All posts tagged health care

Recently, the U.S. Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively the Departments) issued final regulations regarding the definition of short-term, limited-duration insurance, standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits, and an amendment relating to the prohibition on lifetime and annual dollar limits.

Effective Date and Applicability Date

These final regulations are effective on December 30, 2016. These final regulations apply beginning on the first day of the first plan or policy year beginning on or after January 1, 2017.

Short-Term, Limited-Duration Insurance

Short-term, limited-duration insurance is a type of health insurance coverage designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another plan or coverage. Although short-term, limited-duration insurance is not an excepted benefit, it is exempt from Public Health Service Act (PHS Act) requirements because it is not individual health insurance coverage. The PHS Act provides that the term ‘‘individual health insurance coverage’’ means health insurance coverage offered to individuals in the individual market, but does not include short-term, limited-duration insurance.

On June 10, 2016, the Departments proposed regulations to address the issue of short-term, limited-duration insurance being sold as a type of primary coverage.

The Departments have finalized the proposed regulations without change. The final regulations define short-term, limited-duration insurance so that the coverage must be less than three months in duration, including any period for which the policy may be renewed. The permitted coverage period takes into account extensions made by the policyholder ‘‘with or without the issuer’s consent.’’ A notice must be prominently displayed in the contract and in any application materials provided in connection with enrollment in such coverage with the following language:

THIS IS NOT QUALIFYING HEALTH COVERAGE (‘‘MINIMUM ESSENTIAL COVERAGE’’) THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

The revised definition of short-term, limited-duration insurance applies for policy years beginning on or after January 1, 2017.

Because state regulators may have approved short-term, limited-duration insurance products for sale in 2017 that met the definition in effect prior to January 1, 2017, HHS will not take enforcement action against an issuer with respect to the issuer’s sale of a short-term, limited-duration insurance product before April 1, 2017, on the ground that the coverage period is three months or more, provided that the coverage ends on or before December 31, 2017, and otherwise complies with the definition of short-term, limited-duration insurance in effect under the regulations. States may also elect not to take enforcement actions against issuers with respect to such coverage sold before April 1, 2017.

For information on final regulations regarding excepted benefits, specifically similar supplemental coverage and travel insurance—as well as information on the definition of essential health benefits for purposes of the prohibition on lifetime and annual limits, view UBA’s ACA Advisor, “Regulations Regarding Short-Term Limited-Duration Insurance, Excepted Benefits, and Lifetime/Annual Limits.”

Originally published by www.ubabenefits.com

This week, the U.S. Senate passed the 21st Century Cures Act which includes a provision allowing small businesses to offer a new type of health reimbursement arrangement for their employees’ health care expenses, including individual insurance premiums. The act was previously passed by the House and President Obama is expected to sign it shortly. The provision for Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs), a new type of tax-free benefit, takes effect January 1, 2017. Further, the act retroactively relieves small employers from the threat of excise taxes under prior rules for plan years beginning before 2017.

Background

Employers of all sizes currently are prohibited from making or offering any form of payment to employees for individual health insurance, whether through premium reimbursement or direct payment. Employers also are prohibited from providing cash or compensation to employees if the money is conditioned on the purchase of individual health insurance. (Some exceptions apply; e.g., retiree-only plans, dental/vision insurance.) Violations can result in excise taxes of $100 per day per affected employee.

The prohibition, implemented under the Affordable Care Act (ACA), was intended to discourage employers from canceling their group plans and pushing workers into the individual insurance market. The rules have been particularly disruptive for small businesses, however, since previously it had been common practice for many small employers to subsidize the cost of individual policies instead of offering group coverage. The new law, passed this week with broad bipartisan support, responds to the concerns of small businesses.

New Qualified Small Employer HRAs

The new law does not repeal the ACA’s general prohibition against employer payment of individual insurance premiums. Rather, it provides an exception for a new type of arrangement — a Qualified Small Employer HRA or QSEHRA — provided that specific conditions are met.

First, the employer must meet two conditions:

  • Employs on average no more than 50 full-time and full-time-equivalent employees. In other words, the employer cannot be an applicable large employer as defined under the ACA; and
  • Does not offer a group health plan to any of its employees.

Next, the QSEHRA must meet all of the following conditions:

  • It is funded solely by the employer; employee contributions are not permitted;
  • It is offered to all full-time employees, although the employer may choose to include seasonal or part-time employees and/or may exclude employees with less than 90 days of service;
  • For tax-free QSEHRA benefits, the employee must have minimum essential coverage (e.g., medical insurance under an individual policy);
  • It pays or reimburses healthcare expenses (e.g., § 213(d) expenses) and premiums for individual policies;
  • It does not pay or reimburse contributions for any employer-sponsored group coverage;
  • The same benefits and terms apply to all eligible employees, except the benefit amount may vary by:
    • Single versus family coverage;
    • Prorated amounts for partial-year coverage (e.g., new hires); and
    • For premium reimbursements, variations consistent with the age- and family-size rating structure of a representative individual policy; and
  • Benefits do not exceed $4,950 if single coverage (or $10,000 if family coverage) per 12-month plan year. Amounts are prorated if covered for less than 12 months. Limits will be indexed for inflation.

Coordination with Exchange Subsidies

Coverage under a QSEHRA will affect the employee’s eligibility for a subsidized individual policy from an insurance Exchange (Marketplace). Any subsidy for which the employee would otherwise qualify will be reduced dollar-for-dollar by the QSEHRA.

Benefit Laws

Group health plans are subject to numerous federal laws, including SPD and other notice requirements under ERISA, coverage continuation requirements under COBRA, and benefit mandates under the ACA. The new law specifies that QSEHRAs are not group health plans, so COBRA and other requirements will not apply.

QSEHRA Notices

Small employers offering QSEHRAs will be required to provide a notice to each eligible employee that:

  • Informs the employee of the QSEHRA benefit amount;
  • Instructs the employee that he or she must give the QSEHRA information to the Exchange if applying for a subsidy for individual insurance; and
  • Explains the tax consequences of failing to maintain minimum essential coverage.

QSEHRA notices should be provided at least 90 days before the start of the plan year.

Employers also will be required to report the QSEHRA coverage on Form W-2, Box 12. The reporting is informational only and has no tax consequences. Although small employers usually are exempt from this type of W-2 informational reporting, apparently it will be required for QSEHRAs starting with the 2017 tax year.

More Information

To learn more about QSEHRAs starting in 2017, or for details about the relief from excise taxes for small employers before 2017, see the 21st Century Cures Act. The relevant provisions are found in Section 18001 beginning on page 306.

Employers that are considering QSEHRAs are encouraged to work with legal counsel and tax advisors that offer expertise in this area. Starting in 2017, employer-funded QSEHRAs can offer valuable tax-free benefits to employees as long as they are designed and administered to meet all legal requirements.

Originally published by www.thinkhr.com

Significant Shift in Immigration Policy

Trump has been vocal about his stance on immigration in regard to deportation and illegal immigration. He also seeks to strengthen U.S. jobs, wages, and security through the nationwide use of E-Verify. Trump plans to work with Congress to strengthen and expand the use of E-Verify as currently less than half the states require employers to use E-Verify; however, more than 16.4 million cases were run through E-Verify in fiscal year 2016 by employers in every industry, state, and U.S. territory. E-Verify ensures a legal workforce, protects jobs for authorized workers, deters document and identity fraud, and works seamlessly with Form I-9. Employers may also look to the changes in the Form I-9 effective January 21, 2017 designed to make the form more user-friendly and alleviate mistakes, although this was established prior to Trump’s presidency.

Paid Leave for New Mothers

Although the specifics are unclear right now, Trump has proposed six weeks of paid maternity leave to new mothers. These payments would come from recapturing fraud and improper payments in the U.S. unemployment insurance system. Trump has also discussed allowing parents to enroll in tax-free dependent care savings accounts for their children (read in-depth analysis of paid family leave from our own in-house expert Laura Kerekes). According to the National Partnership for Women and Families, employers can expect paid leave to improve worker retention, reduce turnover costs with increased worker productivity, and increase employee loyalty.

Tax Reform

Trump has advocated for significant tax cuts “across the board” by increasing the standard deduction to $30,000 for joint filers (from $12,600), and simplifying the tax code. Trump plans to collapse the seven tax brackets to three with low-income Americans at an income tax rate of 0 percent. Trump’s tax plan also seeks to lower the business tax rate from 35 percent to 15 percent, and eliminate the corporate alternative minimum tax. Proponents of lowering business taxes assert that it creates jobs in the United States rather than overseas, encourages investment in our infrastructure, and because the United States has the highest corporate income tax rates, businesses are at a significant disadvantage. Trump intends to apply this lower rate to all business, both small and large. Additionally, according to Trump’s tax plan, businesses that pay a portion of an employee’s childcare expenses would be permitted to exclude those contributions from income. Employees who are recipients of direct employer subsidies would not be able to exclude those costs from the individual income tax and the costs of direct subsidies to employees could not be used as a cost eligible for the credit.

Repeal of the Affordable Care Act

The Affordable Care Act will be challenged under Trump’s administration. Trump seeks to remove healthcare exchanges and replace them with tax-free health savings accounts for people with high-deductible insurance plans. Trump has also advocated state-based high-risk pools for people with medical conditions that make it hard to get coverage on their own. He also seeks to allow companies to sell insurance across state lines to boost competition and drive down prices.

What’s Next for Employers

Interestingly, the largest impact of a Trump presidency may not be from his stance on these issues but may be seen when it comes time to naming the next U.S. Supreme Court Justices as he will likely appoint four justices during his term in office. Experts predict four because the average age of retirement for a Supreme Court justice has been approximately 78.7 years old, and currently three of the eight justices range in age from 78 – 83. The fourth open seat remains unoccupied since Justice Antonin Scalia’s death in February.

Understandably, there are opposing views to these presented issues, and neither candidate provided many details about how their plans for these issues would be financed or implemented. ThinkHR will follow the changes in labor and employment laws and will provide information and tools to help employers make sense of the changes that impact American businesses.

Originally published by www.thinkhr.com

Millennials are currently the largest generation in the workforce, and statistics show they’re not going anywhere anytime soon. By 2020, millennials are projected to make up 50% of the workforce. As millennials continue to rise in numbers, companies are finding it harder to retain them in their current roles. A study conducted by Deloitte conveyed that 44% of millennials can see themselves switching jobs within two years of employment. Along with this, Gallup found that the millennial turnover rate costs the economy $30.5 billion every year.   These statistics clearly demonstrate that millennials’ expectations are not being met by current employers, so we’ve come up with a list of tips to help you design the perfect benefit plans and employee engagement strategies to attract top young talent.

More Benefit Choices

Contrary to traditional benefit plans where employers offer pre-crafted options, millennials want more say in what benefits they are offered. More choices including flexible work hours, work from home days and paid parental leave offer millennials the opportunity to achieve their ideal work-life balance which keeps them happy to work for your company long-term. Look at your benefit options as a company and assess how you can give your employees more freedom in their benefit choices.

Advancements

By nature, every employee wants to advance in their career. More specifically, millennials are extremely driven and tend to take jobs where they see an opportunity to be promoted quickly. Tower Watson conducted a study which found 41% of employees said they would leave their job if it meant they could advance their career. (http://blog.accessperks.com/employee-engagement-loyalty-statistics-the-ultimate-collection) Clearly, continuously promoting all of your employees is impractical. However, there are other ways to give your employees more power and opportunity to advance without promotions.

Many companies find success in giving millennials more responsibility and the opportunity to prove themselves in the workplace via co-managing projects with older, more experienced employees or trusting them more management oriented tasks. At the end of the day, millennials desire to have a substantial impact in their companies rather than just subscribing to the clock-in, clock-out mentality, and allowing them to have more responsibility furthers a sense of purpose in their work.

Positive Impact

Millennials are known for being a philanthropic generation, and they don’t want this mindset to change once they step into the office. Millennials are success-driven, but also desire to leave a positive impact on the world. Many companies participate in community outreach, so make that clear to both current and prospective employees. If you don’t currently sponsor community events or encourage your team to volunteer together, consider creating a simple initiative that allows your staff to give back and ask a millennial employee to spearhead it! Engage people through the spirit of service, and help the millennial generation see how they will impact society by joining your workforce.

The studies we’ve examined reveal that millennials have a like-minded outlook on what they value at work. They want more choices and flexible work options, opportunity for advancement, unique responsibility and to have a positive influence on not only their company, but on society as a whole. As more Baby Boomers retire and the workplace is faced with an influx of millennial workers, keep these perks in mind as you form your benefit plans and company culture!

Following the November 2016 election, Donald Trump (R) will be sworn in as the next President of the United States on January 20, 2017. The Republicans will also have the majority in the Senate (51 Republican, 47 Democrat) and in the House of Representatives (238 Republicans, 191 Democrat). As a result, the political atmosphere is favorable for the Trump Administration to begin implementing its healthcare policy objectives. Representative Paul Ryan (R-Wis.) will likely remain the Speaker of the House. Known as an individual who is experienced in policy, it is expected that the Republican House will work to pass legislation that follows the health care policies in Speaker Ryan’s “A Better Way” proposals. The success of any of these proposals remains to be seen.

Employers should be aware of the main tenets of President-elect Trump’s proposals, as well as the policies outlined in Speaker Ryan’s white paper. These proposals are likely to have an impact on employer sponsored health and welfare benefits. Repeal of the Patient Protection and Affordable Care Act (ACA) and capping the employer-sponsored insurance (ESI) exclusion for individuals would have a significant effect on employer sponsored group health plans.

Trump Policy Proposals

President-elect Trump’s policy initiatives have seven main components:

  • Repeal the ACA. President-elect Trump has vowed to completely repeal the ACA as his first order of Presidential business.
  • Allow health insurance to be purchased across state lines.
  • Allow individuals to fully deduct health insurance premium payments from their tax returns.
  • Allow individuals to use health savings accounts (HSAs) in a more robust way than regulation currently allows. President-elect Trump’s proposal specifically mentions allowing HSAs to be part of an individual’s estate and allowing HSA funds to be spent by any member of the account owner’s family.
  • Require price transparency from all healthcare providers.
  • Block-grant Medicaid to the states. This would remove federal provisions on how Medicaid dollars can and should be spent by the states.
  • Remove barriers to entry into the free market for the pharmaceutical industry. This includes allowing American consumers access to imported drugs.

President-elect Trump’s proposal also notes that his immigration reform proposals would assist in lowering healthcare costs, due to the current amount of spending on healthcare for illegal immigrants. His proposal also states that the mental health programs and institutions in the United States are in need of reform, and that by providing more jobs to Americans we will reduce the reliance of Medicaid and the Children’s Health Insurance Program (CHIP).

Speaker Ryan’s “A Better Way” Proposal

In June 2016, Speaker Ryan released a series of white papers on national issues under the banner “A Better Way.” With Republican control of the House and Senate, it would be plausible that elected officials will begin working to implement some, if not all, of the ideas proposed. The core tenants of Speaker Ryan’s proposal are:

  • Repeal the ACA in full.
  • Expand consumer choice through consumer-directed health care. Speaker Ryan’s proposal includes specific means for this expansion, namely by allowing spouses to make catch-up contributions to HSA accounts, allow qualified medical expenses incurred up to 60 days prior to the HSA-qualified coverage began to be reimbursed, set the maximum contribution of HSA accounts at the maximum combined and allowed annual high deductible health plan (HDHP) deductible and out-of-pocket expenses limits, and expand HSA access for groups such as those with TRICARE coverage. The proposal also recommends allowing individuals to use employer provided health reimbursement account (HRA) funds to purchase individual coverage.
  • Support portable coverage. Speaker Ryan supports access to financial support for an insurance plan chosen by an individual through an advanceable, refundable tax credit for individuals and families, available at the beginning of every month and adjusted for age. The credit would be available to those without job-based coverage, Medicare, or Medicaid. It would be large enough to purchase a pre-ACA insurance policy. If the individual selected a plan that cost less than the financial support, the difference would be deposited into an “HSA-like” account and used toward other health care expenses.
  • Cap the employer-sponsored insurance (ESI) exclusion for individuals. Speaker Ryan’s proposal argues that the ESI exclusion raises premiums for employer-based coverage by 10 to 15 percent and holds down wages as workers substitute tax-free benefits for taxable income. Employee contributions to HSAs would not count toward the cost of coverage on the ESI cap.
  • Allow health insurance to be purchased across state lines.
  • Allow small businesses to band together an offer “association health plans” or AHPs. This would allow alumni organizations, trade associations, and other groups to pool together and improve bargaining power.
  • Preserve employer wellness programs. Speaker Ryan’s proposal would limit the Equal Employment Opportunity Commission (EEOC) oversight over wellness programs by finding that voluntary wellness programs do not violate the Americans with Disabilities Act of 1990 (ADA) and the collection of information would not violate the Genetic Information Nondiscrimination Act of 2008 (GINA).
  • Ensure self-insured employer sponsored group health coverage has robust access to stop-loss coverage by ensuring stop-loss coverage is not classified as group health insurance. This provision would also remove the ACA’s Cadillac tax.
  • Enact medical liability reform by implementing caps on non-economic damages in medical malpractice lawsuits and limiting contingency fees charged by plaintiff’s attorneys.
  • Address competition in insurance markets by charging the Government Accountability Office (GAO) to study the advantages and disadvantages of removing the limited McCarran-Ferguson antitrust exemption for health insurance carriers to increase competition and lower prices. The exemption allows insurers to pool historic loss information so they can project future losses and jointly develop policy.
  • Provide for patient protections by continuing pre-existing condition protections, allow dependents to stay on their parents’ plans until age 26, continue the prohibitions on rescissions of coverage, allow cost limitations on older Americans’ plans to be based on a five to one ratio (currently the ratio is three to one under the ACA), provide for state innovation grants, and dedicate funding to high risk pools.

Speaker Ryan’s white paper also addresses more robust protection of life by enforcing the Hyde Amendment (which prohibits federal taxpayer dollars from being used to pay for abortion or abortion coverage) and improved conscience protections for health care providers by enacting and expanding the Weldon Amendment.

Speaker Ryan also proposes other initiatives including robust Medicaid reforms, strengthening Medicare Advantage, repealing the Independent Payment Advisory Board (IPAB) that was once referred to as “death panels,” combine Medicare Part A and Part B, repealing the ban on physician-owned hospitals, and repealing the “Bay State Boondoggle.”

Process of Repeal

Generally speaking, the process of repealing a law is the same as creating a law. A repeal can be a simple repeal, or legislators can try to pass legislation to repeal and replace. Bills can begin in the House of Representatives, and if passed by the House, they are referred to the Senate. If it passes the Senate, it is sent to the President for signature or veto. Bills that begin in the Senate and pass the Senate are sent to the House of Representatives, which can pass (and if they wish, amend) the bill. If the Senate agrees with the bill as it is received from the House, or after conference with the House regarding amendments, they enroll the bill and it is sent to the White House for signature or veto.

Although Republicans hold the majority in the Senate, they do not have enough party votes to allow them to overcome a potential filibuster. A filibuster is when debate over a proposed piece of legislation is extended, allowing a delay or completely preventing the legislation from coming to a vote. Filibusters can continue until “three-fifths of the Senators duly chosen and sworn” close the debate by invoking cloture, or a parliamentary procedure that brings a debate to an end. Three-fifths of the Senate is 60 votes.

There is potential to dismantle the ACA by using a budget tool known as reconciliation, which cannot be filibustered. If Congress can draft a reconciliation bill that meets the complex requirements of our budget rules, it would only need a simple majority of the Senate (51 votes) to pass.

Neither President-elect Trump nor Speaker Ryan has given any indication as to whether a full repeal, or a repeal and replace, would be their preferred method of action.

The viability of any of these initiatives remains to be seen, but with a Republican President and a Republican-controlled House and Senate, if lawmakers are able to reach agreeable terms across the executive and legislative branches, some level of change is to be expected.

Adopting best practices for wellness program designs are important in successfully investing in a workplace environment focused on well-being. Finding the right partners, tools, and interventions, and creating an incentive design that hits the sweet spot to motivate employees to participate are all essential. Many organizations fall short and wellness programs often stall when employees do not understand the program. Whether they question an organization’s intent in offering a wellness program, the program components are too overwhelming or not communicated well, or employees simply do not understand how programs affect them, educating employees on wellness program options is crucial to a program’s success.

Culture

Organizations implement wellness programs for many reasons. Some do so in an effort to contain rising health care costs, while others do so to enhance culture. The first step in educating employees about wellness programs is sharing the business objective of the organization’s wellness initiatives. Senior management should share the reasoning behind investing in a wellness program and how it is important to the way the company operates. This can be demonstrated by tying it to an existing mission statement or company credo that emphasizes the value of the people of the organization or through a new wellness program brand that complements key aspects of the business. When a wellness program is launched without establishing how it fits into the bigger picture of the organization, it may seem like the company is penalizing employees by setting additional requirements to meet in order to get health insurance premiums at a certain rate. Sharing the intent of wellness programs can help employees better understand why certain program requirements are in place and empower them to be closely connected to an organization’s vision. Seeing company leaders engaged in wellness programs themselves can be one of the most powerful ways to get employees on board or create interest in the available program options.

Communication

Once an organization has announced its wellness initiative, an effective communication strategy must be developed to get the program information to employees. Drawing out a year-long communication plan can help administrators easily map out key dates and timeframes for programs. Establishing an online platform (whether it be an internal intranet page or a payroll, benefit, or wellness dashboard) is helpful so that employees can access information and program requirements on demand. Determining effective outreach based on organization dynamics is essential. Typically, an organization should rely on a combination of electronic communication and face-to-face meetings (depending on the kind of technology employees can access). As influential as consistent messaging from senior management can be, middle managers and supervisors may play an even larger role in how employees get information. Communicating wellness program updates in their regular team meetings can build momentum and routine for employees. Creating a network of wellness champions (employees throughout the organization that embrace wellness) can be a fantastic way to educate employees on programs. Program administrators can send regular wellness program updates to the wellness champions to spread among their employee groups. Creating regular education sessions can be helpful as well. Most companies will offer an overview of wellness programs at open enrollment or new hire orientation. The volume of information during these meetings can be overwhelming, so follow-up wellness program orientation opportunities and health benefit educational sessions should be offered throughout the year to help employees navigate the benefits available to them and be smart consumers of healthcare.

Impact

Sharing the potential impact of wellness programs is another powerful educational tool from a financial and health perspective. Demonstrating how much money is available in rewards for someone that fully engages in wellness compared to someone who does not can motivate employees to take advantage of programs. Sharing the financial impact of the entire organization focusing on wellness in terms of proactively working to contain long-term healthcare costs can help employees understand how they can directly influence future premiums. Offering small incentive opportunities for employees to submit success stories or health achievements can be a fun way to share how an organization’s wellness program has improved the health and well-being of employees. It can be very inspiring for employees to see their peers having success and embracing company programs. At the end of the day, employees that fully understand the potential impact of wellness programs and how to navigate their medical coverage feel better about their benefits and valued by their employers.

Be sure to read our recent blog on how small businesses can implement effective wellness programs. For additional trends among wellness programs, download In UBA’s new whitepaper: “Wellness Programs — Good for You & Good for Your Organization”.

To understand legal requirements for wellness programs, request UBA’s ACA Advisor, “Understanding Wellness Programs and Their Legal Requirements,” which reviews the five most critical questions that wellness program sponsors should ask and work through to determine the obligations of their wellness program under the ACA, HIPAA, ADA, GINA, and ERISA, as well as considerations for wellness programs that involve tobacco use in any way.

For the latest statistics from the UBA survey examining wellness program design among 19,557 health plans and 11,524 employers, pre-order UBA’s 2016 Health Plan Survey Executive Summary which will be available to the public in late September.

Originally published by www.ubabenefits.com

Many wellness programs start off with good intentions, offer some education and fun, but even after several years, have failed to meet their original goals or produce real culture change. We recently reviewed the first three steps to a successful, sustainable workplace program. Here we conclude with steps four through six for setting up a successful program.

4.  Find internal wellness champions; develop and embrace an organizational vision for wellbeing.

Now that the stars are beginning to align, management is invested in the program, the partners, tools, and resources needed have been established, you can now begin to look internally at where to go next. Most wellness vendors, and consultants like me, recommend setting up a committee to champion the program. Smaller organizations might have one or two people, while a larger organization may have a larger group. To obtain a well-rounded perspective, the committee should represent the office as a whole, not just certain pieces. Different divisions, remote employees, various departments, or other organizational demographics should all be represented. A successful program needs a group of people who are in charge of equal parts of the organization and who are actively engaged in effective change. These champions are the ones the employees come to rely on for information; they are the wellness cheerleaders of your organizations, walking the talk! Members can be appointed or volunteer, but I highly recommend setting guidelines and expectations for committee members up front.

Create a vision within the committee or team and gain insight on what the employees want in a program. What is the goal and purpose of having a health and wellness program? This might seem basic, but it is a necessary question. What do you want to accomplish? Is your organization looking to drive down the cost of claims? Although cost containment may be reason to look at wellness, it should not be your only goal. Successful groups implement programs to improve the lives of employees and their families. Your vision does not have to be formal, but the purpose of the program and why it is being put in place should be communicated. As the employer, sit down and ask the employees what they want in a wellness program. You would be surprised at the number of employers I have worked with that have not asked their employees anything. Engagement with employees is vital to the success of the program; build your vision and plan with their help.

5.  Set health goals and tailor program elements and incentives to meet them.

With the aggregate data in hand, it is time to define a program outline and set goals. It is easy to get ahead of yourself when beginning this program by creating unrealistic goals that are too demanding of employees. You will not have 100 percent participation in your first year. Strategize and establish measurable goals with your committee, wellness vendor, and benefits consultant. Setting realistic expectations is crucial for program success.

Find the balance between offering enough activities to keep employees engaged, but not overwhelming them with so many activities that it becomes taxing. Do not be afraid to want to see your program succeed! Look ahead and create a six- to 12-month program. I prefer to create a 10-month program with some type of monthly healthy activity. Select programs and topics that relate directly back to the aggregate data you collected. For example, if you have data that says less than five percent of your population uses tobacco, then you do not need to implement a 12-week tobacco cessation program. Instead, assist that five percent by providing some free education and resources for support, then focus on where your organization might need more attention.

Find programs that support employees on their overall health journey. Ask questions to identify programs that will encourage and influence behavior changes. For most organizations, it is common to offer programming geared to employees that are pre-hypertensive or hypertensive, overweight, obese, have high cholesterol, or employees experiencing high stress and anxiety. Rely on your benefits consultant or wellness vendor to make the best practice recommendations for creating behavior changes related to these risk areas. You may be able to use your existing Employee Assistance Program (EAP) and market it more heavily. In more extreme cases, you may need to utilize health coaches available with your wellness vendor or through your disease management program.

Think of setting goals in terms of the percentage of participation would you like to see in the first, second, third, and future years. For example, you may want to see utilization of medical preventive care benefits increase from 57 to 75 percent, or see employee engagement increase from one activity to the next. Setting two to five measurable goals early on, then evaluating those goals monthly, provides valuable insight into the program’s success. Make goals and programming obtainable; create an atmosphere of success for your employees.

Do not forget to use incentives. What will get your population “moving?” The discussion of whether intrinsic or extrinsic incentives are more effective is a lengthy one and of much debate these days.

From internal case studies, it is my expert opinion that employers willing to link their wellness program incentives to their benefit plan design in the form of reduced medical premiums, or making contributions to an employee’s health savings account or flexible spending account, see the greatest level of participation and overall behavior change in their employees. Of course, this does not occur overnight, but rather over time in coordination with your benefits consultant. This becomes a way of creating a cost-effective and consumer-driven healthcare plan that uses incentives to encourage your employees to make high-value decisions. A testimonial from one of our client’s employees says it all when it comes to intrinsic vs. extrinsic incentives.

“In short, I came for the savings, I stayed for my health. The first year I only participated for cost savings thinking, ‘Who would really like this?’ The following year I signed up for a health coach. Now I’m living healthier, eating better, exercising more, and more importantly, feeling better. Now I think, ‘Who wouldn’t really like this’?”

6. Kick it off, communicate and evaluate.

Roll out your program! Hold a kick-off party for the employees in the office, and conduct a webinar for the employees who work off-site. Provide employees with an overview of the program so they understand why your organization has created a wellness program, what employees should expect from their program, and the vision of the program.

Make sure to communicate about the program weekly, and use all forms of communication. Ask your employees what frequency of emails they prefer. Many of our clients, including my own company, like to have two emails a week to remind them of what is going on. Use social media, provide videos, webinars, etc. The more buzz that can be created around the program the better. Keep employees engaged and excited when it comes to your program, but do not overwhelm them with communication. Send emails about the challenges keeping employees engaged and involved, on who is winning, and success of activities. Create an environment of success using these communication methods.

Last, evaluate the program realistically. What went well? What needs improvement moving forward? Get real-time reporting from the vendor for participation. Review the program throughout the year and adjust as needed – no program is ever static. If you are not making changes each year, you are not being realistic. Improvements can always be made. Survey employees about things they learned, what they liked, and what they would do differently. You can use your vendor or benefits consultant to assist here. Make sure that the feedback from the employee surveys is taken into consideration when moving forward with the program. The more employees engage in the wellness program in its entirety, the more success you will have moving forward.

Originally published by www.ubabenefits.com

 

The Affordable Care Act (ACA) has brought about many changes to the health insurance industry. As we are now in the sixth year of implementation of the Act, we are seeing more changes coming just around the corner.

Generally speaking, most health plans can be classified into two categories: HMO and PPO. With an HMO plan, you choose your physician group where you will seek services, and you choose a primary care physician that you will see for all of your needs, who will refer you to a specialist or other service facility, if needed. The HMO model is designed to be as cost-effective as possible, only providing services when the physician deems it necessary, or solely for the benefit of the patient.

Due to the ACA, with an HMO plan, a woman is no longer required to get a referral from her primary care physician to an OB-GYN, and a parent is not required to get a referral to a pediatrician for his or her children even though neither are classified as primary care physicians.

In contrast, a PPO plan has more flexibility for the patient. With a PPO plan you are encouraged to see physicians and providers that are participating in your plan’s network, but are not required to do so. You can, in fact, see any doctor or provider that you wish, when you wish to see them, and without a referral from your primary care physician.

However, times they are a-changin’. Beginning January 1, 2017, Covered California, California’s state insurance exchange, will require both HMO and PPO enrollees to specify their primary care physician during the enrollment process. If one is not selected, the plan will select one for the plan participant. A plan participant is allowed to change their primary care physician at any time. Right now, this is only being implemented for individual plan subscribers.

It is expected that this change will be implemented for group PPO plan subscribers in 2018.

Beginning in 2012, the ACA implemented the Patient-Centered Outcomes Research Institute (PCORI) fee. This is a charge of $1 to $2 per enrollee, per year in a plan. If the plan is fully insured, the fee is paid to the government directly by the insurance carrier. If the plan is self-funded it is paid by the plan sponsor using IRS Form 720 and is due by July 31 for the previous plan year.

The purpose of the PCORI is to help analyze the overall costs of health care and identify trends to find ways to best reduce the overall cost of health care.

HMOs like Kaiser Permanente have fully integrated information systems that allow them to track each patient electronically so that they can see everything about the patient in one place. By tracking each patient, notes from the nurses and physicians, treatments, and medications, they can track costs and trends easily by mining the data from the system.

Most PPO plans do not track this data, in part because patients in the past have not had to choose a primary care physician or provider group. When they can see whomever they choose, it makes tracking of this data very difficult across multiple providers. In addition, participants in a small group, fully-insured plan are pooled with other small groups where claim data is not shared with the plan sponsor, and there is no need to track it closely as the information at the patient level is not relevant to the actuaries that calculate plan costs and premiums.

However, that is going to change. In order to study the overall cost of medical care, identify trends, and discover ways to curb inflating costs, data is needed, and selecting a primary care physician for plan participants is the first step.

Cigna, which provides both HMO and PPO plans, has implemented a Collaborative Care Program with more than 120 physician groups in 29 states, including provider group Palo Alto Medical Foundation (PAMF) in the San Francisco Bay area. By tracking client claims data and patient outreach programs to help patients to remember to take their medications as prescribed and continue with follow up treatments, PAMF has been able to reduce its inflation trend by 5 percent compared to other providers in the San Francisco Bay Area. The goal is to duplicate and build on the success that Cigna has already shown through its program and control and reduce the cost of health care.

So when you or your employees are applying for health insurance, make sure that primary care physician information is handy, because it is going to be needed.

Originally published by www.ubabenefits.com

On June 8, 2016, Ohio Governor John Kasich signed legislation (H.B. 523) making Ohio the 25th state to adopt a workable medical marijuana law. The legislation will allow seriously ill patients to use and purchase medical cannabis that will be cultivated and processed in-state.

With regards to employment, the bill does not:

  • Require an employer to permit or accommodate an employee’s use, possession, or distribution of medical marijuana.
  • Prohibit an employer from taking any adverse employment action an employer may take under current law because of a person’s use, possession, or distribution of medical marijuana.
  • Permit a person to sue an employer for taking an adverse employment action related to medical marijuana.
  • Prohibit an employer from establishing and enforcing a drug-testing policy, drug-free workplace policy, or zero-tolerance drug policy or interfere with federal restrictions on employment, including U.S. Department of Transportation regulations.

In addition, a person who is discharged from employment because of the person’s medical marijuana use will be found to have been discharged for just cause under the Unemployment Compensation Law if the use violated an employer’s drug-free workplace policy, zero-tolerance policy, or other formal program or policy regulating medical marijuana use and will be thus ineligible for unemployment benefits.

The bill also maintains the rebuttable presumption that an employee is ineligible for workers’ compensation if the employee was under the influence of marijuana and being under the influence of marijuana was the proximate cause of the injury, regardless of whether the marijuana use is recommended by a physician.

The law goes into effect September 8, 2016.

Originally published by www.thinkhr.com