New direct primary care rules are a tough pill for HSAs

For many Americans, direct primary care has taken control of medical costs, which has cut through many frustrating options and has created a peach of mind when it comes to both health and its costs. Read this blog post to learn more


As an employee benefits attorney and compliance consultant, last summer’s executive order on “improving price and quality transparency in American healthcare to put patients first” piqued my interest. In particular, I honed on in section 6(b), aimed at treating expenses related to direct primary care arrangements as eligible medical expenses.

As someone dealing with a complicated medical history, digging into the order and digesting the resultant proposed IRS rule was more than my job – it was and is part of my life.

Several years ago, I decided to give direct primary care a try. For about $100 a month, I gained direct access to and the undivided attention of a physician who knows me and my unique medical needs. I pay a flat, upfront fee and my doctor coordinates and manages my treatment, which isn’t always smooth sailing for someone dealing with a complex connective tissue disorder. My primary care physician serves as the coach and quarterback of my medical care, directing tests, meds, and visits to various specialists like rheumatologists or neurologists. If I have a common cold or infection, she’s readily available to prescribe treatment and set my mind at ease.

Since arriving on the scene in the 2000s, direct primary care has grown in popularity and availability. In the age of skyrocketing monthly premiums and a multitude of confusing options, more Americans are flocking to direct primary care to supplement their existing coverage. Some employers are even looking at it to drive down costs.

Now, direct primary care only covers, well, primary care, so I’ve paired it with a high-deductible healthcare plan and a health savings account to pay for my many additional medical expenses. I’m not alone: more than 21 million Americans are following the same path.

However, rather than making direct primary care more accessible, the proposed regulations actually make it virtually impossible for all of us with HSAs. Remember, by law, to qualify for an HSA, individuals must be covered by a high deductible health insurance plan. The rationale for this is consumers with more on the line are more responsible in controlling their health care costs and thus rewarded with the tax-advantaged benefits of an HSA.

Here’s the problem: the proposed regulations define direct primary care as a form of insurance – one that is not a high-deductible health plan and would therefore disqualify me from having access to an HSA.

Regulators point out that direct primary care arrangements provide various services like checkups, vaccinations, urgent care, lab tests, and diagnostics before the high deductible has been satisfied. According to the preamble to the proposed regulations, “an individual generally is not eligible to contribute to an HSA if that individual is covered by a direct primary care arrangement.”

Keep in mind, 32 states consider direct primary care a medical service rather than a health plan and exempt it from insurance regulation. Even the Department of Health and Human Services shares that view, noting in a March 12, 2012, final exchange rule that “direct primary care medical homes are not insurance.” In addition, the proposed rule itself includes some contradictory language and implications when it comes to defining direct primary care relating to other factors.

By its very nature, direct primary care is a contract between patient and physician without billing a third party. In cutting out the insurance companies, it seems obvious that direct primary care is not a competing insurance plan, but instead, a valuable service that can accompany existing coverage.

Furthermore, there is no clear justification for painting direct primary care as disqualifying medical insurance for those with HSAs. The IRS has more than enough flexibility and discretion to determine that direct primary care does not count as insurance. Regulators could do so while still treating direct primary care as a tax-deductible medical expense, which seems to be the intention of the proposed rule in the first place.

For millions of Americans, direct primary care has been a godsend in taking control of medical care, cutting through frustrating options, and gaining peace of mind when it comes to both health and healthcare costs. In short, direct primary care is everything primary care should be and was supposed to be. It’s an option that individuals should be permitted to access to complement (not compete with) high deductible health insurance plans and HSAs.

Although the comment period for the proposed regulations is now over, I am hopeful with a few tweaks and small changes they can better align with the stated purpose of the executive order, empowering patients to choose the healthcare that is best for them. If not, the new rules would likely be a hard pill to swallow for the entire direct primary care community.

SOURCE: Berman, J. (26 August 2020) "New direct primary care rules are a tough pill for HSAs" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/new-direct-primary-care-rules-are-a-tough-pill-for-hsas


Overview of COVID-19 Law and Guidance for Health and Welfare Plans

The business operations of many small and large companies have been significantly affected due to the coronavirus pandemic. During this time, health and benefit plans are also being affected. Read this blog post to learn more.


The COVID-19 pandemic has significantly affected the business operations of small and large employers alike. To mitigate the harm from the pandemic to employers, the government has enacted major legislation and issued numerous guidance in the past few months pertaining to COVID-19, including rules that address various aspects of employee benefits.

This article provides an overview of significant COVID-19 legislation and guidance related to employer-sponsored health and welfare benefit plans that has been enacted or issued to date.

Some of these changes are mandatory for group health plans. Other are optional. Employers should carefully review these rules to determine any compliance obligations as well as any opportunities to benefit their businesses and respective employees.

Mandated Coverage of COVID-19 Testing (Mandatory)

Effective March 18, 2020 and until the end of the national emergency period for COVID-19, the Families First Coronavirus Response Act (FFCRA) requires group health plans to cover:

  • COVID-19 diagnostic testing.
  • Certain items and services that result in an order for, or administration of, the testing.

Plans must provide this coverage without imposing any requirements for cost-sharing, prior authorization, or medical management.

CARES ACT

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which was signed into law on March 27, 2020, amended the FFCRA's coverage mandate to:

  • Expand the scope of COVID-19 diagnostic tests that must be covered.
  • Include rules regarding the rate at which a plan must reimburse a health care provider for the mandated services.
  • Require coverage of preventive services and vaccines for COVID-19 as of 15 days after such a service or vaccine is given an "A" or "B" rating in a recommendation by the U.S. Centers for Disease Control and Prevention (CDC) or U.S. Preventive Services Task Force.

ADDITIONAL GUIDANCE

On April 11, 2020, the FFCRA and CARES Act FAQs provided additional information about this COVID-19 mandate. Items included details on required coverage of COVID-19 antibody tests, rules regarding required disclosures of the new coverage to plan participants, and which items and services related to COVID-19 testing must be covered by a plan.

Continuation of Health Benefits During Certain Leaves of Absence (Mandatory)

The FFCRA also requires (with some exceptions) employers with fewer than 500 employees to provide certain paid sick leave and family and medical leave related to certain COVID-19 reasons, as follows:

  • Paid sick leave. An applicable employer must provide two weeks of emergency paid sick leave (EPSL) to an employee who is unable to work (or telework) due to certain reasons related to COVID-19. Reasons include quarantining of an employee (due to a Federal, state or local order or advice from a health care provider) experiencing COVID-19 symptoms, caring for an individual who is quarantined, and caring for a child under age 18 whose school or child care provider is closed.
  • Family and medical leave. The employer must also provide up to twelve weeks of expanded Family Medical and Leave Act (FMLA) leave (ten of which is paid) for an employee who has been employed for at least 30 days and who is unable to work (or telework) due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.

During FMLA leave, an employer is required to allow the employee to continue his or her group health coverage at the same premium rate as that of active employees. The DOL has also issued FAQs stating that employers must continue employees' coverage during EPSL, as well. Note, there are also implications for retirement plans under the FFCRA and CARES Act. Although those retirement plan rules are not discussed in this article, some of the CARES Act rules are conceptually similar for retirement plans (e.g., 401(k) plans may allow participants to take "Coronavirus-related" 401(k) plan distributions due to certain COVID-19 reasons).

High-Deductible Health Plans and Health Savings Accounts (Optional)

IRS GUIDANCE

IRS Notice 2020-15 (March 11, 2020), which was issued prior to passage of the FFCRA and CARES Act, provided that a high-deductible health plan (HDHP) will not lose its HDHP status if it covers COVID-19 testing and treatment before the statutory minimum HDHP deductible is met. Therefore, the plan can cover those COVID-19 related services without causing participants to be ineligible to contribute to a health savings account (HSA). IRS Notice 2020-29 (May 12, 2020) clarified that the provisions in Notice 2020-15 apply to an HDHP's reimbursement of expenses incurred on and after January 1, 2020.

CARES ACT

The CARES Act amended the HSA rules to provide that, for plan years before December 31, 2021, an HDHP does not lose its HSA-eligible status if it covers telehealth and other remote healthcare services before the HDHP deductible is met. This CARES Act provision is broader than the IRS Notices, as it provides that an HDHP can cover telehealth services regardless of whether the services are related to COVID-19. The CARES Act also allows participants to use their HSAs, health flexible spending accounts (FSAs), and health reimbursement arrangements (HRAs) to pay for certain over-the-counter drugs without a prescription as well as certain menstrual care products.

Extended Form 5500 Filing Deadline for Certain Plans (Optional)

IRS Notice 2020-23 (April 9, 2020) extended certain deadlines for a plan to file the required annual Form 5500. Under Notice 2020-23, the Form 5500 deadline was extended to July 15, 2020 for any plan whose plan year ended in September, October, or November 2019 (or any plan that was given a filing extension between April 1 and July 15, 2020). Ordinarily, a plan must file its Form 5500 (absent an extension) by the last day of the seventh month following the end of the plan year.

Relief for Certain Disclosures Required by ERISA (Optional)

EBSA Disaster Relief Notice 2020-01, which was issued by the DOL on April 28, 2020, extended the deadlines for plans to provide certain notices and disclosures under Title I of the Employee Retirement Income Security Act of 1974 (ERISA). Under Notice 2020-01, a plan will not be treated as violating ERISA if it fails to timely furnish a notice, disclosure, or document required by Title I of ERISA between March 1, 2020 and 60 days after the announced end of the national emergency declaration for COVID-19. The plan fiduciary, however, must act in good faith to furnish the notice, disclosure, or document as soon as administratively practicable. For this purpose, a plan fiduciary can meet the "good faith" standard by furnishing a document electronically if it reasonably believes that the recipient has access to electronic communication.

Extensions of Certain Plan Deadlines (Mandatory)

A joint notice issued by the DOL and IRS (published May 4, 2020) required group health plans to extend certain timeframes for participants during the "outbreak period" (defined as the period from March 1, 2020 until 60 days after the announced end of the national emergency for COVID-19). Those plans are required to disregard the outbreak period for purposes of determining the following periods and dates:

  • The 30-day/60-day special enrollment period under the Health Insurance Portability and Accountability Act (HIPAA).
  • The 60-day deadline for a qualified beneficiary to elect continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
  • The deadlines for a COBRA qualified beneficiary to pay his or her required COBRA premiums.
  • The deadline for an individual to notify the plan of COBRA certain qualifying events (e.g., divorce).
  • The deadlines for a participant to file benefit claims, appeals, and external review requests with the plan (or to perfect an external review request).

Because of this joint notice, a group health plan must essentially "pause" the above deadlines during the outbreak period. For example, if an individual experienced a COBRA qualifying event on March 1, 2020, the individual would have until 60 days after the end of the outbreak period (rather than 60 days after March 1) to elect COBRA coverage. This is because the joint notice requires a group health plan to pause the 60-day timeframe for COBRA elections during the outbreak period. Also, because the joint notice was issued on May 4 and is retroactive to March 1, plans may be required to re-process previous claim denials that were based on a participant's failure to meet one of the above deadlines between March 1 and May 4.

Cafeteria Plans and Flexible Spending Accounts (Optional)

2020 MIDYEAR ELECTION CHANGES

IRS Notice 2020-29 (May 12, 2020) relaxed the rules regarding cafeteria plan pre-tax elections in light of the COVID-19 pandemic. Under Notice 2020-20, employers may (but are not required to) amend their cafeteria plans to allow participants to make the following mid-year, pre-tax election changes in 2020:

  • An election to enroll in the health plan by an eligible employee who previously declined coverage (e.g., someone who waived coverage during open enrollment).
  • An election to change plan options (e.g., from an HMO to a PPO) or add dependents.
  • An election to drop coverage by a participant.
  • An election to enroll in or drop health FSA or dependent care FSA coverage or to increase or decrease health FSA or dependent care FSA contributions.

An employer that wishes to adopt any of all of the above cafeteria plan changes must disclose the changes to employees and amend its cafeteria plan by no later than Dec. 31, 2020 (i.e., an amendment is not required in advance of making the changes).

EXTENDED GRACE PERIOD TO INCUR FSA CLAIMS AND INCREASE OF MAXIMUM HEALTH FSA CARRYOVER AMOUNT

Notice 2020-29 also permits employers to amend their health and dependent care FSAs to allow employees to incur eligible claims through the end of the 2020 calendar year for any FSA plan year (or for any FSA grace period that ends in 2020). For example, if a health FSA has a grace period until March 15, 2020 for a participant to incur eligible claims for the 2019 plan year, the FSA can allow participants to incur expenses through 2020 and use their 2019 elections to pay for those expenses.

This change does not apply to FSAs with a carryover provision. IRS Notice 2020-33 (May 14, 2020), however, provides for a permanent FSA carryover increase based upon annual indexing. For the 2020 plan year, employers may amend a cafeteria plan with carryover provision to allow participants to carry over up to $550 in unused health account balances in the 2021 plan year. An employer that adopts the extended FSA grace periods or the increased carryover limit must amend its cafeteria plan or FSA (as applicable) by no later than December 31, 2021.

Tax-Free Payment of Employees' Student Loans (Optional)

The CARES Act amended Section 127 of the Internal Revenue Code (education assistance programs) to permit employers to pay up to $5,250 of an employee's student loans on a tax-free basis. This provision applies from the date of enactment of the CARES Act (March 27, 2020) through the end of 2020. The payment must be for either the principal or interest of a qualifying education loan incurred by the employee, and the employer can make payment either directly to the lender or as a reimbursement to the employee.

Takeaways for Employers

As employers grapple with the impact of the COVID-19 pandemic and return to normal business operations, it is important for them to be aware of their compliance obligations under the FFCRA, CARES Act and other guidance issued by governmental agencies. Employers should also carefully review the guidance and legislation for potential avenues of benefit for their business and employees.

Additional guidance for both mandatory and optional items is likely forthcoming as well, and COVID-19 continues to have a major impact on both companies and individuals as new infections spike in numerous states. Accordingly, employers would be well-advised to keep a close eye out for new legislation and guidance in the coming months and periodically evaluate their benefits programs for compliance and competitive considerations.

SOURCE Tyler Hall, A.; Schillinger, E. (16 July 2020) "Overview of COVID-19 Law and Guidance for Health and Welfare Plans" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/overview-of-covid-19-legislation-and-guidance-for-benefits-plans.aspx


Rising cost of healthcare is hurting HSAs

With HSA's providing a way for users to be able to reduce out-of-pocket costs for healthcare, deductibles still continue to rise. Read this blog post to learn more about why continuously raised healthcare costs are hurting current HSA's and HSA's that could be used for retirement.


Employees are increasingly putting money aside for their HSAs, but they’re using almost the entirety of it to cover basic health needs every year instead of saving the money for future expenses, according to Lively’s 2019 HSA Spend Report.

“People are putting money in and taking money out on a very regular basis, as opposed to trying to create some sort of nest egg for down the road,” says Alex Cyriac, CEO and Co-Founder of Lively.

The San Francisco-based HSA provider says 96% of annual contributions were spent on expected expenses and routine visits as opposed to unexpected health events and retirement care. In 2019, the average HSA account holder spent their savings on doctor visits and services (50%), prescription drug costs (10%), dental care (16%), and vision and eyewear (5%).

The rising cost of healthcare is a factor in these savings trends: Americans spent $11,172 per person on healthcare in 2018, including the rising cost of health insurance, which increased 13.2%, according to National Health Expenditure Accounts. For retirees, the figures are shocking: a healthy 65-year-old couple retiring in 2019 is projected to spend $369,000 in today’s dollars on healthcare over their lifetime, according to consulting firm Milliman.

“Because people can't even afford to save, there's going to be a very low likelihood that most Americans are going to be able to afford their healthcare costs in retirement,” says Shobin Uralil, COO and Co-Founder of Lively.

HSAs were intended to be a way for consumers to save and spend for medical expenses tax-free. Additionally, its biggest benefit comes from being able to use funds saved in an HSA in retirement — when earnings are lowest and healthcare is most expensive. However, just 4% of HSA users had invested assets, according to the Employee Benefit Research Institute.

While HSAs have surged in popularity as a way for more Americans to reduce overall out-of-pocket healthcare spending, more education is required to help account holders understand the benefits of saving and investing their annual contributions for the long-term, the Lively report states.

“As deductibles continue to rise, people just don't seem to have an alternative source for being able to fund those expenses, so they are continuing to dip into their HSA.” Cyriac says. “I think this is just reflective of the broader market trend of healthcare costs continuing to rise, and more and more of those costs being disproportionately passed down to the user.”

SOURCE: Nedlund, E. (29 January 2020) "Rising cost of healthcare is hurting HSAs" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/rising-cost-of-healthcare-is-hurting-hsas


Starbucks Unveils Mental Health Initiatives for Employees

Did you know: One in Five United States adults experiences mental illness. According to the World Health Organization, work is good for mental health but a negative environment can lead to physical and mental health issues. Starbucks has announced that they have launched an app for its employees to improve their mental health along with their anxiety and stress. Read this blog post to learn more about how Starbucks is creating mental health benefits for their employees.


Starbucks has launched an app to help its employees improve their mental health and deal with anxiety and stress.

The global coffee company also announced it will be retooling its employee assistance program based on feedback from employees and mental health experts. It plans to offer training to its U.S. and Canada store managers on how to support workers who experience a mental health issue, substance-abuse problem or other crisis.

Every year, one in five U.S. adults experience mental illness and one in 25 experience serious mental illness, according to the National Alliance on Mental Health. And more people are killing themselves in the workplace, according to the Washington Post. The number of such suicides increased 11 percent between 2017 and 2018. Employers, the Post reported, "are struggling with how to respond."

Business Insider reported that some Starbucks employees it interviewed about the initiatives said much of their stress comes from the company cutting back on hours and relying on employees to work longer shifts with fewer people and no pay increase.

The World Health Organization points out that while work is good for mental health, a negative environment can lead to physical and mental health problems. Harassment and bullying at work, for example, can have "a substantial adverse impact on mental health," it said. There are things employers can do, though, to promote mental health in the workplace; such actions may also promote productivity.

SHRM Online has collected the following articles on this topic from its archives and other sources.

Starbucks Announcements Its Commitment to Supporting Employees' Mental Health 

The company released a statement Jan. 6 about additions to its employee benefits and resources that support mental wellness.

"Our work ahead will continue to be rooted in listening, learning and taking bold actions," it said. In the past, that has included tackling topics such as loneliness, vulnerability "and the power of small acts and conversation to strengthen human connection."
(Starbucks)

Mental Illness and the Workplace  

Companies are ramping up their efforts to navigate the mental health epidemic. Suicide rates nationally are climbing, workers' stress and depression levels are rising, and addiction—especially to opioids—continues to bedevil employers. Such conditions are driving up health care costs at double the rate of illnesses overall, according to Aetna Behavioral Health.

Starting workplace conversations about behavioral health is challenging because such conditions often are seen as a personal failing rather than a medical condition.
(SHRM Online)   

Research: People Want Their Employers to Talk About Mental Health 

Mental health is becoming the next frontier of diversity and inclusion, and employees want their companies to address it. Despite the fact that more than 200 million workdays are lost due to mental health conditions each year—$16.8 billion in employee productivity—mental health remains a taboo subject.
(Harvard Business Review)   

Viewpoint: Addressing Mental Health in the Workplace 

Companies are reassessing their behavioral health needs and are looking to their health care partners for creative, integrated and holistic solutions. Many are turning to employee assistance programs for help.
(Benefits Pro)  

4 Things to Know About Mental Health at Work 

Kelly Greenwood graduated summa cum laude from Duke University with degrees in psychology and Spanish. She holds a master's degree in business from Northwestern University's Kellogg School of Management, contributes to Forbes magazine and is editor-at-large for Mental Health at Work, a blog on Thrive Global.

She also is someone who has managed generalized anxiety disorder since she was a young girl. It twice led to debilitating depression. She shared four things she wishes she had known earlier in her life about mental health.
(SHRM Online)   

Employers Urged to Find New Ways to Address Workers' Mental Health 

An estimated 8 in 10 workers with a mental health condition don't get treatment because of the shame and stigma associated with it, according to the National Alliance on Mental Illness. As a result, the pressure is growing on employers to adopt better strategies for dealing with mental health.
(Kaiser Health News)  

Mental Health 

Depression, bipolar disorder, anxiety disorders and other mental health impairments can rise to the level of disabilities under the Americans with Disabilities Act that requires employers to make accommodations for workers with such conditions.

This resource center can help employers understand their obligations and address their workers' mental health.
(SHRM Resource Spotlight)

SOURCE: Gurchiek, k. (14 January 2020) "Starbucks Unveils Mental Health Initiatives for Employees" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/starbucks-unveils-mental-health-initiatives-for-employees.aspx


New drug plan would curb exorbitant pharmaceutical costs

California Governor, Gavin Newsom has proposed a pharmaceutical plan to cut costs of pharmaceutical prescriptions. It was suggested that using low prices obtained by the state, could help other buyers. Read this blog to learn about how California Governor is purposing an attempt to lower costs for California residents.


California’s governor unveiled plans to establish a state-run generic-drug wholesaler, as part of a series of measures that together would constitute one of the furthest-reaching attempts to curb pharmaceutical costs in the U.S.

Gov. Gavin Newsom on Thursday also proposed creating a single market that would allow drug buyers to pool their bargaining power to drive down costs. And Newsom suggested using low prices obtained by the state’s Medicaid program to aid other buyers, among other steps.

The most populous U.S. state, California has a history of using its economic muscle to try to influence national policy on everything from auto emissions to health care. The drug-pricing proposals, which in some cases appear to require new law, are likely to be opposed by a pharmaceutical industry that has formidable economic and legal wherewithal of its own.

“These nation-leading reforms seek to put consumers back in the driver seat and lower health care costs for every Californian,” Newsom, a Democrat, said in a statement.

The plans, released as part of the state’s proposed 2020-2021 budget, are almost certain to face substantial practical, political and legal hurdles. For example, the proposal to create a state-run drug label would rely on drug companies to supply inventory on a contract basis.

Companies could balk at that notion if it stands to further compress their margins. Major generic manufacturers, including Mylan NV and Teva Pharmaceutical Industries, have struggled to turn a profit on some widely used medications. For higher-cost generic drugs, there can be few competing manufacturers with the licenses to produce the pills for the U.S. market.

Creating a single buying pool could run into difficulties, as well. Newsom’s proposal says state programs, health insurers and private employers would band together as a sole buyer, and that drugmakers would have to offer their products at one price to the entire market.

But that could limit patient access to medications if pricing disputes lead drug companies to withhold their products. In Europe, negotiations between drugmakers and government health programs have resulted in some expensive drugs not being available, one of the trade-offs for the continent’s typically lower costs. It’s unclear if California could successfully hold together a large pool of independent buyers in the face of pressure from patients unable to access treatments.

SOURCE: Bloomberg News (09 January 2020) "New drug plan would curb exorbitant pharmaceutical costs" (Web Blog Post). Retrieved from benefitnews.com/articles/new-c-a-drug-plan-would-curb-exorbitant-pharmaceutical-costs


How to maximize employee participation in HSA plans

According to the Employee Benefit Research Institute (EBRI), 96 percent of HSA account holders do not invest any portion of their contributions. Health Savings Accounts (HSAs) offer account holders the option to invest and investments are not subject to taxation. Read this blog post to learn more about maximizing employee participation in HSA plans.


High-deductible health plans (HDHPs) not only offer employees the opportunity to save on their premium contributions, they also provide access to what are commonly touted as triple-tax-advantaged health savings accounts (HSAs).

HSA users can put away money tax-free, and account distributions for eligible healthcare costs aren’t subject to federal income tax. Plus, these accounts offer users the option to invest and any investment returns aren’t subject to taxation. Not even the storied 401(k) promises this much bang for the proverbial buck. In fact, HSAs offer the best of pre-tax 401(k) and Roth contributions.

But, no matter how sweet a tax deal this is, for most of the over 25 million account holders, investing takes a back seat to current healthcare needs. According to EBRI, 96% of account holders don’t invest any portion of their balance, which leaves just 4% taking advantage of all three tax-advantaged components of the HSA. Instead, HSA users fall into two distinct categories: spenders and savers, with spenders representing over three-quarters of account holders.

In 2017, the average deductible for employee-only coverage was $2,447 and almost a quarter of employees covered under one of these plans had a deductible of $3,000 or more.

Let’s imagine it’s 2017, and our sample employee — let’s call her Emily — has a $2,500 deductible. Emily funded her HSA to the 2017 maximum of $3,400. If Emily had healthcare costs that totally eroded her deductible and she used her HSA dollars to fund them, at the end of the year Emily would have $900 left in her account ($3,400 maximum minus $2,500 to cover her deductible). That assumes no additional cost-sharing or eligible expenses.

However, Emily is in the minority. Only 13% of employees are fully funding their accounts, rendering an investment threshold potentially out of reach for most people, especially when they are using their HSA dollars for out-of-pocket healthcare costs.

With such a small percentage of HSA owners taking advantage of investment opportunities, finding effective ways to support the spending or saving habits of the majority of users seems to be tantamount. So is helping them address their concerns about deductible risk. As employers help people become smarter consumers, they may be able to build their accounts over time and ultimately pull the investment lever.

So, how can employers support these spenders and savers?

Encourage people to contribute, or to contribute moreEBRI found that only half of account holders put anything in their HSA in 2017, and just under 40% of accounts received no contributions — including employer dollars. Employer contributions can help overcome employees’ reluctance to enroll in an HDHP, but the way they are designed matters. Matching contributions act as a strong incentive for employees to save while also protecting the most vulnerable employees from having to shoulder the entire burden of out-of-pocket healthcare costs.

Another technique to help address employees’ anxiety around a high deductible is to pre-fund out-of-pocket costs by allowing employees to borrow from future contributions. If the employee incurs costs but doesn’t have enough HSA dollars to cover them, they can use future contributions as an advance against current out-of-pocket expenses. The employer provides the funds up front and the employee pays back those funds through payroll deductions. This acts as a safety net for new account holders or those without substantive balances.

Drive people toward the maximum contribution. With fewer than 20% of employees fully funding their HSA, there’s certainly room to move the needle. While additional contributions may not be possible for all employees, reinforcing the tax advantages and the portability of the HSA may help people divert more dollars to insulate themselves against healthcare costs.

Highlight ways to save on healthcare costs. When employees are funding their care before meeting a high deductible, help them spend those HSA dollars wisely. Promote telehealth if you offer it and remind employees about the most appropriate places to get care (for example, urgent care versus the emergency room). Reinforce the preventive aspects of your healthcare plan, including physicals, screenings and routine immunizations. If you have a wellness program that includes bloodwork and biometric testing, make sure you tie this into your healthcare consumerism messaging. There’s generally a lot of care employees can get at no cost, and it helps when you remind them.

Don’t lose contributors to an over-emphasis on investing. The tax advantages of investing in an HSA are undeniable, but most people are just not there yet. When we describe HSAs as a long-term retirement savings vehicle, we may inadvertently be messaging to non-participants that these accounts aren’t for them. Speak to the majority with messaging around funding near-term healthcare costs on a tax-advantaged basis and the flexibility to use HSA dollars for a wide variety of expenses beyond just doctor and pharmacy costs. Investing information should be included, but it shouldn’t be the primary focus.

HSAs are gaining in popularity, and the majority of account holders are using them to self-fund their healthcare, which is a good thing. A small but growing number are taking advantage of their plans’ investment options. Employees eventually may become investors as their accounts grow and they better understand the opportunity to grow their assets and save for the longer term. For now, however, the educational and engagement focus for HSA plan sponsors should primarily be around participation, maximizing contributions and spending HSA dollars wisely.

SOURCE: Cosgray, B. (6 December 2019) "How to maximize employee participation in HSA plans" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/how-to-maximize-employee-participation-in-hsa-plans


Improving your employee experience during open enrollment

Is your company open enrollment hosted on an online platform? Employers often struggle with employee participation during the open enrollment season. Hosting enrollments online is one way to increase employee participation this year. Read on for more tips to help ease this open enrollment season.d


For HR professionals, open enrollment is one of the most stressful and demanding times of the year. Many employers struggle with employee participation and expensive, time-consuming roll-outs. They also have to provide resources to help employees make the right plan selections for themselves and their families. As we head into another open enrollment season, consider these tips to ease the process.

Switch your open enrollments to online platforms.

If you’re still relying on paper enrollment forms, you are likely spending more money and time than you need to in pursuit of your manual work process and its many inconsistencies. Online platforms provide optimum efficiency, accuracy and convenience for your workforce, offering employee self-service options that encourage employees to take initiative in selecting the best plan for their situation. Not only will members of your workforce benefit from the convenience of being able to explore their options on their own time, but you’ll be able to offer them multi-lingual enrollment materials and have more time to assist them than ever before.

Prioritize and diversify communication.

One of the top ways to ensure a smooth open enrollment period is to use multiple communication channels, including frequent reminders regarding open enrollment deadlines. Without consistent outreach on the part of your HR officers and general managers, you will likely find yourself hunting people down to meet your enrollment and extension deadlines. Using an online self-service portal as well as traditional in-person meetings allow you to remind your employees of critical dates and changes as enrollment closes in.

The robust benefits administration system you choose should offer enrollment tracking and reporting features so you can see at a glance who still needs to begin open enrollment, who has left enrollment documents incomplete, who has made changes to their benefits (such as adding a dependent) and more. You can arrange for the system to send automatic reminders to signal the employee that further actions are needed. Providing multiple reminders will improve participation and the completion of on-time enrollments.

Help employees choose the best health plan for their situation.

In order to have the most successful open enrollment period possible, educating your employees on the different plan options available will go a long towards ensuring employee satisfaction. Studies have shown that most employees don’t have the necessary understanding of terms like “deductible” and “coinsurance,” let alone the tools to know which plan is best for their individual needs. Incorporating at-a-glance comparison tools and charts into your online or print enrollment materials can help employees make the most informed decision possible. It can also be helpful to provide educational materials like videos and simplified plan charts or cost calculators.

Keep Up with Benefit Trends and Voluntary Offerings.

Given the current labor shortage and competitive talent market, you’ll want to make sure your company is up to speed on which new benefits your competitors are looking to add, as well as which ones are appealing to specific roles, locations or generations within potential candidates from your hiring pool.

Voluntary benefits, for example, are playing an increasingly important role in employee benefits portfolios and they don’t cost you anything. Some of the most popular voluntary benefits right now include identity theft protection, pet insurance, long term care insurance and critical illness protection. If you aren’t currently offering these types of additional benefits, they could be a cost-effective way to boost employee morale, increase participation in enrollment and attract more workers to your business.

SOURCE: Smith, M. (2 December 2019) "Improving your employee experience during open enrollment" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/improving-your-employee-experience-during-open-enrollment


Getting digital transformation in healthcare on the fast track

Outdated protocols, overextended workforces and hundreds of wasted hours in administrative tasks are just a few of the opportunities for a digital overhaul in the healthcare industry. There are tremendous opportunities for digital transformation in the healthcare industry. Read this blog post to learn more.


At first glance, the healthcare field seems to be a goldmine for digital innovation. An overextended workforce, outdated protocols, hundreds of wasted hours in administrative tasks, a patient population that is wide open to digital solutions, a multitude of inefficiencies and redundancies — the opportunities for digital overhaul in healthcare are myriad.

Yet every year the graveyard of digital health tools gets more crowded as innovators fail to overcome healthcare’s uniquely complex barriers to their adoption.

Goldmine and graveyard, the tremendous opportunities for digital transformation in healthcare and the seemingly insurmountable barriers to its adoption are two sides of a coin. They spring from the same root causes: the lack of financial incentives to implement digital solutions; the high stakes that necessitate a cautious approach; and most significantly, providers’ seeming unwillingness to abandon proven workflows or sunk costs to take a chance on a disruptive solution.

This last cause is often the greatest barrier to getting innovation through the door.

Clinicians are the primary end-users of digital health, and a clinical champion can make all the difference in whether a solution is adopted. But in the face of the physician shortage in the United States, doctors don’t have time to trade out their proven workflows to take a risk on a solution that may or may not be successful, and will almost certainly take time to learn and implement into their practice. The majority of providers are already at capacity — 80% have no time to see more patients or take on more duties. Thus what seems like an unwillingness to change is often an inability to find the time to change.

Many physicians agree that digital tools and solutions are worthwhile in theory, but with an average workload of 40-60 hours a week, they don’t have the space in their schedules to evaluate these solutions. As it is, the amount of patients that a physician sees in a day (the most rewarding part of their jobs, according to 80% of doctors) has been reduced in recent years to make time for the mountains of non-clinical paperwork and administrative duties that they are responsible for.

Because of their packed schedules, physicians often default to the status quo for sanity’s sake: 40% of physicians see up to 20 patients per day, with another 40% seeing more (anywhere from 21 to over 70); and all spend almost a quarter of their day on administrative duties like inputting data into EMRs. If physicians do have a chance to sit down with innovators, it’s in the margins of their day — instead of an exciting opportunity for change, a pitch-meeting with an innovator represents another 15 minutes they have to take from their family at the end of a long day, an extra 10 minutes of sleep lost in the morning to get into the office early, the interruption of the small respite of a lunch break.

It’s no surprise that in a 2018 survey conducted by the Physician’s Foundation, 89% of physicians polled felt that they had somewhat to very little influence on changes in healthcare — they have no time to research chances to optimize their practice, and thus essentially no voice in its improvement. Yet only a physician has the kind of intimate knowledge of his or her needs and workflow that can drive effective innovations. Perhaps digital innovations have failed to take hold because the people making decisions around tools to help doctors are not doctors.

If we are going to break the barriers to digital transformation in healthcare, we need to expect physicians to think critically about how their job needs to evolve. And no one can do this without time to reflect on and evaluate the status quo. In the corporate world, executives and other employees are encouraged to do research, to take time in their schedules for professional development. Many tech giants — most famously Google, but also Facebook, Linkedin, Apple, and others — employ the 20% time model, where roughly one-fifth of an employee’s schedule is focused on personal side projects (those side projects have turned into Gmail, Google Maps, Twitter, Slack, and Groupon, to name a few). This is the model that we need to embrace in the healthcare system.

We need to look past the excuse that “doctors are traditionally conservative” and that is why innovation is dead in the water. While that narrative may have explained why cutting edge technology is not more readily adopted by physicians, there are other problems that it doesn’t account for — like why rates of compliance for new protocols and best practices are abysmally low. Those symptoms should point us to a different solution, a solution we can do something about. Not “doctors need to get with the times” but doctors need to get some time.

One solution is to advocate for a higher price per consultation that can eliminate the existential need to pack daily schedules with patient appointments. Under the current model, doctors are incentivized to take as many appointments as possible, double — even triple — booking slots to squeeze as much productivity out of current rates of reimbursement. But with increased reimbursement per consultation, physicians can more easily cover the cost of their salaries for their employers, which can then allow providers to take more time out of the clinic and in the office, thinking critically about their roles and how to improve their delivery of care.

Of course, this begs the question — who pays? The ones who stand to benefit most, of course. Giving physicians more time to develop professionally and research solutions is in the best interest of those who take on the burden of health costs, health insurance providers and the government (ie, taxpayers). Patient outcomes are almost guaranteed to improve when physicians have the time to stay up to date on best practices, and this directly reduces the burden of cost on those stakeholders.

Physician salaries represent a very small part of healthcare costs, paling in comparison to drugs and diagnostic care. If more money was paid to the physician on the front end to develop and implement more preventative solutions — by payers or government subsidies — the cost savings would increase exponentially, making an increase in physician salary an astute business move as well as one that can have a dramatic impact on patients’ lives.

SOURCE: Pablo Segura, J. (11 October 2019) "Getting digital transformation in healthcare on the fast track" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/getting-digital-transformation-in-healthcare-on-the-fast-track


5 ways employers can make diabetes education programs more inclusive

Employees struggling with diabetes often have to make difficult decisions when it comes to their medications. Often, it can be difficult to manage blood sugar daily and feel healthy enough to function at work. Read the following blog post from Employee Benefit News for five ways employers can make diabetes education programs more inclusive.


Diabetes doesn’t quit. Employees struggling with the disease often have to make difficult decisions about their medications. It can be hard to keep control of blood sugar every day and feel healthy enough to function well at work.

Many workers don’t tell their employer they have diabetes. Some 81% of benefits decision-makers believe employees with diabetes at their companies keep it a secret.

Giving voice to an issue is the first step toward solving it. Diabetes in the workplace is in need of attention: rates are rising in the U.S., as are the associated costs — unplanned missed workdays, reduced productivity and the stress associated with uncontrolled diabetes add up to billions of dollars per year.

To help employers find solutions, Roche Diabetes Care commissioned a survey of more than 200 benefits decision-makers at self-funded companies to learn their perceptions of the human and financial burden of diabetes. What’s clear is that addressing the myriad of concerns related to this condition is a top priority for benefits decision-makers; indeed, 70% say it keeps them awake at night.

Benefits decision-makers say the impact of diabetes on their companies is significant:

  • More than one in four report diabetes results in increased costs to replace workers (28%), increased administrative and other indirect costs of managing absenteeism (29%);
  • One in three believe diabetes results in indirect costs resulting from fatigue and understaffing as well as reduced productivity;
  • One in four feel diabetes is responsible for poor morale among employees who must perform work to cover absent co-workers.

The majority (87%) agree it is vital that employers offer continual support to employees with diabetes. Listening, education and help simplifying everyday diabetes management emerge as ways employers can improve the health of their employees with diabetes and the company bottom lines. The following are five approaches to consider.

Cultivate a collaborative, supportive environment to encourage employees with diabetes to feel comfortable and at ease about sharing concerns.

Four in five (81%) benefits decision-makers surveyed say they believe employees keep their condition a secret. Fear of discrimination is one reason those with diabetes keep quiet along with the general sense that their colleagues and superiors just don’t know or understand what it’s like to live with the condition.

Secrets are also stressful. Employers can address this by including diabetes more frequently in workplace wellness education programs and discussions, and creating safe forums for employees with diabetes to share concerns and express their needs. Listening and making employees with diabetes part of a two-way dialogue demonstrate the company values not only their opinions but also their important contributions to the company community.

Designate private places at the office where employees with diabetes can test their blood sugar during the workday.

Some 90% of benefits decision-makers surveyed think their employees would value company access and time to monitor blood sugar or take injections.

Simplify daily diabetes management so employees have what they need to be in control of their blood sugar levels at home and at work.

People with diabetes have different concerns and different needs at different times. A company-sponsored program to simplify the daily decision-making and management of diabetes needs to be personalized, easily accessible and help the user keep track of their blood sugar levels automatically. Benefits decision-makers believe employers supported in this way would be:

  • Less distracted and less stressed at work (37%);
  • More productive (45%) and have better morale;
  • Take fewer sick days (39%);
  • Feel their employer cared about them (41%).

We have created a program that offers the elements that enable personalized accessible support. Participants say they feel more positively engaged in their daily management and more confident at work.

Demonstrate the value of supported employees with diabetes by measuring impact productivity and absenteeism.

Most of those surveyed say they believe company-supported programs that help employees with diabetes simplify daily management of the condition would have myriad benefits:

  • 89% say it would lead to a higher quality of life and reduced sick time and related expenses;
  • More than four in five say a company-supported program would result in more company loyalty and less turnover (83%) and contribute to increased productivity (84%);
  • 90% believe employees with diabetes would feel more empowered at work if they participated in a company-supported program that helped them keep their blood sugar levels in control.

Consider conducting brief surveys of employees about their perceptions of diabetes. These can be done before or after education or awareness efforts are in place. For companies with support programs in place, surveys can be conducted among participants. Qualitative and quantitative data help demonstrate the value of these investments. Just asking the questions among employees show the company cares.

Show your successes; don’t just tell.

Show the value of educating about diabetes and supporting your employees with the condition. There are a number of ways to accomplish this. Collect and tell their stories. Create testimonials in articles for internal newsletters and videos that can be shown on monitors around the office. Stories are powerful ways to educate, build empathy and understanding, and perhaps most importantly, get the secret of diabetes out in the open.

SOURCE: Berman, A. (30 September 2019) "5 ways employers can make diabetes education programs more inclusive" (Web Blog Post). Retrieved from https://www.benefitnews.com/list/how-to-make-diabetes-education-programs-more-inclusive


The Open Enrollment Checklist: Are You Poised for a Successful Season

Are you prepared for open enrollment? According to a recent survey, 56 percent of U.S. adults with employer-sponsored health benefits said health coverage satisfaction is a key factor in deciding whether they should leave their current job. Read this blog post from Employee Benefit News to learn more. 


It’s here… the moment we’ve all been waiting for — or, in the case of HR, preparing for (at least we’d hope). That’s right, open enrollment season has arrived.

Open enrollment is a major opportunity for HR to contribute to their company’s performance — both in terms of healthcare savings and employee productivity. The better employees understand their benefits, the more likely they are to make cost-conscious decisions about their plan choices and their healthcare — saving themselves, and their employers, money. Not only that, but a recent survey found that 56% of U.S. adults with employer-sponsored health benefits said that whether or not they like their health coverage is a key factor in deciding to stay at their current job. And, interestingly, satisfaction with benefits and benefits communications have a tremendous impact on job satisfaction and engagement.

Not sure you’ve done everything you could to turn this annual necessity into a true financial, educational game-changer for your organizations? Ask yourself, did you:

Take stock of last year’s enrollment? Before diving into enrollment for 2020, employers should have taken stock of how the company fared last year. Post-mortem meetings with the enrollment team (along with key internal and external stakeholders) to assess what went well (or didn’t) can ensure the coming enrollment season runs smoothly.

In particular, identify the most time-consuming tasks and discuss how they could be streamlined in the future. Second, determine what questions employees asked the most about last year — and be prepared to answer them again this year. Third, consider whether the company achieved its overall open enrollment goals, and what contributed to those results. By addressing the peaks and pitfalls of last year’s season, HR should have a head start on planning for 2020.

Plan your communications strategy?With a defined approach to open enrollment in place, HR at this point should have developed an organized, well-communicated strategy to keep employees informed about their plan options at enrollment and throughout the year. Have you:

· Defined corporate objectives and how to measure success? · Assessed what messages to share with employees, especially anything that is changing — such as adding or eliminating plans or changing vendors? · Determined what information is best delivered in print (e.g. newsletters, posters, postcards, enrollment guides), online or in person through managers or one-on-one enrollment support? Adopting a multi-channel engagement strategy will ensure key messages reach the intended audience(s).

Make sure employees understand the deadline and process for enrolling — and the implications of missing the enrollment window. They must understand whether their existing coverage will roll over, if they’ll default to a specific plan and/or level of coverage (perhaps different from what they currently have), or end up with no coverage at all.

Take a pro-active approach to open enrollment? Ninety percent of employees report that they roll over their same health plan year over year — though this doesn’t indicate overwhelming plan satisfaction. More typically, it’s because they’re intimidated about what they don’t know, are confused about their choices or just don’t care. Employees don’t have the information they need, and aren’t likely to seek it out on their own.

Offering — or even requiring — one-on-one meetings with benefit experts during open enrollment provides a forum for employees to discuss their individual needs and ensure they are selecting the right coverage. These services — often available through brokers or outside engagement firms — provide employees with a safe space to ask specific questions about their health conditions, family history and potential life changes that could affect their insurance needs. This is the ideal time to remind employees that there is no one-size-fits-all plan, and that the least expensive plan on paper may not, ultimately, be the most cost-effective plan over time.

Revisit your SPD? The document we all love to hate, summary plan descriptions (SPDs) remain the best source for information about how each plan works, what it covers and the participant’s rights and responsibilities under that plan.

Having an SPD that is current, appealing (or at least not off-putting) and easy to access can answer many employee questions before they find their way to HR. Simple fixes like adding charts, callout boxes or icons can make your SPDs easier to navigate. Many employers are taking it a step further and offering interactive SPDs, which include robust search functionality and links to definitions, important forms, modeling tools and calculators, vendor sites and even short video clips. By making SPDs digital and interactive, employers can provide employees access to important information about their coverage 24/7 via any device. And, by adding a data analytics component, HR can track which sections employees visit most and pinpoint knowledge gaps about their benefit options to enhance understanding and drive increased benefits usage.

Account for all demographics? With all the focus on today’s multigenerational workforce, it’s important to remember that there’s more to “demographics” than age and gender. Worksite (office vs. shop floor vs. construction site vs. road warrior) can have a tremendous impact on the communications channels you use and when you use them.

And while some “generational generalizations” hold true — many older workers prefer paper, and most young people prefer mobile communication channels — it’s more important to look at employee cohorts from the perspective of differing priorities (planning for retirement vs. retiring student debt), different levels of education and healthcare literacy, and experience with choosing and using benefits. Employees just starting their careers are likely to need more support and different information than a more seasoned worker who’s had years of experience with the enrollment process. Consider the most effective ways to engage the different demographics of your population to gain their attention and interest in choosing the right plan for them.

Equip employees for smart healthcare choices year-round? For most employees, becoming an educated healthcare consumer is a work in progress — which is why many employers offer year-round resources to support smart healthcare choices. That said, these resources are often under-utilized because employees don’t know they exist.

Open enrollment is the perfect time to spread the word about these programs and address the key question for employees: “What’s in it for me?” For example, many employers offer transparency services, which enable employees to research the potential cost of care and compare prices across several providers in their area.

Other resources, such as benefits advocates, can answer questions from employees in real time — including where to get care, how to get a second opinion and what the doctor’s instructions really mean. When used in conjunction, transparency and advocacy services can lower out-of-pocket spending for the employee and reduce costs for the employer. Does your open enrollment communications strategy highlight that these resources exist, outline how they work and explain how they benefit the employee?

What if open enrollment is only a week away and you haven’t taken most, if any, of these steps? It’s not too early to start your to-do list for next year — perhaps by first tackling your SPD and drafting that communications plan. Most importantly, get that post-mortem meeting on the schedule now, while the lessons learned from this year’s open enrollment are still fresh.

SOURCE: Buckey, K. (3 October 2019) "The Open enrollment checklist: Are you Poised for a successful season" (Web Blog Post) https://www.benefitnews.com/list/the-employers-open-enrollment-checklist