Association Health Plans & Their Benefits
Many individuals do not understand various insurance terms and the plans available to them. Most employers have a hard time trying to find the best and the most affordable coverage for their employees. It is important you find an insurance company or agent that can break it down for you to get the best coverage.
We asked our founding partner and CEO, Jamie Charlton, to shed some light on Association Health Plans (AHPs) and also give their advantages and disadvantages.
What is an AHP, and How Does it Work?
According to Charlton, AHP or Association Health Plans are a conglomeration of smaller groups that come under the guise of a larger umbrella to leverage bulk buying power. They might not be small companies per se, but are those that come together under one industry or from the same geographic area to strengthen their negotiating power. They can be a group of manufacturers, printers or self-employed individuals from the same jurisdiction. An example of such an association is the Chamber Alliance.
Ideally, small businesses, including self-employed individuals in the same industry or geographic location, can merge to form larger groups to get healthcare plans as one large group. Coalitions are more or less the same as these associations, only that coalitions are groups made up of non-profit institutions such as schools. Associations are mostly businesses or organizations aimed at making profits.
AHP Expansion
United States (US) President, Donald Trump, issued an executive order to promote healthcare coverage in the US on October 12, 2017. The order aims at expanding access to small businesses to get the same competitive advantage as large corporations when purchasing health insurance. This order was meant to provide more affordable health insurance plans to as many individuals as possible. These individuals include farmers, wage earners and employees of any small business in the US.
Charlton has a slightly different view of this expansion. Though it has helped a few individuals, the expansion does not present any advantage as the rates keep going higher with age. He explained, “AHPs don’t have an advantage in the long run, unless they have a long-term sponsor.” AHPs have always been in existence, and the expansion is just political rhetoric that will give the plans some credibility.
Advantages of an AHP to Smaller Employers
There are some advantages that come with AHPs, both to the employer and the employees. These include:
- Negotiating power
- Spreading the risk
- Maintaining lower rates instead of lumping them into unverified age groups
- No charging different premiums to employees based on health status
- No charging different rates to employers based on the health status of their employees
- Healthy, younger groups will be fully underwritten
- Self-employed individuals with a few employees and those with no employees are also eligible
- Will not cherry pick or discriminate based on the status of an applicant pre-existing or previous health condition.
There are also some disadvantages. They include:
- Many of these plans might not allow single person groups.
- An individual must be a bona-fide member of a group and pay a membership fee.
The Role Saxon Plays in Helping the Employer
Saxon prides itself as a top provider of AHPs. The company has experts with knowledge of how this system works. Writing these plans for the last four years, Saxon can offer stable rates and consistent, professional assistance.
For more information regarding employee benefits and competitive benefits packages that fit your business strategy, you can contact Jamie Charlton at 513-573-0129 or via email at jcharlton@gosaxon.com.
Fresh Brew with Kevin Hagerty
Welcome to our monthly segment, Fresh Brew, where we will be exploring the delicious coffees, teas, and snacks of some of our employees! You can look forward to our Fresh Brew blog post on the first Friday of every month.
“Try to save what you can. You’ll be glad you did later.”
Kevin Hagerty is a Financial Advisor at Saxon Financial Services.
He joined Saxon in December of 2012, having been a Financial Advisor for 18 years specializing in financial planning solutions.
Kevin and his wife, Lori, enjoy spending their free time involved in various school and sporting events with their two sons. They also enjoy spending time visiting family on the shores of Northern Michigan’s Lakes and working on various projects around the house like landscaping. Kevin also enjoys golfing and traveling as well as spending time outdoors.
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Technology Influencing the Healthcare and Employee Benefits Industry
Technology is taking the world by storm and the healthcare/employee benefits industry is no exception. Whether you are an employee or an employer shopping for benefits can be the same for both parties. Here’s how technology will influence the industry in the future.
Apps will push value-based care
This tech shift to shopping for benefits will bring with it the rise of platforms and app-based insurance. The hope is that apps and platforms will make it easier to buy and understand insurance, and easier to get the best healthcare fast. That means high-quality care at a low price at a time that’s convenient for patients.
Emerging tech platforms should provide employees with more options for insurance — and a better understanding of those options — and make it easier to manage wellness, healthcare and insurance coverage. Apps will put more information in front of the average employee, giving them more freedom to make choices about their care.
The idea is these emerging platforms and apps tie together payroll and HRIS with wellness and healthcare navigator apps to help workers live healthier lives.
Here’s how it could work: When an employee isn’t feeling well, they first turn to their telemedicine app instead of picking up the phone to make a doctor’s appointment or visiting urgent care. Telemedicine is more convenient for them and costs less than a traditional doctor’s visit. If the telemedicine provider refers them to a specialist, they can then turn to a health navigator app to find a high-quality specialist at the lowest price for their next appointment.
When they're feeling better, they can use a connected wellness app to record gym visits, meditate, speak to a therapist and earn points for wellness activities like reaching a step-count milestone or getting a preventive checkup. These points can contribute to a real-time insurance premium discount that they can easily view from an app. The app can also present them with the opportunity to add or change voluntary benefits and, during the open enrollment, learn about their benefits choices and decide on the best plan.
Apps specific to shopping for benefits will provide more information to healthcare consumers and the necessary tools to make better care decisions. The hope is this technology will help people become healthier, get better care and use insurance more efficiently.
How HR fits in
Though employees will have the ability to make easy changes to benefit plans — especially voluntary benefits — the role of HR may change, depending on the employer’s size.
Large, more than 1,000 life employers will likely partner with a technology company and a benefits consultant who will manage the platform and the insurance-buying process for employees. Representatives from the HR technology platform, the benefits consultant and human resources staff will be responsible for educating employees about their options. Importantly, the employer will continue to sponsor employee benefits. They may present cafeteria-style benefits plans and provide a dollar amount toward the purchase of benefits.
Bigger changes may come for small companies with fewer than 100 employees. Many of these businesses may turn to a professional employer organization or other HR outsourcing arrangements with a built-in technology platform. Though healthcare insurance costs will continue to rise, small employers will continue to contribute to employee benefits premiums to help attract and retain talent.
The imperative for employers: communicate and educate
The only way this shift to platforms, apps, and other technology-based solutions will work is if employers, benefits brokers and platform companies themselves work to educate and communicate with employees about how this all works. Insurance platforms can no longer be staffed with technologists only; they need experts who understand health and welfare benefits in order to onboard employees and teach them how to get the most from their benefits platform.
And while HR’s role may change slightly, those teams are still in charge of helping employees learn about the benefits landscape and plan their healthcare and financial well-being for the next plan year. HR teams need to focus on communicating through any channel necessary, whether it’s email, social media, in-person education meetings or podcasts. It benefits everyone when employees understand how to choose the best plan and make decisions about appropriate care.
Putting more healthcare and insurance information in front of employees when they’re shopping for benefits and seeking services can drive them to make smarter decisions and look for better options when possible, but only if they understand how it all works.
SOURCE: Lisa, Mike. (24 July 2019). “Shopping for benefits: What technology holds for clients” (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/what-technology-holds-for-employee-healthcare-benefits?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
4 Things Life Insurance Is Not
What is life insurance? People often get confused about what life insurance is and what it is not. Read this blog post for four things life insurance is not and a few tips on understanding them.
Are you confused about life insurance? I don’t blame you. When I first started writing about finances more than a decade ago, my understanding of life insurance was limited.
I knew about life insurance because it was offered through my employer, and I thought a $50,000 policy was a lot of money. I also recognized insurance company names from late-night TV commercials and the occasional bit of junk mail.
I understood “insurance” to be that stuff that you had to have for your car, your home, and your health. The “life” part was a big, blurry blob of “other.” If that’s how you’re feeling, here are a few tips that might help bring things into focus—by understanding the “nots.”
1. Life insurance through work is generally NOT enough. Since learning this myself some years back, I’ve noticed that many people never explore life insurance past what is offered through their work. Policies through work are a great benefit to have, but are usually limited to one- or two-times your salary or a fixed amount like $50,000. Plus the coverage typically ends when your employment there does.
How far will an amount like that go when you consider what’s left behind for your loved ones: the loss of your income and mostly likely debts and bills. What about things like rent or mortgage, child-care and education costs?
An easy way to get a working idea of how much life insurance you need is with a Life Insurance Needs Calculator from a neutral source like www.lifehappens.org/howmuch.
2. Life insurance is NOT a luxury item. Many people have not even considered buying life insurance because they’re convinced it’s a luxury. In a recent study by Life Happens and LIMRA, consumers thought the cost of a 20-year, $250,000 level term life insurance policy for a healthy 30-year-old was three times higher than it generally is. Younger people, in particular, overestimate the cost of a term policy by a factor of five.
If you took a guess at what that policy above would cost, what would you say? It comes out to about $13 or so a month for that policy. Definitely not a luxury—most of us spend more than that on a meal out.
3. Life insurance is NOT just about covering funeral expenses. While covering funeral expenses is very important, and a major reason people purchase it, life insurance does so much more. If something happens to you, life insurance benefits can help replace lost income, or pay off a mortgage, or help ensure a college fund or safeguard a retirement nest egg.
The proceeds of a life insurance policy are generally tax-free and can be used for anything your loved ones may need now and well into the future. Amazing, right?
4. Life insurance is NOT just for really healthy people. Granted, life insurance is less expensive the younger and healthier you are but don’t discount it just because you’re not in triathlete shape!
Many people don’t considering buying life insurance because they think they won’t qualify. But when certain health conditions, such as diabetes or high blood pressure, are under control with a doctor’s guidance or medication, it’s often possible to qualify. You may even be able to get coverage after a heart attack. Just know that it is probably best to work with an experienced insurance agent if you are concerned about a health issue and qualifying for coverage.
Now, if you’re a bit overwhelmed with this information and perhaps don’t know where to start, just know that a life insurance agent will sit down with you at no cost to go over your needs and help you get life insurance coverage to fit your budget. If you don’t have an agent or advisor, go here for suggestions on how to find one. You can also tap the Agent Locator there to find someone in your area.
Remember, the right agent or advisor can help you make sense of the confusion and get you on track for the financial future you want—with the protection your loved ones need.
SOURCE: Mosher, H. (30 October 2018) "4 Things Life Insurance Is Not" (Web Blog Post). Retrieved from https://lifehappens.org/blog/4-things-life-insurance-is-not/
9 Reasons Why Stay-at-Home Parents Need Life Insurance
It's not just parents with full-time jobs that need life insurance. Stay-at-home parents also need coverage. Read this blog post for 9 reasons why stay-at-home parents should have life insurance as well.
You’re probably already aware that a parent with a job outside the house most likely needs life insurance to protect their loved ones in case something were to happen. But it’s not just breadwinners who need coverage—stay-at-home parents do, too. Here are nine reasons why.
1. To replace the value of their labor. Stay-at-home parents are caretakers, tutors, cooks, housekeepers, chauffeurs, and so much more 365 days a year. And all that work comes with a price tag: Salary.com reports that stay-at-home-parents contribute the equivalent of a $162,581 annual salary to their households. If the unthinkable were to happen, a surviving partner would be on the hook for a slew of new expenses that the stay-at-home parent previously shouldered. Term life insurance is generally a quick and affordable way to get a substantial amount of coverage like this for a specific period of time, such as 10 or 20 years—often until you pay of your mortgage or the kids are grown and gone.
2. To factor in the contributions of any future income. Many stay-at-home parents return to the workforce once their kids are older. Life insurance could help bridge the gap that their future earnings would have contributed to the household.
3. To pay off any debt. From student loans to credit card debt to an informal loan from a family member, there are lots of ways to owe money. Life insurance can help settle any debts left behind so they don’t create stress for grieving loved ones.
4. To cover funeral expenses. Would you believe that the average funeral runs between $7,000 and $10,000, according to parting.com? And that may not cover the cost of the burial, headstone and other expenses. Many families want to honor a loved one’s memory but have trouble finding the funds to cover all the costs. Fortunately, the payout from a life insurance policy can help cover final wishes.
5. To leave a legacy. If a stay-at-home spouse has a passion for a place of worship, an alma mater, or another nonprofit organization, life insurance proceeds can be used to leave a meaningful charitable gift.
6. To boost savings. Permanent life insurance, which offers lifelong protection as long as you pay your premiums, may offer additional living benefits such as the ability to build cash value. This can be used in the future for any purpose you wish, from making a down payment on a house to paying for college tuition. Keep in mind, though, that withdrawing or borrowing funds will reduce your policy’s cash value and death benefit if not repaid.
7. To guarantee insurability. Your health can change in an instant. Getting a permanent life insurance policy when you’re young and healthy means you’ll have lifelong coverage. Then you won’t have to worry if later on, you develop a health condition that would make it hard or even impossible to get life insurance.
8. To receive tax-free benefits. Life insurance is one of the few ways to leave loved one's money that is generally income-tax free.
9. To give loved ones peace of mind. Losing a parent and partner before their time is already hard enough without having to worry about unsettled debts, childcare costs, funeral bills, and other expenses.
As you can see, life insurance for stay-at-home parents is just as important as it is for parents who work outside the home. Schedule a time to talk with an insurance professional in your community to learn about your options and get coverage that fits your lifestyle and budget.
SOURCE: Austin, A. (11 December 2018) "9 Reasons Why Stay-at-Home Parents Need Life Insurance" (Web Blog Post). Retrieved from https://lifehappens.org/blog/9-reasons-why-stay-at-home-parents-need-life-insurance-2/
Summertime—and Working Ain’t Easy
Providing flexible hours during the summer months is often appreciated by employees and can help boost engagement. Continue reading this blog post from SHRM for best practices on managing staff during the summer months.
Summertime is that season when "the livin' is easy," as the famous tune by George Gershwin goes—a season when work often takes a back seat to pool parties, barbecues and beach vacations.
How do employers keep workers' heads in the game when their toes are itching for the sand? Or how do they plan for the disruption that summer holidays and vacation schedules inevitably bring? What are their best practices for keeping productivity high?
In the health care industry, patients' needs mean productivity can't fluctuate with the seasons. At Maine Medical Center in Portland, nurse manager Michele Higgins oversees a staff of 70 on an adult general medical unit.
"Summer is busy in health care, especially at a level-one trauma hospital such as Maine Med, but we continue to care effectively for patients, and we remain patient-centered," she said.
Anticipating higher patient traffic in the summer months, the hospital pushes out its June, July and August schedules as early as March. Staff view the schedules, are reminded of guidelines for taking vacation time, and plan time off around shifts or swap shifts with co-workers.
But what happens when an employee unexpectedly calls out "sick" over the Fourth of July weekend? A pool of floating in-house nurses responds to shortages. When the pool of nurses cannot meet the demand, managers ask staff to cover shifts for incentive pay. According to Higgins, a 10-year Maine Med veteran, the numbers typically work out and the medical center maintains favorable nurse-to-patient ratios. But she's always prepared to show up in scrubs and jump in as needed. "Being present is important to me," she said. "I make myself accessible and stay positive, supporting the staff and recognizing their efforts."
Higgins rewards her staff with hospital-sponsored special events throughout the summer. These include "nurses' week" at the beginning of May, when employees win gift cards and goody bags in daily raffles, participate in a book swap, and play games like cornhole. Later in the summer, senior leaders host staff appreciation lunches, smoothie breaks on the patio and an ice cream bar. The hospital also reserves box seats for each of its 23 units at minor league baseball games at Hadlock Field in downtown Portland.
"Maine Med is a great place to work," Higgins said. "But busy is the norm."
Workers Appreciate Flexibility
For employees who are parents, juggling work and school-age children who are either home for the summer, at camps or in day care can be challenging—and expensive.
Recognizing this, some employers observe summer hours so parents can start and end the workday earlier. Employees at Princeton University call it quits at 4:30 p.m. instead of 5 p.m. from June 1 through Labor Day.
River City Dental, a dental office in Williamsport, Md., operates on an 8 a.m. to 3:30 p.m. schedule in June, July and August. Office manager Lori Robine reports that the employees, many of whom are parents, appreciate the flexibility of the shortened workday and increased free time.
Workplace flexibility is another benefit that can boost spirits—and productivity—during the summer months. Maine Medical Center can't tweak its summer hours, but fewer meetings are held, and they're even put on hold in July.
When summer arrives, workplace productivity doesn't have to suffer. Employers can look for opportunities to be flexible with scheduling and dress codes, find ways to recognize and reward employees, and host events that celebrate the warm months.
Michele Poacelli is a freelancer based in Mercersburg, Pa.
SOURCE: Poacelli, M. (12 July 2019) "Summertime—and Working Ain’t Easy" (Web Blog Post). Retrieved from https://www.shrm.org/ResourcesAndTools/hr-topics/employee-relations/Pages/employee-engagement-in-the-summer.aspx
The unpaid caregiver crisis is landing on employers’ doorsteps
According to new data, 43 million Americans currently are tending to a family member in need, which can be both physically and emotionally taxing on the caregiver. Read this blog post for more on the unpaid caregiver crisis.
Scott Williams knows firsthand what it is like to support a sick relative. But even after spending 20 years tending to his ailing mother, he didn’t consider himself a caregiver.
“She suffered from multiple chronic conditions, but I never considered myself a caregiver,” he says. “I just thought I was a son who loved his mom.”
Williams, who is vice president and head of global patient advocacy and strategic partnerships at the biopharmaceutical company EMD Serono, realized that because he didn’t think of himself as a caregiver, he wasn’t able to take advantage of the benefit offerings his company had in place for these workers.
“Until I really started to think about it, I didn’t realize how burned out I really was,” Williams says. “I was in that sandwich generation, which is a situation that many caregivers find themselves in sometimes.”
Williams dilemma is not uncommon. There are 43 million Americans currently tending to a family member in need, according to data from LIMRA. AARP estimates that caring for a loved one can cost close to $7,000 out of pocket.
"I never considered myself a caregiver, I just thought I was a son who loved his mom.” Scott Williams
It is also both physically and emotionally taxing — 57% of caregivers need medical care or support for a mental health condition, according to an Embracing Carers survey. About 55% of caregivers say their own physical health has diminished, 54% say they don’t have time to tend to their own medical needs and 47% report feeling depressed.
The caregiving crisis puts employers in a unique position to offer benefits, policies and resources that can ease some of this stress. Indeed, there are some employers that already stepped up. For example, Starbucks launched a new caregiver benefit last year. Amgen and Brinker International, use digital tools to offer caregiving benefits to their workers.
Regardless, the need for employer-provided backup child, adult and senior care options is still largely unmet. Only 4% of employers offer backup childcare services and only 2% offer backup elder care, according to data from the Society for Human Resource Management.
The breakdown of communication between the company and the worker may be keeping the majority of employees from accessing the assistance they need. If employers ignore this issue or simply fail to communicate with employees, it can end up becoming a burden that costs the company money or result in the loss of a worker.
But there are some steps employers can take. The first is to identify the responsibilities of the family caregiver so that employers can better address their needs. One of the biggest responsibilities caregivers face is the amount of time they have to spend transporting loved ones, says Ellen Kelsay, chief strategy officer for the National Business Group on Health citing recent data on the subject. These employees often have to leave work early, come in late or take off to get an ill family member to their doctor’s appointments.
“The financial impact is considerable, many of these employees are paying out of their own pocket to support the medical care of a loved one. So there is financial assistance that they need,” Kelsay says. “When you think about the impact on the employee, they [struggle from a] physical, mental and emotional wellbeing perspective.”
About half of unpaid caregivers work full time outside of their home and many have to take leaves of absence or cut back their work hours due to the demands of caring for a family member, LIMRA research shows. A significant portion of employees had to stop working in order to better care for their loved one — about 22% say they voluntarily quit their jobs, 18% had their employment terminated and 13% chose to retire early.
Unlimited PTO, remote work, shared sick time and an employee resource group are just a few offerings employers can offer staff, Williams says. For instance, EMD Serono created an employee resource group for caregivers, a peer to peer network where employers can find dedicated resources, while also having an exchange with colleagues who are going through similar situations.
But there is still more that can be done, Williams says. Training managers to be more understanding of an employee’s needs can go a long way toward bridging the gap. Another option companies should consider is enhancing employee assistance programs to include caregivers, he adds.
“One of the things we see employers doing that can really help is being able to raise the visibility of [the available] resources,” Williams says. “To really ensure that whether you’re a new employee or an established employee in an unpaid caregiving situation that you have access to them.”
SOURCE: Schiavo, A. (11 July 2019) "The unpaid caregiver crisis is landing on employers’ doorsteps" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/improving-caregiving-challenges-through-the-workplace
Giving onsite clinics an engagement booster shot
In efforts to reduce healthcare spend and increase the population's health, many employers are offering a variety of employee wellness services and programs. Read this blog post to learn more about increasing engagement in onsite clinics.
Employers of all sizes and industries are currently offering a variety of wellness services that include preventive, acute, primary, chronic disease and occupational healthcare programs at or near the worksite. These benefits are intended to reduce healthcare spend, increase the population’s health and productivity and positively impact recruitment and retention efforts.
In fact, according to two 2018 studies by the National Association of Worksite Health Centers, more than one-third of all employers and close to 50% of large firms are now operating worksite clinics. But just because employers offer such benefits doesn’t mean employees will take advantage of these services, even when they’re free.
But many employers are frustrated to find that 20% or less of the targeted or covered workers utilizes their programs — with millions of dollars in benefits wasted.
Failure can be caused by lack of promotion, inadequate incentives, poor communications or providers who don’t fit into the culture of the employer. However, one of the most significant problems than can undermine a benefit program, especially a worksite clinic, is when employees don’t trust that their personal health data will be confidential and fear it will be used for employment decisions.
Employers who achieve high benefit utilization build the foundation for success by informing their workforce, prior to a benefit or clinic being available and on an ongoing basis, of the many federal and state confidentiality and privacy laws that dictate who can receive personal and occupational health information and the limitations placed on employers.
Communications, posters, presentations and other marketing vehicles must assure employees that the employer will only see aggregate, not personal data from the offered benefit programs. Emphasize that the program’s or clinic’s medical providers will be the only individuals dealing with this information, and that by law they are legally and ethically obligated to keep this confidential.
Understanding the culture and labor-management dynamics of an organization are also critical to building trust. To increase use, it’s often best to market the program or facility under a new brand name, such as “The Healthy Life” or use the name of the provider who manages the program or clinic, rather than the employer’s name.
The physical design or location of a benefit program or clinic also needs to be kept in mind. Clinical or counseling activities should be separate from business offices or fitness centers where a person taking advantage of the benefit could be seen by their peers, managers and supervisors.
Achieving engagement in a health benefit program or clinic is key to its success, as well as obtaining the resources and support of senior management for its expansion and continuance. The design, marketing and location of benefit programs need to be well-planned so the workforce is confident that the confidentiality of their patient records will be maintained and not used for employment decisions.
SOURCE: Boress, L. (9 July 2019) "Giving onsite clinics an engagement booster shot" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/how-to-increase-employee-engagement-in-healthcare-benefits
PCORI Fee Is Due by July 31 for Self-Insured Health Plans
The annual fee for the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019. Plans with terms ending after September 30, 2012, and before October 1, 2019, are required to pay an annual PCORI fee. Read this article from SHRM to learn more.
An earlier version of this article was posted on November 6, 2018
The next annual fee that sponsors of self-insured health plans must pay to fund the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019.
The Affordable Care Act mandated payment of an annual PCORI fee by plans with terms ending after Sept. 30, 2012, and before Oct. 1, 2019, to provide initial funding for the Washington, D.C.-based institute, which funds research on the comparative effectiveness of medical treatments. Self-insured plans pay the fee themselves, while insurance companies pay the fee for fully insured plans but may pass the cost along to employers through higher premiums.
The IRS treats the fee like an excise tax.
The PCORI fee is due by the July 31 following the last day of the plan year. The final PCORI payment for sponsors of 2018 calendar-year plans is due by July 31, 2019. The final PCORI fee for plan years ending from Jan. 1, 2019 to Sept. 30, 2019, will be due by July 31, 2020.
In Notice 2018-85, the IRS set the amount used to calculate the PCORI fee at $2.45 per person covered by plan years ending Oct. 1, 2018, through Sept. 30, 2019.
The chart below shows the fees to be paid in 2019, which are slightly higher than the fees owed in 2018. The per-enrollee amount depends on when the plan year ended, as in previous years.
| Fee per Plan Enrollee for Payment Due July 31, 2019 |
|
| Plan years ending from Oct. 1, 2018, through Sept. 30, 2019. | $2.45 |
| Fee per Plan Enrollee for Payment Due July 31, 2018 |
|
| Plan years ending from Oct. 1, 2017, through Dec. 31, 2017, including calendar-year plans. | $2.39 |
| Plan years ending from Jan. 1, 2017, through Sept. 30, 2017 | $2.26 |
| Source: IRS. |
Nearing the End
The PCORI fee will not be assessed for plan years ending after Sept. 30, 2019, "which means that for a calendar-year plan, the last year for assessment is the 2018 calendar year," wrote Richard Stover, a New York City-based principal at HR consultancy Buck Global, and Amy Dunn, a principal in Buck's Knowledge Resource Center.
For noncalendar-year plans that end between Jan. 1, 2019 and Sept. 30, 3019, however, there will be one last PCORI payment due by July 31, 2020.
"There will not be any PCORI fee for plan years that end on October 1, 2019 or later," according to 360 Corporate Benefit Advisors.
The PCORI fee was first assessed for plan years ending after Sept. 30, 2012. The fee for the first plan year was $1 per plan enrollee, which increased to $2 per enrollee in the second year and was then indexed in subsequent years based on the increase in national health expenditures.
FSAs and HRAs
In addition to self-insured medical plans, health flexible spending accounts (health FSAs) and health reimbursement arrangements (HRAs) that fail to qualify as “excepted benefits” would be required to pay the per-enrollee fee, wrote Gary Kushner, president and CEO of Kushner & Co., a benefits advisory firm based in Portage, Mich.
As set forth in the Department of Labor's Technical Release 2013-03:
- A health FSA is an excepted benefit if the employer does not contribute more than $500 a year to any employee accounts and also offers a group health plan with nonexcepted benefits.
- An HRA is an excepted benefit if it only reimburses for limited-scope dental and vision expenses or long-term care coverage and is not integrated with a group health plan.
Kushner explained that:
- If the employer sponsors a fully insured group health plan for which the insurance carrier is filing and paying the PCORI fee and the same employer sponsors an employer-funded health care FSA or an HRA not exempted from the fee, employers should only count the employees participating in the FSA or HRA, and not spouses or dependents, when paying the fee.
- If the employer sponsors a self-funded group health plan, then the employer needs to file the form and pay the PCORI fee only on the number of individuals enrolled in the group health plan, and not in the employer-funded health care FSA or HRA.
An employer that sponsors a self-insured HRA along with a fully insured medical plan "must pay PCORI fees based on the number of employees (dependents are not included in this count) participating in the HRA, while the insurer pays the PCORI fee on the individuals (including dependents) covered under the insured plan," wrote Mark Holloway, senior vice president and director of compliance services at Lockton Companies, a benefits broker and services firm based in Kansas City, Mo. Where an employer maintains an HRA along with a self-funded medical plan and both have the same plan year, "the employer pays a single PCORI fee based on the number of covered lives in the self-funded medical plan (the HRA is disregarded)."
Paying PCORI Fees
Self-insured employers are responsible for submitting the fee and accompanying paperwork to the IRS, as "third-party reporting and payment of the fee is not permitted for self-funded plans," Holloway noted.
For the coming year, self-insured health plan sponsors should use Form 720 for the second calendar quarter to report and pay the PCORI fee by July 31, 2019.
"On p. 2 of Form 720, under Part II, the employer needs to designate the average number of covered lives under its applicable self-insured plan," Holloway explained. The number of covered lives will be multiplied by $2.45 for plan years ending on or after Oct. 1, 2018, to determine the total fee owed to the IRS next July.
To calculate "the average number of lives covered" or plan enrollees, employers should use one of three methods listed on pages 8 and 9 of the Instructions for Form 720. A white paper by Keller Benefit Services describes these methods in greater detail.
Although the fee is paid annually, employers should indicate on the Payment Voucher (720-V), located at the end of Form 720, that the tax period for the fee is the second quarter of the year. "Failure to properly designate 'second quarter' on the voucher will result in the IRS's software generating a tardy filing notice, with all the incumbent aggravation on the employer to correct the matter with the IRS," Holloway warned.
A few other points to keep in mind: "The U.S. Department of Labor believes the fee cannot be paid from plan assets," he said. In other words, for self-insured health plans, "the PCORI fee must be paid by the plan sponsor. It is not a permissible expense of a self-funded plan and cannot be paid in whole or part by participant contributions."
In addition, PCORI fees "should not be included in the plan's cost when computing the plan's COBRA premium," Holloway noted. But "the IRS has indicated the fee is, however, a tax-deductible business expense for employers with self-funded plans," he added, citing a May 2013 IRS memorandum.
SOURCE: Miller, S. (2 July 2019) "PCORI Fee Is Due by July 31 for Self-Insured Health Plans" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2019-pcori-fees.aspx
Financial Fitness Benefits Take Center Stage as Debt Worries Grow
According to speakers from the Society for Human Resource Management 2019 Annual Conference & Exposition, employees who are taking advantage of financial health benefits have less stress, reduced distraction and lower absenteeism. Read this blog post for more on financial fitness benefits.
LAS VEGAS—Employers that help workers improve their financial health are seeing increased productivity, job satisfaction and retention. Employees taking advantage of these benefits have less stress, reduced distraction and lower absenteeism, according to speakers at the Society for Human Resource Management 2019 Annual Conference & Exposition.
"Your employees are financially stressed, and it's affecting your business," said Dan Macklin, CEO of Salary Finance, a financial technology firm, during a June 24 panel discussion on financial wellness benefits. A survey conducted by his firm, with responses from 10,484 U.S. employees, found that 48 percent were worried or stressed about their finances. Financially stressed employees lost nearly one month of productive workdays per year.
Money management problems exist across all income levels, Macklin noted.
"Financial worries are the No. 1 cause of employee stress," said Kent Allison, national leader for employee financial education and wellness at PwC. The consultancy's 2019 Employee Financial Wellness Survey, with responses from 1,686 full-time employees, showed that 59 percent cited financial or money matters as their chief source of stress, followed by their job (15 percent) and relationships.
Nearly half (49 percent) of all employees said they find it difficult to meet household expenses on time each month, PwC found.
"Employees are seeking personalized financial guidance and coaching," Allison said. "Successful financial wellness programs find the optimal way to combine technology and human interaction" to help employees get back on track financially.
Organizations are more likely to thrive when they help employees "bring their healthiest and happiest self to work," said Felicia Cheng, wellness benefits program manager at HR technology firm SalesForce.
Organizations are more likely to thrive when they help employees 'bring their healthiest and happiest self to work.'
Have meaningful conversations with employees, said Wendy Myers Cambor, Northeast U.S. HR leader at consulting firm Accenture. "Ask what they want, what they need and how we might be in a position to accommodate them."
Accenture, like many companies, has five generations of employees in its workforce, whose concerns range from "managing student debt and affording to have a child and buy a home, to helping to care and provide for aging parents while preparing for their own retirement," Cambor noted.
Physical wellness and financial wellness are deeply interrelated, said Allison, because financial distress can lead to health distress.
Similar to health risk assessments, he said, financial wellness assessments can be helpful because "how can you change behaviors if you don't know what these behaviors are?" He advised, "Assess employees to know where they are financially and what their needs are, and what behaviors they may need to change."
Financial health assessments could be stymied if employees don't feel comfortable revealing their distress—and don't trust their employers with this information, panelists noted. Cheng said it was important to help employees overcome taboos around admitting to money problems, because, if employers don't understand the scope of the challenges their employees face, they can't provide the help that employees need.
Macklin noted that younger workers seem more willing to discuss their financial difficulties and are grateful for the guidance and assistance employers provide.
Younger workers seem more willing to discuss their financial difficulties and are grateful for the assistance employers provide.
"Engage employees at the right time to provide help when needed," Allison suggested.
"People are suffering," Cambor said. "There are opportunities for HR to make a difference in peoples' lives."
"Employees' stories are powerful," Cheng said. HR should "bring them to the leadership team, coupled with data on the positive impact of financial wellness," to make the case for financial wellness benefits.
Student Loan Benefits Are in Demand
Student loan debt affects employees at all stages of their careers, said Kevin Fudge, director of consumer advocacy at American Student Assistance, a nonprofit that helps students manage their education debt, during a June 25 conference session.
He noted that more than 3 million Americans ages 60 and older currently owe more than $86 billion in unpaid student loans, according to the Consumer Financial Protection Bureau.
Employees face different concerns at different career stages, Fudge pointed out, including:
- Early career: Paying off student loans and related debt.
- Mid-career: Supporting a family and saving for children's college education.
- Late career: Helping children and grandchildren by co-signing loans and preparing for retirement.
Fudge pointed to innovative ways employers are helping with student loans. For instance:
- Abbott Laboratories allows employees to save for retirement and pay down their student loans. If an employee is paying off student loans (using 2 percent or more of their pay), Abbott will put the equivalent of 5 percent of the employee's pay into his or her 401(k) account.
Abbott received a private letter ruling from the IRS to allow this practice. The IRS is expected to sanction similar plans with broader guidance. Legislation has also been introduced to allow this practice.
- Unum, a national insurance firm, lets employees transfer carried-over paid time off into debt repayment.
In a June 24 conference session on student loan benefits, Meera Oliva, chief marketing officer at Gradifi, a loan benefits administrator; Jane Fontaine, senior vice president of HR at Digital Federal Credit Union; and Chad Carter, vice president of benefits at Fareway Stores, shared these examples, showing the range of student loan aid employers are providing:
- AECOM, a Fortune 500 engineering firm, offers student loan refinancing along with student loan counseling and financial wellness content.
- Carvana, an e-commerce platform for buying cars, offers up to $1,000 per year to help full-time employees pay off their student loans.
- Connelly Partners, a Boston-based advertising agency, offers a total benefit of $10,000 with contributions starting at $100 a month for the first year and then increasing $25 a month for the next four years. In another effort to retain employees, the firm gives a $1,000 retention bonus at the end of the fifth year of employment.
- Sotheby's, an auction house and private sales firm, offers $150 per month contribution toward student loans indefinitely until employees are no longer in debt, including parents who have taken on debt for their children.
SOURCE: Miller, S. (27 June 2019) "Financial Fitness Benefits Take Center Stage as Debt Worries Grow" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/financial-fitness-benefits-take-center-stage.aspx