All posts tagged HR

Cafeteria plans, or plans governed by IRS Code Section 125, allow employers to help employees pay for expenses such as health insurance with pre-tax dollars. Employees are given a choice between a taxable benefit (cash) and two or more specified pre-tax qualified benefits, for example, health insurance. Employees are given the opportunity to select the benefits they want, just like an individual standing in the cafeteria line at lunch.

Only certain benefits can be offered through a cafeteria plan:

  • Coverage under an accident or health plan (which can include traditional health insurance, health maintenance organizations (HMOs), self-insured medical reimbursement plans, dental, vision, and more);
  • Dependent care assistance benefits or DCAPs
  • Group term life insurance
  • Paid time off, which allows employees the opportunity to buy or sell paid time off days
  • 401(k) contributions
  • Adoption assistance benefits
  • Health savings accounts or HSAs under IRS Code Section 223

Some employers want to offer other benefits through a cafeteria plan, but this is prohibited. Benefits that you cannot offer through a cafeteria plan include scholarships, group term life insurance for non-employees, transportation and other fringe benefits, long-term care, and health reimbursement arrangements (unless very specific rules are met by providing one in conjunction with a high deductible health plan). Benefits that defer compensation are also prohibited under cafeteria plan rules.

Cafeteria plans as a whole are not subject to ERISA, but all or some of the underlying benefits or components under the plan can be. The Patient Protection and Affordable Care Act (ACA) has also affected aspects of cafeteria plan administration.

Employees are allowed to choose the benefits they want by making elections. Only the employee can make elections, but they can make choices that cover other individuals such as spouses or dependents. Employees must be considered eligible by the plan to make elections. Elections, with an exception for new hires, must be prospective. Cafeteria plan selections are considered irrevocable and cannot be changed during the plan year, unless a permitted change in status occurs. There is an exception for mandatory two-year elections relating to dental or vision plans that meet certain requirements.

Plans may allow participants to change elections based on the following changes in status:

  • Change in marital status
  • Change in the number of dependents
  • Change in employment status
  • A dependent satisfying or ceasing to satisfy dependent eligibility requirements
  • Change in residence
  • Commencement or termination of adoption proceedings

Plans may also allow participants to change elections based on the following changes that are not a change in status but nonetheless can trigger an election change:

  • Significant cost changes
  • Significant curtailment (or reduction) of coverage
  • Addition or improvement of benefit package option
  • Change in coverage of spouse or dependent under another employer plan
  • Loss of certain other health coverage (such as government provided coverage, such as Medicaid)
  • Changes in 401(k) contributions (employees are free to change their 401(k) contributions whenever they wish, in accordance with the administrator’s change process)
  • HIPAA special enrollment rights (contains requirements for HIPAA subject plans)
  • COBRA qualifying event
  • Judgment, decrees, or orders
  • Entitlement to Medicare or Medicaid
  • Family Medical Leave Act (FMLA) leave
  • Pre-tax health savings account (HSA) contributions (employees are free to change their HSA contributions whenever they wish, in accordance with the their payroll/accounting department process)
  • Reduction of hours (new under the ACA)
  • Exchange/Marketplace enrollment (new under the ACA)

Together, the change in status events and other recognized changes are considered “permitted election change events.”

Common changes that do not constitute a permitted election change event are: a provider leaving a network (unless, based on very narrow circumstances, it resulted in a significant reduction of coverage), a legal separation (unless the separation leads to a loss of eligibility under the plan), commencement of a domestic partner relationship, or a change in financial condition.

There are some events not in the regulations that could allow an individual to make a mid-year election change, such as a mistake by the employer or employee, or needing to change elections in order to pass nondiscrimination tests. To make a change due to a mistake, there must be clear and convincing evidence that the mistake has been made. For instance, an individual might accidentally sign up for family coverage when they are single with no children, or an employer might withhold $100 dollars per pay period for a flexible spending arrangement (FSA) when the individual elected to withhold $50.

Plans are permitted to make automatic payroll election increases or decreases for insignificant amounts in the middle of the plan year, so long as automatic election language is in the plan documents. An “insignificant” amount is considered one percent or less.

Plans should consider which change in status events to allow, how to track change in status requests, and the time limit to impose on employees who wish to make an election.

Cafeteria plans are not required to allow employees to change their elections, but plans that do allow changes must follow IRS requirements. These requirements include consistency, plan document allowance, documentation, and timing of the election change. For complete details on each of these requirements—as well as numerous examples of change in status events, including scenarios involving employees or their spouses or dependents entering into domestic partnerships, ending periods of incarceration, losing or gaining TRICARE coverage, and cost changes to an employer health plan—request UBA’s ACA Advisor, “Cafeteria Plans: Qualifying Events and Changing Employee Elections”.

By Danielle Capilla
Originally published by www.ubabenefits.com

Determining how an employer develops the most effective formulary, while protecting the financial stability of the plan, is certainly the challenge of this decade. Prescription management used to mean monitoring that the right people are taking medications to control their disease while creating strategies to move them from brand name to generic medications. With the dawn of specialty medications, formulary management has become a game of maximizing the pass-through of rebates, creating the best prior authorization strategies and tiering of benefits to create some barrier to more expensive medications, all without becoming too disruptive. As benefits managers know, that is a difficult challenge. The latest UBA Health Plan Survey revealed that 53.6 percent of plans offer four tiers or more, a 21.5 percent increase from last year and nearly a 55.5 percent increase in just two years. Thus, making “tiering” a top strategy to control drug costs. There are many additional opportunities to improve and help control the pharmacy investment, but focusing on the key components of formulary management and working on solutions that decrease the demands for medications are critical to successful plan management.

When developing a formulary, Brenda Motheral, RPh, MBA, Ph.D., CEO of Archimedes, suggests that chasing rebates is not a strategy to optimize your investment. Some of the highest rebates may be from medications that add no better therapeutic value than an inexpensive medication that does not offer a rebate, but net cost is much lower than the brand or specialty medication being offered. Best formulary management will mean that specific medications that do not offer a significant therapeutic value are removed from the formulary, or are covered at a “referenced price” so the member pays the cost difference. Formulary management will need to focus on where the drug is filled and which medications are available.

When setting up parameters on where a drug is to be filled, the decision needs to be made if a plan will promote mail order. Mail order, if used and monitored appropriately, makes it more convenient for a patient to receive their regularly used medications and may provide savings. In fact, the UBA Health Plan Survey finds that more than one-third (36.3 percent) of prescription drug plans provide a 90-day supply at a cost of two times retail copays. But if mail order programs are not monitored, people can continue to receive medications that are no longer required and never used, adding to medical spend waste. Furthermore, in our analysis, we are finding that not all medications are less expensive through mail order, as shown in Figure 1 below. Therefore, examining the cost differential is critical in a decision to promote, or not promote, mail order.

Figure 1

Drug Name Rx Category Mail Order Retail
Zytiga® Malignancies $8,749 $6,027
Sumatriptan Succinate Migrane / Neurologic $575 $308
Ranexa® Cardiovascular $259 $413

 

Another formulary consideration is in monitoring the increase in same drug pricing. The stories surrounding the price increases of EpiPens® has been well-documented, but how well do you understand the impact of price increases on your plan? Monitoring price increases, as shown in Figure 2, may help an employer turn to their pharmacy benefit manager (PBM) to ask for help in controlling these price increases, or help in decisions related to formulary inclusion.

Figure 2

Drug Name Rx Category Plan Paid per
30-day Supply
(SPLY)
Plan Paid per
30-day Supply
Cialis® Genito-Urinary / Acute Minor $287 $442
AndroGel® Endocrine / Chronic Meidcal $471 $523
Viagra® Genito-Urinary / Acute Minor $615 $978

 

Formulary management solutions can become a cat-and-mouse game. The ultimate approach to manage the total spending on medications is by managing the growing demand. There has been significant press related to the opioid overutilization in the U.S., as illustrated in the article “Prescription Addiction.” But that issue is much broader in our society and relates to taking a pill as a quick solution to solve our medical problems. In March 2016, the Department of Health and Human Services (HHS) stated that 30 percent of the growth in spending related to medications was due to an increase in prescriptions per person. Certainly, medications should be used when there are no alternatives to control disease or pain. However, turning to medications as a first option for chronic condition control for issues like hypertension, blood sugar control, cholesterol control versus improving diet and exercise, etc., is just a band-aid solution that, in most cases, does not resolve the root issue. Yet, because this is sold as a quick fix, we see an increase in the number of individuals on medications. In 2012, 34 percent of plan members engaged in Vital Incite were taking four or more (active ingredients) medications, and that has grown to more than 45 percent in 2016. The data also illustrates that in 2012 more than 42 percent of members were not on any medications, but that group size has shrunk to only 27 percent. No formulary can impact this issue.

Active Ingredient Use, All Clients, All Members 21 Years and Older

This increased use could be considered an improvement in care if their disease were more controlled. Appropriate and medically-impactful utilization would mean that a person is working toward improving diet and exercise and is taking the least expensive, yet effective, medication to control his or her disease.

Considering that diabetes medication options have really expanded, an employer would hope that the more expensive medication is providing the best control of disease. But, taking the medication alone will not control the disease and, at times, the progression of the medication cost can be related to progression of the disease due to a lack of disease management. For instance, a diabetic may have progressed from taking metphormin (marketed under the tradename Glucophage® among others), which costs approximately $27 per month, to metphormin ER (Glucophage® XR), which allows a person to take only one pill a day, so it may provide increased compliance, but costs $274 per month. Now, the option of taking Glumetza® is offered, which can be reimbursed at up to $3,620 per month, and is said to provide more stable results. But, if we examine the A1c control values from Vital Incite, do we find the reduction in A1c values as evidence that this additional investment in medication options is providing better control? Figure 3 provides an example of A1c control by prescription status. The goal would be that those on medications will become controlled. But, in our data, we are not seeing a significant improvement in persons with HgA1c levels above 7 percent. Control is achieved from diet, exercise, and appropriate medications. There are theories that people on these more expensive medications are using that as an approach to help them maintain their unhealthy behaviors. Therefore, taking medications alone does not appear to provide an effective solution and, in fact, providing chronic condition medications for free, without requiring any other effort, may not be the best investment for an employer.

Figure 3

HgA1c Level In Treatment Untreated Discontinued
Treatment
Possibly
Untreated
< 5.7 6 1 2 3
5.7 to 6.4 21 2 1 11
6.5 to 7.0 17 7
> 7.0 53 4 5

 

In conclusion, determining which issues are having the most impact on an employer group will allow benefits managers to determine the company’s priorities. This is not an easy task, but with pharmacy spend increasing at a national average of 7.3 percent annually and becoming a higher percentage of the overall medical spend, new strategies need to be considered. Focusing on the key components that balance formulary management with the correct approach to manage the demand on medications can influence total pharmacy spend.

Originally published by www.ubabenefits.com

 

Proposed regulations for revising and greatly expanding the Department of Labor (DOL) Form 5500 reporting are set to take effect in 2019. Currently, the non-retirement plan reporting is limited to those employers that have more than 100 employees enrolled on their benefit plans, or those in a self-funded trust. The filings must be completed on the DOL EFAST2 system within 210 days following the end of the plan year.

What does this expanded number of businesses required to report look like? According to the 2016 United Benefit Advisors (UBA) Health Plan Survey, less than 18 percent of employers offering medical plans are required to report right now. With the expanded requirements of 5500 reporting, this would require the just over 82 percent of employers not reporting now to comply with the new mandate.

While the information reported is not typically difficult to gather, it is a time-intensive task. In addition to the usual information about the carrier’s name, address, total premium, and payments to an agent or broker, employers will now be required to provide detailed benefit plan information such as deductibles, out-of-pocket maximums, coinsurance and copay amounts, among other items. Currently, insurance carriers and third party administrators must produce information needed on scheduled forms. However, an employer’s plan year as filed in their ERISA Summary Plan Description, might not match up to the renewal year with the insurance carrier. There are times when these schedule forms must be requested repeatedly in order to receive the correct dates of the plan year for filing.

In the early 1990s small employers offering a Section 125 plan were required to fill out a 5500 form with a very simple 5500 schedule form. Most small employers did not know about the filing, so noncompliance ran very high. The small employer filings were stopped mainly because the DOL did not have adequate resources to review or tabulate the information.

While electronic filing makes the process easier to tabulate the information received from companies, is it really needed? Likely not, given the expense it will require in additional compliance costs for small employers. With the current information gathered on the forms, the least expensive service is typically $500 annually for one filing. Employers without an ERISA required summary plan description (SPD) in a wrap-style document, would be required to do a separate filing based on each line of coverage. If an employer offers medical, dental, vision and life insurance, it would need to complete four separate filings. Of course, with the expanded information required if the proposed regulations hold, it is anticipated that those offering Form 5500 filing services would need to increase with the additional amount of information to be entered. In order to compensate for the additional information, those fees could more than double. Of course, that also doesn’t account for the time required to gather all the data and make sure it is correct. It is at the very least, an expensive endeavor for a small business to undertake.

Even though small employers will likely have fewer items required for their filings, it is an especially undue hardship on many already struggling small businesses that have been hit with rising health insurance premiums and other increasing costs. For those employers in the 50-99 category, they have likely paid out high fees to complete the ACA required 1094 and 1095 forms and now will be saddled with yet another reporting cost and time intensive gathering of data.

Given the noncompliance of the 1990s in the small group arena, this is just one area that a new administration could very simply and easily remove this unwelcome burden from small employers.

Originally published by www.ubabenefits.com

When you hear the term “paid parental leave”, what do you think of? Here in the U.S., paid leave benefits are somewhat of a luxury. Although the Family and Medical Leave Act (FMLA) has made it possible for parents working at companies with 50 or more employees to secure 12 weeks of unpaid leave, the U.S. is one of only three countries on a list of 185 that does not mandate a period of paid parental leave. This leaves the country ranked below Iran and Mexico, who both offer 12 weeks of paid parental leave. On the other end of the spectrum, employees in the UK benefit from up to 40 weeks of paid leave.
 
As a result of having no mandated paid parental leave policy, approximately a quarter of U.S. women who become pregnant while employed quit their jobs upon giving birth, one third of women are forced to borrow money or withdraw from savings to cover time off from work, and 15% utilize public assistance. The June 2015 Enforcement Guidance on Pregnancy Discrimination from the Equal Employment Opportunity Commission (EEOC) was the first legislation to make a case for offering equal parental leave to mothers and fathers, setting a new precedent for the evolution of the paid leave benefit.
 
Why Should You Offer Paid Parental Leave to Employees?
The EY & Peterson Institute for International Economics recently released a study revealing that 38% of millennials would move to a new country if they would be afforded better paid parental leave benefits. Millennials now make up the largest demographic in the American workforce, and companies will need to increasingly take statistics like this into account when building benefit plans that will attract and retain top talent.
 
Aside from talent acquisition, the study goes on to show the positive impacts a paid parental leave benefit can have on keeping women in the C-Suite, as men who would usually be considered secondary caregivers take advantage of the time off and allow women to get back to work more quickly. In addition, change.org, who has implemented a generous paid parental leave policy, observed that dads who took leave in their company encouraged other new fathers to take advantage of the benefits as well, creating a culture of safety in which to utilize leave and invest more fully in their family life.
 
Ultimately, employees are happier and are empowered to do better work when they are allowed to honor their priorities. Whether this means a new mother is allowed to take stress-free, paid time off to bond with her child, or a father takes advantage of leave to be with his family or allow his partner to return to work, the ability to balance work and life is of the utmost importance to younger generations.
 
Case Studies – Top Companies Doing it Right
 
American Express
American Express recently announced that they were changing their paid parental leave policy from three months for primary caregivers and two weeks for secondary caregivers to five months of paid parental leave for all full-time and part-time employees.
 
All genders are eligible for the benefit, and employees may become parents via birth, adoption or surrogacy. In addition, American Express offers up to $35,000 for adoption or surrogacy fees with a limit of two events.  A lifetime maximum of $35,000 is also allotted for fertility treatments.
 
The company also announced a unique supplemental benefit of 24-hour lactation consultants available to nursing mothers, and a breast milk shipment program available to mothers traveling for business who need to send milk home.
 
Bank of America
Bank of America offers 16 weeks of paid leave for biological and adoptive parents. A unique feature of their policy allows parents to take leave any time during the first year of the child’s life, enabling partners to take overlapping or subsequent time off, whichever best fits their family’s needs. The company values providing this option, as they see almost half of parents in today’s society raising their kids together at home while both holding jobs.
 
The banking giant also tries to make life after baby easier for working parents by offering a more flexible work-from-home program and providing $240 in monthly childcare reimbursement for employees whose household income comes in under $100,000 annually.
 
Netflix
Netflix took the spotlight when it comes to paid parental leave benefits when they announced that the company would offer unlimited paid leave with no loss of benefits during the first year after a child’s arrival. Leave can be taken at any time during the year, and employees may choose to work part-time, or come back to work and then leave again if desired.
 
Netflix chief talent officer, Tawni Cranz, said of the monumental decision, “Experience shows people perform better at work when they’re not worrying about home.”
 
Twitter
While Twitter offers 20 weeks of paid leave for mothers and 10 for fathers and adoptive parents, the most innovative benefits this company offers come through its pre and post-natal programs for parents. Twitter offers quarterly “New Moms and Moms-To-Be” roundtables, a Mommy Mentor Program, Working Mom lunches and most lately, “Dads on Leave” roundtables. In-house support for employees when it comes to family life provides a safe place to embrace new roles as parents while still progressing in their careers.
 
How Can You Adopt This Benefit?
Job participation by women in peak years is declining, and paid parental leave is a way to help remove barriers in the workplace that leave women in only 5% of CEO positions at Fortune 500 companies. Karyn Twaronite, EY global diversity and inclusiveness officer, said, “Companies that view parental leave as something solely for mothers are becoming extinct, as more modern and enlightened companies are realizing that many people, especially millennials, are even more interested in co-parenting given most are part of dual career couples.”
 
If your company is unable to keep up with the generous paid leave packages larger businesses can afford, consider taking a page out of Twitter’s book and offering mentoring programs and support groups for new parents. Budget for childcare reimbursement costs like Bank of America. Even smaller changes that are made thoughtfully, with the employee in mind, will increase the appeal of your benefits package.
 
As the benefits landscape changes with shifting demographics, consider carefully how offering paid parental leave could positively impact your employees, and ultimately, your bottom line as workers are motivated to work harder and smarter, knowing things are taken care of at home. 
 
By Kate McGaughey, eTekhnos

 

Employer-paid life insurance can be an important part of protecting your family in the event that you die prematurely. Companies offer the program on top of other benefits, such as health insurance. The coverage is generally term insurance, meaning there is no investment or cash-value component. If you pass on unexpectedly, depriving your family not only of your presence but also your income, your dependents will be glad you signed up for your workplace’s life insurance benefit.

Basics

Employer-paid term life insurance comes as an option through some employee benefits packages. It works, in a sense, like group health insurance: Rather than buying a separate policy for each employee, the employer buys a single policy that covers all workers who participate, according to Insurance.com. Thus, the employer pays one premium, not a separate premium for each employee. You may be responsible for a part of the premium, too. Typically, the death benefit is one or two times your yearly salary, according to the American Institute of Certified Public Accountants.

Advantages

Life insurance acquired through your employer is likely to be cheaper than what you can buy on the open market, since your employer is likely to cover at least part of the premiums, according to Insurance.com. Additionally, you do not have to undergo individual underwriting, which means you can get coverage even if you have a serious health condition, like heart disease, that would, according to Insure.com, get you denied or make you have to pay high premiums if you were buying on the open market.

Warning

Depending exclusively on employer-paid life insurance to protect your family has some disadvantages, according to Insurance.com. The main one is that if you leave your job, you stand a high chance of losing your insurance. Depending on your age and health status at that time, according to Insurance.com, you may or may not be able to get new insurance at a reasonable rate. For that reason, it is best to carry employer group insurance only as a supplement to other coverage. Another drawback to such coverage is that the amount of insurance available to you is likely to be limited, though some plans allow you to get more coverage for an additional fee.

Considerations

Some employer-paid life insurance plans, according to the American Institute of Certified Public Accountants’ 360 Degrees of Financial Literacy website, can follow you even when you leave your job. But most employees decide against doing this for the reason that the “conversion premiums” tend to be higher than prices for comparable individual policies. Typically, according to the site, “only those who are otherwise uninsurable take advantage of this conversion option.”

Taxes

The Internal Revenue Service taxes life insurance that has a value above $50,000. It uses a formula that takes into account your age and the amount of your death benefit to determine the taxable value per month.

Originally published by www.livestrong.com

Measuring program value, or return on investment, is critical and imperative in managing a healthy wellness program. Further, clearly identifying and objectively evaluating the impact helps keep the vendor focused on what is critical for the employer. If these programs are not having the impact intended, then the cost of those services is only adding to medical spending waste.

When adding wellness services to any employer benefits package, it is imperative to clearly identify the intended impact and outcome. Outcomes fall into three general categories:

  1. Employee satisfaction with the employer, which adds to recruitment and retention
  2. Reducing biometric risk and improving the health of the population
  3. Reducing medical spending

Employee Satisfaction

In the book, Shared Values, Shared Results by Dee W. Eddington, Ph.D., and Jennifer S. Pitts, Ph.D., the value of employees appreciating the benefits an employer offers is clearly outlined as a win-win strategy. If an employer’s intent in providing wellness services is to improve the support for its employees, then measuring the satisfaction related to those outcomes is critical. Employee surveys are typically the best approach to gather outcomes related to these intended programs. Some key questions to ask may include:

  • Is working at this organization beneficial for my health? (“Strongly Agree” to “Disagree” responses)
  • Do I trust that my organization cares about me? (“Strongly Agree” to “Disagree” responses)
  • Which of the following wellness program initiatives do you find to be valuable? (list all programs offered)

Collecting employee, or spouse, feedback on these programs will provide insight to allow an employer/ consultant to know if programs are appreciated, or if modifications are required in order to achieve the desired outcomes.

Reducing Biometric Risk and Controlling Disease

If the intent of a wellness program is to help improve the health of individuals so that future medical spending will be reduced, then it is critical to determine if the program is engaging the correct members and then measure the impact on their risk. At Vital Incite, we utilize Johns Hopkins’ risk indexing along with biometric risk migration to provide feedback to vendors and employers of the impact of their programs. Some suggested goals may include:

  • Engaging 80 percent of persons with high risk biometrics
  • Reduction in weight of persons overweight or obese by greater than 5 percent in 30 percent of the engaged population
  • Of diabetics with an A1c greater than 7 percent, 80 percent will reduce their A1c by 1 percent in one year
  • Of persons with blood pressure in the high-risk range, 40 percent will have achieved controlled blood pressure without adding medications in one year
  • Of persons who take fewer than 10,000 steps per day, 70 percent will increase their average step count by 20 percent or more

These goals need to be very specific and targeted to address the exact needs of your population, measuring what is most likely to have an impact on a person’s long-term health. This provides specific direction for your wellness providers, but allows an employer/consultant to monitor the impact throughout the year to continue to redirect communication and services to help provide the best outcomes.

The first step in any program is to engage the intended audience. UBA’s Health Plan Survey finds that 54.6 percent of employers with wellness programs use components such as on-site or telephone coaching for high-risk employees, an increase of 7.5 percent from last year. Once you target the intended audience, engagement of those at risk is critical. Monitoring this subset of data can make sure the vendor resources are directed appropriately and, many times, identify areas where the employer may be able to help.

Engagement of High Risk Individuals in CoachingOf course, engagement is only the first step and the intended outcome is to reduce risk or slow down the progression of risk increasing, that is really the final outcome desired. The following illustration allows employers and the vendor solution to monitor the true impact of the program by reviewing the risk control, or improvement based on program participation.

Participant vs non-participant results

Reducing Medical Spending

Although many employers are interested in helping their employees become healthier, the reality is these efforts have to help reduce medical costs or increase productivity so these efforts are sustainable. Since, to date, few employers have data on productivity, the analysis then is focused on reducing medical spending. The correct analysis depends on the size of your population and the targeted audience, but a general analysis to determine if those engaged are costing less than persons who have similar risk on your plan would look something like the analysis below.

participant engagement chart

If your program is targeted specifically on a disease state, then the impact on the cost to care for that disease state may be more appropriate. In the example below, the employer instituted a program to help asthmatics, and therefore, the analysis is related to the total cost to care for asthma comparing the year prior to the program to the year of the program. In this analysis, the impact is very clear.

Impact of Program on Cost for all ID-Asthma

The employer anticipated first year savings due to high emergency room (ER) utilization for persons with asthma and the report proved that along with ER utilization declining, the total cost of care for asthma significantly declined.

Summary

In summary, having a clear understanding of the expectation and desired outcomes and monitoring that impact throughout the year, we believe, drives better outcomes. When we first started analyzing outcomes of programs, the impact of many programs were far less impressive than vendor reports would allow us to believe. That false sense of security is not because they were trying to falsify information, but the reports did not provide enough detail to fully illustrate the impact. Most vendor partners don’t have access to all of the data to provide a full analysis and others will only show what makes them look good. But, if you identify the impact you need in order to achieve success, all parties involved focus on that priority and continually work to improve that impact. We believe that wellness programs can have an impact on a population culture, health and cost of care if appropriately managed.

Originally published by www.ubabenefits.com

Question: Are we required to allow employees (either exempt or nonexempt) to work from home if we must close the office due to bad weather?

Answer: No, employers are not required to allow employees to telework (work from home or another location; virtual work) under any specific weather conditions regardless of Fair Labor Standards Act (FLSA) exemption status. However, employers may allow employees to telework. Company policy should delineate procedures for both teleworking and notice requirements when inclement weather affects the workplace; for instance, notice from the employer that the workplace is closed and notice from the employee that they cannot travel to the workplace due to weather-related or other emergency conditions. These policies should be in the employee handbook, and should also detail whether the employer will allow nonexempt employees to make up missed time.

Note that if the employer closes the workplace for weather-related reasons, nonexempt employees are not entitled to pay because such employees are only entitled to compensation for hours actually worked. However, an employer may allow nonexempt employees to use accrued paid time off so as to receive compensation during such an absence. If paid time off is not available, then the time off remains unpaid.

Alternatively, exempt employees who are able and available to work but do not work because the employer closed the workplace due to inclement weather are still entitled to their full week of pay. This is because the exempt employee is available to work but rather the employer made the work unavailable. As a general rule, if an exempt employee performs any work during the workweek, they must be paid their full salary amount. An employer may not make deductions from an exempt employee’s pay for absences caused by the employer or by the operating requirements of the business. If the exempt employee is ready, willing and able to work, an employer cannot make deductions from the exempt employee’s pay when no work is available. Additionally, the U.S. Department of Labor specifically states that an example of an improper deduction from an exempt employee’s pay includes deduction of a days’ pay because the employer was closed due to inclement weather.

Originally published by www.thinkhr.com

Recently, the Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) issued FAQs About Affordable Care Act Implementation Part 34 and Mental Health and Substance Use Disorder Parity Implementation.

The Departments’ FAQs cover two primary topics: tobacco cessation coverage and mental health / substance use disorder parity.

Tobacco Cessation Coverage

The Departments seek public comment by January 3, 2017, on tobacco cessation coverage. The Departments intend to clarify the items and services that must be provided without cost sharing to comply with the United States Preventive Services Task Force’s updated tobacco cessation interventions recommendation applicable to plan years or policy years beginning on or after September 22, 2016.

Mental Health / Substance Use Disorder Parity

Generally, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance use disorder (MH/SUD) benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits.

A financial requirement (such as a copayment or coinsurance) or quantitative treatment limitation (such as a day or visit limit) is considered to apply to substantially all medical/surgical benefits in a classification if it applies to at least two-thirds of all medical/surgical benefits in the classification.

If it does not apply to at least two-thirds of medical/surgical benefits, it cannot be applied to MH/SUD benefits in that classification.

If it does apply to at least two-thirds of medical/surgical benefits, the level (such as 80 percent or 70 percent coinsurance) of the quantitative limit that may be applied to MH/SUD benefits in a classification may not be more restrictive than the predominant level that applies to medical/surgical benefits (defined as the level that applies to more than one-half of medical/surgical benefits subject to the limitation in the classification).

In performing these calculations, the determination of the portion of medical/surgical benefits subject to the quantitative limit is based on the dollar amount of all plan payments for medical/surgical benefits in the classification expected to be paid under the plan for the plan year. The MHPAEA regulations provide that “any reasonable method” may be used to determine the dollar amount of all plan payments for the substantially all and predominant analyses.

MHPAEA’s provisions and its regulations expressly provide that a plan or issuer must disclose the criteria for medical necessity determinations with respect to MH/SUD benefits to any current or potential participant, beneficiary, or contracting provider upon request and the reason for any denial of reimbursement or payment for services with respect to MH/SUD benefits to the participant or beneficiary.

However, the Departments recognize that additional information regarding medical/surgical benefits is necessary to perform the required MHPAEA analyses. According to the FAQs, the Department have continued to receive questions regarding disclosures related to the processes, strategies, evidentiary standards, and other factors used to apply a nonquantitative treatment limitation (NQTL) with respect to medical/surgical benefits and MH/SUD benefits under a plan. Also, the Departments have received requests to explore ways to encourage uniformity among state reviews of issuers’ compliance with the NQTL standards, including the use of model forms to report NQTL information.

To address these issues, the Departments seek public comment by January 3, 2017, on potential model forms that could be used by participants and their representatives to request information on various NQTLs. The Departments also seek public comment on the disclosure process for MH/SUD benefits and on steps that could improve state market conduct examinations or federal oversight of compliance by plans and issuers, or both.

 

By Danielle Capilla, Originally published by United Benefit Advisors – Read More

Tis the season for company holiday parties. The time of year when employees gather to mix and mingle with co-workers outside of the normal work setting. It sounds like a merry ol’ time to most, but holiday parties can be a headache for HR leaders. While it’s a great opportunity to thank employees for all their hard work and let loose, it’s important to ensure it happens responsibly. Every year, ThinkHR publishes tips for making events safer to decrease potential hidden costs involved in employer-sponsored events (see Workday Holiday Parties–A Great Way to End the Year!)  This year we’ve broken it down into simple dos and don’ts to provide a high-level guide for executing this year’s festivities.

DO

Follow your stated employee policies. Keep in mind that holiday parties are employer-sponsored, so the company may be responsible for whatever happens at the party and sometimes for events that occur after the party. Be sure to emphasize that all guidelines will apply to the party even if it is off-site or after work hours.

Consider taking steps to limit alcohol consumption. If you decide that alcohol will be served and the party is off-site and after hours, provide plenty of food rich in carbs and protein to slow the absorption of alcohol into the bloodstream. You can also have a cash bar, limit the number of drink tickets or close the bar early to deter over-consumption.

Make sure your employees get home safely. Offer incentives to employees who volunteer to be designated drivers or arrange transportation and accommodations. Thinking ahead about transportation demonstrates responsibility on the employer’s part, as well as potentially minimizing the company’s liability if an employee causes an accident while driving under the influence.

Determine how to handle pay issues in advance of the party. It’s not required to pay employees that voluntarily attend a party after hours. However, nonexempt employees need to be compensated if they are working the party or if attendance is mandatory. If the party is held during regular work hours, then all employees would be paid for attending the party.

Make it a family affair. Experts suggest that employee behavior actually improves at company events when spouses or partners and children are present. If your budget allows, it can be a giant gesture to include the entire family in the celebration and one that many employees appreciate. Be sure to review your liability coverage with your broker first.

DON’T

Do not allow employees to get away with any bad behavior. Follow up on any complaints associated with the holiday party and conduct a thorough investigation. Racial or sexual jokes, gossiping about office relationships, and unwelcome touching should not be permitted during the holiday party just as they are not allowed in the office.

Do not make your party work related to avoid liability for any injuries. Typically, workers’ compensation does not apply if the injury is “incurred in the pursuit of an activity, the major purpose of which is social or recreational.” If the carrier determines that the company party was truly voluntary and not related to work, then the carrier would most likely deny the claim.

Do not penalize employees who choose not to attend. The message may be misinterpreted and could create employee relations concerns for those who may have other religious beliefs or are simply uncomfortable attending the event. Avoid religious symbols or themes as they could offend individuals of different faiths.

Do not serve alcohol if your policies do not permit drinking either on your company’s premises or during work hours and you plan to have the party at the office as a part of the workday. Remind your supervisors to set a good example, keep an eye out for employee behavior that needs managing, and to deter employees from any informal gathering after the party that gets the alcohol flowing.

Do not forget to reach out to your broker if you have any questions or concerns. The holidays are a great time to spread cheer, and holiday parties help sustain a positive work culture, but it’s important to be aware of potential issues that could arise and to plan accordingly. We’re here to help you along the way, as are your brokers, so be sure to leverage all of your resources.

Have more questions related to your company’s holiday party? Check out this Q&A from a recent ThinkHR webinar.

Originally published by www.thinkhr.com

Question: For Form I-9 purposes, can we accept a new employee’s Social Security card that shows a maiden name rather than her married name?

Answer: The quick answer is yes. The Social Security card has the individual’s legal name. She must complete the Form W-4 and Form I-9 with her legal name (as listed on the Social Security card). If, on its face, the card reasonably appears to be genuine and relate to the person presenting it, then you must accept it. Additionally, a signature on the card is not required for it to be valid, so long as the Social Security card does not state ““NOT VALID FOR EMPLOYMENT,” “VALID FOR WORK ONLY WITH INS AUTHORIZATION,” or “VALID FOR WORK ONLY WITH DHS AUTHORIZATION.” Additionally, metal or plastic reproductions of a Social Security card are not acceptable for Form I-9 purposes.

Of note, an employer should not use the Social Security Number Verification Service (SSNVS) to audit an employee’s Form I-9. According to the SSNVS handbook, any notification about a mismatch makes no statement about an employee’s immigration status. Rather, it simply indicates an error in either the employer’s records or Social Security Administration’s records and should not be used as a basis to take adverse action against an employee. In other words, the SSNVS is not intended to be used to verify employment authorization in connection with the Form I-9 process.

Originally published by www.thinkhr.com