Association Health Plans & Their Benefits

Many individuals do not understand various insurance terms and the plans available to them. Most employers have a hard time trying to find the best and the most affordable coverage for their employees. It is important you find an insurance company or agent that can break it down for you to get the best coverage.

We asked our founding partner and CEO, Jamie Charlton, to shed some light on Association Health Plans (AHPs) and also give their advantages and disadvantages.

What is an AHP, and How Does it Work?

According to Charlton, AHP or Association Health Plans are a conglomeration of smaller groups that come under the guise of a larger umbrella to leverage bulk buying power. They might not be small companies per se, but are those that come together under one industry or from the same geographic area to strengthen their negotiating power. They can be a group of manufacturers, printers or self-employed individuals from the same jurisdiction. An example of such an association is the Chamber Alliance.

Ideally, small businesses, including self-employed individuals in the same industry or geographic location, can merge to form larger groups to get healthcare plans as one large group. Coalitions are more or less the same as these associations, only that coalitions are groups made up of non-profit institutions such as schools. Associations are mostly businesses or organizations aimed at making profits.

AHP Expansion

United States (US) President, Donald Trump, issued an executive order to promote healthcare coverage in the US on October 12, 2017. The order aims at expanding access to small businesses to get the same competitive advantage as large corporations when purchasing health insurance. This order was meant to provide more affordable health insurance plans to as many individuals as possible. These individuals include farmers, wage earners and employees of any small business in the US.

Charlton has a slightly different view of this expansion. Though it has helped a few individuals, the expansion does not present any advantage as the rates keep going higher with age. He explained, “AHPs don’t have an advantage in the long run, unless they have a long-term sponsor.” AHPs have always been in existence, and the expansion is just political rhetoric that will give the plans some credibility.

Advantages of an AHP to Smaller Employers

There are some advantages that come with AHPs, both to the employer and the employees. These include:

  • Negotiating power
  • Spreading the risk
  • Maintaining lower rates instead of lumping them into unverified age groups
  • No charging different premiums to employees based on health status
  • No charging different rates to employers based on the health status of their employees
  • Healthy, younger groups will be fully underwritten
  • Self-employed individuals with a few employees and those with no employees are also eligible
  • Will not cherry pick or discriminate based on the status of an applicant pre-existing or previous health condition.

There are also some disadvantages. They include:

  • Many of these plans might not allow single person groups.
  • An individual must be a bona-fide member of a group and pay a membership fee.

The Role Saxon Plays in Helping the Employer

Saxon prides itself as a top provider of AHPs. The company has experts with knowledge of how this system works. Writing these plans for the last four years, Saxon can offer stable rates and consistent, professional assistance.

For more information regarding employee benefits and competitive benefits packages that fit your business strategy, you can contact Jamie Charlton at 513-573-0129 or via email at jcharlton@gosaxon.com.


Giving onsite clinics an engagement booster shot

In efforts to reduce healthcare spend and increase the population's health, many employers are offering a variety of employee wellness services and programs. Read this blog post to learn more about increasing engagement in onsite clinics.


Employers of all sizes and industries are currently offering a variety of wellness services that include preventive, acute, primary, chronic disease and occupational healthcare programs at or near the worksite. These benefits are intended to reduce healthcare spend, increase the population’s health and productivity and positively impact recruitment and retention efforts.

In fact, according to two 2018 studies by the National Association of Worksite Health Centers, more than one-third of all employers and close to 50% of large firms are now operating worksite clinics. But just because employers offer such benefits doesn’t mean employees will take advantage of these services, even when they’re free.

But many employers are frustrated to find that 20% or less of the targeted or covered workers utilizes their programs — with millions of dollars in benefits wasted.

Failure can be caused by lack of promotion, inadequate incentives, poor communications or providers who don’t fit into the culture of the employer. However, one of the most significant problems than can undermine a benefit program, especially a worksite clinic, is when employees don’t trust that their personal health data will be confidential and fear it will be used for employment decisions.

Employers who achieve high benefit utilization build the foundation for success by informing their workforce, prior to a benefit or clinic being available and on an ongoing basis, of the many federal and state confidentiality and privacy laws that dictate who can receive personal and occupational health information and the limitations placed on employers.

Communications, posters, presentations and other marketing vehicles must assure employees that the employer will only see aggregate, not personal data from the offered benefit programs. Emphasize that the program’s or clinic’s medical providers will be the only individuals dealing with this information, and that by law they are legally and ethically obligated to keep this confidential.

Understanding the culture and labor-management dynamics of an organization are also critical to building trust. To increase use, it’s often best to market the program or facility under a new brand name, such as “The Healthy Life” or use the name of the provider who manages the program or clinic, rather than the employer’s name.

The physical design or location of a benefit program or clinic also needs to be kept in mind. Clinical or counseling activities should be separate from business offices or fitness centers where a person taking advantage of the benefit could be seen by their peers, managers and supervisors.

Achieving engagement in a health benefit program or clinic is key to its success, as well as obtaining the resources and support of senior management for its expansion and continuance. The design, marketing and location of benefit programs need to be well-planned so the workforce is confident that the confidentiality of their patient records will be maintained and not used for employment decisions.

SOURCE: Boress, L. (9 July 2019) "Giving onsite clinics an engagement booster shot" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/how-to-increase-employee-engagement-in-healthcare-benefits


PCORI Fee Is Due by July 31 for Self-Insured Health Plans

The annual fee for the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019. Plans with terms ending after September 30, 2012, and before October 1, 2019, are required to pay an annual PCORI fee. Read this article from SHRM to learn more.


An earlier version of this article was posted on November 6, 2018

The next annual fee that sponsors of self-insured health plans must pay to fund the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019.

The Affordable Care Act mandated payment of an annual PCORI fee by plans with terms ending after Sept. 30, 2012, and before Oct. 1, 2019, to provide initial funding for the Washington, D.C.-based institute, which funds research on the comparative effectiveness of medical treatments. Self-insured plans pay the fee themselves, while insurance companies pay the fee for fully insured plans but may pass the cost along to employers through higher premiums.

The IRS treats the fee like an excise tax.

The PCORI fee is due by the July 31 following the last day of the plan year. The final PCORI payment for sponsors of 2018 calendar-year plans is due by July 31, 2019. The final PCORI fee for plan years ending from Jan. 1, 2019 to Sept. 30, 2019, will be due by July 31, 2020.

In Notice 2018-85, the IRS set the amount used to calculate the PCORI fee at $2.45 per person covered by plan years ending Oct. 1, 2018, through Sept. 30, 2019.

The chart below shows the fees to be paid in 2019, which are slightly higher than the fees owed in 2018. The per-enrollee amount depends on when the plan year ended, as in previous years.

Fee per Plan Enrollee for Payment Due
July 31, 2019
Plan years ending from Oct. 1, 2018, through Sept. 30, 2019. $2.45
Fee per Plan Enrollee for Payment Due
July 31, 2018
Plan years ending from Oct. 1, 2017, through Dec. 31, 2017, including calendar-year plans. $2.39
Plan years ending from Jan. 1, 2017, through Sept. 30, 2017 $2.26
Source: IRS.

Nearing the End

The PCORI fee will not be assessed for plan years ending after Sept. 30, 2019, "which means that for a calendar-year plan, the last year for assessment is the 2018 calendar year," wrote Richard Stover, a New York City-based principal at HR consultancy Buck Global, and Amy Dunn, a principal in Buck's Knowledge Resource Center.

For noncalendar-year plans that end between Jan. 1, 2019 and Sept. 30, 3019, however, there will be one last PCORI payment due by July 31, 2020.

"There will not be any PCORI fee for plan years that end on October 1, 2019 or later," according to 360 Corporate Benefit Advisors.

The PCORI fee was first assessed for plan years ending after Sept. 30, 2012. The fee for the first plan year was $1 per plan enrollee, which increased to $2 per enrollee in the second year and was then indexed in subsequent years based on the increase in national health expenditures.

FSAs and HRAs

In addition to self-insured medical plans, health flexible spending accounts (health FSAs) and health reimbursement arrangements (HRAs) that fail to qualify as “excepted benefits” would be required to pay the per-enrollee fee, wrote Gary Kushner, president and CEO of Kushner & Co., a benefits advisory firm based in Portage, Mich.

As set forth in the Department of Labor's Technical Release 2013-03:

  • health FSA is an excepted benefit if the employer does not contribute more than $500 a year to any employee accounts and also offers a group health plan with nonexcepted benefits.
  • An HRA is an excepted benefit if it only reimburses for limited-scope dental and vision expenses or long-term care coverage and is not integrated with a group health plan.

Kushner explained that:

  • If the employer sponsors a fully insured group health plan for which the insurance carrier is filing and paying the PCORI fee and the same employer sponsors an employer-funded health care FSA or an HRA not exempted from the fee, employers should only count the employees participating in the FSA or HRA, and not spouses or dependents, when paying the fee.
  • If the employer sponsors a self-funded group health plan, then the employer needs to file the form and pay the PCORI fee only on the number of individuals enrolled in the group health plan, and not in the employer-funded health care FSA or HRA.

An employer that sponsors a self-insured HRA along with a fully insured medical plan "must pay PCORI fees based on the number of employees (dependents are not included in this count) participating in the HRA, while the insurer pays the PCORI fee on the individuals (including dependents) covered under the insured plan," wrote Mark Holloway, senior vice president and director of compliance services at Lockton Companies, a benefits broker and services firm based in Kansas City, Mo. Where an employer maintains an HRA along with a self-funded medical plan and both have the same plan year, "the employer pays a single PCORI fee based on the number of covered lives in the self-funded medical plan (the HRA is disregarded)."

Paying PCORI Fees

Self-insured employers are responsible for submitting the fee and accompanying paperwork to the IRS, as "third-party reporting and payment of the fee is not permitted for self-funded plans," Holloway noted.

For the coming year, self-insured health plan sponsors should use Form 720 for the second calendar quarter to report and pay the PCORI fee by July 31, 2019.

"On p. 2 of Form 720, under Part II, the employer needs to designate the average number of covered lives under its applicable self-insured plan," Holloway explained. The number of covered lives will be multiplied by $2.45 for plan years ending on or after Oct. 1, 2018, to determine the total fee owed to the IRS next July.

To calculate "the average number of lives covered" or plan enrollees, employers should use one of three methods listed on pages 8 and 9 of the Instructions for Form 720. A white paper by Keller Benefit Services describes these methods in greater detail.

Although the fee is paid annually, employers should indicate on the Payment Voucher (720-V), located at the end of Form 720, that the tax period for the fee is the second quarter of the year. "Failure to properly designate 'second quarter' on the voucher will result in the IRS's software generating a tardy filing notice, with all the incumbent aggravation on the employer to correct the matter with the IRS," Holloway warned.

A few other points to keep in mind: "The U.S. Department of Labor believes the fee cannot be paid from plan assets," he said. In other words, for self-insured health plans, "the PCORI fee must be paid by the plan sponsor. It is not a permissible expense of a self-funded plan and cannot be paid in whole or part by participant contributions."

In addition, PCORI fees "should not be included in the plan's cost when computing the plan's COBRA premium," Holloway noted. But "the IRS has indicated the fee is, however, a tax-deductible business expense for employers with self-funded plans," he added, citing a May 2013 IRS memorandum.

SOURCE: Miller, S. (2 July 2019) "PCORI Fee Is Due by July 31 for Self-Insured Health Plans" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2019-pcori-fees.aspx


Federal Appeals Court Takes Up Case That Could Upend U.S. Health System

A federal appeals court in New Orleans has taken up a case against the Affordable Care Act. If the lower court's ruling in the case, Texas v. United States, is upheld, it has the potential to shake the nation's health care system. Read this article to learn more about this case.


The fate of the Affordable Care Act is again on the line Tuesday, as a federal appeals court in New Orleans takes up a case in which a lower court judge has already ruled the massive health law unconstitutional.

If the lower court ruling is ultimately upheld, the case, Texas v. United States, has the potential to shake the nation’s entire health care system to its core. Not only would such a decision immediately affect the estimated 20 million people who get their health coverage through programs created under the law, ending the ACA would also create chaos in other parts of the health care system that were directly or indirectly changed under the law’s multitude of provisions, such as calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions.

“Billions of dollars of private and public investment — impacting every corner of the American health system — have been made based on the existence of the ACA,” said a friend-of-the-court brief filed by a bipartisan group of economists and other health policy experts to the 5th Circuit Court of Appeals. Upholding the lower court’s ruling, the scholars added, “would upend all of those settled expectations and throw healthcare markets, and 1/5 of the economy, into chaos.”

Here are five important things to know about the case:

It was prompted by the tax bill Republicans passed in 2017.

The big tax cut bill passed by the GOP Congress in December 2017 eliminated the penalty included in the ACA for failure to maintain health insurance coverage. The lawsuit was filed in February 2018 by a group of Republican attorneys general and two governors. They argued that since the Supreme Court had upheld the ACA in 2012 specifically because it was a valid exercise of Congress’ taxing power, taking the tax away makes the entire rest of the law unconstitutional.

Last December, Judge Reed C. O’Connor agreed with the Republicans. “In some ways the question before the court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote in his decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”

State and federal Democrats are defending the law.

Arguing that the rest of the law remains valid is a group of Democratic attorneys general, led by California’s Xavier Becerra.

“Our argument is simple,” said Becerra in a statement last Friday. “The health and wellbeing of nearly every American is at risk. Healthcare can mean the difference between life and death, financial stability and bankruptcy. Our families’ wellbeing should not be treated as a political football.”

The Democratic-led House of Representatives has also been granted “intervenor” status in the case.

The Trump administration has taken several positions on the lawsuit.

The defendant in the case is technically the Trump administration. Traditionally, an administration, even one that did not work to pass the law in question, defends existing law in court.

Not this time. And it is still unclear exactly what the administration’s position is on the lawsuit. “They have changed their position several times,” Sen. Chris Murphy (D-Conn.) told reporters on a conference call Monday.

When the administration first weighed in on the case, in June 2018, it said it believed that without the tax penalty only the provisions most closely connected to that penalty — including requiring insurers to sell policies to people with preexisting conditions — should be struck down. The rest of the law should stay, the Justice Department argued.

After O’Connor’s ruling, however, the administration changed its mind. In March, a spokeswoman for the Justice Department said it had “determined that the district court’s comprehensive opinion came to the correct conclusion and will support it on appeal.”

Now it appears the administration is shifting its opinion again. In a filing with the court late last week, Justice Department attorneys argued that perhaps the health law should be invalidated only in the GOP states that are suing, rather than all states. It is unclear how that would work.

Legal scholars — including those who oppose the ACA — consider the case dubious.

In a brief filed with the appeals court, legal scholars from both sides of the fight over the ACA agreed that the lawsuit’s underlying claim makes no sense.

In passing the tax bill that eliminated the ACA’s tax penalty but nothing else, Congress “made the judgment that it wanted the insurance reforms and the rest of the ACA to remain even in the absence of an enforceable insurance mandate,” wrote law professors Jonathan Adler, Nicholas Bagley, Abbe Gluck and Ilya Somin. Bagley and Gluck are supporters of the ACA; Adler and Somin have argued against it in earlier suits. “Congress itself — not a court — eliminated enforcement of the provision in question and left the rest of the statute standing. So congressional intent is clear.”

It could end up in front of the Supreme Court right in the middle of the 2020 election.

Depending on what happens at the appeals court level, the health law could be back in front of the Supreme Court — which has upheld the health law on other grounds in 2012 and 2015 — and land there in the middle of next year’s presidential campaign.

Democrats are already sharpening their rhetoric for that possibility.

“President Trump and Republicans are playing a very dangerous game with people’s lives,” Senate Minority Leader Chuck Schumer told reporters on a conference call Monday.

Murphy said he is most concerned that if the lower court ruling is upheld and the health law struck down, Republicans “won’t be able to come up with a plan” to put the health care system back together.

“Republicans tried to come up with a replacement plan for 10 years, and they couldn’t do it,” he said.

SOURCE: Rovner, J. (9 July 2019) "Federal Appeals Court Takes Up Case That Could Upend U.S. Health System" (Web Blog Post). Retrieved from https://khn.org/news/federal-appeals-court-takes-up-case-that-could-upend-u-s-health-system/


Creating an ‘urgent care first’ mindset for employee benefits

With urgent cares continuing to pop up everywhere, it’s important to guide your employees in adopting an "urgent care first" mentality. Continue reading this blog post to learn more.


Urgent care centers are popping up everywhere, which means getting quick healthcare is easier and more convenient for patients. But these centers could also help employers minimize expensive emergency room claims. That’s why it’s important to guide employees to adopt an “urgent care first” mentality.

The concept of urgent care has been around since the 1970s, but rising healthcare costs, especially for ER care, have spurred an increase in centers across the U.S. over the last decade. In fact, from 2014 through June 2017, the number of urgent care centers rose by nearly 20%.

Urgent care centers provide care for health problems that aren’t life-threatening, but can’t wait for an appointment with a primary care provider. No one wants to suffer with a sore throat all weekend. Many urgent care centers are staffed with doctors and nurses, and provide more advanced capabilities than what’s typically available at a primary care doctor’s office. For example, some urgent care centers give stitches, provide X-rays and even MRIs.

Patients can also get treatment at urgent care for conditions they’d typically see a primary care doctor for, such as the flu or a fever, mild to moderate asthma, skin rashes, sprains and strains, and a severe sore throat or cough — illnesses that produce unnecessary high claims if treated in an ER.

Still, when a severe sore throat and high fever strike on a weekend and the doctor’s office is closed, employees may gravitate to the ER because they’re sick and need help right now. That’s where the urgent care first mindset becomes good medicine. It typically costs the employer (and often the employee) far less if that sore throat is treated in an urgent care facility.

The high cost of ER care is enough to make anyone run a high temp. From 2009 to 2016 (the most recent data available), the average amount that hospitals billed insurance carriers for an emergency room visit more than doubled, from $600 to $1,322. By contrast, urgent care typically costs about $150 per visit. Members often pay a lower copay for urgent care visits, too.

The urgent care first mindset is starting to take hold. New data analysis from Aetna shows that as urgent care centers began to proliferate, ER visits for minor health issues dropped 36%, while the use of urgent care and other non-emergency health settings increased 140%.

However, the same study shows that plans only saw a decrease in ER visits if there were several urgent care centers in the geographic region where their employees lived. Awareness is key.

Fostering an urgent care first mentality

Employers can’t just include urgent care in a benefits plan and expect employees to use it. They need to design the plan to encourage use and follow up with plenty of education.

Education about the benefits of primary care versus urgent care versus the ER should take place during open enrollment and throughout the plan year so members understand the medical necessity and financial implications of each option. Including the closest urgent care centers to employees, as well as a list of services they provide, can help encourage them to adopt an urgent care first mentality.

A word of caution: not every nearby urgent care center is actually in-network. It literally pays for employees to keep a list of nearby in-network centers handy when that inevitable weekend sore throat strikes.

Reminders about urgent care before spring allergies, summer vacations, fall school physicals and flu season can also help encourage their use.

The too-low ER copay

Plan design is another important piece of the puzzle to help steer employees to the right level of care for their needs. It’s not that unusual to see a $100 copay for an emergency department visit. While no one wants to discourage ER visits for true emergencies, it makes sense to adjust the plan design to encourage primary and urgent care visits instead. That may mean a $20 copay for primary care, a $40 copay for urgent care and a $200 to $250 copay for ER visits — which is waived if the plan participant is admitted to the hospital.

For high-deductible health plans paired with a health savings account, the savings can be even more drastic; patients may pay $200 for an urgent care visit versus $1,200 for an ER visit.

The combination of education and plan design can help curb unnecessary ER visits, which could help employers control healthcare increases from plan year to plan year. For health issues that crop up during off hours, the urgent care first mindset is good for both employers and employees, who will ultimately save time and money.

SOURCE: O'Conner, P. (5 July 2019) "Creating an ‘urgent care first’ mindset for employee benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/creating-an-urgent-care-first-mindset-for-employees


It’s time to incorporate cancer screenings into your wellness program

The National Cancer Institute reported that newer FDA-approved novel immunotherapies have shown to be beneficial responses to colorectal cancer but can cost upwards of $400,000 per year. This post from Employee Benefit News discusses incorporating cancer screenings into corporate wellness programs.


Scott Wilson, an employee at brewing company Molson Coors in Denver, was diagnosed with stage four metastatic colorectal cancer in 2016 — a disease that would cost him upward of $1.3 million to date, with significant dollars paid out for non-covered medical expenses.

As a consequence of a later-stage diagnosis, colon and liver resections were necessary coupled with aggressive treatment using chemotherapy and Vectobix — a newer and costly immunotherapy that is priced at $8,000 per week. On average, more than 40,000 people undergo treatment for metastatic colorectal cancer each year and the cost of treatment varies depending on the stage at diagnosis, treatment response and plan.

The availability of newer FDA-approved novel immunotherapies have shown to be beneficial responses to this deadly cancer, but at staggering costs that can be upward of $400,000 per year at market introduction, according to the National Cancer Institute.

Today, about 60% of diagnosed colorectal cases are discovered in later stage disease due to under-screening — a third of the eligible population have never been screened or are not up-to-date with screening guidelines. As a result, about 140,000 Americans are diagnosed with any stage of colorectal cancer and about 51,000 people die of this cancer annually. A recent study examined 1,750 colorectal cancer deaths from 2006 to 2012 in the Kaiser Permanente Health System — 76% of those deaths occurred in patients who were never screened or were not up-to-date with screening.

Cancer screening in the workplace

Last year, the American Cancer Society lowered the colorectal cancer screening age to 45 based on the rising rates of cancer trending in younger age populations — other cancer organization’s recommendations remain at age 50. Employers are in a unique position to reinforce and support these national recommendations among their employees.

Employees between 50 and 65 years of age have the lowest screening rates for colorectal cancer screening, and are typically covered by employer-sponsored health plans. Employers find offering cancer screening programs that reward participation via health and wellness programs are reducing disease risk and financial burdens for themselves and their employees.

The costs for treatment of cancer are more than double the rate of other healthcare expenses. For an employer, the impact of a late versus an early stage diagnosis is significant. National expenditures for treatment and care of colorectal cancer are second only to breast cancer.

In people age 65 and younger, the U.S spends in excess of $7.4 billion for treatment of colorectal cancer. For those employees diagnosed with any stage of colorectal cancer, a large percentage of costs are paid out by company-sponsored health plans despite the implementation of high-deductible health plans.

It would seem prudent to institute a screening initiative to find cancer early in your employee populations, or prevent it altogether by supporting screening for preventable cancers. Employees who test positive are referred by their physician for diagnostic colonoscopy to determine if colorectal cancer is present or to remove precancerous polyps or lesions. The intangible costs associated with cancer is the time off of work for treatment and lost productivity.

Most companies administer a wellness program for employees and families, like Molson Coors, but only about 20% offer colorectal cancer screening. Incorporating a blood test as a preventive cancer screening strategy alongside workplace wellness programs can get employees up-to-date with screening recommendations. Employers who are interested in instituting a colorectal cancer screening program in the office should consider the following suggestions.

Incorporate CRC screening into wellness programs. Screenings provide the opportunity to identify risks early and can bridge the gap between doctor office visits for employees who do not see their providers on a regular or annual basis.

Partner with third-party administrators. Third party administration services can ensure HIPAA regulations are followed for privacy. TPAs also will arrange for the delivery of results.

Create communications campaigns. Target your messaging to those eligible for colorectal cancer screening and make sure to cite the correct statistics for benefits and risk.

Reward participation. Participation is shown to increase when incentives are provided to reward participation. Decide what incentives work for your employees – PTO, financial rewards, gym memberships, coupons or gift cards.

Follow up. Plan for next steps based on employee screenings. Results should be provided in a timely manner to enable employees.

Wilson, the Molson Coors employee, remains in remission for nearly 20 months. He’s since devoted his time to advocate for access to colorectal cancer screening, especially in the workplace. Wilson recently joined the Colorectal Cancer Alliance organization as a board member, a non-profit dedicated to reducing the incidence of colorectal cancer through their many efforts aimed at prevention and awareness. He also wrote a book, “Through the Window: A Photographic Tale of Cancer Recovery” for the alliance. Wilson has been an advocate for the vital need for employee access and employer support for CRC screening in the workplace.

SOURCE: Childers, P. (27 June 2019) "It’s time to incorporate cancer screenings into your wellness program" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/add-cancer-screenings-to-wellness-programs


Finding the Hidden Benefits within your Offered Health Insurance Plan

Benefits packages offered by employers are just one of the many elements an employee considers when joining, remaining at or leaving a company. Striking the right balance of what employees want and what your business has to offer will allow for a return on investment. In this installment of CenterStage, Kelley Bell, a Group Health Benefits Consultant at Saxon Financial, explains how to unlock and bring forth benefits often overlooked by employers and employees.

The Reason for Employee Benefits

Employers of all sizes within the United States aim to offer attractive health insurance benefits that will both attract prospective employees and retain those talented individuals who are currently employed. Aside from looking to earn money to put food on the table, pay bills and set aside for later, people seek employment for assistance in alleviating the burden of having to pay for insurance plans singlehandedly. Thus, they plan where they will work and for how long they will work based on what your company has to offer.

When looking at benefits plans, most people assume the usual: a comprehensive health plan that assists in providing medical insurance and reduces pharmacy costs. However, a benefits package you receive from an employer today is no longer your parents’ benefits package. Just as trends in fashion and pop culture come and go, so should the benefits within an employer’s plan.

It is unique offerings that attract potential employees and retain current ones. Additionally, it is in the hands of employers to offer methods to achieve and shift culture in a positive way by offering necessary methods to do so. Employee benefits packages today are shaped to fit the needs of the employees.

As the nation’s health has declined, an uptick in the popularity in offering benefits such as discounted or free gym memberships has become a major plus. How are employees to be aware of the perks of employment with your business? They need to be properly educated about their plans. Kelley explained, “Employers must take time to educate employees as they are their most valuable asset.”

Benefits That Get Overlooked

Every employer, no matter how big or small, has something to offer. With over 25 years of experience in the financial industry, Kelley has seen and heard it all from employers with whom she partners with in selecting benefits for their employees. “I’ve heard people say they have a horrible plan but in reality, it is not a horrible plan, they don’t understand it or how to use it.” When investing in an ‘add-on’ benefit, there is typically a large sum injected into a new initiative, but the results are often short-lived, a short spark of novelty. The benefits that carry stamina are usually those that hold tremendous value in both a sense of time and money. Kelley continued, “Some of the embedded benefits in their existing plans will help save them money, become a wise consumer and ultimately choose to live a healthier lifestyle.”

What are some examples of benefits that fly under the radar of employers and their employees?

  • Telemedicine medical services. Telemedicine is a fantastic way to recover and receive treatment for an illness or injury from the comfort and convenience of their car, work or home rather than in a doctor’s office.
  • Wellness initiatives are another fantastic offering which is simply implementing a wellness committee dedicated to the well-being of your employees.
  • Saxon offers a free portal with wellness information available to clients. Becoming a member includes receiving newsletters, email blasts, wellness information and challenges your business can utilize.
  • Consumers of healthcare have historically been conscious purchasers. Within your plan, check for the ability to leverage multiple doctors and pharmacies to find the most cost-effective option for each employee. Medical offices inside pharmacy’s, or retail outlets, as well as Urgent cares, have seen increased rates of attention simply for their competitive prices as opposed to a traditional hospital.
  • Employers looking for additional ways to offer savings for employees on their prescription medications can turn to mobile apps such as GoodRx which offers money-saving coupons for medications.
  • Online wellness tools allow you to view claims, ID cards, locate doctors, browse medications and estimate costs. Many of the plans have teams to help people who are pregnant, want to stop smoking, lose weight or have specific health conditions such as asthma, diabetes, heart disease, etc.”

How Saxon Helps

Kelley understands every business is unique and is dedicated to proactively serving the needs of each client. At Saxon, Kelley and our team of advisors begin by engaging experts that truly listen, building successful strategies that stay focused on your vision and goals.

Saxon exists to care, cultivate and empower through relationships, expertise and exceptional standards of service. Saxon’s WIN team is always available at your convenience to unlock the benefits you did not know you had in order to excel your organizational efforts upward.

To begin the conversation about putting your overlooked benefits into action, contact Kelley Bell today at (513) 774-5493 or (937) 672-1547 or via email at kbell@gosaxon.com.


Engaging employees in healthcare — even while traveling

In 2018, Americans took 463.6 million trips for business, leaving employees unsure of what to do when they get sick or injured while away. Read this blog post for how employers can engage employees who are traveling in healthcare.


Business travel is booming. Americans took 463.6 million trips for business last year. But what happens when a business traveler gets sick or injured while away from home and how can employers help their employees in this situation?

It starts with a simple solution: Make sure you’re providing employees with a health insurance plan that includes coverage outside the state or region where the business is located. While the majority of plans provide coverage for illnesses and injuries that meet the insurer’s definition of an emergency, some plans don’t cover care for common serious, but non-emergency health problems like strep throat, migraine headaches, a sprained ankle or back pain. Employers should ensure they offer at least one plan option that includes either an extended physician and hospital network or coverage for out-of-network care.

If employees need to travel out of the country for business, employers may want to consider offering travel medical insurance, which provides coverage during the period of time while the employee is outside the U.S. and medical evacuation if needed. To ensure employees have all the immunizations they need and are aware of any health risks at their destinations, employers can offer access to or reimbursement for pre-trip visits with a travel medicine specialist.

Even when employees have health insurance that gives them access to care while they’re away from home, connecting with experienced healthcare providers can still be difficult. Some insurers offer phone support for plan members seeking care providers, although often these providers are not heavily vetted for the experience or providing the highest quality care. Health advisory services can also help employees find and connect with healthcare providers in the U.S. and overseas.

When considering health advisory firms, employers should ask how the firm vets the healthcare providers it connects employees with and whether the firm uses a set network of providers or whether it connects employees with the most appropriate providers regardless of their health system affiliation.

Make sure employees know how to find the right type of care

When an employee falls ill or gets injured while traveling for business, her or his first instinct may be to seek care at a local emergency room, but that’s not always the best option. In addition to long wait times, the cost of care delivered in the emergency room is significantly higher than other care settings.

  • Employers can help employees make better choices by providing information about the options available and how to choose the right care setting:
  • The emergency room for serious, life-threatening illnesses and injuries such as chest pain, symptoms of a stroke, serious burns, head injury or loss of consciousness, eye injuries, severe allergic reactions, broken bones and heavy bleeding
  • An urgent care center for conditions you’d usually make a doctor’s appointment for such as vomiting or diarrhea, fever, sprains, moderate flu symptoms, small cuts, wheezing and dehydration
  • A walk-in or retail clinic for minor problems such as a rash with no fever, mild flu-like symptoms, sore throat, cough and congestion, ear pain and eye itchiness or redness
  • Telemedicine or virtual physician visits for minor illnesses and injuries and advice on whether additional care is needed

The key to helping employees know which care setting is the most appropriate is ongoing communication and education, which can take the form of in-person meetings with the benefits team, newsletter articles and email blasts, and video content shared through the company’s intranet channels.

Employees who are living with chronic health conditions should take special steps when traveling for business, including ensuring they have enough of any prescription medication they take and bringing an extra prescription with them for essential medications in case they’re lost in transit.

Ensure employees can quickly share their medical records with providers

Another important part of the healthcare equation for business travelers is ensuring that when they need care while they’re on the road, the healthcare providers who treat them can get quick, secure access to their medical records. Access to these records is important for several reasons:

  • It gives a provider who’s not familiar with the employee’s medical history a comprehensive look at past and current health problems and chronic conditions, medications, allergies or adverse reactions, and treatments and surgeries. Having this information can lower the risk of misdiagnosis, inappropriate care and duplicate care or testing, which not only adds unneeded costs but can also cause harm.
  • This information can be especially important when employees are seriously ill or injured and can’t speak for themselves to share medical history and their wishes about issues like the use of a ventilator or feeding tube.

There are several online services and apps that allow users to upload medical records so they can share them with healthcare providers. Another option is to work with a health adviser who can make sure employees’ records are carefully reviewed to ensure accuracy and stored in a secure universal medical record that can be accessed in minutes by treating physicians anywhere in the world.

Giving employees who travel for business the right resources and guidance can not only increase their peace of mind, it can help make sure they have access to the care they need wherever work takes them.

SOURCE: Varn, M. (18 June 2019) "Engaging employees in healthcare — even while traveling" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/engage-employees-in-healthcare-when-traveling


One overlooked way to promote well-being: Target oral health

Are you promoting oral health when promoting employee wellness? Research shows an association between gum disease and conditions like diabetes and coronary artery disease. Continue reading to learn more.


With the cost of employer-sponsored healthcare benefits approaching $15,000 a year per employee, according to the National Business Group on Health, innovative companies are looking for new and creative ways to get maximum value from their benefits dollars.

By embracing benefits strategies focused on overall health, companies can help their current employees be healthier and more productive and attract and retain the workers they need to succeed in today’s competitive labor markets.

And although wellness programs or health apps might first spring to mind, there’s an overlooked way to promote employees’ health: oral care.

Guided by research that shows associations between gum disease and conditions like diabetes and coronary artery disease, forward-thinking dental insurers are developing products that emphasize the importance of regular oral care, particularly for workers with those conditions — and smart companies are jumping on board.

Products that emphasize the importance of maintaining oral health are an important step in integrating care. Over the next several years, leading-edge insurers will create new ways to engage patients in conversations about their dental and overall health, as they seek to encourage behavior changes and improve health outcomes. To help improve oral and overall well-being, insurers will need to share oral care information with their members through targeted emails, text messages and phone calls.

Additionally, because individuals dealing with a complex treatment plan may put off receiving oral care while they address their medical issues, they could benefit from plans featuring a case manager, or a “dental champion.” Working in conjunction with medical case managers, a dental champion can help employees understand how receiving regular oral care can influence their overall health. They also can ensure a company’s workforce is getting the oral care they need, helping them find providers and arrange appointments.

Savvy employers recognize that any realistic effort to limit the increase in healthcare costs begins by addressing chronic ailments. According to the Centers for Disease Control and Prevention, six in 10 Americans live with at least one chronic disease, like heart disease, cancer, stroke or diabetes.

By promoting overall health — including regular oral care — employers can encourage positive lifestyle changes that help their employees reduce the likelihood of many chronic problems. Those who brush and floss their teeth regularly, receive frequent cleanings and checkups and deal with oral issues at early stages are taking steps to improve their overall health.

Because everyone’s individual situation is different, insurers and employers will need to include a more personalized approach, engaging members in conversations about their dental health and how it contributes to attaining their overall health goals.

SOURCE: Palmer, T. (13 June 2019) "One overlooked way to promote well-being: Target oral health" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/promoting-wellbeing-through-dental-health


Here’s how to get the best ROI on a wellness program

How many hours do your employees work per year? According to the International Labour Organization, Americans work nearly 500 more hours per year than French workers and 260 more hours per year than British workers. Continue reading to learn how employers can get the best ROI on a wellness program.


U.S. employees are working harder than ever and need more support from their employers as a result.

In fact, according to the International Labour Organization, Americans work 137 more hours per year than Japanese workers, 260 more hours per year than British workers, and nearly 500 more hours per year than French workers.

With that growing burden — along with more individuals of all ages recognizing how important their health is — comes an increased need for companies to invest in well-designed health and wellness programs. Rolling out these programs can lead to better employee morale and engagement, a healthier and more inclusive culture and fewer absences due to illness, according to research — all of which are especially important in today’s fast-paced work atmosphere.

In addition, the rise of social media means that businesses are being held accountable by their employees in a way that was not the case for previous generations. According to the British Standards Institution, employees trusting their employers’ commitments is now an increased focus. Health and well-being are becoming a significant part of that workforce trust agenda.

With these points in mind, it’s important to recognize that your organization needs to make and keep commitments to investing in and executing successful health and wellness programs for your workforce. These programs must keep trust momentum going to ensure healthier and happier workers, and it is proven that happier and healthier workers are more productive. This can lead to overall company success.

For example, a recent employee wellness study from the U.S. Chamber of Commerce showed that effective wellness programs have good return on investment of $1.50 to $3.00 per wellness dollar spent over a two to nine year timeframe. Another study from the Australian-based Black Dog Institute concluded that thriving and healthy workforces typically perform more than two times above average, compared with organizations that do not invest at all in their employees’ health and well-being.

BSI recommends a three-pronged approach for successfully investing in your employees’ health and wellness. First, it’s important to define your health and well-being initiative and what it means for your company. While there are many definitions, BSI recommends considering one that recognizes the need to manage workplace occupational health and safety, in addition to the promotion and support of managing healthy behavior, such as stress management, work-life balance and an ever-changing work environment.

Next, employers should define what their health and wellness program for workers should include. In particular, BSI suggests a good model to follow: the U.S. federal government’s recommended approach for workplace health and well-being programs. Created by the Center for Disease Control’s National Institute for Occupational Safety and Health, the program is called Total Worker Health.

TWH is a holistic approach to occupational health and safety and worker well-being. It recognizes that work has an important function in the social determinants for health and is defined as “policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.”

However, this program also goes much further than other wellness programs and reflects the nature and challenges of the changing workplace, from new forms of employment to new technologies. It also reflects that non-work-related illness and stress can be adversely impacted by work, can have health and safety implications within the workplace, and the way an organization manages absence and rehabilitation policies can have hugely positive or negative impacts on the individual and the business.

Once you know what health and well-being means to your business and what kind of program your organization wants to execute, it’s time to move forward. For step three, BSI recommends companies review and implement ISO 45001, the new global management system standard on occupational health and safety. This standard has physical, mental and cognitive well-being and health at its core, while continuing to drive high safety standards for companies.

ISO 45001 also recognizes that the most successful and productive organizations take a holistic approach and therefore, good occupational health and safety management can be integrated with employee well-being initiatives. Related to this, holistic employee wellness programs can be used as a recruitment tool. Evidence from WhenIWork.com suggests that employees want their employers to take an active role in their health, so if you can show potential employees that you are invested in their well-being, you will gain an advantage over companies offering only bare-bones benefits.

As a global standard, ISO 45001 also enables a consistent worldwide approach. With its focus on culture and employee participation, it also provides businesses a best practice model for developing an effective health and well-being program. And employee participation will happen. For example, experts from the Johns Hopkins Bloomberg School of Public Health recently analyzed surveys to determine the overall perceptions of wellness programs from employee and employer perspectives. Its data analysis revealed that nearly 60% of employees think employers should attempt to improve the health of their workers.

Overall, seeking accredited certification of the standard not only builds trust within the organization, but also provides external assurance to customers, shareholders and the wider community. Investing in employee health and wellness programs increases healthy behavior and curbs the risk of lifestyle-related disease, leading to happier workers, more productivity and overall company success.

SOURCE: Field, K. (4 June 2019) "Here’s how to get the best ROI on a wellness program: (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/how-to-get-the-best-roi-for-your-wellness-program