4 ways to help employees master their HDHPs in 2019
Now is a great time to help your employees better understand their High Deductible Health Plans (HDHP) for 2019. Continue reading this blog post for steps HR can take to help employees stay on the right track.
As 2018 draws to a close, it’s a great time to give HDHP veterans and newbies at your company some help understanding — and squeezing more value out of — their plans in 2019.
Here are four simple steps your HR team can take over the next few months to put employees on the right track.
1. Post a jargon-free FAQ page on your intranet
When: Two weeks before your new plan year begins
Keep your FAQ at ten questions (and answers!), maximum. Otherwise, your employees can get overwhelmed by their health plans and by the FAQ.
When writing up the answers, pretend you’re talking directly to an employee who doesn’t know any of the insurance jargon you do. Keep it simple, straightforward, and free of insurance gobbledegook.
[Image credit: Bloomberg]
Make sure your questions reflect the concerns of different employee types: Millennials who haven’t had insurance before, older employees behind on retirement, employees about to have a new kid, etc. To get a clear sense of these concerns, invite a diverse group of 5-7 employees out for coffee and ask them.
Some sample questions for your FAQ might be:
• Is an HSA different from an FSA?
• Do I have to open an HSA?
• How much money should I put in my HSA?
• This plan looks way more expensive than my PPO. What gives?
2. Send a reminder email about setting up an HSA and/or choosing a monthly contribution amount
When: The first week of the new plan year
When your employees don’t take advantage of their HSA not only do they miss out on low-hanging tax savings, your company misses out on payroll tax savings, too.
So right at the start of the new year, send an email that explains why it’s important to set up a contribution amount right away.
A few reasons why it’s really important to do this:
- You can’t use any HSA funds until your account is fully set up and you’ve chosen how much you’re going to contribute.
- If you pay for any healthcare at all next year, and don’t contribute to your HSA, you’re doing it wrong. Why? You don’t pay taxes on any of the money you put into your HSA and then spend on eligible health care…which puts real money back in your pocket. (Last year, the average HSA user contributed about $70 every two weeks and saved $267 in taxes as a result!)
- There’s no “use it or lose it” rule! Any money you put into your HSA this year is yours to use for medical expenses the rest of your life. And once you turn 65, you can use it for anything at all. A Mediterranean cruise. A life-size Build-a-Bear. You name it!
3. Give your HDHP newbies tips on navigating their first visit to the doctor and pharmacy
When: The week insurance cards are mailed out
When employees who are used to PPO-style co-pays realize they have to pay more upfront with their HDHP, they can get…cranky. And start to doubt their plan choice — or worse, you as their employer choice.
So set expectations ahead of time to avoid employee sticker shock and to prevent you from getting an earful. Specifically, remind employees which types of visits are considered preventative care (and likely free) and which aren’t. Then explain their options when it comes to paying for — and getting reimbursed for — the visit.
4. Share tips on saving money on care with all your HDHP users
When: Any time before the end of the first quarter of the year
Specifically, you might recommend that your employees:
- Check prescription prices on a site like Goodrx.com before they buy their meds
- Visit an urgent care center instead of the ER, if they’re sick or hurt but it’s not life-threatening
- Use a telemedicine tool (if your company offers one) to get free online medical advice without having to leave their Kleenex-riddled beds
Sure, following this communication schedule requires extra elbow grease. But if you defuse your employees’ stress and confusion early, they’ll feel more prepared to take control of their healthcare and get the most out of their plans. And as a bonus, you and your team get to spend less time answering panicked questions the rest of the year.
SOURCE: Calvin, H. (17 December 2018) "4 ways to help employees master their HDHPs in 2019" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/4-ways-to-help-employees-master-their-hdhps-in-2019?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
More part-time workers getting access to benefits
A new study by the International Foundation of Employee Benefit Plans found that more employers are moving toward extending more benefits to part-time workers. Continue reading this blog post to learn more.
Gone are the days that new talent might come to work for a company part-time in exchange for some extra cash and the promise of discounted merchandise.
Employers are moving toward extending more benefits to part-time workers, according to a new study by the International Foundation of Employee Benefit Plans. The Flexible Work Arrangements: 2017 Survey Report found that 78% of organizations employ part-time workers, and 90% of those organizations define part-time work as fewer than 30 hours a week.
And part-time workers can thank the tight labor market for the increase in benefit offerings.
“In order to attract and retain key talent, employers are seeing the need to broaden the scope of work from the traditional ‘40-hour per week model,” says Julie Stich, CEBS, associate vice president of content at IFEBP. “They’re also seeing that benefit offerings and other workplace perks are essential for growing any talented organization, regardless of the number of hours employees work per week.”
The most favorable medical benefits among employees working fewer than 30 hours a week were healthcare coverage (54%), prescription drug coverage (53%), dental and vision care (52%), flexible spending accounts (47%) and health savings accounts (33%), according to the report.
In addition, paid leave benefits offered to part-timers saw an uptick to include holidays, bereavement leave, sick pay, short-term disability, maternity leave, parental/family leave and personal leave.
Clothing retailer H&M recently announced its plan to offer six weeks of paid leave to the company’s 18,000 employees — including part-timers.
In addition, Eataly, said in September its new paid parental leave policy — eight weeks of time off for both mothers and fathers following the birth or adoption of a child — is available to all employees who have been working at the company for at least a year, regardless of hours worked per week. Dollar General also introduced a new paid parental leave benefit in March, offering two weeks of paid time off for all eligible full-time and part-time employees, and eight weeks of paid time off for birth mothers.
“U.S. organizations are not required to provide paid leave to part-time workers, but many do for several reasons: to retain high-performing workers, attract high-quality applicants, build worker loyalty and provide work-life balance,” Stich adds.
Paid time off and healthcare were also key benefits identified in the Society for Human Resource Management’s annual survey, with a 10% increase in companies offering healthcare benefits and more than half saying they offer some sort of paid time off to part-time workers.
More employers will likely offer benefits to part-time workers as the workforce shifts toward more flexible work options, Stich says. “Certainly, each organization is structured differently, and company cultures vary, but if offering part-time work arrangements and benefits is appropriate, they can be a vehicle for attracting top-tier talent while providing additional flexibility for current employees.”
SOURCE: Otto, N. (12 December 2018) "More part-time workers getting access to benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/more-part-time-workers-getting-access-to-benefits?brief=00000152-14a7-d1cc-a5fa-7cffccf00000
The case for self-funded health benefit plans and reference-based pricing
Small businesses are starting to explore self-funded plan designs that use reference-based pricing. Continue reading for more about self-funding and reference-based pricing.
Self-funding and reference-based pricing are hot topics with small businesses. They are so popular, in fact, that a recent survey shows an overall increase in their 2019 projection of small employer clients having a reference-based pricing health benefit plan design. Small businesses are seeing these savings, and they’re starting to explore how reference-based pricing can help them, too.
Before we get to why self-funded plan designs that use reference-based pricing are becoming more popular for small businesses, let’s review the basics.
Reference-based pricing is a methodology of calculating payment to providers for covered treatments and services using a “reasonable fee” based on a reference point. A common reference point is the Medicare fee schedule. Some self-funded health benefit plans calculate the reasonable fee as a percentage of the Medicare fee schedule to determine reimbursement for services rendered.
Bottom line: Self-funded health benefit plan designs that use reference-based pricing can allow for a great deal of flexibility with a variety of arrangements and overall cost-savings.
So, what’s behind the recent trend toward reference-based pricing for smaller employers? A few key factors.
First, a self-funded health benefit plan design that uses referenced-based pricing can mean less expensive coverage for employees and employers.
When coupling a self-funded health benefit plan with stop-loss insurance, reference-based pricing provides an affordable way to extend coverage to employees through lower employee contributions. So, employees are happy because they’re saving money.
And employers are happy, too, because they’re allowing for more coverage to more employees. There’s a refund potential for employers if claims dollars are less than funded. There’s also a premium tax savings of around 2% since self-funded claim dollars are not subject to state health insurance premium taxes.
Moreover, self-funded health benefit plan designs that utilize reference-based pricing may also include transparency reports with aggregate health claims data and demographic information, which allow employers to better manage costs. Overall, anytime you can design a plan that’s beneficial for employees and employers, it’s a win.
Second, reference-based pricing can provide employees more flexibility when it comes to choosing a provider. Typically, an important feature of any health benefit plan design for employees is the ability to choose the provider they want. Some self-funded plan designs that use reference-based pricing give employees the chance to pick the provider that’s right for them. And, when employees are happy with their health plan, employers are usually pretty happy, too.
Finally, self-funded plan designs that use reference-based pricing can help employees become smarter healthcare consumers because of all the transparency and choice involved. When employees better understand the healthcare processes and system, costs come down for both the employee and employer. In fact, just understanding their coverage better may help employees better use their health benefit plans.
For example, using telemedicine when appropriate, establishing a relationship with a primary care doctor and using client advocacy services can all help employees better utilize their health benefit plans. In the end, employees get smarter about how they manage their care, and employers win with reduced costs.
These factors are driving more small businesses to consider reference-based pricing self-funded health benefit plan designs with stop-loss insurance. And, for good reason. These plan designs can give employers the opportunity to offer their employees affordable health benefits, provide more choice in their health plans and providers, and encourage more employee engagement. While moving to reference-based pricing may be too big of a leap for some employers, self-funding continues to provide a means for employers to offer comprehensive major medical health benefits at lower costs.
SOURCE: MacLeod, D. (6 December 2018) "The case for self-funded health benefit plans and reference-based pricing" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/the-case-for-self-funded-health-benefit-plans-and-reference-based-pricing
It’s peak flu season. Here’s what employers should do now
Employers can expect to see an influx of coughing, sneezing, and germ passing at the office this time of year. Read this blog post to learn what proactive steps employers can take to keep the workplace healthy.
The U.S. is in the height of flu season, which means employers are likely to see an influx of employees coughing, sneezing and spreading germs in the office. Aside from passing a box of tissues, employers may be wondering what they are legally permitted to do when their workers get sick.
One benefit that is becoming increasingly relevant is paid sick leave. Several cities and states — including Arizona, California, Connecticut, Massachusetts, Chicago and others — have paid sick leave laws on the books. But while many companies offer paid sick leave as a benefit, there is no federal paid sick leave law. Paid sick leave laws may remove some incentive for sick workers to report to work, making the illness less likely to spread to the rest of the workforce.
But paid sick leave laws do place limitations on employers. For example, companies cannot make taking a paid sick leave day contingent upon the employee finding someone to cover their shift. Depending on the law, employees don’t always need to give notice of their absence before their shift begins, which could make scheduling difficult. Some laws limit an employer’s ability to ask for a doctor’s note.
Employers do, however, have some latitude when it comes to requiring employees to stay home from work or sending them home if they show signs of illness. Employers just need to be careful not to cross any lines set by the federal Americans with Disabilities Act or a state fair employment statute. This means steering clear of conducting medical examinations or making a disability-related inquiry.
According to the U.S. Equal Employment Opportunity Commission, employers should avoid taking an employee’s temperature. This is considered a medical examination by an employer, which is generally prohibited except in limited circumstances.
They should also avoid asking employees to disclose whether they have a medical condition that could make them especially vulnerable to complications from influenza or other common illnesses. Doing so would likely violate the ADA or state laws, even if the employer is asking with the best of intentions. Employers also cannot require workers to get a flu shot, according to the EEOC.
Employees could have a disability that prevents them from taking the influenza vaccine, which could compel them to disclose an underlying medical condition to their employer to avoid taking the shot. Additionally, some employees may observe religious practices that would prevent them from taking the flu vaccines. Thus, requiring an employee to take a vaccine could lead to a violation of Title VII of the federal Civil Rights Act of 1964 in addition to the ADA.
Beyond these limitations, employers can take these proactive steps to keep the workplace healthy.
Ask employees if they are symptomatic. In determining who should go home or not report to work, employers may ask workers if they are experiencing flu-like symptoms. This would not rise to the level of a medical exam or a disability-related inquiry, according to the EEOC.
Advise workers to go home. Employers can order an employee to go home if they are showing signs of the flu. The EEOC says that advising such workers to go home is not a disability-related action if the illness is like seasonal influenza.
Encourage workers to telecommute as an infection-control strategy. But keep in mind that the company could be establishing a precedent for telecommuting as a reasonable accommodation in other circumstances, such as for an employee recovering from major surgery who cannot come to the workplace.
Encourage flu shots. Employers may encourage — but not require — employees to get flu shots. For example, a company can invite a healthcare professional to the workplace to administer flu shots at a discounted rate or free.
Employers may require its employees to adopt certain infection-control strategies, such as regular hand washing, coughing and sneezing etiquette, proper tissue usage and disposal, and even wearing a mask.
The ADA, Title VII, state fair employment laws and paid sick leave statutes are also incredibly nuanced. Moreover, it’s important to balance the mandates of OSHA, which require employers to maintain a safe working environment. Before taking any significant actions, employers should consult with an employment attorney or HR professional for guidance.
SOURCE: Starkman, J.; Dominguez, R. (4 December 2018) "It’s peak flu season. Here’s what employers should do now" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/its-peak-flu-season-heres-what-employers-should-do-now?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
More pay? Nah. Employees prefer benefits
A new report by the Institute of CPAs revealed that workers would choose a job that offers benefits over a job that offers 30 percent more salary but does not offer benefits. Read this blog post to learn more.
Workers across the country say you can't put a price on great benefits, according to a new survey.
By a four-to-one margin (80% to 20%), workers would choose a job with benefits over an identical job that offered 30% more salary with no benefits, according to the American Institute of CPAs, which released the results of its 2018 Employee Benefit Report, a poll this spring of 2,026 U.S. adults (1,115 of whom are employed) about their views on workplace benefits.
“A robust benefits package is often a large chunk of total compensation, but it’s the employees' job to make sure they’re taking advantage of it to improve their financial positions and quality of life,” said Greg Anton, chairman of the AICPA’s National CPA Financial Literacy Commission. “Beyond the dollar value of having good benefits, employees gain peace of mind knowing that if they can take a vacation without losing a week’s pay or if they need to see a doctor, they won’t be responsible for the entire cost.”
Employed adults estimated that their benefits represented 40% of their total compensation package, according to the study. The Bureau of Labor Statistics, though, states that benefits average 31.7% of a compensation package. Still, workers in the report see benefits as a vital part of their professional lives.
“Despite overestimating the value of their benefits as part of their total compensation, it is concerning that Americans are not taking full advantage of them,” Anton said. “Imagine how employees would react if they were not 100% confident they could get to all the money in their paycheck. Leaving benefits underutilized should be treated the same way. Americans need to take time to truly understand their benefits and make sure they’re not leaving any money on the table.”
Other notable findings from the report include:
- 63% of employed adults believe that being their own boss is worth more than job security with an employer, while 18% added that they will likely start or continue their own businesses next year.
- Millennials were the most likely generation to believe that being their own boss is worth more than job security. They were also the most likely generation to start their own businesses.
- 88% of employed adults are confident they understood all the benefits available to them when they were initially hired at their current job. However, only 28% are "very confident" they are currently maximizing all of their benefits.
- When asked which workplace benefits would help them best reach their financial goals, 56% of adults said a 401(k) match or health insurance, with 33% citing paid time off and 31% citing a pension.
- Baby boomers favor health insurance and having a 401(k) match more than younger generations, while 54% of baby boomers also prioritized a pension, versus only 16% of millennials.
- Millennials put the highest priority on work-life balance benefits, such as paid time off, flexible work hours, and remote work.
For the full report, visit the AICPA’s 360 Degrees of Financial Literacy site here.
SOURCE: McCabe, S. (3 December 2018) "More pay? Nah. Employees prefer benefits" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/workers-prefer-benefits-over-more-pay?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
New resource offers guidance on digital tools for diabetes management
The market for digital diabetes management tools is continuing to mature. Read this blog post for the Northeast Business Group on Health’s updated guide on diabetes management tools.
The Northeast Business Group on Health has updated its “Digital Tools and Solutions for Diabetes: An Employer’s Guide,” to include both enhanced and new solutions—and promising future innovations—to help employers help their workers better manage their diabetes, lower costs and ultimately save more lives.
“Employers are well aware of the costs associated with diabetes in their employee and dependent populations—they continue to indicate this is a top concern and are increasingly aware of the links between diabetes and other chronic and debilitating health conditions, including cardiovascular disease,” says Candice Sherman, CEO of NEBGH.
The market for digital diabetes prevention and management solutions continues to mature since the group published its first guide in 2016, Sherman says. The updated guide provides a detailed checklist of the features and functionalities of the digital tools available now to manage diabetes, as well as information on several unique and innovative digital diabetes solutions that are being targeted to employers but were not part of NEBGH’s research, including Proteus Discover, BlueLoop and do-it-yourself programs.
“Proteus Discover is comprised of ingestible sensors, a small wearable sensor patch, an application on a mobile device and a provider portal,” the guide cites the provider. “Once activated, Proteus Discover unlocks never-before-seen insight into patient health patterns and medication treatment effectiveness, leading to more informed healthcare decisions for everyone involved.”
“BlueLoop is the one and only tool that allows kids and their caregivers to log and share diabetes information—both online and with the app—in real time, via instant e-mail and text message, giving peace of mind to parents,more class time for students and fewer phone calls and paper logs for school nurses,” the provider tells NEBGH. “Online, parents can share real-time BG logs with their clinicians, who can see logs (in the format they prefer), current dosages and reports, all in one place.”
The guide also hints at promising future innovations:
“Technology is constantly evolving: by connecting sensors, wearables and apps, it is increasingly possible to pool and leverage data in innovative ways to provide timely interventions so that people with diabetes can be truly independent and effectively self-manage their care,” the authors write.
The guide lists a hypothetical scenario: A person with diabetes enters a restaurant where a GPS sensor identifies the location, reviews the menu and proposes the best choices based on caloric and carbohydrate content. The technology also proposes and delivers a rapidly acting insulin bolus dose based on the person’s exercise level that day and prior experiences when eating similar meals.
Also included are key questions for employers considering implementing digital diabetes tools or solutions, including:
- What does the company want to achieve with a digital tool?
- How much is the company willing to pay?
- How will success be measured?
- How will digital solutions and tools be marketed to employees and their families?
- What privacy issues need to be addressed when tools or solutions are implemented?
“Digital health tools hold the promise of improved health outcomes and reduced health care expenses through improved engagement, better collaboration and sustained behavior change,” says Mark Cunningham-Hill, NEBGH’s medical director. “However, digital diabetes solutions are not a panacea. Employers will need to address several obstacles such as the difficulty of recruitment and enrollment, lack of sustained employee engagement and the cost of deployment of digital solutions. This can be accomplished through careful planning and learning from other employers that have successfully implemented these tools.”
SOURCE: Kuehner-Hebert, K. (4 December 2018) "New resource offers guidance on digital tools for diabetes management" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/12/04/new-resource-digital-tools-for-diabetes-management/
Association Health Plans Meet the 2018 Form M-1
The Employee Benefits Security Administration (EBSA) recently released the 2018 version of the Form M-1. Read this blog post for more information about the new Form M-1.
The Employee Benefits Security Administration (EBSA) is continuing to do what it can to help bring the new class of association health plans (AHPs) to life.
EBSA, an arm of the U.S. Department of Labor, unveiled the 2018 version of the Form M-1 Monday.
Administrators of multiple employer welfare arrangements (MEWAs) that provide medical benefits use Form M-1 to report on the MEWAs’ operations to the DOL.
The administration of President Donald Trump completed work on major new AHP regulations in June. The administration is hoping small employers will use the new AHPs to shield themselves from some state and federal mandates and to get a chance to benefit from being part of a large coverage buyer.
Any AHPs out there, including any AHPs formed under the new regulations, will need to file the 2018 Form M-1 with the Labor Department, EBSA said Monday.
An AHP, or other MEWA, can use Form M-1 both to register a new plan and to file the annual report for an in-force plan.
The 2018 annual report for an AHP or other MEWA in operation now will be due March 1, 2019.
If agents, brokers, benefit plan administrators or other financial professionals are trying to start AHPs, they are supposed to use Form M-1 to register the AHPs at least 30 days before engaging in any AHP activity.
“Such activities include, but are not limited to, marketing, soliciting, providing, or offering to provide medical care benefits to employers or employees who may participate in the AHP,” EBSA officials said in the form release announcement.
Resources
Links to AHP information, including information about the 2018 Form M-1, are available here.
SOURCE: Bell, A. (4 December 2018) "Association Health Plans Meet the 2018 Form M-1" (Web Blog Post). Retrieved from https://www.thinkadvisor.com/2018/12/04/association-health-plans-meet-the-2018-form-m-1/
2019: A Look Forward
A number of significant changes to group health plans have been made since the Affordable Care Act (ACA) was enacted in 2010. Many of these changes became effective in 2014 and 2015 but certain changes to a few ACA requirements take effect in 2019.
Changes for 2019
- Cost-sharing Limits – Non-grandfathered plans are subject to limitations on cost sharing for essential health benefits (EHB). The annual limits on cost sharing for EHB are $7,900 for self-only coverage and $15,800 for family coverage, effective January 1, 2019.
- Health plans with more than one service provider can divide maximums between EBH as long as the combined amount does not exceed the out-of-pocket maximum limit for the year.
- Beginning in 2016, each individual – regardless of the coverage the individual is enrolled – is subject to the self-only annual limit on cost sharing.
- The ACA’s annual cost-sharing limits are higher than high deductible health plans (HDHPs) out-of-pocket maximums. For plans to qualify as an HDHP, the plan must comply with HDHP’s lower out-of-pocket maximums. The HDHP out-of-pocket maximum for 2019 is $6,750 for self-only coverage and $13,500 for family coverage.
- Coverage Affordability Percentages – If an employee’s required contribution does not exceed 9.5 percent of their household income for the taxable year (adjusted each year), then the coverage is considered affordable. The adjusted percentage for 2019 is 9.86 percent.
- Reporting of Coverage – Returns for health plan coverage offered or provided in 2018 are due in early 2019. For 2018, returns must be filed by February 28, 2019, or April 1, 2019 (if electronically filed). Individual statements must be provided by January 31, 2019.
- ALEs are required to report information to the IRS and their eligible employees regarding their employer-sponsored health coverage. This requirement is found in Section 6056. Reporting entities will generally file Forms 1094-B and 1095-B under this section.
- Every health insurance issuer, self-insured health plan sponsor, government agency that provides government-sponsored health insurance, and any other entity that provides MEC is required to finalize an annual return with the IRS, reporting information for each individual who is enrolled. This requirement is found in Section 6055. Reporting entities will generally file Forms 1094-C and 1095-C under this section.
- ALEs that provide self-funded plans must comply with both reporting requirements. Reporting entities will file using a combined reporting method on Forms 1094-C and 1095-C.
- Forms Used for Reporting – Reporting entities must file the following with the IRS:
- A separate statement for each individual enrolled
- A transmittal form for all returns filed for a given calendar year.
- Electronic Reporting – Any reporting entity that is required to file 250 or more returns in either section must file electronically on the ACA Information Returns (AIR) Program. Reporting entities that file less than 250 returns can file in paper form or electronically on the ACA Information Returns (AIR) Program.
- Penalties – Entities that fail to comply with the reporting requirements are subject to general reporting penalties for failure to file correct information returns and failure to furnish correct payee statements. Penalty amounts for failure to comply with the reporting requirements in 2019 are listed below:
| Penalty Type | Per Violation | Annual Maximum | Annual Maximum for Employers with up to $5 million in Gross Receipts |
| General | $270 | $3,275,500 | $1,091,500 |
| Corrected within 30 days | $50 | $545,500 | $191,000 |
| Corrected after 30 days but before August 1 | $100 | $1,637,500 | $545,500 |
| Intentional Disregard | $540* | None | N/A |
**Intentional disregard penalties are equal to the greater of either the listed penalty amount or 10 percent of the aggregate amount of the items required to be reported correctly.
Expected Changes
- Health FSA Contributions – Effective January 1, 2018, health FSA salary contributions were limited to $2,650. The IRS usually announces limit adjustments at the end of each year. This limit does not apply to employer contributions or limit contributions under other employer-provided coverage.
- Employer Shared Responsibility Regulations – The dollar amount for calculating Employer Shared Responsibility 2 penalties is adjusted for each calendar year. Applicable large employers (ALEs) must offer affordable, minimum value (MV) healthcare coverage to full-time employees and dependent children or pay a penalty. If one or more full-time employees of an ALE receive a subsidy for purchasing healthcare coverage through an Exchange, the ALE is subject to penalties.
- Applicable Large Employer Status – ALEs are employers who employ 50 or more full-time employees on business days during the prior calendar year.
- Offering Coverage to Full-time Employees – ALEs must determine which employees are full-time. A full-time employee is defined as an employee who worked, on average, at least 30 hours per week or 130 hours in a calendar month. There are two methods for determining full-time employee status:
- Monthly Measurement Method – Full-time employees are identified based on a month-to-month analysis of the hours they worked.
- Look-Back Measurement Method – This method is based on whether employees are ongoing or new, and whether they work full time or variable, seasonal or part-time. This method involves three different periods:
- Measurement period – for county hours of service
- Administration period – for enrollment and disenrollment of eligible and ineligible employees
- Stability period – when coverage is provided based on an employee’s average hours worked.
- Applicable Penalties – ALEs are liable for penalties if one or more full-time employees receive subsidies for purchasing healthcare coverage through an Exchange. One of two penalties may apply depending on the circumstances:
- 4980H(a) penalty – Penalty for not offering coverage to all full-time employees and their dependents. This penalty does not apply if the ALE intends to cover all eligible employees. ALEs must offer at least 95 percent of their eligible employees’ health care coverage. Monthly penalties are determined by this equation:
- ALE’s number of full-time employees (minus 30) X 1/12 of $2,000 (as adjusted), for any applicable month
- The $2,000amount is adjusted for the calendar year after 2014:
- $2,080 – 2015; $2,160 – 2016; $2,260 – 2017; $2,320 – 2018
- 4980H(b) penalty – penalty for offering coverage – ALEs are subject to penalties even if they offer coverage to eligible employees if one or more full-time employees obtain subsidies through an Exchange because:
- The ALE didn’t offer all eligible employees coverage
- The coverage offered is unaffordable or does not provide minimum value.
- Monthly penalties are determined by this equation: 1/12 of $3,000 (as adjusted) for any applicable month
- $3,120 – 2015; $3,240 – 2016; $3,390 – 2017; $3,480 – 2018
- 4980H(a) penalty – Penalty for not offering coverage to all full-time employees and their dependents. This penalty does not apply if the ALE intends to cover all eligible employees. ALEs must offer at least 95 percent of their eligible employees’ health care coverage. Monthly penalties are determined by this equation:
Contact one of our advisors for assistance or if you have any questions about compliance in the New Year.
SOURCES: www.dol.gov, www. HHS.gov, https://www.federalregister.gov/documents/2018/04/17/2018-07355/patient-protectionand-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019, https://www.irs.gov/e-fileproviders/air/affordable-care-act-information-return-air-program
Poor employee health costs employers half trillion dollars a year
According to a recent report from the Integrated Benefits Institute, poor employee health costs employers half a trillion dollars each year and almost 1.4 billion in missed work days. Read on to learn more.
Poor employee health is costing employers in a big way — to the tune of half a trillion dollars and nearly 1.4 billion days of missed work each year.
That’s according to a new report from the Integrated Benefits Institute, which finds that employees miss around 893 million days a year from illness and chronic conditions, and another 527 million days because of impaired performance due to those illnesses. Those days add up to $530 billion in lost productivity.
“To put this in further context, the cost of poor health to employers is greater than the combined revenues of Apple, Amazon, Microsoft, Netflix, eBay and Adobe,” says Thomas Parry, president of Integrated Benefits Institute, an independent nonprofit that serves more than 1,250 employers including Amazon, Kroger, McDonald’s and Walmart.
The $530 billion price tag is on top of what employers already spend on healthcare benefits. Employers pay $880 billion in healthcare benefits for their employees and dependents, which means that poor health costs amount to “60 cents for every dollar employers spend on healthcare benefits,” according to the study.
“There’s not a CEO or CFO that can placidly accept their business expending the equivalent of almost two-thirds of their healthcare dollars on lost productivity,” Perry says. “Illness costs this country hundreds of billions of dollars, and we can no longer afford to ignore the health of our workforce.”
Employers invest in healthcare benefits to maintain a productive workforce. But this new study suggests that more needs to be done to keep employees healthy, or strategies need to be put in place to lower spending. Or both.
“It’s critical that employers understand how strategies for managing healthcare spend — such as cost- shifting to employees or ensuring better access and more cost-effective care — can impact the kinds of conditions that drive illness-related lost productivity,” says Brian Gifford, director of research and analytics at IBI.
The study broke down the estimated costs of poor health into several categories:
Wage and benefits (incidental absence due to illness, workers’ compensation and federal family and medical leave): $178 billion.
Impaired performance (attributed to chronic health conditions): $198 billion.
Medical and pharmacy (workers’ compensation, employee group health medical treatments, employee group health pharmacy treatments): $48 billion.
Workers’ compensation other costs (absence due to illness, reduced performance): $25 billion.
Opportunity costs of absence (missed revenues, costs of hiring substitutes, overtime): $82 billion.
For its study, IBI used 2017 data from the U.S. Bureau of Labor Statistics as well as its own benchmarking data from 66,000 U.S. employers.
SOURCE: Paget, S. (20 November 2018) "Poor employee health costs employers half trillion dollars a year" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/poor-employee-health-costs-employers-half-trillion-dollars-a-year?brief=00000152-14a7-d1cc-a5fa-7cffccf00000
Healthcare waste is costing billions — and employers aren’t doing anything about it
Providing your employees with healthcare insurance is expensive. A large chunk of healthcare costs is being wasted by the healthcare industry, according to a new survey. Read on to learn more.
Providing the workforce with healthcare coverage is expensive, but a new survey of 126 employers suggests a large chunk of that cost is being wasted by the healthcare industry on treatments patients don’t need.
The healthcare industry wastes $750 billion per year on unnecessary tests and treatments, according to a survey from the National Alliance of Healthcare Purchaser Coalitions and Benfield, a market research, strategy and communications consulting firm. Some 60% of employers don’t take steps to manage their healthcare plan’s wasteful spending, despite the fact that the same percentage of employers view it as a problem, the survey says.
“While waste has long been identified as a key concern and cost contributor, employers are operating blind and need to look at a more disciplined approach to address top drivers that influence waste,” says Michael Thompson, National Alliance president and CEO.
Employers are under the impression that prescription drugs are the culprit behind the spending waste, and they are, just not as much as other services. Around 54% of health spending waste is caused by unnecessary medical imaging tests, such as MRIs and X-rays, the survey says. Specialty drugs, unnecessary lab tests and specialists referrals are also major money pits.
However, the survey data isn’t suggesting these procedures and treatments shouldn’t be covered by employer health plans. The tests and treatments are potentially life-saving, they’re just used more than they should be. Sometimes previous test results can help with a current diagnosis, but medical staff don’t always check patient files before ordering new tests.
Most employers don’t monitor unnecessary healthcare spending. The 34% of employers who do rely entirely on their healthcare vendors to do it for them, trusting that it’s being taken care of.
“The idea of reducing waste in the healthcare system can be overwhelming,” says Laura Rudder Huff, senior consultant for Benfield. “While employers ask themselves: ‘Where to start?’ this is an issue where even small steps matter. Employers can begin by collecting data to identify where the inefficiencies are in their workforce and community and use assets such as vendors and organizations like coalitions to realize market improvements.”
The survey also recommends employers enlist the services of Choosing Wisely, an organization that counsels patients and employers on healthcare plans and medical treatments.
SOURCE: Webster, K. (7 November 2018) "Healthcare waste is costing billions — and employers aren’t doing anything about it" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/healthcare-waste-is-costing-billions-and-employers-arent-doing-anything-about-it