Beware: Losing health plan grandfathered status is an administrative nightmare
Some interesting points on grandfathered status' from HRMorning, by Jared Bilski
Employers that have managed to keep their grandfathered status until now may think they’re immune from the hassles of the ACA, but a recent DOL investigation is a good reminder that the feds are always watching for a slipup.
Sierra Pacific Industries Health Plan was one of the few remaining grandfathered plans in existence, and they managed to keep that status for years after the ACA took effect.
But, according to a DOL investigation, the plan made some changes beginning on Jan. 1, 2013, that prevented the plan from keeping its grandfathered status and led to a relinquishing of that status in the feds’ eyes.
Those plan changes, as well as how the plan made determinations on employee health claims, violated both the ACA (specifically the provisions on preventive health services and internal claims and appeals rules) and ERISA, the DOL claimed.
‘Operating as though it were exempt’
As the DOL’s Assistant Secretary of Labor for Employee Benefits Security Phyllis C. Borzi said:
“The Affordable Care Act put into place standards and protections for workers covered by employee benefit plans. The Sierra Pacific plan was operating as though it was exempt from such requirements, when indeed, it was not. This settlement means that workers improperly denied health benefits will have their claims paid. Corrections made to plan procedures will also mean that all future claims are processed and paid properly.”
No premium or deductible bumps
The end result of the feds’ investigation: A lot of administrative work and changes for Sierra Pacific.
As part of the settlement, plan fiduciaries agreed to comply with the ACA requirements for non-grandfathered plans moving forward, specifically the rules for internal claims and appeals and coverage of preventive health services.
Plus, for the 2017 plan year, the company will have to forgo any increases to participant premiums, annual out-of-pocket limits, annual deductible and coinsurance percentages in effect for the 2016 plan year.
On top of all that, the company agreed to:
- Revise plan documents and internal procedures.
- Re-adjudicate past claims for preventive services, out-of-network emergency services, claims affected by an annual limit and pay claims in compliance with the ACA and ERISA.
- Submit to an independent review organization claims were eligible for external review.
- Pay claims that had been left on hold for a long time.
- Comply with timelines for deciding claims as provided in the department’s claim regulation.
See the original article Here.
Source:
Bilski, J. (2016 October 14). Beware: losing health plan grandfathered status is an administrative nightmare. [Web blog post]. Retrieved from address https://www.hrmorning.com/beware-losing-health-plan-grandfathered-status-is-an-administrative-nightmare/
Majority of workers cannot define copay, deductible
Do your employees understand the healthcare acronyms? Vlad Gyster explains how educating your employees can have a major impact on proper usage of healthcare benefits.
Very soon, thousands of employees across the United States will be choosing their health insurance. That’s scary, because there’s an emerging body of data that shows that most people don’t understand the basics of how health plans work. That knowledge gap may be causing some serious issues: From sick people not going to the doctor, to employees over-paying for health insurance.
If you're like most employers, there's a good chance that you're moving to consumer-driven health plan designs that employ a high deductible. In 2006, only one in 10 employees had a general health insurance deductible of $1,000 or more for single coverage. Today, nearly half do.
As adoption accelerates, benefit professionals find themselves in the midst of a developing crisis: Though HDHPs clearly help cut healthcare costs new research indicates that they do so in the worst way possible. Instead of shopping for better prices, sick people are simply not getting the care they need. As one of the study’s authors puts it: “We [didn't] find any evidence [employees] look for a lower cost. They just don't go."
Here's what’s puzzling: This isn't necessarily happening because of cost. This research is based on an employer that fully funded the deductible. As Vox explains: “In some cases, you could chalk this up to a liquidity issue: A worker might not have enough money in her checking account to pay for all the care below the $3,750 deductible. But that explanation doesn't work here: In this case, the employer put a $3,750 subsidy in workers' health savings accounts.”
So, what could it be? There could be many complex reasons. But there could also be a very simple one: 86% of people cannot define deductible, copay, coinsurance and out-of-pocket maximum. And people can’t properly use what they don’t understand.
A central assumption in consumer-driven plan design is that people can get the same care at a lower price and avoid care that they don’t actually need. To do that, employees need to be educated healthcare consumers, and companies have added tools to help. Utilization modeling and cost transparency technologies are becoming more and more broadly available. But there's a much more foundational piece of the puzzle that's been taken for granted.
In a paper published in Journal of Health Economics, researchers found that 86% of participants couldn’t define all of the following four terms on a multiple choice questionnaire:
· Deductible
· Copay
· Coinsurance
· Out-of-pocket maximum
While the healthcare industry is focused on utilization prediction and cost transparency tools, which are hard to create and implement, something quite basic is slipping right under our noses: Teaching people basic terms that they need to know to make informed decisions.
Understanding these terms is a building block of healthcare consumerism, without which a lot starts to unravel. If an employee doesn’t understand the terms that make-up every health plan design, it's hard to convince an employee to even switch to a high deductible health plan, even when it saves the employee money. It may also cause the employee to avoid care that she needs, because she has trouble predicting what she'll pay.
As more employers adopt HDHPs, a troubling reality is on the horizon: A healthcare crisis may be around the corner due to employees not getting the care that they need.
What to do about it
The good news is that healthcare consumerism isn’t a one-time event. It requires ongoing education and now is as good a time as ever to begin.
Here is something completely free you can do:
· Survey your employees to see what percentage understand basic health plan concepts.
· Send a weekly email to all employees defining each healthcare term, one at a time.
· Re-survey your employees with the exact same questions to measure the change.
This alone will give you a measurable starting point, a way to make progress, and measure the progress made.
See the original article from BenefitNews.com Here.
Source:
Gyster, V. (2016, June 27). Majority of workers cannot define copay, deductible [Web log post]. Retrieved from https://www.benefitnews.com/opinion/majority-of-workers-cannot-define-copay-deductible
Take out the earbuds
Intriguing artile from Benefits Pro by Marty Traynor
Walk around any workplace and unless there's a safety issue, almost every employee under 50 is wearing earbuds and remains focused on their own personal music zone. What a perfect metaphor for the barriers we must overcome to gain the attention we need for benefit purchase decisions.
With the fall enrollment season approaching, let's consider some of the ways we should work to “remove the buds” and focus employee attention on the process of benefit enrollment.
- Employer's earbuds must come out first. Employees are not the only ones ignoring the importance of benefit-related communications. Employers often think a simple introductory email is sufficient. That kind of communication is enough if the goal is to tell employees about an event. However, in no way does this type of message convey importance or opportunity. You must convince the employer that a well-designed campaign will be a big positive for them, both in terms of employee engagement and happiness with employee benefit options.
- Know your audience. Many otherwise great campaigns have failed because they are tone deaf to their audience. A program benefitting union members better not be littered with “employee” references. The graphics used to illustrate the benefit plan should also be carefully designed to match the demographics of the employee audience. Designers often tend to show “beautiful people,” but benefit plans need to be shown benefitting real people.
- Use multiple approaches to connect with people. You often hear about the importance of multi-channel benefit communications. Unfortunately, we cannot just say, “Alexa, create a multi-channel campaign to teach employees about their benefits and get them to enroll to best meet their needs.” We must do what's next best and create a campaign that gives employees information in multiple ways: web details, calculators, videos, printable pieces with brief, explanatory, and detailed options. Use on-site materials such as break room table tents and bulletin board posters to augment e-campaigns.
- Use “real speak” whenever possible. The benefits business is full of jargon. Studies have shown that words we use all the time are confusing; even a term like “premium” isn't clear. Most people think of premium as an adjective, meaning “expensive, special or high class.” They don't see it as an everyday expenditure, but rather as a luxury type of item. So when we say “your premium is affordable,” employees may immediately think we are trying to scam them. Watch the jargon, and use terms that make sense to employees.
- Get people in front of people. The best way to communicate is in person. Regardless of how effective an employer's enrollment system is, the most effective communications campaigns still have a human element. Personal meetings, group meetings or call center-based enrollments can all add the personal touch. Without a personal touch, a benefit enrollment campaign may seem empty to many employees.
- Make sure employees know what's in it for them. They need to understand the importance of good benefit elections for themselves. This helps ensure they credit their employer for offering a valued program, and ensures they will understand the importance of good choices in enrollment.
Good luck with your fourth quarter enrollments. Earbuds are not noise cancelling headphones, so there is still a great opportunity to break through to employees and make your benefit communications campaigns your best to date.
See the original article Here.
Source:
Traynor, M. (2016 September 13). Take out the earbuds. [Web blog post]. Retrieved from address https://www.benefitspro.com/2016/09/13/take-out-the-earbuds?slreturn=1474041704
8 Common But Costly Benefits Communication Mistakes
Original Post from HRMorning.com
By: Tim Gould
Here are a few stats that really drive home just how critical benefits communication is for HR pros.
When employees that were offered rich employer benefits received poor communication, just 22% of those workers reported being satisfied with their benefits.
On the other hand, when employers with less-rich benefits communicated those benefits effectively, 76% of workers reported being satisfied with their employers’ benefit offerings.
These stats were part of a recent study by Towers Watson WorkUSA.
At the 2015 Mid-Sized Retirement & Healthcare Plan Management Conference in San Diego, Benefits Strategist Julie Adamik used those surprising stats as an opening to launch into a presentation about effective benefits communication.
What to avoid
During the presentation, Adamik covered some of the most common — and costly — benefits communication mistakes, which included:
1. Holding a boring benefits presentation. There’s a common misconception among workers that anything about benefits is going to be boring. But when HR pros don’t make the effort to make their benefits presentations interesting, the message is bound to be lost on employees.
2. Letting Legal draft all of your benefit communications. When employers let a legal department write all your benefits communications, there’s a very good chance the documents will be littered with legalese that confuses employees, bores them to the point of tuning out or both.
3. Not allotting enough of the budget to the benefits communications. Upper management often doesn’t have a handle on just how much solid benefits communications are going to cost — at least not in the same way HR does.
Benefits communication must be more detailed than standard inter-office communications, so it’s likely to take more time to prepare and produce.
4. Relying on workers will bring their benefits info home and discuss it with their family members.Effective benefits communication should always try to include spouses and family members.
5. Assuming employees will simply act on the messages in the benefit communications. It’s up to HR to specifically tell staffers what they should do with the benefits info as well as why.
6. Thinking workers will read their open enrollment materials cover to cover on their own time. The more HR can go over during the actual open enrollment meeting, the better. Of course, enrollment time shouldn’t be the only time benefits info should be addressed. Communication should be a year-long process.
7. Opting for “professional-sounding” language instead of simple “plain-speak” English. Sure, HR pros’ world is filled with jargon, buzzwords and benefits-related acronyms, but rank-and-file employees’ worlds are not. Keep the benefit communications as simple as possible.
8. Covering too much info. It’s only natural to try and cram everything possible into your open enrollment materials, but when there’s just too much being thrown at employees, they suffer from information overload — and retain little (if any) of what was covered.
Remember, continuous education is a proven way to improve employees’ decision-making regarding their benefits, which should be the goal of every communication effort..
Adapted from “Effective Benefit Communications” by Julie Adamik, CEBS, CCP, CBP, as presented at the 2015 Mid-Sized Retirement & Healthcare Plan Management Conference in San Diego.
Many Employees Still Unaware of Free Preventive Care Benefits
Original post benefitspro.com
Even employees covered by an employer-sponsored health plan remain confused about the benefits that are free of charge to them under health care reform law. But employers say that they often don’t have the resources or effective communications tools to fully explain these benefits to the workforce.
This finding emerged from a small sample study by the Midwest Business Group on Health, which surveyed 53 workplaces, more than half of which had 5,000 or more employees in their plans.
The survey indicated that progress is being made: 62 percent said they were aware of all the free services, which include vaccinations, maternity and pregnancy related services, pediatric services and others. But another 36 percent admitted they weren’t aware of the full spectrum of these free benefits. (Just 2 percent pleaded complete ignorance of the benefits.)
The survey said that larger employers that often use participation incentives to increase benefits usage had higher rates of preventive service use compared to small- to mid-sized employers, with larger ones reporting about 60 percent participation and small-to-mid-sized around 50 percent. Overall, 53 percent said they offer such incentives.
“In addition,” the report said, “outside of the flu vaccination, survey respondents indicated they are not promoting important adult vaccinations, and for those that do, employee use is low.”
Digging deeper into the benefits available to workers, the study found that 58 percent of respondents offered vaccines only to those covered and their dependents. A small number — 42 percent — included retirees in the coverage.
The flu vaccine was far and away the most prevalent benefit for employers with onsite or near-site clinics, offered by 70 percent. Vaccinations for hepatitis B were the second most common, at 41 percent, with hepatitis A found in 39 percent of plans. Vaccinations for diseases such as HPV, shingles, pneumonia, measles and others were in the 27 percent to 37 percent range. Nearly half of plans (43 percent) covered all vaccinations costs.
Increasingly, larger employers, and even some with fewer employees, are turning to onsite service centers to encourage greater use of free preventive benefits. Nearly half reported having an onsite clinic, 21 percent said they use a near-site clinic, and 7 percent reported using a mobile van.
While overall, employers felt their benefits communications strategies were working fairly well, a major area where they are not finding success is in encouraging employees to choose a specific location to receive vaccines. This indicates that the employer-led national effort to attempt to steer workers to centers of excellence, or at least of cost efficiency, is not yet working well.
The MBGH has created a preventive benefits “toolkit” designed to help employers spread the word about free benefits and increase participation in them.
“Employers are the primary purchasers of health care for employees and families, so it’s important that these benefits are effectively understood and appropriately used,” said Larry Boress, MBGH president and CEO. “Otherwise, consumer engagement levels suffer, resulting in millions of benefit dollars being wasted each year. Many employers don’t know where to start or how to effectively communicate available preventive care benefits to their covered population. That’s why we’re launching an employer toolkit to help employers do a more effective job.”
New benefit offers education help to parents of special-needs children
Originally posted September 12, 2014 by Andrea Davis on https://ebn.benefitnews.com.
Joanne Burke can’t count the number of hours she spent researching special-needs law and preparing for meetings with educators and therapists about her daughter Gabby’s individualized education plan. Gabby, eight, was born with spina bifida, a birth defect that happens in utero when a baby’s still-developing spinal column doesn’t close all the way. When she was four, Gabby was also diagnosed with a rare form of epilepsy, which caused steep cognitive regression. Today, Gabby primarily uses forearm crutches to get around and attends third grade at a public school.
It is families like Burke’s that led Adam Goldberg to launch myEdGPS, a company that helps parents of children with special needs map out an education plan for their child. It’s a program that can be offered as a standalone employee benefit, and it is also being offered through Bright Horizons, a provider of child care services as part of that company’s suite of employer offerings. The Bright Horizons program, Special and Exceptional Needs, powered by myEdGPS, will be exclusively offered to companies with more than 3,500 U.S. employees by College Coach, a division of Bright Horizons specializing in providing answers to education concerns.
Burke’s employer, an automotive parts supplier based in Michigan where Burke lives with her husband and Gabby, has been supportive of her need for flexibility. They’ve offered Burke a flex-time schedule where she starts at 6:30 a.m. and leaves the office by 2:30 p.m. to collect Gabby from school. And, when she returned to work after Gabby was born, she was able to work from home on days when Gabby had multiple medical appointments. Still, when Gabby was ready to go to school, Burke spent countless hours attempting to figure out the family’s options. While she investigated sending Gabby to a private school, in the end, the private school could not handle Gabby’s multiple needs. Through the public school system, Gabby has access to physical and occupational therapy, as well as speech therapy.
“It's just a lot of juggling. It's almost like having two full-time jobs at once,” says Burke. “The case management aspect of it can be pretty heavy at times. It's not all the time, but if there's any sort of medical issue going on, it can take up a lot more time and effort to manage all of that at once.”
After years of providing private consulting services to parents who could afford to pay for it, Goldberg, who holds a masters’ degree in education with a concentration in assessment, realized that “we were turning away 95% of folks who couldn’t afford to pay for these types of private services,” he says. “This really was the manifestation of my burning desire to democratize the model and be able to scale it through technology so that we could have an impact on millions of children and their families out there.”
One in five children struggle with some type of special or exceptional need and Goldberg estimates that translates into an impact on 10% or more of the workforce. Working parents lose up to five hours a week running around to various doctor, therapist and teacher appointments, to say nothing of the hours they spend filling out paperwork and figuring out who’s paying for what.
Goldberg likens myEdGPS to TurboTax for special education because when parents first enter the online system, they’re asked a series of questions, a virtual intake of sorts. Then, depending on how far long parents are in their journey, the system serves up a series of roadmaps designed to guide parents and give them the necessary information, depending on what their needs and goals are.
They system also includes a virtual binder that can be accessed on any mobile device to help manage and store all the documentation involved. There’s also a calendar feature, which Goldberg says is particularly useful since different states have different timelines for when certain documentation needs to be provided and to whom.
“Once the system knows your child is being educated in Ohio, for example, and you request an evaluation, the system knows to alert you that within X number of school or calendar days, based on Ohio regulations, that you should expect to hear a response back from the school and then it goes to the next step in the timeline,” he explains.
The system also includes a behavioral tracking journal for parents and a letter generator “so that you can get it right the first time when you’re requesting an evaluation from the school or an independent evaluation of the school, or requesting a team meeting to address an issue,” says Goldberg.
Bright Horizons is currently piloting the program with a handful of companies, says CEO David Lissy. It’s included in the company’s core offerings but employers can also customize the program to include in-person education onsite and/or live webinars.
And apart from helping employers with productivity issues, Goldberg says myEdGPS offers the opportunity for tangible savings on health care expenses.
“What most people don't know -- including parents, administrators, and especially employers -- is that the knee-jerk reaction is to go to the medical plan if you suspect something's going on with your child, without any knowledge that you can actually get some of these same exact services from a school,” he explains. “That's a federally mandated system. The two systems [health care and education] really don't talk to each other that well. What we're doing is we're helping empower these parents to be able to understand what their rights are and how to go about it, step by step, finding the right help in the right ways through schools.”
For example, an employee has a five-year-old child who may not be hitting certain developmental milestones. The parent’s first instinct is to take the child to the pediatrician, who then refers the child to a series of specialists. Each visit requires the parent to take time off work, the medical plan incurs costs and the employee may have co-pays to deal with.
“The reality is, at the very beginning you should also be requesting an evaluation through school, because it's free if you ask for it in the right way,” says Goldberg, adding that there’s a whole host of related services, including speech language therapy and some behavioral therapies, that are within the legal construct of the Individuals with Disabilities Education Act.
“All of this fundamentally is supposed to be free and in very many cases overlap with those medical services,” he says.
For Joanne Burke, who researched all of daughter Gabby’s educational and therapeutic needs herself, a service like myEdGPS would have been invaluable. “If I had access to a resource like this it would free up valuable time to address other issues,” she says. “The law is complex and learning how it affects our daughter as well as learning about accommodations and assistive technology is constantly in the back if my mind.”