

Today, voluntary benefits may include:

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

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

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

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

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

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

How to communicate advantages

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

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

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

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

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

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

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

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

Interest in voluntary growing

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

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

See the original article Here.

Source:

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

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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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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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