Senate bill aims to expand telehealth services for veterans
A bill introduced in the Senate aims to improve health care for disabled or rural veterans by expanding telehealth services.
Senators Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii) introduced the Veterans E-Health & Telemedicine Support or VETS Act last week.
The bipartisan legislation would allow Department of Veterans Affairs Physicians to practice across state lines. The physicians would also be able to provide telehealth services, including mental health care, to patients in the comfort and privacy of their own homes.
The current law allows the Veterans Administration to waive state licensure requirements only if both the patient and physician are physically at a VA facility. And home telehealth requires both physician and patient to be in the same state. These barriers can deter veterans from seeking medical help.
An announcement of the bill was posted to Sen. Ernst's website with the following comments included.
“The bipartisan Veterans E-Health & Telemedicine Support Act moves us one step closer to achieving more affordable, patient-centered health care that our veterans deserve by embracing telehealth services to offer physician care and health treatment beyond the walls of a VA facility,” said Senator Ernst. “Telehealth care is an innovative and important means to meet the wide-ranging needs of veterans in Iowa and nationwide, including the invisible struggles of mental health care.”
“Our nation has a moral obligation to provide the best care for all veterans,” said Senator Hirono. “This legislation would eliminate the added burden of traveling long distances, or even to different states, in order to see a doctor. The VETS Act will build on a VA telemedicine program that is proven to work and removes barriers to accessing care particularly for veterans in rural areas like Hawaii’s Neighbor Islands.”
Click here to read the announcement.
Click here to view the bill.
Pay attention to Medicare Part D Coverage and 5 other things you should know during open enrollment
Once a year Medicare beneficiaries get the chance once a year to make a change. Open enrollment runs from Oct. 15 through Dec. 7.
Medicare beneficiaries can choose from original Medicare which is provided by the government or Medicare Advantage which is offered by private health insurance companies.
Beneficiaries can also change their Part D plans which provides prescription drug coverage.
Part B Premiums May Be Increasing for Some People
A report this month in the AARP Bulletin, based on data from the Medicare Boards of Trustees, finds 1 in 7 Medicare beneficiaries could see their Part B premiums increase as much as 52 percent next year.
The increase will go into effect if there is no cost-of-living adjustment for Social Security in 2016, but it will apply mainly to those already paying higher premiums because of their income and affect those who pay premiums directly to the government. Most people making direct payments are doing so because they are delaying Social Security benefits, a strategy that can increase their future monthly payments.
“Should folks in the latter situation sign up for Social Security now?” asks Patricia Barry, a features editor for AARP Publications who wrote the AARP report and author of "Medicare For Dummies.” Under the law, those who have their Part B premiums deducted from Social Security cannot be subject to a premium increase.
Barry says applying for Social Security in October may allow people to save money on premiums in the short run but could cost them more in the future. “They might be giving up higher [Social Security] payments for the rest of their lives for the sake of what could well turn out to be just one year of inflated Part B premiums.”
Pay Special Attention to Your Part D Coverage
Although it’s a smart idea to review your health insurance options each open enrollment period, experts say most plans stay largely the same each year. Instead, most people will find changes in Part D plans.
“It’s something [consumers] want to check into every single year,” says Kristin Romel, a health and life agent with Alpine North Insurance Agency in Alpena, Michigan.
Romel explains that many companies use a claims-based system for determining prescription drug costs and coverage. A medication for which they had a large number of claims may end up moving into a tier with higher copays. However, other insurers may not have had the same number of claims for those drugs, and the out-of-pocket costs for those prescriptions might remain lower in other plans.
Barry’s research supports this finding. In the last few years, she has analyzed what different Part D plans in the same state charge as copays for the same drug. “Those copays vary enormously, often by more than $100 for a 30-day supply, and sometimes by a lot more,” she says.
The Network May Be More Important Than the Price
Those shopping for a Medicare Advantage plan may gravitate toward the option with the lowest premium. However, there is more than price to consider.
“Patients should be scrutinizing the providers [in a plan’s network],” says Colin LeClair, senior vice president of business and product development for ConcertoHealth, a health care provider for dual-eligible Medicare and Medicaid patients. “The quality of providers is far more important than cost.”
While it may hard to gauge the quality of unknown physicians, Medicare beneficiaries should at least check a plan’s network to see if their preferred doctors and facilities participate. “You’ve got to be careful with little, fly-by-night companies,” Romel says. “Are hospitals actually going to take that insurance?”
Your Mailbox Is Full, but the Best Help May be Found Elsewhere
Barry has a simple piece of advice when it comes to all those brochures you’ve received: “Ignore that avalanche of mailings from Medicare plans that are coming through the door.”
Instead, use the plan finder at Medicare.gov to look over your options. Your State Health Insurance Assistance Program may also be able to help you navigate your choices. LeClair says he finds a lot of his company’s clients bring their stack of mailings to the doctor’s office.
“Physicians should not be advising patients on which plan to use,” LeClair says, “but they can help [patients] understand them.”
65-Year-Olds Need to Enroll Even If They Delay Social Security
Open enrollment is only for those who are already enrolled in Medicare, but John Piershale, a certified financial planner and wealth advisor with Piershale Financial Group in Crystal Lake, Illinois, says now is a good time to remind 65-year-olds that they need to enroll in Medicare, or they will face penalties.
For those filing for Social Security by age 65, enrollment in Medicare is typically automatic. However, those waiting to claim Social Security until a later age will need to be proactive about enrolling. The initial enrollment period runs for seven months and includes the three months before your birthday month, your birthday month and the three months after it.
Failing to enroll in Medicare during this period results in a 10 percent increase in Part B premiums for every year you delay enrolling. “A lot of people don’t know about [the penalty], and there is no way to fix it,” Piershale says.
The Biggest Change to Medicare Is One You Can't See
One of the biggest changes coming to Medicare is one that won’t be immediately obvious to patients, LeClair says. Many insurance companies are moving toward outcome-based contracts with providers, which could change how patients are seen by doctors. These contracts are intended to reward physicians who are, for example, successfully managing chronic conditions and reducing hospital admissions.
“Historically, [insurers] paid physicians on a fee-for-service model,” LeClair says. That system encouraged physicians to move through patients quickly and possibly order unnecessary testing and other services. “Now you have providers focused on doing less and providing better outcomes,” LeClair says.
From a patient perspective, an emphasis on positive outcomes may mean shorter wait times to get in to see a doctor and more time spent with a physician once you’re in the office.
Until outcome-based care becomes standard, Medicare beneficiaries can use the annual open enrollment period to switch to a new plan with different providers if they are unhappy with their options. However, to make the most of the opportunity, you’ll need to compare more than just the price. “Don’t go cheap on your health insurance,” Romel advises. “Don’t put a price tag on your health.”
President Obama silently signs PACE Act into law
There was no fanfare when President Barack Obama signed into law a bipartisan change to the Affordable Care Act (ACA). The PACE Act was signed alongside eight other bills on Wednesday evening.
The PACE Act, known in longform as the Protecting Affordable Coverage for Employees Act, was approved overwhelmingly by Congress last week. It redefines a small employer from one with 50 employees or fewer to an employer with 100 employees or fewer.
RELATED: ACA tweaks help small employers, but add confusion
The change was intended to stabilize the group market under the ACA. However, small businesses raised concern the change would mean higher premiums for their employees.
The bill's Republican co-author, Sen. Tim Scott (R-South Carolina) released a statement Thursday praising President Obama for signing the bill. However, Scott remains "committed to a full repeal of the health care law."
Since 2009, there have been few changes to the healthcare law.
14 tips to help your company implement wearables in wellness programs
Fitbit, Garmin, and Mio are just a few of the companies offering everyone the chance to keep track of their fitness level throughout the day. Features include tracking steps, sleep and workouts.
Companies, like Target, are finding ways to implement wearable technology into their Wellness Programs. The programs, a part of employee benefits packages, can help lower healthcare costs, reduce absenteeism and increase productivity.
Implementing the wearable technology is a viable option, but without proper implementation it could create legal challenges.
Experts from various industries came together at Fitbit's recent Captivate 2015 conference and created a list of best practices and lessons learned from their experiences with wellness programs tied to wearables.
James Martin with CIO.com compiled a list of the best tips from those speakers in San Francisco.
Employee wellness plans, privacy and compliance
1) Show employees their personal information is secure
Several speakers emphasized that organizations should show (not tell) employees that health and fitness data is secure.
Some employees initially hesitate to share step counts or other health data with their employers, according to Jim Huffman, senior vice president and head of U.S. Health and Wellness Benefits for Bank of America. These people worry that the information could negatively affect their insurance premiums, chances for promotions or opportunities for raises.
Bank of America is "loud and clear" when it regularly addresses such fears in employee communications and assures staff such information won't be used against them. Buffman said companies have to "prove it," too. In the second year of its wellness program, for example, Bank of America didn't increase health insurance premium rates for any of its U.S. employees, even though the company's own costs rose. Bank of America leaders felt it was important to "pay it forward" and demonstrate to employees that participating in its fitness programs is only beneficial. However, Huffman adds that organizations will "always have a portion of employees who will not share their information."
2) Go above and beyond to protect employee data
Wellness and fitness program managers should "take extraordinary steps" to protect sensitive information collected via wellness programs, Huffman said. He also suggested that companies work closely with HR managers to assure staff that their wellness program teams don't have access to sensitive data, such as employee health insurance claims.
Eric Dreiband, a partner with law firm Jones Day, stressed the importance of maintaining a secure "firewall" between data collected by wearable technology and personnel records. The goal is to keep staff health and fitness data away from supervisors or other decision makers, so that it cannot inadvertently affect employee pay or promotions.
If that data isn't kept separate, and there's an employee complaint, the government could investigate and file a lawsuit, according to Dreiband. The Equal Employment Opportunity Commission sued companies in the past because their wellness programs allegedly violated federal anti-discrimination laws when they coerced people to participate.
3) Stay up to data on relevant regulations
Organizations that use wearables to collect employee data need to be clear on the potential compliance and legal issues related to the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), and Americans with Disabilities Act (ADA), Dreiband said. Wellness plans that collect medical information, such as heart rate and blood pressure, must be voluntary and may not carry a penalty for non-participation in any way, or they could violate the ADA, for example.
Putting employee fitness data to work
4) Compare anonymous fitness data and business goals
Whenever possible, it's a good idea to tie aggregated, anonymous data from corporate wellness program or fitness challenges to metrics that measure business goals, according to Liz Boehm, experience innovation network director for Vocera, a healthcare communication system vendor.
By combining these data sets, senior management can see how (or if) wellness program engagement helps the company achieve fewer manufacturing errors, lower employee turnover rates, or achieve other business goals. These insights can help keep senior executives bullish on the company's wellness and fitness programs, and convince skeptics the programs are worth the effort and expense.
5) Don't overthink baselines
Companies should avoid getting bogged down when they try to determine baselines for the wellness and fitness program data they want to measure, according to Jennifer Benz, CEO of Benz Communications, which specializes in helping organizations communicate health and wellness programs to employees. (Notable Benz clients include Intuit and Adobe.)
"There's already a lot of great baseline data out there, so you don't have to figure out precisely where your organization is to figure out how to measure improvements."
6) Keep it simple
Companies shouldn't get carried away and try to measure too many things, Benz said.
"Most successful organizations find a couple of metrics to track that are key to their overall business environment," she said.
Wellness programs can often have a "halo effect," as well, giving employees a better sense of their health, according to Benz, which is "something you may not be able to measure, but will be able to see and hear among people in your organization."
Tips for enhanced communication, outreach for fitness programs
7) No silver bullet
There is no single communications channel that's best for raising employee awareness and engagement, according to Benz. So, it's best to embrace multiple channels and formats. Most employees have preferred ways of receiving information, such as viewing online video or reading infographics and email, and the way to reach the largest audience is by using more communication methods.
Ultimately, the goal is "to change wellness behavior, not communications behavior," Boehm said.
Bank of America uses "every form of communications possible" to detail updates, features and benefits related to its wellness program and health challenges, according to Huffman, including the company Intranet, email, "snail mail" sent to employee homes, and team meetings. Before opening each day, Bank of America branches also have "team huddles," which are ideal for communicating information about company wellness programs.
8) Share employees' positive experiences
Several speakers at the San Francisco Fitbit conference said sharing testimonials is an excellent way to engage employees in wellness programs or fitness challenges.
"People love to read stories about their colleagues," Benz said. For example, an 'average Joe' who was a smoker for 20 years successfully completed a cessation program offered by one of Benz's corporate clients. The company highlighted 'Joe's' accomplishment in one of its employee newsletters, and nearly 100 fellow employees emailed him to say the story inspired them to join the program, Benz said. Joe also told his company benefits manager that, after all the recognition he received for quitting, he "definitely can't start smoking again."
Boehm added that organizations should find testimonials from all levels of the company and "keep putting them out there." Employees featured in testimonials can be a wellness program's "best advocates."
9) Focus over generality in communications
Unfortunately, there's no one-size-fits-all approach to effective communication, Boehm said. "The more tailored your communications are (to individual interests), the more engagement you'll get." You're trying to get people to change their behavior, she said. But if your approach is too broad or general, employees might think the message doesn't apply to them.
10) Be timely and proactive
Organizations' communications should be timely and relevant whenever possible, according to Benz. She suggests following the "TaskRabbit model" by striving to make communications "helpful for others" and giving employees information they can act on. For example, if an employee needs an MRI, a company might provide information on affordable facilities that perform the test before the employee makes an appointment.
More tips for successful corporate wellness programs
11) It's not all about the Benjamins
It's never a good idea to depend solely on financial incentives to motivate employees. Many employers choose to increase financial incentives to motivate staff health improvement, but the majority of workers don't take full advantage of the incentives, according LuAnn Heinen, vice president, National Business Group on Health (NBGH).
In 2015, 79 percent of employers will offer monetary health incentives, up from 63 percent five years earlier, according to a 2015 NBGH and Fidelity Investments survey, which Heinen cited. The same survey also found the average maximum incentive amount rose to $693 this year compared to $594 in 2014, while only 47 percent of employees earn the full incentive amount, and 26 percent earn just a portion of the total.
Though important, financial incentives, as well as future health rewards don't always motivate sustainable participation in wellness challenges and fitness programs, Heinen said. The promise of fun, overall better quality of life, and higher energy levels are often more effective motivators, she said.
12) Help employees help themselves
Creativity can go a long way toward giving employees easy options to care for themselves. For example, mindfulness — the act of "being in the moment" —is gaining popularity in corporate wellness programs, according to Heinen. Pitney Bowes, for example, offers five-minute guided meditation for employees over the phone.
13) More physical activity isn't always better
The goal of increasing physical activity isn't always appropriate for all workers. Some workers, such as nurses or employees in packing and shipping departments are always on their feet, so increasing steps isn't necessarily a wise move, Boehm said. Instead, decreasing steps can make these types or workers more efficient in their jobs and "give them energy to focus on what matters most" at work and at home.
14) Cheaters never prosper
Organization shouldn't worry about fitness challenge "cheaters," or people who manipulate their fitness data. Companies that roll out a Fitbit Wellness program can enable or disable employees from manually logging steps, according to Amy McDonough, vice president and general manager, Fitbit Wellness. However, McDonough says Fitbit has "found that with good communications and transparency about how a program ties to incentives and what data is being shared, the majority of employees will be honest and will keep each other honest."
ACA tweaks help small employers, but add confusion
Medicare Part D Notices Due October 15
The Creditable Coverage notification requirements for Medicare eligible employees are required by the Centers for Medicare and Medicaid Services (CMS) on October, 15th of each year.
This is a friendly reminder that all plan sponsors are required to notify their employees about their creditable coverage status. For your convenience, the model notification letters for both credible and non-credible coverage provided by CMS for this year can be found below and are in Word document format.
What do the ICD-10 codes mean for health providers, employers and HR managers?
After two years of delays, the new ICD-10 codes are live in hospitals across the country.
The tends of thousands of new government-mandated codes describe diseases and hospital procedures in the billing process. The codes are aimed to cover everything that medical professionals may be called on to treat.
X98.0XXD Assault by steam or hot vapors, subsequent encounter #icd10
— EveryICD10 (@EveryICD10) October 1, 2015
Y31.XXXS Falling, lying or running before or into moving object, undetermined intent, sequela #icd10
— EveryICD10 (@EveryICD10) October 1, 2015
Y92.141 Dining room in prison as the place of occurrence of the external cause #icd10 — EveryICD10 (@EveryICD10) October 1, 2015
Read more codes via @EveryICD10 on Twitter.
How do these codes affect health insurance companies, employers and their human resource departments. Forbes.com contributor Bruce Japsen covers that part of the story.
From erroneous medical bills to denied health services, Americans may need patience grappling with insurance claims beginning today, the much-anticipated launch of tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the billing process.
At least one analysis says one in four of the nation’s doctor practices aren’t ready for the transition to International Classification of Diseases, Tenth Revision, known as “ICD-10.” After two years of delays, medical care providers have to be ready for the conversion to 140,000 new codes that they will use in order to bill government and private insurers.
Health insurance companies, employers and their human resources departments have been working with patients and health plan enrollees, warning of potential problems. Aon Hewitt (AON ), a large employee benefits consultancy, says there is potential for doctors and hospitals to use outdated codes and potentially bill patients for services that could be covered.
“This is a complex conversion that could initially lead to disruptions across the medical field,” said Chris Miles, senior vice president of Aon Hewitt’s health group. “Providers may see overall delays in claims processing, and some individuals may have insurance claims that are denied for services that were provided, but not properly coded.”
The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The outgoing ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future healthcare needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” the Centers for Medicare and Medicaid Services (CMS) has told doctors.
“The impact of the ICD-10 switchover on the healthcare system will not be fully understood until after claims processing begins on Oct. 1,” American Medical Association president Dr. Steven Stack said earlier this week.
But physician groups admit there could be challenged based on surveys they’ve conducted of their colleagues.
Medical Group Management Association president and chief executive Dr. Halee Fischer-Wright said a recent “survey showed 20% or more of physician practices have not received the billing system updates necessary for ICD-10.”
“This could significantly disrupt the submission of patient claims,” Fischer-Wright added.
ICD-10 conversion has been a massive undertaking for private insurers as well since they will use the codes in their claims processing and paying doctors and other providers of medical care. It has added significant capital expenses to health insurance companies, impacting the likes of Anthem WLP +% (ANTM), Aetna AET -0.93% (AET), Cigna CI -0.75% (CI), Humana HUM +0.06% (HUM) and UnitedHealth Group UNH -1.75% (UNH).
Benefits experts say health plan enrollees could see a delay in authorization for certain tests and procedures if doctors aren’t adequately coding the services. Insurance claims also could be denied.
But the shift to new codes is a good thing overall, particularly as doctors and hospitals move away from fee-for-service medicine to a healthcare system that pays providers based on outcomes and quality.
“Transferring to the new medical claim codes will allow key industry stakeholders to better track and manage diseases, measure the quality of care and evaluate patient outcomes—all of which support the shift toward value-based payment plans,” Miles said.
Technology, interaction, variety: What Millenials look for in a benefits package
Millenials are thinking differently about their company's benefit packages. Understanding what this growing generation in the workforce is looking for could help with your company's recruiting efforts.
A Millenial is someone born after 1980 and the first generation to come of age in the millennium. Pew Research reports this group will number 75 million this year. That's greater than Generation X and Baby Boomers.
But not all Millenials in the workforce are signing up for a benefits package. The Society for Human Resources Management found that just under half of all Millenials consider their overall benefits package to be very important.
Those that find the benefit package important are likely to offer up these answers when asked about employee benefits, according to benefitspro.com.
"I want choice and variety."
Millennials are accustomed to having access to what they want when they want, especially when it comes to information. They want choices and are often offended by a one-size-fits-all approach. Overall, they look for a well-rounded array of benefits, which may mean that a mix of employer-paid products with supplemental and voluntary products will play an increasingly important role for many employers.
"I want customization and control."
Personalization is highly important to millennials. When they’re offered benefits, they expect those benefits to be tailored to their needs. And, they want control over how they spend their money. While giving them plenty of options puts them in the driver’s seat, too many options may paralyze them. Try to strike a healthy balance by considering a choice of plan designs within a product category, or perhaps core/buy-up options.
"I want true simplicity."
Employee benefits shouldn’t be complicated, and communication is the key. Millennials are looking for simple, clear, easy-to-follow steps, which includes systems that are easy to use. It will be to your advantage to recommend working with a carrier who embraces simplicity and offers varying enrollment strategies. This gives you flexibility in recommending the one that’s likely to be most effective.
"I want interaction and collaboration."
Social is the name of the game for the millennial generation. Peer networks play a huge role in decision-making. Employers would be wise to offer ways their employees can interact and network to get information. Blogs are an important way millennials build trust, gather information and connect. Promote them with your clients. They work.
"I want technology, not paper."
Clearly, the biggest difference between millennials and other generations is their use of technology … and their expectation that technology also be important to others with which they interact. They want to use tools that make benefits easier, such as apps and online portals. And they want alternatives to paper. They trust technology.
4 ways to maximize the benefit of your workday breaks
Take a look at your workday. When do you take a break? How long is your break? What do you do on your break? Do you take more than one break? Do you feel recharged after your break?
Those questions were the focus of a study done by 2 Baylor University researchers. Emily Hunter, Ph.D. and Cindy Wu, Ph.D. are associate professors of management in Baylor's Hankamer School of business. The pair surveyed 95 employees between the ages of 22 and 67 over a 5-day workweek. Each person was asked to document each break they took.
The research defined a break as “any period of time, formal or informal, during the workday in which work-relevant tasks are not required or expected, including but not limited to a break for lunch, coffee, personal email or socializing with coworkers, not including bathroom breaks.”
When compiling the total of 959 break surveys, Hunter and Wu were able to provide a greater understanding of workday breaks. Their findings offer suggestions on when, where and how to plan the most beneficial daily escapes when on the clock.
Key findings of the study include:
1) Best time to take a workday break: Mid-morning.
A typical work day may have you counting down to lunch, but the study found an earlier break is more successful in replenishing energy, concentration and motivation.
“We found that when more hours had elapsed since the beginning of the work shift, fewer resources and more symptoms of poor health were reported after a break,” the study says. “Therefore, breaks later in the day seem to be less effective.”
2) What to do on your break: Something you enjoy and not necessarily non-work related.
The study found no evidence that non-work-related activities are more beneficial. Instead, do things choose to do and like to do which could include work-related tasks.
“Finding something on your break that you prefer to do – something that’s not given to you or assigned to you – are the kinds of activities that are going to make your breaks much more restful, provide better recovery and help you come back to work stronger,” Hunter said.
3)"Better Breaks" = Better health, increased job satisfaction
Employee surveys showed those that took mid-morning breaks and did things they preferred led to less somatic symptoms like headaches, eyestrain and lower back pain after the break.
The study also found the employees also experienced increased job satisfaction and a decrease in emotional exhaustion.
4) But how long should the break be?
The study wasn't able to pinpoint an exact length of time for a better workday break, but it did find that more short breaks with associated with higher resources - energy, concentration, and motivation.
“Unlike your cellphone, which popular wisdom tells us should be depleted to zero percent before you charge it fully to 100 percent, people instead need to charge more frequently throughout the day,” Hunter said.
Hunter and Wu believe the results of the study benefit both managers and employees.
10 things to check when planning 2016 health benefit packages
The clock is ticking down to 2016 which means time is running out to dot the 'i' and cross the 't' for your health benefit packages. Employee Benefit Adviser has these tips.
1) Employer shared-responsibility (ESR) strategy: Ensure the intended goal of avoiding or paying ESR assessments for 2016 coverage is supported by coverage offers, administrative and recordkeeping processes, and benefit documents.
2) ESR reporting: Arrange data sources, systems and administrative processes to collect all information about enrollees with minimum essential coverage (MEC), full-time employees, and coverage offers needed for reporting on 2016 coverage. Create a process for correcting any erroneous IRS filings and personal statements.
3) Preventative care: Ensure “non-grandfathered” group health plans comply with the final ACA rules and recent guidance on cost-free preventive services.
4) Other ACA reporting and disclosure requirements: Review delivery operations for summaries of benefits and coverage (SBCs) and watch for revised SBC templates. Prepare for round two of online submission and payment of ACA’s reinsurance fee.
5) Mid-year changes to cafeteria plan elections: Decide whether to permit mid-year changes to cafeteria plan elections for either or both of the status-change events in IRS Notice 2014-55.
6) ACA’s out-of-pocket maximum: Verify that self-only and other (e.g., family) coverage tiers in “non-grandfathered” plans meet ACA’s 2016 out-of-pocket (OOP) limits for in-network care. Confirm that family coverage also satisfies ACA’s self-only OOP limit for each enrollee.
7) Same-sex marriages and domestic partnerships: Assess how the U.S. Supreme Court’s Obergefell v. Hodges ruling that legalizes same-sex marriage nationwide affects your benefit programs and employment policies. Also, consider the decision’s indirect implications for domestic partner coverage.
8) Mental health parity: Check that plan designs and operations provide parity between medical/surgical and mental health/substance use disorder (MH/SUD) coverage. Federal audits of health plans now evaluate compliance with the final Mental Health Parity and Addiction Equity Act (MHPAEA) rules that took effect in 2015. In addition, state legislative activity and litigation around parity issues continue.
9) Wellness: Review employee wellness programs against the proposed Equal Employment Opportunity Commission (EEOC) rules requiring voluntary participation and restricting incentives for completing health risk assessments and/or biomedical screenings. Be prepared to make changes after EEOC finalizes these rules for nondiscriminatory wellness plans under the Americans with Disabilities Act.
10) Fixed-indemnity and supplemental health insurance: Review fixed-indemnity and supplemental health insurance policies to ensure they qualify as excepted benefits under the ACA and the Health Insurance Portability and Accountability Act (HIPAA).