High court nullifies contraceptive mandate for family-owned businesses
Originally posted June 30, 2014 by Jerry Geisel on www.businessinsurance.com.
Family-owned for-profit employers cannot be forced by the federal health care reform law to provide coverage for prescription contraceptives, the U.S. Supreme Court ruled 5-4 on Monday.
The decision, written by Justice Samuel Alito for the majority, came in a challenge to the prescription contraceptive mandate filed by three companies owned by Christian families — Oklahoma City-based Hobby Lobby Stores Inc. and Mardel Inc. and East Earl, Pennsylvania-based Conestoga Wood Specialties Corp. — which argued they should be exempt because of their religious objections to a Patient Protection and Affordable Care Act provision that requires employers with 50 or more full-time employees to provide group health plan enrollees with cost-free coverage of contraceptive prescriptions and services as part of the ACA preventive care mandate.
The mandate as it applies to privately held corporations violates the 1993 federal Religious Freedom Restoration Act, which bars the federal government from actions that substantially burden the exercise of religion, the court ruled.
“We hold that the regulations that impose the obligation violate RFRA, which prohibits the federal government from taking any action that substantially burdens the exercise of religion,” the majority ruled. “The plain terms of RFRA make it perfectly clear that Congress did not discriminate this way against men and women who wish to run their businesses as for-profit corporations in the manner required by their religious beliefs.”
“Protecting the free-exercise rights of closely held corporations thus protects the religious liberty of the humans who own and control them,” the court ruled.
The high court noted, however, that that the ruling applies only to family-owned businesses, not to publicly traded corporations, which the justices said would be unlikely to assert religious rights.
“The idea that unrelated shareholders — including institutional investors with their own set of stakeholders — would agree to run a corporations under the same religious beliefs seems improbable,” the high court ruled.
The court also said there could be alternative ways to provide contraceptives to people who work for family-owned organizations with religious objections to contraceptives — ones that would not violate corporate owners' religious rights.
“The most straightforward way” of accomplishing this, the court said, would have the government provide contraceptive coverage to women who work for employers with religious objections to prescription contraceptives.
Another alternative approach, the justices said, could be businesses' third-party administrators obtaining contraceptive coverage without payment from the employer. The government already extends that option to nonprofit organizations with religious objections to prescription contraceptives.
Several organizations, though, are challenging that approach.
While the justices struck down the contraceptive mandate for companies whose family owners have religious objections to contraceptives, they said it does not negate all insurance-related mandates, such as vaccinations or blood transfusions.
Does the employer mandate matter?
Originally posted June 27, 2014 by Kathryn Mayer on www.benefitspro.com.
Over the past few years, the Patient Protection and Affordable Care Act has had no shortage of scrutiny.
But the employer mandate, perhaps more than any provision, has become a lightning rod for criticism of the law. The provision — once thought of as a key, if not essential, part of PPACA — since its inception has been vehemently attacked by employer groups and business owners. Originally scheduled to go into effect in 2014, the mandate has twice been delayed by the administration, which says it needs more time to implement the provision.
Under the latest delay, announced in February of this year, employers with between 50 and 99 employees have until January 2016 to offer health insurance or pay a fine, and employers with more than 100 employees must offer insurance or pay a fine of $2,000 per worker by January 2015. Companies with fewer than 50 employees are exempt.
Attention to the mandate hit a new high at the Benefits Selling Expo back in April, when Robert Gibbs predicted during a keynote address that the mandate would never be put into effect.
“I don’t think the employer mandate will go into effect. It’s a small part of the law. I think it will be one of the first things to go,” he said to a notably surprised audience.
Gibbs, a former longtime advisor to President Barack Obama, noted there aren’t many employers who fall into the mandate window. He said the delays point to the fact that the mandate “will never happen.”
Media outlets quickly ran with the news, prompting the White House to respond.
House Minority Leader Nancy Pelosi, D-Calif., maintained that PPACA’s employer mandate will — and must — remain part of the law.
Appearing on CNN’s “State of the Union,” Pelosi said that the “employer mandate, the individual mandate, are an integral part” of PPACA, “This is an initiative that has strong pillars in it that relate to each other.”
Even if it’s nothing more than political fodder over the often controversial law, the latest debate raises the question: Will PPACA’s employer mandate really go into effect? And perhaps more importantly, does it matter?
Mandate doesn’t matter
Experts at the Urban Institute researched this very idea. Their overall consensus? Eliminating the mandate “certainly wouldn’t spell disaster.”
Overall, the Washington, D.C., based think tank said, eliminating the mandate would have little effect on employer-sponsored coverage, would “remove labor market distortions” in the law, and might even squash some of the political opposition.
First of all, it would “scarcely affect the total number of Americans who have coverage.” Even without the mandate, 250.9 million people will have coverage, compared to 251.1 million — only 200,000 more — if the mandate remains intact, researchers said.
“So many people have coverage through their employer now, and no one is requiring them to do,” says Linda Blumberg, a health economist and senior fellow at The Urban Institute. “But there are still incentives for [employers] to do it. It’s a way for them to retain and attract the kinds of workers they want. What we did [in our report] was analyze the tradeoff — firm by firm, worker by worker — and look at how employers make these decisions. And for most of them, they will continue to do this to keep employees happy.”
Frankly, Blumberg says, the employer mandate isn’t central to PPACA’s overarching goals.
“The employer mandate isn’t what’s driving the increase of health insurancecoverage; the individual mandate is,” she says. “And also the subsidies. You don’t want to think about the employer and the individual mandate in the same breath. They are very different. One is really essential to it achieving its goal, and one really isn’t.”
Another advantage of eliminating the employer mandate is simply to please employers. Groups such as the U.S. Chamber of Commerce and the National Retail Federation have been asking for the mandate to be repealed all along. They’ve argued over detrimental effects: that numerous companies would downsize or cut hours for their employees to dodge the rule. So not only will killing the mandate subdue those concerns, but, Blumberg says, it could get employers to focus on more important issues — and potentially get them on board with supporting the controversial law.
By taking away those requirements for employers, Blumberg says, “you lessen, significantly, the political resistance to the law from employers.”
“If we could get employers more involved with making sure that the workers have coverage, instead of them worrying about how to avoid [the mandate] or being angry about a requirement that might not even affect them, this could be more successful,” she says. “You take away that friction that the employer community has felt, and I think that’s an advantage for broad-based implementation of the law.”
The mandate matters
Still, there are reasons to be cautious about repealing the mandate. One significant one is funding.
By eliminating the employer penalties and the expenses for employee subsidies, the repeal would open a giant hole in PPACA’s financing. The Congressional Budget Office has estimated that gap at $140 billion through 2023, while the Urban Institute places it lower, at about $46 billion.
“What we found was smaller than what the CBO estimated, but still, penalties make the revenue,” Blumberg says. “That helps support the cost of the program. I would expect it would have to be replaced by another revenue source.”
Of course, there is the issue of what’s best for employees and employers. Without the requirement of offering employees coverage, will employers simply dump their employees into the exchanges? That’s the fear — one that’s been supported by various studies and reports.
The CBO has predicted that as many as 1 million more people may be uninsured in the absence of the employer mandate, though others argue the number will be much smaller. And those dropped from employer-sponsored coverage would likely face paying more for coverage on the exchanges, some argue.
Tim Jost, a professor at Washington and Lee Law School who supports the law, outlined some issues in a post in Health Affairs.
“The end of the employer mandate, and the reporting requirements that accompany it, would also make the exchanges’ job of determining eligibility for premium tax credits and for exemptions from the individual mandate more difficult,” Jost said. “Eligibility for tax credits and for the individual mandate exemption turns on employee coverage offers and enrollment. If employer reporting were eliminated together with the mandate, precise verification of whether an employee is eligible for coverage and the extent and cost of that coverage might not be possible.”
Killing the mandate, too, many industry insiders say, wouldn’t quash political wrangling. Killing it may bring up legal questions—the government could face lawsuits over not implementing the law, for example--and it might also be an admission from the administration that Obamacare is failing. Democrats may suffer in the next election cycle. PPACA opponents may call for more repeals in the law. Arguments are endless.
Other alternatives
Of course, because of the revenue hole, there needs to be an alternative if the employer mandate is repealed.
Jost suggested one way: to not just repeal the mandate, but replace it—by requiring employers to spend a certain percentage of their payroll on health benefits. He noted that the House passed a similar version of the employer mandate in 2009.
“The House bill required all employers to spend at least 8 percent of payroll on health benefits,” Jost wrote for Health Affairs. “Small employers were required to pay a smaller percentage of payroll, which rose as total payroll increased. Employers who spent less than the minimum paid the difference between what they actually spent and 8 percent of payroll to the federal treasury as a tax.”
The new version of the mandate, Jost said, would “dramatically” reduce the complexity of the current approach.
“Employers would only need to know two numbers: the amount of their payroll and the amount they spent on health benefits,” Jost said.
Of course, it’s not easy to simply repeal and replace.
Still, even without the employer mandate, industry insiders note, employers would need help from brokers on other areas of PPACA compliance, including market reforms and notice requirements.
And, of course, the political environment might not allow for any changes.
“There are certainly a lot of revenue sources, like a payroll tax assessment,” Blumberg says. “There are lots of options for revenue; the problem is you’re going to have political agreement to do that. But that puts us back in the place of, can we get folks to reach across the aisle and say, ‘this isn’t an essential component of this law; it’s a revenue-raising tool causing enough grief and concern among employers that we’d like to find a different revenue source.’ I think the chances are low because of the political reactions these days.”
Looking forward
Whatever the decision, industry folks want to know it — and soon.
Delaying the mandate — though praised by some — has caused more anxiety in the community, because no one knows when, or if, the requirement will really go into effect. And the mandate, whether in place or not, can have an effect on future premiums under the law.
“There’s a real fear, there’s a lack of understanding and there’s confusion — it’s a complicated law,” Blumberg says. “You take a complicated law and you layer on top of it delays and implementing pieces of it — it creates more confusion and angst.”
Glenn Dunehew, director of health and benefits at the Barrow Group in Atlanta, agrees.
“We need to know, now, that the law is either going to be implemented or postponed,” he says. “The longer that the administration waits on starting it, the more money it costs companies and brokers.”
New proposal would make same-sex partners eligible under FMLA
Originally posted June 23, 2014 by Lynette Gil on www.lifehealthpro.com.
No one should have to choose between succeeding at work and being a loving family caregiver, according to the Labor Department's Secretary, Thomas E. Perez. That's why the Labor Department proposed a rule that any employee in the private-sector is eligible for leave to care for a same-sex spouse under the Family and Medical Leave Act (FMLA) regardless if the state they live in recognizes their marital status. Officials did not say how many employees would fall under this rule.
Meanwhile, the Office of Personal Management issued its own proposal, which extends the same benefits to federal employees. However, this rule won't apply to those who work in Social Security or veteran benefits offices because their eligibility is based on the law where the employees live, instead of where they celebrated their marriage.
According to the Washington Post, the Obama administration will call on Congress this Friday to pass a handful of bills "aimed at extending those benefits to same-sex couples in states that don't recognize gay marriage." And the director of the American Civil Liberties Union (ACLU) Lesbian Gay Bisexual and Transgender Project, James Esseks, said that Congress needs to pass legislation so that "LGBT Americans who have been paying into the [Social Security] system for decades" can take advantage of it.
What if the PPACA plan tax credit is wrong?
Originally posted June 20, 2014 by Allison Bell on www.lifehealthpro.com.
Issuers of public exchange plans should use enrollment records and formal appeal processes to clear up any consumer concerns about tax credit subsidy amounts. Issuers of "qualified health plans" (QHPs) should not simply assume a consumer knows what the right subsidy amount is.
Officials at the Center for Consumer Information & Insurance Oversight (CCIIO) -- the U.S. Department of Health and Human Services (HHS) agency in charge of overseeing Patient Protection and Affordable Care Act (PPACA) commercial health insurance programs -- give that answer and others in a new batch of exchange plan casework advice.
CCIIO officials also answer questions about matters such as "plan enrollees" who appear out of nowhere, the definition of "defective enrollment," and the meaning of "ARC referral."
In answers to questions about QHP "advance premium tax credit" problems, officials note that QHP issuers may have access to two sets of enrollment data: 834 transaction files from the exchange, and "pre-audit files." An issuer can use either the 834 file data or the pre-audit file data to solve tax credit questions, officials say. If neither source works, the consumer will have to file a formal appeal through the exchange program appeal system, according to officials.
Similarly, if consumers say they have enrolled in a QHP, and the QHP has no ready information about the consumers, the first step should be for the issuer to look at the 834 files and the pre-audit files. If consumers can show that they have formal confirmation that they enrolled in the QHP, the issuer should talk to the help desk CCIIO runs for the QHP issuers, the CCIIO says.
Officials note that they are using the term "defective enrollment" to refer to a situation in which a consumer has completed a QHP enrollment through an exchange, but the QHP issuer has no record of the enrollment in either an 834 file or a pre-audit file.
In the answer to a question about "ARC referrals," CCIIO officials say they use the term to describe urgent QHP problems that are referred to an "advance resolution center." The call center routes those urgent cases to regional offices.
For insurers, the standard resolution time for ARC referral cases is 72 hours. But "we request that issuers give these infrequent cases their prompt attention," officials say.
Men’s HSA account balances far outpace women’s
Originally posted June 19, 2014 by Dan Cook on www.benefitspro.com. 
Women, on average, don't have as much money in their health savings accounts than do men. This nugget is among the findings of an Employee Benefit Research Institute study, which was conducted on the 10th anniversary of the creation of HSAs.
At the end of 2013, men had an average of $2,326 in their account, while women had $1,526, EBRI said.
While the male-vs.-female gap went unexplained by the researchers, that output was perhaps the most surprising to come from the study. Other findings were more or less in line with expectations about those who choose HSAs to pay for their health care.
EBRI reported that older individuals have considerably more money in their accounts that do younger HSA users: Those under 25 had an average of $697, while those ages 55-64 $3,780 those 65 or older had an average account balance of $4,460.
Younger ones used a small percent of their account balances for health-related expenditures, and they also tended to take fewer distributions from their accounts that did older individuals. Yet at a certain age, the likelihood of a distribution fell significantly.
“The likelihood of taking a distribution increased from 44 percent among individuals under age 25, to 66 percent among those ages 35–44 and 45–54,” EBRI said in a release. “That likelihood dipped slightly (to 64 percent) among those ages 55–64 and still further (to 49 percent) among those ages 65 and older.”
“The decline in the average amount distributed, as well as the likelihood of there being a distribution for health care claims at older ages, may have been a reflection of fewer people covered by the HSA-eligible health plan as fewer dependent children are covered by older account owners,” said Paul Fronstin, director of EBRI’s health research and education program, and author of the report.
Other findings:
- The average HSA balance at the end of 2013 was $1,766, up from $1,280 at the beginning of the year;
- On average, individuals who made contributions deposited $2,032 to their account. HSAs receiving employer contributions received $1,184, on average;
- Four-fifths of HSAs with a contribution also had a distribution for a health care claim during 2013;
- Looking at HSAs with claims, the average amount distributed for health care claims in 2013 was $1,953.
Input for the study came from data collected from HSA providers with total assets of $2.7 billion as of Dec. 31, 2013. This represents 14 percent of the universe of HSAs and 14 percent of HSA assets, EBRI said.
Minimum-Wage Debate Pits Cities Against States
Originally posted June 23, 2014 by David Klepper and Blake Davis on https://www.inc.com.
Dominique Mayfield makes $8.25 an hour washing dishes and busing tables at a Syracuse brewpub. Shantel Walker makes $8.50 an hour at her pizzeria in New York City, where the rent is more than double what it is in Syracuse. Two very different cities, but nearly the same wage.
The economic differences between America's big cities and elsewhere have prompted leaders in Seattle, New York City, Chicago, San Francisco, Oklahoma City, and other cities to push to raise the minimum wage within their borders.
The efforts are running into opposition from state lawmakers from both parties and business groups who say a patchwork of minimum wages could lead to a confusing and unequal business climate in which labor costs would vary dramatically from city to city.
The minimum wage has emerged as perhaps the top issue of a newly emboldened, urban liberal movement that in many places is led not by governors or state lawmakers but by local leaders backed by organized fast-food workers. After years of grappling with state and federal budget cuts, mayors and city councils are pushing back against state and federal officials who they say don't understand the income inequality of 21st-century American cities.
"So many people have been pushed out of this city," said Seattle City Councilman Nick Licata, who successfully pushed to raise the city's wage to $15, more than $5 higher than the state wage. "Local politicians don't have the luxury of not doing something. The state and federal governments, they've been AWOL. They haven't been engaged."
The fight to raise minimum wages has lawmakers in many states on the defensive, arguing that higher wages will lead to reductions in hours and jobs for low-income workers--and retail price increases that are likely to hit them hardest. The business-backed American Legislative Exchange Council argues that local minimum wages could lead to a race to the bottom, where businesses locate in whichever city within a region has the lowest starting wage.
"This is a debate that's happening around the country, and although it's well intended, it's misguided," said Cara Sullivan, a minimum-wage policy expert at ALEC. "In Seattle, they raised it to $15, and right across the city line, it's $5 less. It increases the cost of doing business for businesses in that city. You're creating chaos from one business to the next."
Members of the city council in Providence, Rhode Island, considered raising the minimum wage from $8 to $15, but only for workers in the city's large hotels. In response, the Democratic leaders of the Rhode Island General Assembly have moved to block the proposal by taking away cities' authority to set local minimums.
Oklahoma Gov. Mary Fallin, a Republican, signed legislation in April that prohibits cities from setting their own wage after organized labor groups suggested that Oklahoma City raise its wage from $7.25 an hour--the federal minimum--to $10.10.
B.J. Marsh, a single mother in a suburb of Oklahoma City, says the $7.25 she makes requires her to choose between eating or getting to work. Marsh said her 7-year-old son began living with her father to save on expenses and allow her to work.
"I don't eat because I have to have gas in my car," she said.
But supporters of Oklahoma's new law said higher local minimum wages were likely to hurt the very low-income workers they were proposed to help by raising food prices and reducing employment.
"We have seen businesses flee from cities that have tried this in other states," said Republican House Speaker Jeff Hickman. "Artificially inflating the minimum wage raises the price of everything from housing and rental costs to a loaf of bread, and causes the loss of jobs which means fewer opportunities for those working to feed their families."
In 2011 and 2012, four states passed laws keeping state minimum wages from being higher than the federal wage. This year, 14 such bills have been introduced, according to the National Conference of State Legislatures.
In New York City, Mayor Bill de Blasio and members of the City Council are seeking authority to raise the local minimum wage to $15--nearly double the state's $8 minimum. State law doesn't currently permit cities to set their own minimums, and although Democratic Gov. Andrew Cuomo first warned the idea would lead to a "chaotic" business environment, he now supports a proposal to raise the wage to $10.10 and let cities impose a minimum up to 30 percent higher.
Restaurant owners and business groups have opposed the plan, and on Thursday, it appeared state lawmakers would adjourn without voting on the measure. The state's minimum wage is already set to increase to $8.75 at the end of this year and to $9 at the end of 2015.
For Shantel Walker, the pizzeria worker in Brooklyn, the proposal would mean nearly $5 more per hour. Walker went to Albany last month to rally for a higher minimum wage outside a McDonald's at the Capitol. She said it makes no sense that fast-food workers in New York City are held to the same minimum wage as those upstate.
"If we have to do this every week, that's what we're going to do," she said. "We have to fight the powers that be."
--Associated Press
Employee medical self-care programs reduce spending: SHRM speaker
Originally posted June 23, 2014 by Sheena Harrison on www.businessinsurance.com.
ORLANDO, Fla. — Medical self-care programs that teach employees which symptoms can be treated at home and which need medical attention can help reduce unnecessary medical spending for workers and employers, said Don R. Powell, president and CEO of the American Institute for Preventive Medicine in Farmington Hills, Michigan.
Mr. Powell gave a presentation Monday about the characteristics of best-in-class wellness programs during the Society for Human Resource Management's Annual Conference & Exposition in Orlando, Florida.
He said about 25% of physician visits each year are unnecessary, equaling about $227 million in excess medical costs for workers and employers, and 55% of emergency room visits are unnecessary, resulting in $65.6 million in extra costs to treat medical problems that are not urgent.
Employers should provide printed employee resource guides and websites that employees can use to evaluate whether their medical symptoms can be treated at home, whether they should visit a doctor and what questions to ask when they visit a physician, Mr. Powell said. Such guides typically include an easy-to-use flow chart that employees can follow to determine whether they need immediate medical care.
In addition to resource guides, Mr. Powell said some companies offer a nurse advice hotline to employees to discuss whether their symptoms need medical care.
Usage and ROI
Mr. Powell noted that printed self-care resource guides, which cost about $5 to $8 per copy, are more likely to be used by employees of all ages than websites or nurse hotlines when considering the urgency of a medical problem. However, he said, offering a variety of delivery methods — as well as communicating the program’s availability through newsletters, emails and posters — can make employees more likely to use self-care programs.
Companies see anywhere from a 3-1 to a 15-1 return on investment for every dollar spent on medical self-care programs, Mr. Powell said.
“You're cutting into those unnecessary doctor and ER visits,” he said. “If you're a self-funded company ... that's $199 per visit to $350 per ER visit right back into your pocket, so you stand to gain the most. Not to say a company that’s fully insured doesn't stand to gain, because it allows employees not to miss work when they’re at the doctor or ER unnecessarily and because people really appreciate a medical self-care program.”
Other factors in successful wellness programs include having corporate leaders and employee peers involved in such initiatives, making it easy for workers to participate in wellness initiatives and health coaching to program participants, Mr. Powell said.
Communicating with Employees - Don't Shove it into the Back Burner
Originally posted May 28, 2014 by Stephen Bruce on https://hrdailyadvisor.blr.com
Ask employees what they like least about their jobs, and they typically cite a problem with communication. In fact, in many national employee attitude surveys, participating organizations across the board were rated lowest on questions related to communication, while at the same time employees who took the survey said communication was very important to them.
If communication is a problem in your organization, dig down to find out what types of information employees feel they aren’t getting, for example:
- Employees don’t have a good understanding of what is expected of them or how they fit in the organization.
- Management does not provide employees with information about how the organization is doing or the direction in which it is heading.
- Employees feel they aren’t well compensated because they don’t have any information on the value of benefits and their total compensation.
Tools for Better Communicating
It is important to consider your audience when you determine what communication tools you will use to communicate a certain piece of information.
- Do all of your employees have access to e-mail?
- Are all of your employees on-site?
- Do some of your employees work only on specific days?
- Do some of your employees have jobs on the line that prevent them from attending meetings?
Keeping these things in mind, there is a variety of methods for enhancing communication in the workplace.
Intranet
A company intranet is a great place for posting information on a variety of topics for employees, particularly if most employees have a computer.
Company Newsletter
Company newsletters are a great way to communicate changes, successes, and important information to your employees.
Meetings
Meetings are an effective way to bring employees face-to-face, which is particularly appreciated when the news is good and the purpose of the meeting is to show employees are valued. Meetings are also a good forum for allowing employee questions or discussion on a topic and for obtaining employee thoughts, concerns, and ideas.
Telephone Conferences and Web and Video Conferences
Telephones and conference calls are effective tools for communicating with individuals or groups of employees who are not present at the worksite. Invest in conferencing technology (e.g., phones, video, good microphones) that delivers high-level transmission of audio and/or video to avoid the stilted delays and overlapping conversations caused by low-tech conferencing technology. Train employees on how conferencing technology should be used. If materials or printed information will be distributed at a meeting, make arrangements to ensure access to the material for those participating by phone.
E-mail is an easy way to disperse information to a large group of people at once. Unfortunately, the overuse of e-mail can make employees feel isolated, lacking face-to-face contact. E-mails are stored on company computer systems, and once sent, the sender has no control over where they are forwarded. As a result, an e-mail should be considered a permanent written record. This is much different than the casual conversations people have face-to-face or over the phone.
Bulletin Boards
Well-organized and up-to-date bulletin boards are an effective, convenient, and inexpensive way to communicate with employees, especially workers who do not have access to a computer at their workstations.
Social Media
Social media, including blogs, podcasts, and social networks, can be used to build community, gather feedback, and make updates more engaging. For example, daily, weekly, or as-needed podcasts can provide a venue for managers and executives to talk to their employees via the intranet. While social media can be a great way to communicate with all employees at once, it shouldn’t be a complete substitute for face-to-face communication.
Employee Surveys
Employee surveys can be an effective and efficient way to obtain information from a large group of employees. A well-written survey provides feedback on how employees feel about the organization, their role in the organization, their compensation and benefits, and communication at each level of the organization.
However, conducting a survey and then leaving employees feeling as if they weren’t heard or that nothing is actually going to be done in response to feedback obtained in the survey may actually cause more harm to employee relations than good.
Communicating Bad News No one likes to be the bearer of bad news. But the right approach can help. The following tips are especially important when communicating bad news: Be straightforward. Confront the situation honestly and openly. Don’t hedge or try to hide the unpleasant truth. Act promptly. Delay will only make the task more difficult. Deliver bad news face-to-face whenever possible. This provides the opportunity to show concern and deal with questions directly. Always explain the reason behind the bad news. The more information people have, the more easily they will be able to accept the situation. Put the situation in perspective. In most cases, there’s an upside as well—however small. Be sure to highlight any positive aspects that will help the listener look beyond disappointment and see the big picture.
Ancillary Plans Get a New Spin
Originally posted June 9, 2014 by Amber Taufen on https://www.benefitspro.com
Employers struggling with new mandates for basic health care programs probably don’t even want to think about offering their employees ancillary benefits like vision and dental insurance.
However, as many experts have noted, these two particular ancillary benefits can save employers money in the long run because regular dental and vision screenings can detect some chronic health conditions early.
Employer-provided flexible spending accounts and health savings accounts can be one alternative option to traditional health and dental insurance, but sometimes employees have difficulty understanding the parameters of these programs, or can’t find affordable out-of-pocket care on their own. So many employers are turning to alternative ways to provide vision and dental coverage to their employees – new, innovative methods of coverage that provide both flexibility and cost-savings. And the biggest trends all revolve around cost transparency and empowering employees to make educated care decisions.
Jason Szczuka, general manager of Brighter PRO, says that his tech company has helped fill a need for more cost-effective employee dental coverage – a need he says will definitely continue to grow.
“Traditional dental insurance does not work for employers and employees as a cost-effective benefit offering,” Szczuka says. “And there’s been zero innovation in this industry for the past 20 years. However, by leveraging newer technologies, our platform aligns the interests of patients, providers, and payers alike to lower claims costs through new efficiencies in benefits payments, network fee schedules, utilization review and group plan designs.”
Although the Brighter PRO set-up looks somewhat similar to a traditional preferred provider organization insurance plan, it’s actually a cost-transparency technology resource that creates new efficiencies to create lower overall dental costs.
Brighter PRO maximizes the savings it generates through a transparent online marketplace so members can easily shop for providers based on price and quality, while participating providers can compete for more patients by improving their prices and quality scores, and payers can lower their claims by optimizing how and where members use their benefits.
“We’ve built the technology that helps transform health care consumers into health care shoppers,” Szczuka says. “They can compare dentists side-by-side on cost, quality and convenience. Schedule their appointment online 24/7. And when the appointment is over, the user’s electronic dental record is updated so they can more easily and affordable maintain their oral health.”
Derek Moore, a senior benefits consultant with Leavitt Group, says his clients have appreciated the addition of Brighter PRO to his portfolio of benefit offerings.
“Some of my clients are saving 70 percent on their premiums for something they can do online – if you have a computer or a phone, you can use this service,” he notes. “Everything in today’s market seems to be quick, so it was only a matter of time before these technological innovations made its way into health care.”
Gene Erdman, director of human resources for the Southern California Pizza Co., likes the program because he’s able to offer a dental benefit for all of his employees – including his part-time workers.
“The adjustability and flexibility offered with a service like this fits our employee base very well,” he notes. “Our workforce skews toward millennials, and the concept of them being able to shop and price and make a decision about a care provider from data they can access from their iPad or phone or computer and really individualize that decision is significant for us.”
A clearer vision
And while companies like Brighter PRO look at new ways to provide dental coverage options for employers, other companies like Careington address the vision component of ancillary benefits.
“We’re a discount plan, and we’ve developed a somewhat exclusive network with vision carriers,” explains Greg Rudisill, senior vice president of strategic partnerships at Careington. “Many times, we can go into a big group and bundle all of these carrier networks together so that our members have the broadest access available.”
Rudisill notes that many Careington clients use the service in conjunction with FSAs or HSAs to help their employees manage their vision needs.
“Everything is very transparent, so the member can see what it would cost them for different services before they go in. If they know what it’s going to cost them in advance, they can set aside that specific aside of money in their FSA. And there are no claims to file, so providers love it because they don’t have to do a lot of administrative work like they would with an insurance plan.”
“The Patient Protection and Affordable Care Act is building our market for us,” Szczuka says, “because, although the need for dental coverage has been around for a while, the adult dental gap is going to continue to grow as the premium-to-benefit value of traditional dental insurance erodes even more quickly than it already has been.”
And if those trends continue in the ancillary world, employers will increasingly seek new, innovative methods to provide health care value to their employees.
Most employers to keep health benefits for workers but some may drop spouses
Originally posted June 9, 2014 by Jerry Geisel on https://www.businessinsurance.com
Most employers will continue to offer health care coverage to their employees, but some will eliminate coverage for employees' spouses, according to a survey released Monday.
Just 6% of employers surveyed by Willis Group Holdings P.L.C survey say they will not comply with a Patient Protection and Affordable Care Act mandate that requires employers with at least 50 employees to offer coverage to their full-time employees or be hit with a stiff financial penalty. Sixty-two percent said they will comply with the mandate, and 32% said they were undecided.
That requirement goes into effect in 2015 for larger employers and in 2016 for smaller firms.
“The results of the survey underscore that organizations recognize the value of offering competitive medical benefits to employees and, despite concerns over health care reform, appear poised to continue to offer employer-sponsored health plans as part of a total rewards package,” said Jay Kirschbaum, St. Louis-based practice leader of the Willis human capital practice's national legal and research group, in a statement.
On the other hand, 12% of employers already have added a special surcharge or eliminated coverage to employees' spouses if the spouse is eligible for coverage from his or her own employers, while 3% plan to take such action between 2015 and 2018, and 20% will likely do so but haven't set a date yet.
The motivation behind such action is financial. Employers can reap significant financial savings when employees' spouses are not covered or are required to pay premium surcharges when they are eligible for coverage through their own employers but don't take it.
For example, the average premium in 2013 for employee-only coverage was $5,884, according to the Kaiser Family Foundation in Washington. Adding a spouse easily will double that premium, experts say.
Other findings
The health care reform law also gives employers a further incentive to pare their health plan enrollment numbers.
In 2014, employers have to pay a $63 reinsurance fee that is imposed for every health care plan participant, while a $44 per participant fee will be assessed in 2016. The amount of the fee in 2017 — the last year such fees will be imposed — has not been set yet by federal regulators. Revenue generated by the transitional reinsurance program fee will be used to partially reimburse insurers for covering high-cost individuals through health exchanges.
The survey also found that just 37% of respondents have calculated the cost of the reform law on their health care plans.
That relatively low percentage “demonstrates that for many organizations, determining an accurate assessment of these figures is still a challenge,” the survey said.,
Among respondents that have calculated the cost impact, 54% said the law would boost costs between 0% and 5%, while 22% put the increase in the 5% to 10% range.
The survey is based on the responses of 1,033 employers, including 36% with between 100 and 499 employees and 26% with less than 100 employees.