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In previous posts, I have talked about several aspects of strategic benefits communication. Now it’s time to put those strategies into action. As we approach enrollment season, let’s look at five key steps to ensuring this year’s open enrollment is successful for you and your employees.

1. Determine your key objectives

What do employees need to know this enrollment season? As you review your benefit plan designs, think once again about your key objectives, and for each, how you will make employees aware and keep them engaged. What are the challenges employees face when making their benefits decisions?

  • Are you rolling out new medical plan options? Does this include HDHP options? An HSA? Are there changes in premiums and contribution levels?
  • Are there any changes to other lines of coverage such as dental, life insurance, disability insurance?
  • Are you adding new voluntary plans this year? How do they integrate with your medical plans? Do they plug gaps in high deductibles and out-of-pocket expenses? Are there existing voluntary plans with low participation?
  • Are there other important topics to share with employees, like new wellness programs, or health-driven employee events?

Once you’ve gathered this information, you can develop a communication strategy that will better engage employees in the benefits decision-making process.

2. Perfect your script

What do you know about your employee demographics? Diversity doesn’t refer only to age or gender. It could mean family size, differences in physical demands of the job, income levels, or simply lifestyle. It isn’t a one-size-fits-all world anymore. As you educate employees on benefits, you will want to give examples that fit their lives.

You will also want to keep the explanations as simple as possible. Use as much plain language as you can, as opposed to “insurance speak” and acronyms. Benefit plans are already an overwhelming decision, and as we have seen in our research, employees still don’t fully understand their options.

3. Use a multi-faceted communications strategy

Sun Life research and experience has shown that the most appreciated and effective strategies incorporate multiple methodologies. One helpful tactic is to get a jump-start on enrollment communication. As enrollment season approaches, try dynamic pre-enrollment emails to all employees, using videos or brochures. Once on-site enrollment begins, set up group meetings based on employee demographics. This will arm employees with better knowledge and prepared questions for their one-to-one meeting with a benefits counselor.

Consider hard-to-reach employees as well, and keep your websites updated with helpful links and provide contacts who are available by phone for additional support.

Also, look to open enrollment as a good time to fill any employee data gaps you may have, like beneficiaries, dependents, or emergency contacts.

4. Check your tech!

We have talked in previous posts about leveraging benefits administration technology for effective communications. For open enrollment, especially when you may be introducing new voluntary insurance plans, it is important to check your technology. I recommend this evaluation take place at least 6 to 8 weeks before open enrollment if possible.

Working with your UBA advisor, platform vendor and insurance carriers, some key considerations:

  • Provide voluntary product specifications from your carrier to your platform vendor. It is important to check up front that the platform can handle product rules such as issue age and age band pricing, age reduction, benefit/tier changes and guarantee issue rules. Also, confirm how the system will handle evidence of insurability processing, if needed.
  • Electronic Data Interface (EDI). Confirm with your platform partner as well as insurance carriers that there is an EDI set-up process that includes testing of file feeds. This is a vital step to ensure seamless integration between your benefits administration platform, payroll and the insurance carriers.
  • User Experience. Often benefits administration platforms are very effective at moving data and helping you manage your company’s benefits. As we have discussed, when it comes to your employee’s open enrollment user experience, there can be some challenges. Especially when you are offering voluntary benefits. Confirm with your vendor what, if any, decision support tools are available. Also, check with your voluntary carriers. These could range from benefit calculators, product videos, and even logic-driven presentations.

5. Keep it going

Even when enrollment season is over, ongoing benefits communications are a central tool to keeping employees informed, educated, and engaged. The small window of enrollment season may not be long enough for people to get a full grasp of their benefits needs, and often their decisions are driven by what is easily understood or what they think they need based on other people’s choices. Ongoing communications can be about specific benefits, wellness programs, or other health and benefit related items. This practice will also help new hires who need to make benefits decisions rather quickly.

In summary, work with your UBA consultant to customize benefits and enrollment communications. Leverage resources from your provider, who may, as Sun Life does, offer turnkey services that support communication, engagement, and enrollment. Explore third-party vendors that offer platforms to support the process. The whole thing can seem daunting, but following these steps and considerations will not only make the process easier for you, it will make a world of difference to your employees.

By Kevin D. Seeker
Originally Posted By www.ubabenefits.com

Where to Start?

First, expand the usual scope of wellness activity to well-BEING. Include initiatives that support more than just physical fitness, such as career growth, social needs, financial health, and community involvement. By doing this you increase your chances of seeing a return on investment (ROI) and a return on value (ROV). Qualitative results of a successful program are just as valuable as seeing a financial impact of a healthier population.

Wellness program ROI and ROV

Source: Katherine Baicker, David Cutler, and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs, February 2010, 29(2): pp 304-311

To create a corporate culture of well-being and ensure the success of your program, there are a few important steps.

  1. Leadership Support: Programs with leadership support have the highest level of participation. Gain leadership support by having them participate in the programs, give recognition to involved employees, support employee communication, allow use of on-site space, approve of employees spending time on coordinating and facilitating initiatives, and define the budget. Even though you do not need a budget to be successful.
  2. Create a Committee or Designate a Champion: Do not take this on by yourself. Create a well-being committee, or identify a champion, to share the responsibility and necessary actions of coordinating a program.
  3. Strategic Plan: Create a three-year strategic plan with a mission statement, budget, realistic goals, and measurement tools. Creating a plan like this takes some work and coordination, but the benefits are significant. You can create a successful well-being program with little to no budget, but you need to know what your realistic goals are and have a plan to make them a reality.
  4. Tools and Resources: Gather and take advantage of available resources. Tools and resources from your broker and/or carrier can help make managing a program much easier. Additionally, an employee survey will help you focus your efforts and accommodate your employees’ immediate needs.

How to Remain Compliant?

As always, remaining compliant can be an unplanned burden on employers. Whether you have a wellness or well-being program, each has their own compliance considerations and requirements to be aware of. However, don’t let that stop your organization from taking action.

There are two types of programs – Group Health Plans (GHP) and Non-Group Health Plans (Non-GHP). The wellness regulations vary depending on the type of employer and whether the program is considered a GHP or Non-GHP.

Group health plan compliance table

Employers looking to avoid some of the compliance burden should design their well-being program to be a Non-GHP. Generally, a well-being program is Non-GHP if it is offered to all employees regardless of their enrollment in the employer’s health plan and does not provide or pay for “medical care.” For example, employees receive $100 for attending a class on nutrition. Here are some other tips to keep your well-being program Non-GHP:

  • Financial: Do not pay for medical services (e.g., flu shots, biometric screenings, etc.) or provide medical care. Financial incentives or rewards must be taxed. Do not provide premium discounts or surcharges.
  • Voluntary Participation: Include all employees, but do not mandate participation. Make activities easily accessible to those with disabilities or provide a reasonable alternative. Make the program participatory (i.e., educational, seminars, newsletters) rather than health-contingent (i.e., require participants to get BMI below 30 or keep cholesterol below 200). Do not penalize individuals for not participating.
  • Health Information: Do not collect genetic data, including family medical history. Any medical records, or information obtained, must be kept confidential. Avoid Health Risk Assessments (i.e. health surveys) that provide advice and analysis with personalized coaching or ask questions about genetics/family medical history.

By Hope DeRocha
Originally Posted By www.ubabenefits.com

Death and loss touch all of us, usually many times throughout our lives. Yet we may feel unprepared and uncomfortable when grief intrudes into our daily routines. As a manager, when grief impacts your employees it’s helpful to have a basic understanding of what they are going through as well as ways you can help.

Experiencing Grief

Although we all experience grief in our own way, there are behaviors, emotions and physical sensations that are a common part of the mourning process. J. William Worden’s “Four Tasks of Mourning” will be experienced in some form by anyone who is grieving. These tasks include accepting the reality of the loss, experiencing and accepting our emotions, adjusting to life without the loved one, and investing emotional energy into a new and different life.

Commonly experienced emotions are sadness, anger, frustration, guilt, shock and numbness. Physical sensations include fatigue or weakness, shortness of breath, tightness in the chest and dry mouth.

Manager’s Role

When employees are mourning, it’s important to create a caring, supportive and professional work environment. In most cases, employees will benefit from returning to work. It allows them to resume a regular routine, focus on something besides their loss and boost their confidence by completing work tasks.

At the same time, bereaved employees may experience many challenges when returning to work. They may have poor concentration, be extremely tired, feel depressed or have a short temper and uncontrollable emotions.

As a manager, the best thing you can do is acknowledge the loss and maintain strong lines of communication. Even if you believe someone else is checking in with them, make sure you stay in touch and see if there is anything you can do.

Developing a Return to Work Plan

In order to help your employees have a smooth transition back to work you must listen and understand their needs. Some additional questions you’ll want to answer are:

  • What are your company’s policies and procedures for medical and bereavement leave?
  • What information do your employees want their co-workers to have and would they rather share this information themselves?
  • Do they want to talk about their experience or would they rather focus on work?
  • Do they need private time while at work?
  • Does their workload and schedule need to be adjusted?
  • Do they need help at home – child care, meals, house work, etc.?
  • Are there others at work that may be experiencing grief of their own?

Helpful Responses for Managers

  • Offer specific help – make meals, wash their car, walk their pet, or anything else that will make their life easier.
  • Say something – it can be as simple as, “I’m so sorry for your loss.”
  • Listen – be kind but honest.
  • Respect privacy – honor closed doors and private moments.
  • Expect tears – emotions can hit unexpectedly.
  • Thank your staff – for everything they are doing to help.

Grieving is a necessity, not a weakness. It is how we heal and move forward. As a manager, being there for your employees during this time is important in helping them through the grieving process.

An Employee Assistance Program is a great resource for both you and your employees when grief comes to work.

By Kathryn Schneider
Originally Posted By www.ubabenefits.com

Across most industries, HSA contributions are, for the most part, down or unchanged from three years ago, according to UBA’s Health Plan Survey. The average employer contribution to an HSA is $474 for a single employee (down 3.5 percent from 2015 and 17.6 percent from five years ago) and $801 for a family (down 9.2 percent from last year and 13.7 percent from five years ago). Government and education employers are the only industries with average single contributions well above average and on the rise.

Government employees had the most generous contributions for singles at $850, on average, up from $834 in 2015. This industry also has the highest employer contributions for families, on average, at $1,595 (though that is down from 1,636 in 2015). Educational employers are the next most generous, contributing $636, on average, for singles and $1,131 for families.

Singles in the accommodation/food services industries received virtually no support from employers, with average HSA contributions at $166. The same is true for families with HSA plans in the accommodation/food services industries with average family contributions of $174.

Retail employers also remain among the least generous contributors to single and family HSA plans, contributing $305 and $470, respectively. This may be why they have low enrollment in these plans.

HSA Plans by Industry

The education services industry has seen a 109 percent increase in HSA enrollment since 2013 (aided by employers’ generous contributions), catapulting the industry to the lead in HSA enrollment at 23.8 percent. The professional/scientific/tech and finance/insurance industries follow closely at 23.3 percent and 22.1 percent, respectively.

The mining/oil/gas industry sees the lowest enrollment at 3.8 percent. The retail, hotel, and food industries continue to have some of the lowest enrollment rates despite the prevalence of these plans, indicating that these industries, in particular, may want to increase employee education efforts about these plans and how they work.

For a detailed look at the prevalence and enrollment rates among HSA and HRA plans by group size and region, view UBA’s “Special Report: How Health Savings Accounts Measure Up”.

Benchmarking your health plan with peers of a similar size, industry or geography makes a big difference in determining if your plan is competitive. To compare your exact plan with your peers, request a custom benchmarking report.

For fast facts about HSA and HRA plans, including the best and worst plans, average contributions made by employers, and industry trends, download (no form!) “Fast Facts: HSAs vs. HRAs”.

By Bill Olson
Originally Posted By www.ubabenefits.com

Best Practices for Initial COBRA Notices | Ohio Benefit Advisors

Categories: Benefits, Blog, COBRA, Team K Blog, UBA, UBA News
Comments Off on Best Practices for Initial COBRA Notices | Ohio Benefit Advisors

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires group health plans to provide notices to covered employees and their families explaining their COBRA rights when certain events occur. The initial notice, also referred to as the general notice, communicates general COBRA rights and obligations to each covered employee (and his or her spouse) who becomes covered under the group health plan. This notice is issued by the plan administrator within the first 90 days when coverage begins under the group health plan and informs the covered employee (and his or her spouse) of the responsibility to notify the employer within 60 days if certain qualifying events occur in the future.

The initial notice must include the following information:

  • The plan administrator’s contact information
  • A general description of the continuation coverage under the plan
  • An explanation of the covered employee’s notice obligations, including notice of
    • The qualifying events of divorce, legal separation, or a dependent’s ceasing to be a dependent
    • The occurrence of a second qualifying event
    • A qualified beneficiary’s disability (or cessation of disability) for purposes of the disability extension)
  • How to notify the plan administrator about a qualifying event
  • A statement that that the notice does not fully describe continuation coverage or other rights under the plan, and that more complete information regarding such rights is available from the plan administrator and in the plan’s summary plan description (SPD)

As a best practice, the initial notice should also:

  • Direct qualified beneficiaries to the plan’s most recent SPD for current information regarding the plan administrator’s contact information.
  • For plans that include health flexible spending arrangements (FSAs), disclose the limited nature of the health FSA’s COBRA obligations (because certain health FSAs are only obligated to offer COBRA through the end of the year to qualified beneficiaries who have underspent accounts).
  • Explain that the spouse may notify the plan administrator within 60 days after the entry of divorce or legal separation (even if an employee reduced or eliminated the spouse’s coverage in anticipation of the divorce or legal separation) to elect up to 36 months of COBRA coverage from the date of the divorce or legal separation.
  • Define qualified beneficiary to include a child born to or placed for adoption with the covered employee during a period of COBRA continuation coverage.
  • Describe that a covered child enrolled in the plan pursuant to a qualified medical child support order during the employee’s employment is entitled to the same COBRA rights as if the child were the employee’s dependent child.
  • Clarify the consequences of failing to submit a timely qualifying event notice, timely second qualifying event notice, or timely disability determination notice.

Practically speaking, the initial notice requirement can be satisfied by including the general notice in the group health plan’s SPD and then issuing the SPD to the employee and his or her spouse within 90 days of their group health plan coverage start date.

If the plan doesn’t rely on the SPD for furnishing the initial COBRA notice, then the plan administrator would follow the U.S. Department of Labor (DOL) rules for delivery of ERISA-required items. A single notice addressed to the covered employee and his or her spouse is allowed if the spouse lives at the same address as the covered employee and coverage for both the covered employee and spouse started at the time that notice was provided. The plan administrator is not required to provide an initial notice for dependents.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

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

UBA’s compliance team leverages the collective expertise of its independent partner firms to advise 36,000 employers and their 5 million employees. Lately, a common question from employers is: If a health and welfare benefit plan has fewer than 100 participants, then does it need to file a Form 5500?

If a plan is self-funded and uses a trust, then it is required to file a Form 5500, no matter how many participants it has.

Whether the plan must file a Form 5500 depends on whether or not the plan is “unfunded” (where the money comes from to pay for the self-funded claims).

Currently, group welfare plans generally must file Form 5500 if:

  • The plan is fully insured and had 100 or more participants on the first day of the plan year (dependents are not considered “participants” for this purpose unless they are covered because of a qualified medical child support order).
  • The plan is self-funded and it uses a trust, no matter how many participants it has.
  • The plan is self-funded and it relies on the Section 125 plan exemption, if it had 100 or more participants on the first day of the plan year.

There are several exemptions to Form 5500 filing. The most notable are:

  • Church plans defined under ERISA Section 3(33)
  • Governmental plans, including tribal governmental plans
  • Top hat plans which are unfunded or insured and benefit only a select group of management or highly compensated employees
  • Small insured or unfunded welfare plans. A welfare plan with fewer than 100 participants at the beginning of the plan year is not required to file an annual report if the plan is fully insured, entirely unfunded, or a combination of both.

A plan is considered unfunded if the employer pays the entire cost of the plan from its general accounts. A plan with a trust is considered funded.

For smaller groups that are self-funded or partially self-funded, you’d need to ask them whether the plan is funded or unfunded.

If the employer pays the cost of the plan from general assets, then it is considered unfunded and essentially there is no trust.

If the employer pays the cost of the plan from a specific account (in which plan participant contributions are segregated from general assets), then the plan is considered funded. For example, under ERISA, pre-tax salary reductions under a cafeteria plan are participant contributions and are considered plan assets which must generally be held in trust based on ERISA’s exclusive benefit rule and other fiduciary duty rules.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

When we hear something’s magnetic, it’s likely the first thought that comes to mind is attraction. By definition, a magnetic force is the attraction or repulsion that arises between electrically charged particles because of their motion. What perfect framing for an organization – the desire to attract (or repel) people to help advance your organization. With this framing comes the assumption that there’s motion, which is, hopefully, a result of intentional action.

If we follow the thought of intentional action, there are seven steps (and many more details for each step that would be too lengthy to include here) that attract what’s desired and repel what’s not desired.

Seven Steps to Being a Magnetic Organization

1.  Decide what you want for the company

Simple, right? Yes. However, often an assumption is made that everybody knows what’s wanted. The best way to determine if you know what’s wanted is to ask the question, “Can I paint a clear, colorful and compelling story of the future?” This is one of the most important roles of leadership in an organization. Create, and tell a compelling story worthy of the effort it will take to get there.

2.  Get 100 percent buy-in from top leadership

It’s not enough for the CEO or owner to own the future story, every top leader who’s responsible for the performance and experience of employees and customers needs to be 100 percent committed to the future. This is perhaps the most telling test of how quickly and assuredly you will achieve the goals to support the future state. It’s critical to check for this buy-in up front as well as at key milestone points along the way.

3.  Communicate

As important as the first two steps are, a pinnacle point in the process is sharing with your employees, customers, and other stakeholders what you intend to do.

This is a step that is often overlooked and undervalued. If you ascribe to the rule of seven for marketing, it takes at least seven exposures for a person to hear something with the likelihood of remembering the message. Communicate often and keep your message clear and consistent. Also, keep in mind that people absorb information differently. This absorption is relative to learning styles. Presenting information will be accepted differently if someone is visual, aural, verbal, physical, logical, social, or solitary in their learning style.

As you design your communication plan, explore not only what you’ll share, but how you’ll promote the messages.

4.  Build Your Culture

This speaks to the actions necessary to achieve desired outcomes. It’s intentionally ordered after communication. Reinforce the mission of the company, or roll it out if it’s newly created. To move forward, you need every employee to be aware of the direction and expectations for the organization. Share organizational goals and keep leaders accountable to create alignment for their teams, including working with each person on their team to understand how his or her unique role fits into the overall picture. This will drive interactions that contribute to, or detract from, success.

Involve employees in the early phases of culture change and share quick wins. Consider including stories and testimonials from employees that show how the company is already making strides to get to the future vision.

Assure the right fit of employees. Clearly identify the top three expectations for each role and then find people who will be on fire to do these things well.

David Pink, in his book Drive, explores exactly what motivates people and claims that true motivation consists of: 1) autonomy, the desire to direct our own lives; 2) mastery, the desire to continually improve at something that matters; and 3) purpose, the desire to do things in service of something larger than ourselves.

In addition, make a habit of catching people doing the right things right. Recognition of work well done continuously reinforced will add fuel to building a positive culture. Finally, allow people to be who they are and find ways to insert moments of fun.

5.  Evaluate

There are many evaluation tools to help identify what’s happening. Asking for feedback from employees and customers can be a highly effective way to help understand where the best practices exist and where improvements are needed. Measuring what’s happening on a regular basis offers identification of value in processes and with products.

According to the Predictions for 2017 Bersin by Deloitte report, “Driven by the need to understand and improve engagement, and the continuous need to measure and improve employee productivity, real time feedback and analytics will explode.”

6.  Assess

The intention of assessment is to determine how things are going and then focus on improvement. The people who know the operations the best are the ones working the business. Trust your employees. As you understand the frustrations and barriers employees encounter, there’s an opportunity to reengineer how to tailor processes, deliver services, and provide products to support the changing needs of the customer.

7.  Adjust

When you identify what’s working and what needs to be changed – act with a sense of urgency to make the necessary changes. The organizations who adapt are the ones who have the greatest longevity. Market changes are constant and the ability to understand what’s happening and move toward what will occur in the future is not only admirable, but necessary for sustainability.

It’s obvious how these steps attract people with desired talents and attitudes to help advance your organization, but how will these same actions repel those who don’t align? When there’s consistent reinforcement of the culture, those who don’t fit will have a sense that your company just isn’t the right place for them, like trying to fit into a jacket that is too small or too large. This will be true for current employees and potential employees.

Not getting the results you want? Consider revisiting these actions – one step at a time.

 

By Joan Morehead
Originally Posted By www.ubabenefits.com

 

In conversations with HR professionals and benefit brokers, we find that the topic of long-term care insurance (LTCi) is often covered in less than two minutes during renewal meetings. When I ask why the topic of conversation is so short, they tell me, “Employees just aren’t asking about it, so they must not be interested.”

If employees aren’t asking about LTCi, does it mean they aren’t interested? They just may be unaware of the value of LTCi and that it can be offered by their employer with concessions not available in the open market. Here are the top seven reasons why LTCi should be a bigger part of the employee benefits conversation.

  1. Do you know LTCi can be offered as an employee benefit?
    There are multiple employer-sponsored products, including those with pricing discounts, guarantee issue, and payroll deduction.
  2. Do you believe Medicaid and Medicare will provide long-term care for employees?
    This is a popular misconception. Medicare and Medicaid will restrict your employees’ choices of where and how they receive care. These options will either not offer custodial or home care, or they’ll force employees to spend down their assets for care.
  3. Do you think LTCi is too expensive, or that your employee population is too young to need it?
    Many plans can be customized to meet personal budgets and potential care needs. It’s also important to know that rates are based on employees’ ages. The younger the employees are, the lower their rates will be.
  4. Are you aware of the variety of LTCi plans?
    Many policies offer flexible coverage options. Depending on the policy an employer selects, LTCi can cover a wide range of care—in some cases even adult day care and home safety modifications.
  5. Do you believe the market is unstable?
    Today’s products are priced based on conservative assumptions, and employers are enrolling very stable LTCi plans for their employees. Each month, we see new plan options and products being introduced along with new carriers entering the market.
  6. Do you already offer an LTCi plan but it’s closed to new hires?
    Being able to offer a similar LTCi benefit to all employees is crucial for most employers. Find a partner that can assist with the current LTCi plan and can assist with bringing in a new LTCi offering for new hires

By Christine McCullugh
Originally Posted By www.ubabenefits.com

DOL Asks for MHPAEA Related Comments; Clarifies Eating Disorder Benefit Requirements | Ohio Benefit Advisors

Categories: 21st Century Cures Act, ACA, Mental Health, Team K Blog, UBA, UBA News
Comments Off on DOL Asks for MHPAEA Related Comments; Clarifies Eating Disorder Benefit Requirements | Ohio Benefit Advisors

Earlier this month, the Department of Labor (DOL) provided an informational FAQ relating to the Mental Health Parity and Addiction Equity Act (MHPAEA) and the 21st Century Cures Act (Cures Act). This is the DOL’s 38th FAQ on implementing the Patient Protection and Affordable Care Act (ACA) provisions and related regulations. The DOL is requesting comments on a draft model form for participants to use to request information regarding nonquantitative treatment limitations, and confirms that benefits for eating disorders must comply with the MHPAEA. Comments are due by September 13, 2017.

The MHPAEA amended various laws and regulations to provide increased parity between mental health and substance use disorder benefits and medical/surgical benefits. Generally, financial requirements such as coinsurance and copays and treatment limitations for mental health and substance use disorder benefits cannot be more restrictive than requirements for medical and surgical benefits. Regulations also provide that a plan or issuer may not impose a nonquantitative treatment limitation (NQTL) unless it is comparable and no more stringent than limitations on medical and surgical benefits in the same classification.

On December 13, 2016, President Obama signed the 21st Century Cures Act into law. The Cures Act has numerous components including directing the Secretary of Health and Human Services, Secretary of Labor, and Secretary of the Treasury (collectively, the Agencies) to issue compliance program guidance, share findings with each other, and issue guidance to group health plans and health insurance issuers to help them comply with the mental health parity rules.

The Agencies must issue guidance to group health plans and health insurance issuers; the guidance must provide information and methods that plans and issuers can use when they are required to disclose information to participants, beneficiaries, contracting providers, or authorized representatives to ensure the plans’ and issuers’ compliance with the mental health parity rules.

The Agencies must issue the compliance program guidance and guidance to group health plans and health plan issuers within 12 months after the date that the Helping Families in Mental Health Crisis Reform Act of 2016 was enacted, or by December 13, 2017.

In the June 2017 FAQ, the DOL reiterated its request for comments on the following questions, originally asked in the fall of 2016:

  1. Whether issuance of model forms that could be used by participants and their representatives to request information with respect to various NQTLs would be helpful and, if so, what content the model forms should include. For example, is there a specific list of documents, relating to specific NQTLs, that a participant or his or her representative should request?
  2. Do different types of NQTLs require different model forms? For example, should there be separate model forms for specific information about medical necessity criteria, fail-first policies, formulary design, or the plan’s method for determining usual, customary, or reasonable charges? Should there be a separate model form for plan participants and other individuals to request the plan’s analysis of its MHPAEA compliance?
  3. Whether issuance of model forms that could be used by States as part of their review would be helpful and, if so, what content the model form should include. For example, what specific content should the form include to assist the States in determining compliance with the NQTL standards? Should the form focus on specific classifications or categories of services? Should the form request information on particular NQTLs?
  4. What other steps can the Departments take to improve the scope and quality of disclosures or simplify or otherwise improve processes for requesting disclosures under existing law in connection with mental health/substance misuse disorder MH/SUD benefits?
  5. Are there specific steps that could be taken to improve State market conduct examinations and/or Federal oversight of compliance by plans and issuers?

The DOL is also asking for input on a draft model form that participants, enrollees, or representatives could use to request information from their health plan or issuer regarding NQTLs that may affect their MH/SUD benefits.

The Cures Act also requires that benefits for eating disorders be consistent with the requirements of MHPAEA. The DOL clarified that the MHPAEA applies to any benefits a plan or issuer may offer for treatment of an eating disorder.

By Danielle Capilla
Originally Posted By www.ubabenefits.com