EEOC Proposed Rule on Wellness and the Americans with Disabilities Act – What Employers Need to Know
Originally posted by M. Brian Magargle and Robin E. Shea on April 30, 2015 on www.thinkhr.com.
The employer community has been waiting for years to receive guidance from the Equal Employment Opportunity Commission on wellness programs and how an employer’s obligations under the Americans with Disabilities Act intersect with its rights and obligations under the Health Insurance Portability and Accountability Act (as amended by the Affordable Care Act).
The EEOC finally issued a proposed rule on April 20. The following is what employers need to know in a “Q&A” format.
What problem is the EEOC trying to resolve?
The quick answer is an apparent conflict between the ADA rules on employer “medical inquiries,” on the one hand, and the “wellness program” provisions of the HIPAA/ACA, on the other.
Title I of the ADA (the part of the ADA that applies to private sector employers) generally prohibits employers from making “medical inquiries” of current employees unless the inquiries are “job-related and consistent with business necessity” (for example, to verify the need for a reasonable accommodation). The general rule is that employers are not supposed to be asking for medical information from current employees.
There are some limited exceptions to this rule, including an exception for medical inquiries made in connection with a “voluntary wellness program.”
As employer wellness programs have become more popular, many employers began offering specific rewards or penalties to employees based on whether they participated in the programs and even on whether they achieved certain “results.” As will be discussed in more detail below, the HIPAA and the ACA specifically authorize wellness programs to offer incentives for “participation” and “outcomes” under certain circumstances. However, the question arose whether the use of such incentives would render the wellness program not “voluntary” for ADA purposes. If the wellness program was not voluntary because of the incentives, then any requests for employee medical information made in connection with the wellness program would violate the ADA.
(Title I of the ADA would not have an impact on medical inquiries made, say, to the family member of an employee who might also be eligible to participate in the employer’s wellness program.)
Thus, it was possible that an employer could offer a wellness program that was authorized and lawful under the HIPAA/ACA but still be vulnerable to charges and lawsuits under the ADA. The EEOC’s proposed rule seeks to address this problem, and for the most part, it should be welcomed by employers who offer wellness programs.
What does the proposed rule say, in a nutshell?
The proposed rule says that a wellness program can still be “voluntary” for ADA purposes if the program provides “incentives” for employees (both rewards and penalties), as long as the employer complies with the wellness incentive requirements of the HIPAA/Affordable Care Act.
There are two caveats: The wellness program would have to be associated with a group health plan (either insured or self-insured), and the EEOC proposals do not exactly match the HIPAA/ACA rules, although they are reasonably close.
Can you give us a recap of the HIPAA/ACA requirements?
Under the HIPAA/ACA scheme, there are two types of wellness programs. A “participatory” program is one that rewards employees just for participating and does not require a specific goal to be met. (An example would be an employer who reimburses employees for fitness club memberships.) Under the HIPAA/ACA, participatory programs can be offered without limitation, as long as they’re available to all similarly situated individuals.
The other type of wellness program is a “health-contingent” program. There are two types of “health-contingent” programs: (1) activity-only programs, in which the employee is rewarded for completing an activity but doesn’t have to achieve or maintain an outcome (for example, “we’ll pay you $100 if you walk a mile three days a week for a year”); and (2) outcome-based programs, in which employees are rewarded for achieving or maintaining results (for example, “we’ll pay you $100 if you keep your BMI at or below 25 for a year, or if you quit smoking”).
If the program is health-contingent, employers are allowed to offer incentives (carrots or sticks) if –
- Employees are allowed to try to qualify at least once a year,
- The total reward offered doesn’t exceed 30 percent of the total cost of employee-only coverage under the plan or the total cost of family coverage if dependents are also allowed to participate in the program (“total” means the employee’s and the employer’s share). The percentage is up to 50 percent for tobacco prevention or cessation,
- The program is reasonably designed to promote health or prevent disease,
- The full reward must be available for all similarly situated individuals, and reasonable alternatives must be offered to those who can’t qualify, and
- The availability of reasonable alternatives must be disclosed in plan materials and in any disclosure telling an individual that he or she did not meet an initial outcome-based standard.
Under the HIPAA/ACA, the 30 percent/50 percent incentive limit applies only to “health-contingent” programs. HIPAA and the ACA have no limit on rewards that apply to “participatory” programs (if the programs are available to all similarly situated individuals).
The EEOC’s proposed rule is slightly different.
How does the EEOC proposed rule contrast with the HIPAA/ACA rule?
The EEOC would allow employers to offer incentives for employee participation in wellness programs associated with group health plans if the total reward does not exceed 30 percent of the total cost of employee-only coverage under the plan for both participatory and health-contingent wellness programs. The EEOC proposed rule does not allow a 50 percent reward level for tobacco cessation programs (unless there are no associated disability-related questions or medical exams), and the total cost used in the reward calculations does not take into account family-level coverage, even where dependents can participate in the program.
In addition, the wellness program must be completely voluntary. The EEOC would define “voluntary” as follows:
- Employees aren’t required to participate in the wellness program,
- Health insurance coverage is not denied or made more difficult to get if the employee chooses not to participate (with the exception of the permitted “incentives”), and
- The employer does not take adverse action against an employee for refusing to participate . . .as this employer allegedly did.
The EEOC invites the public to comment on the proposed rule through June 19. The agency is particularly interested in comments pertaining to how much medical information an employee should be required to disclose to be eligible for an incentive, whether the rule should require that the incentives not render health insurance “unaffordable” within the meaning of the ACA, issues related to the “notice” requirement, how to treat wellness programs that are not associated with group health insurance, as well as other topics.
The employer would also be required to provide a notice “that clearly explains what medical information will be obtained, who will receive the medical information, how the medical information will be used, the restrictions on its disclosure, and the methods the covered entity will employ to prevent improper disclosure of the medical information.”
The wellness program would be required to disclose medical information to the employer only in aggregated, non-individually-identifiable form, “except as needed to administer the health plan.”
Are there any other issues to consider under the HIPAA/ACA?
Although the EEOC rule is currently in proposed form, we expect any final version to still be somewhat different from the HIPAA/ACA requirements for wellness programs. For example, one of the primary requirements of a outcome-based program under HIPAA is the ability of an employee to meet a “reasonable alternative standard” to receive the reward. Participants in the program must be clearly informed of that option, and it remains to be seen how that notification will be coordinated with the notice proposed by the EEOC. A related issue is the intersection of the “reasonable alternative standard” under HIPAA with the reasonable accommodation and interactive process obligations under the ADA. The EEOC’s Interpretive Guidance to the proposed rule says that provision of a “reasonable alternative standard” along with the required notification will generally satisfy the employer’s reasonable accommodation obligations under the ADA, but no specifics are given. Moreover, the Interpretive Guidance notes that under the ADA an employer would have to make reasonable accommodations for an employee who could not be in a “participatory” program because of a disability, even though the HIPAA/ACA rules do not require a “reasonable alternative standard” for participatory programs.
Also, details about wellness programs commonly appear in ERISA-governed summary plan descriptions, so will the EEOC rules also have to appear there as well?
There are similarities between the employee benefits issues affecting wellness programs, on the one hand, and the ADA and employee-relations issues, on the other, but the differences are equally important and will hopefully be addressed by the EEOC in the final rules expected to be issued later this year.
What should employers do?
The proposed rule describes certain employer “best practices,” as follows:
- Employers should ensure that employees who handle medical information know their obligations under the laws.
- Employers should adopt privacy policies for collection and handling of employee medical information, assuming that they have not already done so.
- If medical information is stored electronically, it should be encrypted and other security measures implemented such as password protection and firewalls.
- If possible, employees who handle medical information should not be “making decisions related to employment, such as hiring, termination, or discipline.” If this is not possible, then the employer should ensure that there is no discrimination based on an employee’s disability.
- Breaches of confidentiality should be promptly and effectively addressed, and the affected employees should be informed immediately.
- Employers should take appropriate action against an employee who breaches confidentiality, and should “consider discontinuing” their relationships with vendors who breach confidentiality.
Why doesn’t the EEOC proposed rule have a 50-percent incentive for tobacco-related programs, since the HIPAA/ACA does?
The EEOC explained that it did not include the 50 percent incentive for tobacco programs because, it said, most of those programs do not seek employee medical information at all. If not, there would be no ADA issue. But if a tobacco program does seek such information (for example, through testing for nicotine, or monitoring blood pressure), then the tobacco program would have to be included in computing the 30-percent limit for incentives.
Did the proposed rule address the employer’s right to get medical information from an employee’s family members, who may be covered under the employee’s health insurance and might be eligible for participation in the wellness program?
No, because Title I of the ADA applies only to employers and employees. Medical inquiries about an employee’s family member would, of course, be covered under the Genetic Information Nondiscrimination Act, which is also enforced by the EEOC. The EEOC says it will issue guidance on wellness and the GINA “in future EEOC rulemaking.”
Did the proposed rule contain anything else of interest?
Yes. The EEOC has explicitly disagreed with a wellness/ADA decision from the U.S. Court of Appeals for the Eleventh Circuit, Seff v. Broward County. At issue in the Seff case was a $20-per-paycheck penalty that employees had to pay if they chose not to participate in the county’s wellness program. The court found that the county’s program fell within a “safe harbor” in the ADA, which provides that a covered entity is not prohibited “from establishing, sponsoring, observing or administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks that are based on or not inconsistent with State law.” Because the program fell within the safe harbor, the court said, it was irrelevant whether the program was “voluntary” or whether medical inquiries made in connection with the program violated the ADA.
The EEOC’s position is that this “safe harbor” provision in the ADA does not apply to wellness programs.
Employers who operate in the Eleventh Circuit states of Alabama, Florida, or Georgia can continue to follow Seff for the time being. However, employers who operate in other states may choose to follow the EEOC’s position once its proposal becomes final. The conflict between the EEOC and the Eleventh Circuit will probably be resolved eventually by the courts.
Too Many Choices?
Source: ThinkHR.com
Some of the earliest investment advice given: “Don’t put all of your eggs in one basket.” Its value is enduring. An investor can minimize the risk of losing money by diversifying the allocation of money into different categories of investments. Even within a single category, an investor can choose investment vehicles, such as mutual funds, spreading ownership over an array of financial instruments. Are plan sponsors successful if they offer participants the highest possible amount of mutual funds and other investment choices?
Offering a large number of funds does not equate to success in either the realm of compliance with regulation, nor in achieving maximum levels of employee participation. It is important to offer the appropriate number of choices to empower participants to meet goals for retirement income. It is also important to do this in a manner that allows the employer to meet fiduciary responsibilities.
Fiduciary Responsibility
On one hand, participant-directed accounts, such as many 401(k) plans, give members control over their own investment accounts. On the other hand, the plan sponsor is generally still responsible for the fiduciary liability associated with selecting and monitoring the investment vehicles being made available to participants. Good processes with solid documentation of their application provide the foundation, enabling employees to make good decisions about investments. These factors also position the employer to face an Employee Benefits Security Administration (EBSA) audit without undo fear of negative consequences. Most employers will need to engage the services of a “prudent expert” as a guide along the path of selecting and monitoring appropriate investment opportunities.
A prudent expert financial advisor must be familiar with methods required to deliver comprehensive analysis of investment vehicles. Among these methods is the necessity to establish and track appropriate benchmarks to measure a particular investment’s performance over time. Understanding the purpose of a particular class of investments and how the particular fund being offered relates to its peers is more important than offering a large number of funds in that class.
Sponsors need to maintain an Investment Policy Statement outlining the categories of investments to be offered to participants. This document should also identify the committee and entities responsible for choosing, monitoring, and, when appropriate, replacing the individual investment options offered to participants. This tool will assist the sponsor in seeing when it is appropriate to replace an option instead of just adding new options. Beyond concerns about managing an employer’s exposure to liability, providing a reasonable, yet limited, choice of options can actually improve employees’ willingness to participate in the benefit plan.
Participant Behavior
Fewer choices are better when people do not come into a situation already knowing for sure what they prefer. This describes most employees in their relationship to employee benefit plans. They simply do not know what to do without education. Initially, it may seem logical to grant the widest possible range of options. If surveyed, employees may even indicate a strong preference for unlimited choices. However, the employer’s goal is not to merely capture interest — the goal is to make it easy for employees to participate in a benefit plan and see progress towards fulfillment of their own financial objectives.
The opportunity to make some choices is a good thing for participants. Indeed, it is necessary for employees with participant-directed accounts to be offered options so that they can achieve diversification of their investments. However, too much of a good thing is manifest when participants experience choice overload.
Behavioral scientists are finding choice overload to be a condition people experience when they withdraw from a situation out of fear of making the wrong decision. Often an individual starts off highly motivated as they begin to examine the choices they have been presented. As choice overload sets in, the extensive array of choices becomes demotivating, and the individual may put off a decision to commit or give up entirely.
Sheena S. Iyengar of Columbia University and Mark R. Lepper of Stanford University demonstrated the impact of choice overload when they studied the influence of choice on the purchasing habits of 502 people who were introduced to various selections of exotic jams. They found that 60 percent of the people given the opportunity to choose from 24 items were interested in investigating, but only 3 percent made a purchase. By contrast, only 40 percent of those given the limited choice of 6 items investigated, but 30 percent made a purchase. The average quantities of jam individuals were willing to taste test was less than 2, regardless of whether they were offered an array of 6 or 24.
Employers can promote participation in benefit plans by reducing the complexity of presentations to employees. Making use of competent advisors, employers can present employees with properly labelled choices packaged in a consumer-friendly manner.
5 companies that dropped part-time employee health care
Originally posted on https://ebn.benefitnews.com.
Just 25% of companies that offered employee health insurance made coverage available to part-time workers in 2013, according to the Kaiser Family Foundation. That percentage will decline further with Walmart Stores Inc.’s announcement that it is dropping health insurance for part-time employees. Walmart joins a growing list of major retailers that have done the same.
Target announced in January 2014 that it was dropping coverage for part-time employees. The company said in a blog post that less than 10% of its total employee population participated in that plan.
The world’s largest home improvement retailer said in September 2013 that it was ending coverage for 20,000 part-time employees. Employees with fewer than 30 hours a week were no longer offered limited liability medical coverage, Bloomberg reported. At the time, 5% of the company’s 34,000 employees were enrolled in that plan.
In August 2013, the retailer sent a memo to staff that it was dropping coverage for part-timers, but giving them a check for $500 to find coverage through the public exchanges.
In August 2013, the retailer announced it was cutting some employees’ hours to 29.5 hours, or just under the 30 hour threshold at which the Affordable Care Act mandates coverage be provided. Forever 21 does not provide coverage to part-time employees. In a Facebook note, the company said the decision was made “independent of the Affordable Care Act” and that the change impacted less than 1% of all U.S. store employees.
On Oct. 7, the world’s largest retail chain said it plans to stop offering health benefits to employees who work less than 30 hours a week, or about 2% of its U.S. staff.
7 ways to keep your sanity during open enrollment
Originally posted on https://ebn.benefitnews.com.
‘Tis the open enrollment season in the benefits world. For many benefit managers, that means stress, panic and very long days (and nights). But there are ways to make this time of year less frantic and more productive.
HR cannot run open enrollment in a vacuum. So lean on consultants and communication pros to craft your messaging. Turn to senior leaders for top-down messaging on why changes are happening. Bring in your benefit vendors to explain the impact of changes and walk employees through the enrollment process. Like many things, open enrollment takes a village, so use yours.
Few things can set off a fire drill like systems crashing and just plain misbehaving – especially with online enrollment. Get ahead of the game by partnering with IT to determine how people will enroll, how data will be handled and how it needs to flow between departments (like HR and payroll). Map out contingency plans and decide who will be on point if things go awry.
Be straight-up with employees about what’s changing, why and what they need to do. No spin. No sugar. If you’re making significant plan changes this year, use personas to help people understand how this will affect them. And provide decision guides that walk them through all the variables (particularly deductibles, co-payments, HSA contributions, covered services and provider network details) so they can make the best choice for themselves and their families.
We all put a ton of blood, sweat and tears into benefit planning and open enrollment communications – so much so, that it can become a bit of a one-way street. Keep in mind that this is a time when employees are sitting up straight and paying attention. Ask for their feedback. How do they feel about what’s changing? The benefits overall? Why? What could be done differently? Whether you’re talking with employees at a town hall, engaging with them over social media or asking for their honest responses to a survey, really listen to what they have to say, thoughtfully respond and act on their feedback as much as you can.
We know – right now, it’s all you can do to stay focused on the enrollment at hand. But it’s less daunting than it sounds: what we’re suggesting is that you take employee feedback and lessons learned from this enrollment period and start compiling them for next year. That might be possible benefit changes, new benefits to add or ways to communicate differently. You know what they say about the early bird … and in this case, the sooner you nail down what 12 months from now looks like, the more proactive (and effective) you’ll be when it comes to next year’s systems and communications.
Why not make open enrollment fun – and an opportunity to earn points and prizes? Launch an Open Enrollment Challenge and reward employees for taking various actions, like attending an open enrollment info session, updating beneficiary details and enrolling by a certain date. Or plan an Open Enrollment Walk, where people can head out for a stroll with HR and colleagues, giving them an opportunity to ask benefit questions along the way (and make time afterward too).
Although you may feel like you just don’t have time to take a break, right now you need it more than ever. Along with those enrollment meetings, town halls, social media replies and survey reviews, block time for yourself on the calendar. Go for a run, head out for a relaxing healthy lunch, read a great book, meditate, take a yoga class – whatever makes you happy and keeps you sane.
Nearly One in Four Employers Say Private Health Insurance Exchanges Could Provide a Viable Alternative for Full-Time Active Employees in 2016
Originally posted September 25, 2014 on https://www.insurancebroadcasting.com.
ARLINGTON, Va.--(BUSINESS WIRE)--Results of a July 2014 survey of midsize to large employers by global professional services company Towers Watson (NYSE, NASDAQ:TW) showed that 28% said they had already extensively evaluated the viability of private exchanges. Nearly one in four (24%) said private exchanges could provide a viable alternative for their active full-time employees as soon as 2016.
“Private exchanges are a relatively new path for many employers — one that has only recently become available to provide benefits for active employees”
The results are from the 2014 Towers Watson Health Care Changes Ahead Survey, which was completed by 379 employee benefit professionals from a variety of industries and reflect health care benefit decisions for 2016 – 2017.
The survey also revealed that the top three factors that would cause employers to adopt a private exchange for full-time active employees are:
Evidence they can deliver greater value than their current self-managed model (64%)
Adoption of private exchanges by other large companies in their industry (34%)
An inability to stay below the excise tax ceiling as 2018 approaches (26%)
Public Exchanges Not Considered Viable for Full-Time Active Employees
In contrast, nearly all employers surveyed (99.5%) said they have no plan to exit health benefits for active employees and direct them and their families to public exchanges, with or without a financial subsidy. More than three out of four employers (77%) said they are not at all confident public exchanges will provide a viable alternative for their active full-time employees in 2015 or 2016.
“Private exchanges are a relatively new path for many employers — one that has only recently become available to provide benefits for active employees,” said Dave Osterndorf, a managing director with Towers Watson’s OneExchange. “However, with the Patient Protection and Affordable Care Act’s excise tax top of mind for large employers, and with the potential to cost companies billions of dollars unless they act now to keep the cost of health benefits below government-mandated thresholds in 2018 and beyond, new solutions are necessary. Even employers that have managed to keep increases in their health care benefit costs lower than industry averages are working very hard to maintain that success. Private exchanges offer employers a new opportunity to save on health care coverage with a reduced operational burden, which is the main reason they are more seriously evaluating them for their active employees.”
Data from the 2014 Towers Watson Health Care Changes Ahead Survey revealed that nearly three-quarters (73%) of employers said they are somewhat or very concerned they will trigger the excise tax based on their current plans and cost trajectory. More than four in 10 (43%) said avoiding the excise tax is the top priority for their health care strategies in 2015.
Osterndorf added, “Effective private exchanges can provide value in many ways. For example, as more employers move to account-based health plans, they can realize the promise of avoiding the excise tax while providing the added benefit of putting employees in charge of how their health care dollars are spent. Private exchanges offer more choice, including account-based plans, with the tools and support for helping employees make better health decisions, and recognize the connection between their physical and financial well-being. Employee understanding and engagement are critical to the long-term sustainability of an employer’s program. Private exchanges can accelerate the fulfillment of that goal.”
According to the 19th Annual Towers Watson National Business Group on Health Employer Survey on Purchasing Value in Health Care, released in March 2014, nearly three-quarters of respondents currently offer account-based health plans (ABHPs), with another 9% expecting to add one for the first time in 2015. Nearly 16% of respondents have adopted ABHPs as their only plan option, up from only 7% in 2012. Nearly one-third of all companies could offer ABHPs as their only option by 2015, if they follow through with current plans.
About the Surveys
The 2014 Towers Watson Health Care Changes Ahead Survey offers insights into the focus and timing of U.S. employers’ plans and perspectives related to their health benefits, and their efforts to better manage costs and employee engagement, as well as their planned responses to the business risks associated with the 2018 excise tax. The survey was completed during July 2014 by 379 employee benefit professionals from midsize to large companies across a variety of industries and reflects respondents’ 2014 – 2017 health care benefit decisions. The responding companies comprise a broad range of industries and business sizes, and collectively employ 8.7 million employees.
The 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers’ strategies and practices, and the results of their efforts to provide and manage health benefits for their workforce. This report identifies the actions of high-performing companies, as well as current trends in the health care benefit programs of U.S. employers with at least 1,000 employees. The survey was completed by 595 employers between November 2013 and January 2014. Respondents collectively employ 11.3 million full-time employees, have 7.8 million employees enrolled in their health care programs and represent all major industry sectors.
ABOUT TOWERS WATSON
Towers Watson (NYSE, NASDAQ: TW) is a leading global professional services company that helps organizations improve performance through effective people, risk and financial management. The company offers consulting, technology and solutions in the areas of benefits, talent management, rewards, and risk and capital management. Towers Watson has more than 14,000 associates around the world and is located on the web at towerswatson.com.
New benefit offers education help to parents of special-needs children
Originally posted September 12, 2014 by Andrea Davis on https://ebn.benefitnews.com.
Joanne Burke can’t count the number of hours she spent researching special-needs law and preparing for meetings with educators and therapists about her daughter Gabby’s individualized education plan. Gabby, eight, was born with spina bifida, a birth defect that happens in utero when a baby’s still-developing spinal column doesn’t close all the way. When she was four, Gabby was also diagnosed with a rare form of epilepsy, which caused steep cognitive regression. Today, Gabby primarily uses forearm crutches to get around and attends third grade at a public school.
It is families like Burke’s that led Adam Goldberg to launch myEdGPS, a company that helps parents of children with special needs map out an education plan for their child. It’s a program that can be offered as a standalone employee benefit, and it is also being offered through Bright Horizons, a provider of child care services as part of that company’s suite of employer offerings. The Bright Horizons program, Special and Exceptional Needs, powered by myEdGPS, will be exclusively offered to companies with more than 3,500 U.S. employees by College Coach, a division of Bright Horizons specializing in providing answers to education concerns.
Burke’s employer, an automotive parts supplier based in Michigan where Burke lives with her husband and Gabby, has been supportive of her need for flexibility. They’ve offered Burke a flex-time schedule where she starts at 6:30 a.m. and leaves the office by 2:30 p.m. to collect Gabby from school. And, when she returned to work after Gabby was born, she was able to work from home on days when Gabby had multiple medical appointments. Still, when Gabby was ready to go to school, Burke spent countless hours attempting to figure out the family’s options. While she investigated sending Gabby to a private school, in the end, the private school could not handle Gabby’s multiple needs. Through the public school system, Gabby has access to physical and occupational therapy, as well as speech therapy.
“It's just a lot of juggling. It's almost like having two full-time jobs at once,” says Burke. “The case management aspect of it can be pretty heavy at times. It's not all the time, but if there's any sort of medical issue going on, it can take up a lot more time and effort to manage all of that at once.”
After years of providing private consulting services to parents who could afford to pay for it, Goldberg, who holds a masters’ degree in education with a concentration in assessment, realized that “we were turning away 95% of folks who couldn’t afford to pay for these types of private services,” he says. “This really was the manifestation of my burning desire to democratize the model and be able to scale it through technology so that we could have an impact on millions of children and their families out there.”
One in five children struggle with some type of special or exceptional need and Goldberg estimates that translates into an impact on 10% or more of the workforce. Working parents lose up to five hours a week running around to various doctor, therapist and teacher appointments, to say nothing of the hours they spend filling out paperwork and figuring out who’s paying for what.
Goldberg likens myEdGPS to TurboTax for special education because when parents first enter the online system, they’re asked a series of questions, a virtual intake of sorts. Then, depending on how far long parents are in their journey, the system serves up a series of roadmaps designed to guide parents and give them the necessary information, depending on what their needs and goals are.
They system also includes a virtual binder that can be accessed on any mobile device to help manage and store all the documentation involved. There’s also a calendar feature, which Goldberg says is particularly useful since different states have different timelines for when certain documentation needs to be provided and to whom.
“Once the system knows your child is being educated in Ohio, for example, and you request an evaluation, the system knows to alert you that within X number of school or calendar days, based on Ohio regulations, that you should expect to hear a response back from the school and then it goes to the next step in the timeline,” he explains.
The system also includes a behavioral tracking journal for parents and a letter generator “so that you can get it right the first time when you’re requesting an evaluation from the school or an independent evaluation of the school, or requesting a team meeting to address an issue,” says Goldberg.
Bright Horizons is currently piloting the program with a handful of companies, says CEO David Lissy. It’s included in the company’s core offerings but employers can also customize the program to include in-person education onsite and/or live webinars.
And apart from helping employers with productivity issues, Goldberg says myEdGPS offers the opportunity for tangible savings on health care expenses.
“What most people don't know -- including parents, administrators, and especially employers -- is that the knee-jerk reaction is to go to the medical plan if you suspect something's going on with your child, without any knowledge that you can actually get some of these same exact services from a school,” he explains. “That's a federally mandated system. The two systems [health care and education] really don't talk to each other that well. What we're doing is we're helping empower these parents to be able to understand what their rights are and how to go about it, step by step, finding the right help in the right ways through schools.”
For example, an employee has a five-year-old child who may not be hitting certain developmental milestones. The parent’s first instinct is to take the child to the pediatrician, who then refers the child to a series of specialists. Each visit requires the parent to take time off work, the medical plan incurs costs and the employee may have co-pays to deal with.
“The reality is, at the very beginning you should also be requesting an evaluation through school, because it's free if you ask for it in the right way,” says Goldberg, adding that there’s a whole host of related services, including speech language therapy and some behavioral therapies, that are within the legal construct of the Individuals with Disabilities Education Act.
“All of this fundamentally is supposed to be free and in very many cases overlap with those medical services,” he says.
For Joanne Burke, who researched all of daughter Gabby’s educational and therapeutic needs herself, a service like myEdGPS would have been invaluable. “If I had access to a resource like this it would free up valuable time to address other issues,” she says. “The law is complex and learning how it affects our daughter as well as learning about accommodations and assistive technology is constantly in the back if my mind.”
7 sins of wellness programs
Gold standards are starting to emerge for corporate wellness programs. Virgin Pulse, which has been monitoring wellness program adoption and design, says there are basically two categories extant in the corporate world today: wellness 1.0 and wellness 2.0.
The overarching difference lies in engagement levels. But engagement has been a tricky quality to define, and even harder to achieve. Virgin's idea with 1.0/2.0 is to simplify the process, identify the major components that can lead to engagement, and offer easy-to-adopt methods to begin to grow engagement.
“While wellness 1.0 is a great start to showing your employees you care, it’s limited from the very beginning — many of these programs can be inapplicable and unappealing to a vast majority of people,” Virgin says in “Moving Beyond Wellness 1.0. “They may not offer enough variety or flexibility for people at different stages of their journey to better health. For some, there may be too many barriers to participation for them to overcome.”
Wellness 2.0 programs tend to include options that address three key health areas:
- Exercise options, which make “people more energetic, focused, and productive”;
- Healthy food options and health eating support, which offset “poor nutrition stemming from eating too much sugar, carbs, or fat can actually [which] cause cognitive impairment”; and
- Sleep assistance options, because people who are well rested perform much better on the job than do those who don't get enough sleep.
But beyond those elements, the 2.0 programs don't have the characteristics that Virgin found in programs that are bedeviled by lack of engagement.
Virgin starts by examining the 1.0 level of wellness programs, and offering a list of defects that these low-engagement programs typically display. The Seven Deadly Sins of wellness 1.0 programs are:
- They only target the sick
Positive: Good for those with health issues who want to change.
Negative: Limits the number of employees who will be interested in the program or who can take advantage of what is offered. - They don’t encourage lasting behavior change
Positive: Elements of the program can lead to quick benefits.
Negative: Healthy behaviors aren't reinforced so health gains are often lost later on. - They don’t engage your potential wellness champions
Positive: For those they target, these plans can work well in the short term.
Negative: If the program is all about helping people with health problems get somewhat healthier, the program leaves out the healthy workers who want to further enhance their health. These people can be champions of the wellness plan, Virgin says. But too often they are not considered in plan design, so they don't participate.
- hey lack daily engagement
Positive: There isn't one for this category.
Negative: Poor communications with employees about their wellness options can doom even a robust wellness program. As Virgin notes, “Once the kickoff meeting is over, an employee’s health risk assessment is complete, and they have their login for the wellness site, most don’t engage with the program again until they’re nudged — or as far out as the next wellness kickoff meeting.” Engagement needs to be daily, Virgin argues, to drive engagement. - They focus on HRAs and biometrics alone
Positive: Both are great tools for evaluating the physical well-being of your workforce.
Negative: Too often, the information from HRAs and biometrics screenings isn’t used to create an actionable wellness plan that helps address the health concerns these assessments uncover.
- They only offer rewards upfront
Positive: The upfront “bonus” attracts people to the program initially.
Negative: That bonus is often the only tangible reward employees ever see for participation. “The unfortunate result is that many of the people you’d like to see in your program may very likely disengage after the big initial reward is gone,” Virgin says. - They’re an administrative burden
Positive: Keeps employment strong in the HR department.
Negative: Costly! “The last thing you need is a system that’s tough for you to manage and tough for your people to use. Unfortunately, that’s often what happens with wellness 1.0 programs. The harder it is to administer, the further down the list of priorities it falls.”
How to help alleviate specialty Rx costs
Originally posted September 9, 2014 by Melissa A. Winn on https://ebn.benefitnews.com.
Half of large employers say the cost of specialty pharmacy drugs is their second or third highest cost-driver, behind high-cost claims and special conditions, according to a recent survey by the National Business Group on Health. Brian Marcotte, NBGH’s president, calls the concern “significant,” considering specialty pharmacy currently impacts only about 2% of the population, but advancements in the manufacturing of these expensive drugs threaten to greatly increase the number of employees using them.
As employers consider their 2015 health plan designs, they “are very focused on specialty pharmacy drugs and the potential impact they have” on the company’s bottom-line, says Marcotte. Benefit advisers can add value by offering solutions to reign in the costs of these drugs, including programs to limit the quantity of the drugs dispensed at any one given time, the use of prior authorization to confirm the necessity of the treatment, and even the use of a freestanding specialty pharmacy.
“Benefit advisers should make sure employers are utilizing all of the specialty clinical programs offered by the medical and pharmacy vendors for their benefits,” says Brenda Gagnon, a pharmacy benefit adviser and president and CEO of the health care consulting firm B.M Gagnon Associates.
This is especially true in light of the fact the utilization of the drugs is bound to increase. “Current estimates for specialty medications are that they will cost an employer 50% to 60% of their total health benefits by 2016,” says Gagnon.
That’s true not only because the high cost of developing and manufacturing the drugs is reflected in their high price tag, but also Gagnon says, because “drug manufacturers have put more effort into finding more than one drug therapy for the drug.”
For example, she notes, AbbVie’s Humira is used for rheumatoid arthritis, Crohn’s disease, colitis and psoriasis.
Research and development costs are “passed onto the employer when an employee is taking a specialty medication,” Gagnon adds, saying the cost of the drugs can be anywhere from $1,200 to $12,000 a month, depending on the disease.
Utilization controls
An employer client has no control over the high price tag on these drugs, says Michael Zucarelli, national pharmacy practice leader for the employee benefit and financial firm CBIZ.
Where benefit advisers can help employers tame their client’s drug spend, however, is through health plan options designed to manage these drugs’ utilization, he says.
First and foremost, plans should have some sort of appropriate use protocol or prior authorization. Such a procedure would ensure claims are reviewed to make sure the drugs are safe and effective for the employee, as well as safeguard the plan financially, suggests Zucarelli.
In addition, employers have an opportunity to manage drug use as the number of specialty drugs available to treat any one disease expands, creating competition within the drug classes.
Employers “can now become a little more creative in how they set up their plan. They may prefer one or a couple of treatments over another,” he says.
This can be designed as a formulary in which a less expensive drug option would be covered at 100% and the more expensive option would require the employee to pay 100% of the cost share, he says. Otherwise, it can be set up as a step-therapy program, in which the more expensive drug cannot even be used until the less expensive option has been tried and failed.
“We’re seeing plan sponsors look at that as an option and more are adopting it,” says Zucarelli, adding that he typically advises employers to institute a step-therapy program as soon as possible, while it affects only a small number of plan members.
Advisers can also work with employers on channel management, Zucarelli suggests, saying employers should have a consultant, pharmacy benefit manager, or medical plan carrier evaluate where the drug spend is to gain visibility and look at opportunities for site-of-care management.
“Maybe a patient is getting a particular specialty drug in a hospital infusion suite and that may not be the most convenient or cost-effective treatment,” he suggests.
Gagnon agrees employers can use a third-party consultant company like Artemtetrx, which uses data analytics to evaluate claims data and identify high drug spend and opportunities for cost management across clinical management, reimbursement management, site of care management and plan design.
When an employer client raises a question about a high-dollar claim, Zucarelli says the plan’s PBM or carrier could also be asked to do a case review and insure the patient is taking the high-cost drug for an appropriate use.
“Unfortunately, once an employee is on a certain drug, it’s hard to get them off of it or switch it,” he says, adding that that’s why he suggests employers get a lot of these tactics in place now, before the use of the drugs increases, which is inevitable.
“Getting these management techniques in place now is going to further minimize disruption,” he adds.
5 tips to make retirement education meaningful
Originally posted on https://eba.benefitnews.com.
Through the use of education and communication, employers and benefit advisers can have a huge impact on their employees’ retirement readiness. Making that education meaningful, however, is key to employee engagement and understanding. Here are five tips from Grinkmeyer Leonard Financial and investment advisers with Commonwealth Financial Network on how to make retirement education meaningful.
1. Paint a picture of their "future self"
Employees who can envision their future selves are more likely to understand their financial needs during retirement. The advisers with Commonwealth Financial Network suggest one strategy for embracing your future self is to have employees envision not only their financial retirement goals, but also lifestyle retirement goals. By forcing today’s self to recognize how he or she will look in the future, employees are more likely to save for that future, they say.
2. Help them plan for an achievable number
For too long the financial services industry has focused on the daunting pot of money people should accumulate in order to retire, the advisers say, adding that breaking the number down to monthly saving increments is less scary and seems more achievable to employees.
3. Account for health care
A 2013 study conducted by Fidelity's Benefits Consulting Group estimated that out-of-pocket health care costs for a 65-year-old couple with no employer-provided retiree health care will be $220,000, assuming a life expectancy of 17 years for the man and 20 years for the woman. As part of a comprehensive financial education plan, the Commonwealth Financial Network advisers say it is imperative that medical and insurance costs be incorporated into the retirement planning discussion.
4. Start 'em young
The power of compounding interest is evident in retirement plan balances, the advisers say, adding that evidence has shown the benefits of starting to save at a young age. Interest adds up over time, so even starting to save at 30 instead of 40 can save exponentially more money.
5. Keep the message relatable
Paramount to the success of any education strategy is using simple terms and relatable examples to illustrate potentially complex issues, the advisers say. For example, telling a group of participants that inflation will erode the buying power of their dollar over the entirety of their retirement may be lost in translation, they say. But telling that same group of participants that the $5 sandwich they enjoy today will cost $22.93 in 30 years will likely keep their eyes from glazing over.
Better understanding of benefits helps both employee and employer
According to new research from Unum, a recent survey of more than 1,500 employees shows only half of U.S. employees would rate their employer as excellent or very good. Even less than that, the 47% who were offered benefits by their employer, rated the actual benefits as excellent or very good — some of the lowest ratings for benefits the Unum has seen in recent years.
The data points to a lack of employees getting information needed on the benefits being offered. Only 33% of those surveyed who were asked to review benefits in the prior year rated the benefits education they received as excellent or very good — a drop from 2012 and reversal of the upward trend since 2009.
“Offering employees effective benefits education can contribute to satisfaction with their employer,” says Bill Dalicandro, vice president of the consumer solutions group at Unum. “Even if employees don’t have a particularly good benefits package, those who say they received quality education about the benefits they are offered are far more likely to consider their employer a very good place to work.”
Employers can also get a win when providing educational guidance in choosing the right benefits. Correlation between employee satisfaction with their benefits continues to run parallel with overall employer satisfaction.
More than three-quarters of those employees who rate their benefits package as highly also rate their employer as an excellent or very good place to work. By contrast, only 17% of employees who consider their benefits package to be fair or poor rate their workplace as excellent or very good.
Additionally 79% of employees who reviewed benefits in the past year and rated their education as excellent or very good also rate their employer as excellent or very good — compared to 30% who said the education they received was fair or poor.
The survey also found:
- 40% of employees say they understand supplemental medical coverage somewhat or very well.
- 47% say they understand critical illness insurance somewhat or very well
- 48% whose employers offered long or short term disability insurance said no one explained disability insurance to them.
- 66% agree employers should do a better job educating employees about these important benefits.
“This research underscores the value of an effective benefits education plan, because when an employee understands their benefits, they tend to value them more and in turn may then value their employers more for providing access to them,” Dalicandro adds.