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Modern medicines have resulted in longer, more productive lives for many of us. Prescription drugs soothe sore muscles after a strenuous workout or manage the conditions of a chronic disease. Unfortunately, this use of prescriptions drugs can come with a hefty price tag.

Americans are spending more money on prescription drugs than ever before and the United States as a nation spends more per capita on prescription drugs than any other country. With the cost of some drugs exceeding thousands of dollars for a 30-day supply, this can translate into financial hardship for many Americans.

For employers sponsoring a medical plan, managing the cost of these prescription drugs is also becoming a task. Insurance companies and employers struggle with the ability to provide affordable medical plans, and the ever-increasing prescription drug costs are a primary driver of this difficulty. As a result, prescription drug plan designs are changing shape – moving to a model that helps push more of the cost of these drugs to the member along with increasing awareness of the true cost of the prescriptions.

Flat dollar copay plans have become an expected norm in medical plans for almost a decade. However, insurance companies underwriting fully insured medical plans and employers sponsoring self-funded medical programs now need to make modifications to these plan designs to manage the ever-increasing prescription drug costs. As a result, we are seeing more prescription drug plans combining some aspect of coinsurance along with or in place of the flat dollar copayments.

According to the 2016 UBA Health Plan Survey, copay models are still the most popular, with a three-tier copay structure the most prevalent. Median retail copayments for these three-tier plans are $10 for generic drugs, $35 for preferred brand drugs (drugs on the carrier’s prescription drug list) and $60 for non-preferred brand drugs (drugs not on the carrier’s prescriptions drug list). While 54.5 percent of all prescription plans are copay only, approximately 40 percent of all prescription drug plans have co-insurance along with (or in lieu of) copays–a plan design that is particularly common among four-tier plans.

Coinsurance models have many unique designs. Some plans are a straight percentage of the cost of the drug; some may involve a maximum or minimum dollar copayment combined with the coinsurance. For example, a plan may require 40 percent coinsurance for a preferred brand drug, but there is a minimum copayment of $30 and a maximum copayment of $50. Typically, we see a higher coinsurance percentage for non-preferred brand drugs and specialty drugs. The member cost of the drug is calculated after any negotiated discounts, so members covered by a coinsurance plan are reaping the benefits of any discounts negotiated with the pharmacy by the pharmacy benefit manager (PBM).

Coinsurance plans do provide several advantages to managing prescription drug costs. Under a flat dollar copay plan design, members may not truly understand the full cost of the drug they are purchasing. Pharmacies are now disclosing the full cost of drugs on the purchase receipts. Yet, most consumers do not take note of this disclosure, focusing only on the copayment amount. When a member pays a percentage of the cost of the drug as in a coinsurance model, the true cost of the drug becomes much more apparent.

Another advantage of the coinsurance model is that it automatically increases the member share of the cost as the price of the drug increases. Under the flat dollar copayment model, as the true cost of the drug increases, the member pays a smaller portion of the total cost. When the member’s portion is determined by a coinsurance percentage, the member pays more as the cost of the drug increases.

As the costs of health care overall continue to increase, we all need to become better consumers of our healthcare. Members covered by a prescription drug plan with a coinsurance model will have a better understanding of the true cost of their prescriptions. As members become more aware of the true costs of their care, they make better health care decisions, managing the overall cost of care.

We expect to see prescription drug benefit plans change even more as the cost of health care – especially prescription drugs – escalates. These changes will likely result in more of the cost being pushed to the patient. There are resources available to patients for assistance with some of these out-of-pocket costs. It is vital for the patient to understand their costs and know how to maximize their benefits. In a few weeks, the UBA blog will highlight some of these resources and provide information on how to educate employees on maximizing their benefits and the industry resources available to them.

For all the cost and design trends related to health and prescription drug plan costs by group size, industry and region, download UBA’s Health Plan Survey Executive Summary.

By Mary Drueke-Collins
Originally Posted By www.ubabenefits.com

Under U.S. federal law, employers must keep the payroll records of their employees or former employees for a certain length of time. The amount of time, however, varies according to which statute you refer to, which can make knowing how long to keep employee records confusing. By keeping in mind the required time limits under each statute as well as what payroll-related records the statute wants you to retain and why, you can more easily develop a system that keeps payroll records as long as the law requires.

Identification

Payroll records are, generally, any records that relate to the hours an employee works and the wages paid to him or her, according to the U.S. Department of Labor. Under the Fair Labor Standards Act, payroll records include information on the hour and day each work week begins; the number of hours worked in each work day and each work week; the total amount the employee earned working non-overtime hours; the regular hourly pay for any week in which the employee worked overtime; total overtime pay for each work week; the amounts of any additions or deductions to the employee’s pay each week; the total amount paid for each pay period; and the dates covered by each pay period, according to the U.S. Department of Labor. This information should be marked with the employee’s personal information, including name, address, occupation and sex. If the employee is less than 19 years old, also include his date of birth.

Applicable Laws

As of 2010, only two federal statutes require employers to retain payroll records for any length of time, according to the U.S. Department of Labor and the U.S. Equal Employment Opportunity Commission, or EEOC. These two statutes are the Fair Labor Standards Act and the Age Discrimination in Employment Act. For the FLSA and the ADEA, most payroll records must be kept for three years, according to the U.S. Department of Labor and the EEOC. Although the FLSA allows employers to discard some supplementary payroll records, including wage tables, after two years, the ADEA requires that employers keep these records for three years.

Format

The ADEA does not require employers to keep payroll records in any particular format, as long as the records are available when the EEOC requests them, according to the EEOC. The FLSA does not require that time clocks be used to keep track of employee hours, according to the U.S. Department of Labor. Nor does the FLSA require that records be kept in a particular format. However, according to the U.S. Department of Labor, microfilm or punched tape should not be used unless the employer also has the equipment to make these formats easily readable.

Function

The purpose of maintaining employee payroll records under the Fair Labor Standards Act is to protect an employee’s rights to fair pay, according to the U.S. Department of Labor, including the right of covered, nonexempt workers to the minimum wage and to overtime pay. The records may also be used to ensure an employer is not employing children too young to work legally and is not employing children who may work legally for an illegal number of hours. Maintaining records under the Age Discrimination in Employment Act is intended to ensure an employee who discovers she may have been discriminated against due to his age is able to find the information necessary to prove or disprove her claim, according to the EEOC.

Considerations

Under the FLSA and the ADEA, payroll records are generally kept for three years following the date of an employee’s termination, according to the EEOC. The ADEA, FLSA, and other statutes may require an employer to keep different portions of an employee’s file for different lengths of time. For instance, while the ADEA requires payroll records to be kept for three years, it requires basic information about the employee to be kept only one year, according to the EEOC. To ensure your business meets all its recordkeeping retention requirements, consult a qualified employment law attorney.

By A.L. KENNEDY
Originally Posted By www.livestrong.com 

AHCA and the Preexisting Conditions Debate—What Employers Can Do During Uncertainty | Ohio Benefit Advisors

Categories: Benefits, Blog, Employers, Preexisting Conditions, Team K Blog
Comments Off on AHCA and the Preexisting Conditions Debate—What Employers Can Do During Uncertainty | Ohio Benefit Advisors

Preexisting conditions. While it’s no doubt this term has been a hot topic in recent months—and notably misconstrued—one thing has not changed; insurers cannot deny coverage to anyone with a preexisting condition.  Now that House Resolution 1628 has moved to the Senate floor, what can employers and individuals alike expect? If passed by the Senate as is and signed into law; some provisions will take place as early as 2019—possibly 2018 for special enrollment cases. It’s instrumental for companies to gear up now with a plan on how to tackle open enrollment; regardless of whether your company offers medical coverage or not.

Under the current proposed American Health Care Act (AHCA) insurance companies can:

  • Price premiums based on health care status/age. The AHCA will provide “continuous coverage” protections to guarantee those insured are not charged more than the standard rate as long as they do not have a break in coverage. However, insurers will be allowed to underwrite certain policies for those that do lapse—hence charging up to 30% more for a preexisting condition if coverage lapses for more than 63 days. This is more common than not, especially for those who are on a leave of absence for illness or need extensive treatment. In addition, under current law, insurers are only allowed to charge individuals 50 and older 3 times as much than those under this age threshold. This ratio will increase 5:1 under AHCA.
  • Under the ACA’s current law employers must provide coverage for 10 essential health care benefits. Under AHCA, beginning as early as 2020, insurers will allow states to mandate what they consider essential benefit requirements. This could limit coverage offered to individuals and within group plans by eliminating high cost care like mental health and substance abuse. Not that it’s likely, but large employers could eventually opt out whether they want to provide insurance and/or choose the types of coverage they will provide to their employees.

It’s important to note that states must apply for waivers to increase the ratio on insurance premiums due to age, and determine what they will cover for essential health benefits. In order to have these waivers granted, they would need to provide extensive details on how doing so will help their state and the marketplace.

So what can employers do moving forward? It’s not too soon to think about changing up your benefits package as open enrollment approaches, and educating yourself and your staff on AHCA and what resources are out there if you don’t offer health coverage.

  • Make a variety of supplemental tools available to your employees. Anticipate the coming changes by offering or adding more supplemental insurance and tools to your benefits package come open enrollment. Voluntary worksite benefits, such as Cancer, Critical Illness, and Accident Insurance handle a variety of services at no out-of-pocket cost to the employer. HSA’s FSA’s and HRA’s are also valuable supplemental tools to provide your employees if you’re able to do so. Along with the changes listed above, the AHCA has proposed to also increase the contribution amounts in these plans and will allow these plans to cover Over-the-Counter (OTC) medications.
  • Continue to customize wellness programs. Most companies offer wellness programs for their employees. Employers that provide this option should continue advancing in this area. Addressing the specific needs of your employees and providing wellness through various platforms will result in the greatest return on investment; and healthier employees to boot. Couple this with frequent evaluations from your staff on your current program to determine effectiveness and keep your wellness programs on point.
  • Educate, educate, educate—through technology. Regardless if you employ 10 or 10,000, understanding benefit options is vital for your employees; what you have to offer them and what they may need to know on their own. Digital platforms allow individuals to manage their healthcare benefits and stay in the know with valuable resources at their fingertips. There’s no limit on the mediums available to educate your employees on upcoming changes. Partnering with a strong benefit agency to maximize these resources and keep your employees “in the know” during a constantly changing insurance market is a great way to start.

While the health care affordability crisis has become so significant, questions still linger—will private exchanges become a viable solution for employers and payers, and will they will continue to grow? Back in 2015, Accenture estimated that 40 million people would be enrolled in private exchange programs by 2018; the way we see this model’s growth today doesn’t speak to that. So, what is preventing them from taking off as they were initially predicted? We rounded up a few reasons why the private exchange model’s growth may be delayed, or coming to a halt.

They Are Not Easy to Deploy

There is a reason why customized benefits technology was the talk of the town over the last two years; it takes very little work up-front to customize your onboarding process. Alternatively, private exchange programs don’t hold the same reputation. The online platform selection, build, and test alone can get you three to six months into the weeds. Underwriting, which includes an analysis of the population’s demographics, family content, claims history, industry, and geographic location, will need to take place before obtaining plan pricing if you are a company of a certain size. Moreover, employee education can make up a significant time cost, as a lack of understanding and too many options can lead to an inevitable resistance to changing health plans. Using a broker, or an advisor, for this transition will prove a valuable asset should you choose to go this route.

A Lack of Education and a Relative Unfamiliarity Revolves Around Private Exchanges

Employers would rather spend their time running their businesses than understanding the distinctions between defined contribution and defined benefits models, let alone the true value proposition of private exchanges. With the ever-changing political landscape, employers are met with an additional challenge and are understandably concerned about the tax and legal implications of making these potential changes. They also worry that, because private exchanges are so new, they haven’t undergone proper testing to determine their ability to succeed, and early adoption of this model has yet to secure a favorable cost-benefit analysis that would encourage employers to convert to this new program.

They May Not Be Addressing All Key Employer and Payer Concerns

We see four key concerns stemming from employers and payers:

  • Maintaining competitive benefits: Exceptional benefits have become a popular way for employers to differentiate themselves in recruiting and retaining top talent. What’s the irony? More options to choose from across providers and plans means employees lose access to group rates and can ultimately pay more, making certain benefits less. As millennials make up more of today’s workforce and continue to redefine the value they put behind benefits, many employers fear they’ll lose their competitive advantage with private exchanges when looking to recruit and retain new team members.
  • Inexperienced private exchange administrators: Because many organizations have limited experience with private exchanges, they need an expert who can provide expertise and customer support for both them and their employees. Some administrators may not be up to snuff with what their employees need and expect.
  • Margin compression: In the eyes of informed payers, multi-carrier exchanges not only commoditize health coverage, but perpetuate a concern that they could lead to higher fees. Furthermore, payers may have to go as far as pitching in for an individual brokerage commission on what was formerly a group sale.
  • Disintermediation: Private exchanges essentially remove payer influence over employers. Bargaining power shifts from payers to employers and transfers a majority of the financial burden from these decisions back onto the payer.

It Potentially Serves as Only a Temporary Solution to Rising Health Care Costs

Although private exchanges help employers limit what they pay for health benefits, they have yet to be linked to controlling health care costs. Some experts argue that the increased bargaining power of employers forces insurers to be more competitive with their pricing, but there is a reduced incentive for employers to ask for those lower prices when providing multiple plans to payers. Instead, payers are left with the decision to educate themselves on the value of each plan. With premiums for family coverage continuing to rise year-over-year—faster than inflation, according to Forbes back in 2015—it seems private exchanges may only be a band-aid to an increasingly worrisome health care landscape.

Thus, at the end of it all, change is hard. Shifting payers’, employers’, and ultimately the market’s perspective on the projected long-term success of private exchanges will be difficult. But, if the market is essentially rejecting the model, shouldn’t we be paying attention?

By Paul Rooney
Originally Posted By www.ubabenefits.com

On April 18, 2017, the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) published its final rule regarding Patient Protection and Affordable Care Act (ACA) market stabilization.

The rule amends standards relating to special enrollment periods, guaranteed availability, and the timing of the annual open enrollment period in the individual market for the 2018 plan year, standards related to network adequacy and essential community providers for qualified health plans, and the rules around actuarial value requirements.

The proposed changes primarily affect the individual market. However, to the extent that employers have fully-insured plans, some of the proposed changes will affect those employers’ plans because the changes affect standards that apply to issuers.

The regulations are effective on June 17, 2017.

Among other things impacting group plans, the rule provided clarifications to the scope of the guaranteed availability policy regarding unpaid premiums. The guaranteed availability provisions require health insurance issuers offering non-grandfathered coverage in the individual or group market to offer coverage to and accept every individual and employer that applies for such coverage unless an exception applies. Individuals and employers must usually pay the first month’s premium to activate coverage.

CMS previously interpreted the guaranteed availability provisions so that a consumer would be allowed to purchase coverage under a different product without having to pay past due premiums. Further, if an individual tried to renew coverage in the same product with the same issuer, then the issuer could apply the enrollee’s upcoming premium payments to prior non-payments.

Under the final rule and as permitted by state law, an issuer may apply the initial premium payment to any past-due premium amounts owed to that issuer. If the issuer is part of a controlled group, the issuer may apply the initial premium payment to any past-due premium amounts owed to any other issuer that is a member of that controlled group, for coverage in the 12-month period preceding the effective date of the new coverage.

Practically speaking, when an individual or employer makes payment in the amount required to trigger coverage and the issuer lawfully credits all or part of that amount to past-due premiums, the issuer will determine that the consumer made insufficient initial payment for new coverage.

This policy applies both inside and outside of the Exchanges in the individual, small group, and large group markets, and during applicable open enrollment or special enrollment periods.

This policy does not permit a different issuer (other than one in the same controlled group as the issuer to which past-due premiums are owed) to condition new coverage on payment of past-due premiums or permit any issuer to condition new coverage on payment of past-due premiums by any individual other than the person contractually responsible for the payment of premiums.

Issuers adopting this premium payment policy, as well as any issuers that do not adopt the policy but are within an adopting issuer’s controlled group, must clearly describe the consequences of non-payment on future enrollment in all paper and electronic forms of their enrollment application materials and any notice that is provided regarding premium non-payment.

By Daniella Capilla
Originally Posted By www.ubabenefits.com

The change in the regulations that would increase the salary threshold for overtime exemption that was all over the news for the last several months may now be decided by the end of June.

The Fifth Circuit Court of Appeals has granted the U.S. Department of Labor (DOL) another 60-day extension of time to file its final reply brief in the in the pending appeal of a nationwide injunction issued by a federal district court in Texas blocking implementation of the DOL’s final overtime rule. As we reported at the time, the final rule, which raised the salary threshold for the white collar overtime exemptions, was scheduled to go into effect on December 1, 2016. The final brief is now required to be filed by June 30, 2017. In its unopposed motion, the DOL stated that the extension was necessary “to allow incoming leadership personnel adequate time to consider the issues” and noted that the nominee for Secretary of Labor has not been confirmed.

As a result of the extension, it is not likely that employers will see any resolution of this issue until midsummer at the earliest. This also assumes that President Trump’s nominee for Secretary of Labor, Alexander Acosta, is confirmed within the next few weeks.

By Rick Montgomery, JD
Originally published by www.thinkhr.com

One might describe the series of events leading to the death of the American Health Care Act (Congress’s bill to repeal and replace the Affordable Care Act) as something like a ballistic missile exploding at launch. The Patient Protection and Affordable Care Act (ACA) repeal debate began nearly a decade ago with former President Barack Obama’s first day in office and reemerged as a serious topic during the 2016 presidential election. Even following the retraction of the House bill, repeal of the ACA remains a possibility as the politicians consider alternatives to the recent bill. The possibility of pending legislation has caused some clients to question the need to complete their obligation for ACA reporting on a timely basis this year. The legislative process has produced a great deal of uncertainty which is one thing employers do not like, especially during the busy year end.

While the “repeal and replace” activity is continuing, it is imperative that employers and their brokers put their noses to the grindstone to fulfill all required reporting requirements. To accomplish this, employers will need brokers that can effectively guide them through this tumultuous season. We recommend that employers ask their brokers about their strategies for

  • Implementing the employer shared responsibility reporting
  • Sending all necessary forms to the employer’s employees
  • Submitting the employer’s reporting to the IRS
  • Closing out the employer’s 2016 filing season

Employers should also inquire about any additional support that the broker provides. They should provide many of the services that we at Health Cost Manager provide to our clients: They should apprise their clients of the latest legislative updates through regular email communication and informational webinars. Brokers should also bring in experts in the field that have interacted with key stakeholders in Washington. And most important, they should remain available during this uncertain period to answer any questions or concerns from clients.

We know employers would prefer not to have to comply with these reporting obligations – many have directly told us so. We understand this requires additional work on their part to gather information for the reporting and increased compliance responsibility. Knowing how stressful the reporting season can be for employers, brokers should go out of their way to help their clients feel confident that they can steer through the reporting process smoothly. The broker’s role should be to take as much of the burden off the employer’s shoulders as possible to enable them to reach compliance in the most expedient manner possible. Sometimes this involves stepping in to solve data or other technical issues, or answering a compliance-related question that helps the client make important decisions. It’s all part of helping employers navigate through the ACA’s strong headwinds during these uncertain times.

Audit-proof your company with UBA’s latest white paper: Don’t Roll the Dice on Department of Labor Audits. This free resource offers valuable information about how to prepare for an audit, the best way to acclimate staff to the audit process, and the most important elements of complying with requests.

The IRS updated its longstanding Q&A guidance on codes that employers should use when completing Forms 1094-C and 1095-C. For information on the IRS’ updated guidance, including COBRA reporting information that had been left pending in earlier versions of the IRS guidance for the past year, view UBA’s ACA Advisor, “IRS Q&A About Employer Information Reporting on Form 1094-C and Form 1095-C”.

By Michael Weiskirch
www.ubabenefits.com

Flex Work.  No doubt you’ve heard this term (or some variation) floating around the last decade or so, but what exactly does it mean? Flexible work can vary by definition depending on who you ask, but one thing is for sure, it’s here to stay and changing the way we view the workforce. According to a recent study by Randstad, employer commitment to increase the amount of flex workers in their companies has increased 155% over the last four years. If fact, 68% of employers agree that the majority of the workforce will be working some sort of flexible arrangement by 2025.

So then, since the landscape of a traditional office setting is changing, what exactly is Flex Work? Simply stated, it’s a practice employers use to allow their staff some discretion and freedom in how to handle their work, while making sure their schedules coordinate with colleagues. Parameters are set by the employer on how to get the work accomplished.  These guidelines may include employees working a set number of hours per day/week, and specifying core times when they need to be onsite. No matter how it’s defined, with a new generation entering the workforce and technology continuing to advance, employers will need to explore this trend to stay competitive.

Let’s take a look at how this two-fold benefit has several advantages for employers and employees alike.

Increases Productivity

When employees work a more flexible schedule, they are more productive. Many will get more done in less time, have less distractions, take less breaks, and use less sick time/PTO than office counterparts. In several recent studies, employees have stated they’re more productive when not in a traditional office setting. In a recent article published by Entrepreneur.com, Sara Sutton, CEO and Founder of FlexJobs wrote that 54% of 1500 employees polled in one of their surveys would choose to undertake important job-related assignments from home rather than the office. And 18% said that while they would prefer to complete assignments at the office, they would only do so before or after regular hours. A mere 19% said they’d go to the office during regular hours to get important assignments done.

Flexible workplaces allow employees to have less interruptions from impromptu meetings and colleagues, while minimizing the stress of office chatter and politics—all of which can drain productivity both at work and at home. What’s more, an agile setting allows your employees to work when their energy level is at peak and their focus is best. So, an early-riser might benefit from working between the hours of 4:30 and 10 a.m., while other staff members excel in the evening; once children are in bed.

Reduces Cost Across the Board

Think about it, everything we do costs us something. Whether we’re sacrificing time, money, or health due to stress, cost matters. With a flexible work environment, employees can tailor their hours around family needs, personal obligations and life responsibilities without taking valuable time away from their work. They’re able to tap into work remotely while at the doctor, caring for a sick child, waiting on the repairman, or any other number of issues.

What about the cost associated with commuting? Besides the obvious of fuel and wear and tear on a vehicle, an average worker commutes between 1-2 hours a day to the office. Tack on the stress involved in that commute and an 8 hour workday, and you’ve got one tired, stressed out employee with no balance. Telecommuting reduces these stressors, while adding value to the company by eliminating wasted time in traffic. And, less stress has a direct effect – healthier and happier employees.

Providing a flexible practice in a traditional office environment can reduce overhead costs as well. When employees are working remotely, business owners can save by allowing employees to desk or space share. Too, an agile environment makes it easier for businesses to move away from traditional brick and mortar if they deem necessary.

Boosts Loyalty, Talent and the Bottom Line

We all know employees are the number one asset in any company. When employees have more control over their schedule during the business day, it breeds trust and reduces stress. In fact, in a recent survey of 1300 employees polled by FlexJobs, 83% responded they would be more loyal to their company if they offered this benefit. Having a more agile work schedule not only reduces stress, but helps your employees maintain a good work/life balance.

Offering this incentive to prospective and existing employees also allows you to acquire top talent because you aren’t limited by geography. Your talent can work from anywhere, at any time of the day, reducing operational costs and boosting that bottom line—a very valuable asset to any small business owner or new start-up.

So, what can employers do?  While there are still companies who view flexible work as a perk rather than the norm, forward-thinking business owners know how this will affect them in the next few years as they recruit and retain new talent. With 39% of permanent employees thinking to make the move to an agile environment over the next three years, it’s important to consider what a flexible environment could mean for your company.  Keep in mind there are many types that can be molded to fit your company’s and employees’ needs. Flexible work practices don’t have to be a one-size-fits-all approach. As the oldest of Generation Z is entering the workforce, and millennials are settling into their careers, companies are wise to figure out their own customized policies. The desire for a more flexible schedule is key for the changing workforce—often times over healthcare, pay and other benefits. Providing a flexible arrangement will keep your company competitive.