All posts tagged health benefits

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

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

Voluntary Benefits are Supplementary Benefits in addition to the core benefits package that the employee can choose to add.

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

On April 4, 2017, the Department of Labor (DOL) announced that the applicability date for the final fiduciary rule will be extended, and published its final rule extending the applicability date in the Federal Register on April 7. This extension is pursuant to President Trump’s February 3, 2017 presidential memorandum directing the DOL to further examine the rule and the DOL’s proposed rule to extend the deadline released on March 2, 2017.

The length of the extension differs between certain requirements and/or components of the rule.  Below are the components and when and how applicability applies:

  • Final rule defining who is a “fiduciary”: Under the final rule, advisors who are compensated for providing investment advice to retirement plan participants and individual account owners, including plan sponsors, are fiduciaries. The applicability date for the final rule is extended 60 days, from April 10 until June 9, 2017. Fiduciaries will be required to comply with the impartial conduct or “best interest” standards on the June 9 applicability date.
  • Best Interest Contract Exemption: Except for the impartial conduct standards (applicable June 9 per above), all other conditions of this exemption for covered transactions are applicable January 1, 2018. Therefore, fiduciaries intending to use this exemption must comply with the impartial conduct standard between June 9, 2017 and January 1, 2018.
  • Class Exemption for Principal Transactions: Except for the impartial conduct standards (applicable June 9 per above), all other conditions of this exemption for covered transactions are applicable January 1, 2018. Therefore, fiduciaries intending to use this exemption must comply with the impartial conduct standard between June 9, 2017 and January 1, 2018 and thereafter.
  • Prohibited Transaction Exemption 84-24 (relating to annuities): Except for the impartial conduct standard (applicable June 9 per above), the amendments to this exemption are applicable January 1, 2018.
  • Other previously granted exemptions: All amendments to other previously granted exemptions are applicable on June 9, 2017.

By Nicole Quinn-Gato, JD
Originally published by www.thinkhr.com

It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits.  And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

In a recent study conducted by the Aloft Group on the state of Telemedicine, 47.7% of respondents weren’t sure about what Telemedicine meant, but it’s possible they may have experienced it, as 52.4% have had interaction with a physician or clinician via email or text. Further, 78.5% of respondents indicated they would be comfortable talking with a physician using an online method.

Dr. Tony Yuan, an experienced ER doctor in San Diego, who also consults for Doctor on Demand, provides insight into this increasing trend during a recent Q and A session. Currently, over half of the patients he sees in his ER could utilize a digital healthcare model. In fact, 90% of patients who head to the ER for minor illnesses can be treated through this service. So, the next sinus, ear infection, or other minor health issue just may provide you and your family the chance to try what will become the new standard in minor healthcare.

Here are few benefits TeleMedicine has to offer:

It’s Fast and Simple

There’s no question apps are available for everything to make our lives easier—and TeleMed is no exception. Within minutes, standard first time users can set up an account, complete a few medical profile questions, then create and save a session. Having the ability to log on with a board-certified physician or clinician 24/7/365, using any PC, smart device, and even phone in some cases, saves time and money. Many services, like Teledoc and MDLive, will connect you with a licensed doctor or clinician online in just a few minutes – no scheduling or wait required. Once on, you can discuss your healthcare needs confidentially. After the visit, the doctor will update his/her records, notify your primary care physician of the call, and send an electronic prescription to the pharmacy of your choice, if necessary—all in the time it takes for a lunch break.

It’s Flexible

The ability to connect with a professional whether you are at home, work, or traveling makes getting the care you need invaluable. How often have you experienced the symptoms—or the full blown-effect—of getting sick while traveling? Many, no doubt, have had to adjust flight/travel plans to get the help needed from their PCP, in order to avoid getting worse.  By using an app or online service from your smart phone or laptop, you’re able to get the antibiotics you need quicker without cutting trips short or missing work to do so.

In addition, patients in smaller communities without the resources available of classically- trained, emergency-med physicians, see the benefit and flexibility of tapping into these online doctor services. Not only is it a plus for the patient to access more advanced care if needed, doctors in these rural areas value this as well. These digital healthcare models provide immediate, life-saving tools for both doctors and their patients who may not have access to higher, acute facilities.

It’s Affordable

Many TeleMedicine services now accept insurance, making a patient’s visit free, or at minimum the same as most deductible or co-insurance amounts for office visits; around $40. For those on a high-deductible plan, paying $40 for an online doctor service is a much cheaper alternative than paying $150 or more for an Urgent Care visit, or over $1200 for a trip to the ER. For employers, group options are low cost and can be a clear asset when creating solutions EEs will value.

It’s Beneficial to Employers

Today, 3 of 5 corporations, or 59% of employers provide digital healthcare benefits to their employees. As an employer, the benefits are straightforward. First, employees can participate in professional consultations for their family members or themselves without taking away from productivity. Second, when employers incorporate these services into their benefit plans, non-emergency care is redirected from expensive ER visits, ultimately saving thousands of dollars or more to the bottom line. Additionally, TeleHealth services offer frequent monitoring from clinicians for those employees who may need regular support due to more chronic issues, reducing trips to the hospital. Reducing these costs have a direct ROI for the employer and relieves the stress on the employee’s pocketbook. Third, many companies are now adding this digital benefit to their packages as a way to recruit new talent.

There’s no doubt 2017 will see a greater opportunity for all to experience the increasing trend of Telemed. Creating a clear communication strategy to make sure employees know how to find, access and utilize this service to the highest potential is key.

Entities such as employers with group health plans that provide prescription drug coverage to individuals that are eligible for Medicare Part D have two major disclosure requirements that they must meet at least annually:

  • Provide annual written notice to all Medicare eligible individuals (employees, spouses, dependents, retirees, COBRA participants, etc.) who are covered under the prescription drug plan.
  • Disclose to the Centers for Medicare and Medicaid Services (CMS) whether the coverage is “creditable prescription drug coverage.”

Because there is often ambiguity regarding who in a covered population is Medicare eligible, it is best practice for employers to provide the notice to all plan participants.

CMS provides guidance for disclosure of creditable coverage for both individuals and employers.

Who Must Disclose?

These disclosure requirements apply regardless of whether the plan is large or small, is self-funded or fully insured, or whether the group health plan pays primary or secondary to Medicare. Entities that provide prescription drug coverage through a group health plan must provide the disclosures. Group health plans include:

  • Group health plans under ERISA, including health reimbursement arrangements (HRAs), dental and vision plans, certain cancer policies, and employee assistance plans (EAPs) if they provide medical care
  • Group health plans sponsored for employees or retirees by a multiple employer welfare arrangement (MEWA)
  • Qualified prescription drug plans

Health flexible spending accounts (FSAs), Archer medical savings accounts, and health savings accounts (HSAs) do not have disclosure requirements. In contrast, the high deductible health plan (HDHP) offered in conjunction with the HSA would have disclosure requirements.

There are no exceptions for church plans or government plans.

By Danielle Capilla
Originally published by www.ubabenefits.com

There is no denying our industry is changing rapidly, and it’s not about to slow down. Combined with disruptive advances in technology and evolving consumer expectations, we’re seeing consumer-driven health care emerge. Take, for example, the fact that employees now spend more than nine hours a day on digital devices.

There’s no doubt that all this screen time takes a toll.

  • Device screens expose users to blue light. It’s the light of the day and helps us wake up and regulate our sleep/wake cycle.
  • Research suggests blue light may lead to eye strain and fatigue. Digital eye strain is the physical eye discomfort felt by many individuals after two or more hours in front of a digital screen.
  • In fact, digital eye strain has surpassed carpal tunnel syndrome and tendonitis as the leading computer-related workplace injury in America1.

Employees are demanding visibility into health care costs and transparency in the options available so they can take control of their own health. Consumers are more knowledgeable and sensitive to cost, and as a result becoming very selective about their care.

 

Technology Exposure Spends more than nine hours
a day on digital devices
Millennials 2 in 5
Gen-Xers 1 in 3
Baby Boomers 1 in 4

 

Lack of preventive care

Preventive screenings are a crucial piece of overall health and wellness. In fact, the largest investment companies make to detect illnesses and manage medical costs is in their health plan. But if employees don’t take advantage of preventive care, this investment will not pay off. Only one out of 10 employees get the preventive screenings you’d expect during an annual medical visit2.

It’s a big lost opportunity for organizations that are looking for a low-cost, high-engagement option to drive employee wellness.

How a vision plan can help

The good news is that the right vision plan can help your employees build a bigger safety net to catch chronic conditions early. It all starts with education on the importance of an eye exam.

Eye exams are preventive screenings that most people seek out as a noninvasive, inexpensive way to check in on their health; it’s a win-win for employers and employees.

  • A comprehensive eye exam can reveal health conditions even if the person being examined doesn’t have symptoms.
  • The eyes are the only unobtrusive place in a person’s body with a clear view of their blood vessels.
  • And, an eye exam provides an opportunity to learn about the many options available to take control of their health and how to protect their vision.

By screening for conditions like diabetes, high blood pressure, and high cholesterol during eye exams, optometrists are often the ones to detect early signs of these conditions and put the patient on a quicker path to managing the condition. In a study conducted in partnership with Human Capital Management Services (HCMS), VSP doctors were the first to detect signs of3:

  • Diabetes – 34 percent of the time
  • Hypertension – 39 percent of the time
  • High cholesterol – 62 percent of the time

To learn more about the changing landscape of employee benefits, watch the UBA WisdomWorkplace webinar How Telehealth and Technology is Changing the Landscape of Employee Benefits. VSP Global offers world-class products and services to eye care professionals, employers, and more than 80 million members.

By Pat McClelland
Originally published by www.ubabenefits.com

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees.

In order for the Internal Revenue Service (IRS) to verify that (1) individuals have the required minimum essential coverage, (2) individuals who request premium tax credits are entitled to them, and (3) ALEs are meeting their shared responsibility (play or pay) obligations, employers with 50 or more full-time or full-time equivalent employees and insurers will be required to report on the health coverage they offer. Similarly, insurers and employers with less than 50 full time employees but that have a self-funded plan also have reporting obligations. All of this reporting is done on IRS Forms 1094-B, 1095-B, 1094-C and 1095-C.

Final instructions for both the 1094-B and 1095-B and the 1094-C and 1095-C were released in September 2015, as were the final forms for 1094-B, 1095-B, 1094-C, and 1095-C.

Form 1094-C is used in combination with Form 1095-C to determine employer shared responsibility penalties. It is often referred to as the “transmittal form” or “cover sheet.” IRS Form 1095-C will primarily be used to meet the Section 6056 reporting requirement, which relates to the employer shared responsibility/play or pay requirement. Information from Form 1095-C will also be used in determining whether an individual is eligible for a premium tax credit.

Form 1094-C contains information about the ALE, and is how an employer identifies as being part of a controlled group. It also has a section labeled “Certifications of Eligibility” and instructs employers to “select all that apply” with four boxes that can be checked. The section is often referred to as the “Line 22” question or boxes. Many employers find this section confusing and are unsure what, if any, boxes they should select. The boxes are labeled:

  1. Qualifying Offer Method
  2. Reserved
  3. Section 4980H Transition Relief
  4. 98% Offer Method

Different real world situations will lead an employer to select any combination of boxes on Line 22, including leaving all four boxes blank. Practically speaking, only employers who met the requirements of using code 1A on the 1095-C, offered coverage to virtually all employees, or qualified for transition relief in 2015 and had a non-calendar year plan will check any of the boxes on Line 22. Notably, employers who do not use the federal poverty level safe harbor for affordability will never select Box A, and corresponding with that, will never use codes 1A or 1I on Line 14 of a 1095-C form.

To fully understand each box, including plain language explanations of the form instructions, request UBA’s ACA Advisor, “IRS Reporting Tip: Form 1094-C, Line 22”.

By Danielle Capilla
Originally published by www.ubabenefits.com