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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

How to Get Employees’ Attention during Open Enrollment | Ohio Employee Health Insurance

Categories: Enrollment
Comments Off on How to Get Employees’ Attention during Open Enrollment | Ohio Employee Health Insurance

By Matthew Augustine, GPHR, REBC, CEO of Hanna Global Solutions, a UBA Partner Firm

It’s that time of the year – open enrollment season is here! Insurance carriers are presenting renewals and brokers are presenting ways to alleviate the cost pressure with innovative cost management strategies. HR and benefits professionals are under pressure to think out of the box and come up with new and improved benefit programs to Open enrollmentengage employees. Benefits administration companies are busy getting staffed, trained and ready for long hours and last-minute client decisions. And employees are getting ready for the barrage of benefits-related communications that are coming their way.

Are employees really looking forward to this?

My daughter was recently hired by a global pharmaceutical company and had to complete her benefits enrollment online. She was definitely was not looking forward to this part of her onboarding process. For her, it was one of those necessary ”to do” items that had to be checked off, and the less time it took, with the least bit of engagement or attention required from her, the better. That is, until I intervened and pointed out the possibility of higher costs and money being left on the table if she ignored some of the attractive benefit programs.

Employees comparison shop for other purchases, so why aren’t they curious about the price differences between plans and ways they could save money with the right choices? HR and benefits professionals have been looking for better ways to engage employees in the enrollment process for many years, especially as costs have escalated, and employers have had to scale back their share of costs.

Online enrollment systems with attractive presentations of benefit programs and ”engaging” user experiences in enrollment are one method. Forcing employees to select from a portfolio of plans using a combination of their own and employer money is another way. Add to all this a big dose of communications, both in print and online, that attempt to educate employees on their benefit options.

Within a couple of months of her starting her job, my daughter received an award for her contribution to work on a project. The reward was in the form of points that she could redeem for items offered on a rewards website. She was much more interested in browsing the ”stuff” that she could get with her rewards, or with rewards she could earn in future, than in browsing for something as important as insurance coverage.

Maybe a creative blend of shopping for rewards and shopping for insurance and other traditional employee benefits is what we need to get employees engaged in benefits enrollment. Many employers already offer enrollment rewards – gift cards for attending an open enrollment meeting, credits for completing a health risk assessment, and other such ideas. The next step is to integrate the benefits enrollment process with the employee reward program in a seamless experience, using one portal for comparing and enrolling in benefit plans, and offering payroll deduction options for purchases made with reward points.

With added reward products and programs on the shelves, employee benefits enrollment systems will become online marketplaces that attract employees to shop there.

Learn more about UBA’s online private insurance exchange platforms.

For information on how your health plan stacks up against other employers, pre-order the 2015 Health Plan Executive Summary, which highlights the latest findings of the UBA survey, the largest health plan cost survey in the industry.

 

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