All posts tagged UBA

What Employers Need to Know about the Senate Proposed Healthcare Bill | Ohio Benefit Advisors

Categories: ACA, ACA Repeal, Benefits, Blog, Health Care Reform, UBA News
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On June 22, 2017, the United States Senate released a “Discussion Draft” of the “Better Care Reconciliation Act of 2017” (BCRA), which would substitute the House’s House Resolution 1628, a reconciliation bill aimed at “repealing and replacing” the Patient Protection and Affordable Care Act (ACA). The House bill was titled the “American Health Care Act of 2017” (AHCA). Employers with group health plans should continue to monitor the progress in Washington, D.C., and should not stop adhering to any provisions of the ACA in the interim, or begin planning to comply with provisions in either the BCRA or the AHCA.

Next Steps

  • The Congressional Budget Office (CBO) is expected to score the bill by Monday, June 26, 2017.
  • The Senate will likely begin the voting process on the bill on June 28 and a final vote is anticipated sometime on June 29.
  • The Senate and House versions will have to be reconciled. This can be done with a conference committee, or by sending amendments back and forth between the chambers. With a conference committee, a conference report requires agreement by a majority of conferees from the House, and a majority of conferees by the Senate (not both together). Alternatively, the House could simply agree to the Senate version, or start over again with new legislation.

The BCRA

Like the AHCA, the BCRA makes numerous changes to current law, much of which impact the individual market, Medicare, and Medicaid with effects on employer sponsored group health plans. Also like the AHCA, the BCRA removes both the individual and the employer shared responsibility penalties. The BCRA also pushes implementation of the Cadillac tax to 2025 and permits states to waive essential health benefit (EHB) requirements.

The BCRA would change the excise tax paid by health savings account (HSA) owners who use their HSA funds on expenses that are not medical expenses under the Internal Revenue Code from the current 20 percent to 10 percent. It would also change the maximum contribution limits to HSAs to the amount of the accompanying high deductible health plan’s deductible and out-of-pocket limitation and provide for both spouses to make catch-up contributions to HSAs. The AHCA contains those provisions as well.

Like the AHCA, the BCRA would remove the $2,600 contribution limit to flexible health spending accounts (FSAs) for taxable years beginning after December 31, 2017.

The BCRA would allow individuals to remain on their parents’ plan until age 26 (the same as the ACA’s regulations, and the AHCA) and would not allow insurers to increase premium costs or deny coverage based on pre-existing conditions. Conversely, the AHCA provides for a “continuous health insurance coverage incentive,” which will allow health insurers to charge policyholders an amount equal to 30 percent of the monthly premium in the individual and small group market, if the individual failed to have creditable coverage for 63 or more days during an applicable 12-month look-back period.

The BCRA would also return permissible age band rating (for purposes of calculating health plan premiums) to the pre-ACA ratio of 5:1, rather than the ACA’s 3:1. This allows older individuals to be charged up to five times more than what younger individuals pay for the same policy, rather than up to the ACA limit of three times more. This is also proposed in the AHCA.

The ACA’s cost sharing subsidies for insurers would be eliminated in 2020, with the ability of the President to eliminate them earlier. The ACA’s current premium tax credits for individuals to use when purchasing Marketplace coverage would be based on age, income, and geography, and would lower the top threshold of income eligible to receive them from 400 percent of the federal poverty level (FPL) to 350 percent of the FPL. The ACA allowed any “alien lawfully present in the US” to utilize the premium tax credit; however, the BCRA would change that to “a qualified alien” under the definition provided in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. The BCRA would also benchmark against the applicable median cost benchmark plan, rather than the second lowest cost silver plan.


By Danielle Capilla
Originally Posted By www.ubabenefits.com

2018 Amounts for HSAs; Retroactive Medicare Coverage Effect on Contributions | Ohio Benefit Advisors

Categories: Benefits, Blog, Employee Communication, Employees, HRA, HSA, UBA News
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IRS Releases 2018 Amounts for HSAs

The IRS released Revenue Procedure 2017-37 that sets the dollar limits for health savings accounts (HSAs) and high-deductible health plans (HDHPs) for 2018.

For calendar year 2018, the annual contribution limit for an individual with self-only coverage under an HDHP is $3,450, and the annual contribution limit for an individual with family coverage under an HDHP is $6,900. How much should an employer contribute to an HSA? Read our latest news release for information on modest contribution strategies that are still driving enrollment in HSA and HRA plans.

For calendar year 2018, a “high deductible health plan” is defined as a health plan with an annual deductible that is not less than $1,350 for self-only coverage or $2,700 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,650 for self-only coverage or $13,300 for family coverage.

Retroactive Medicare Coverage Effect on HSA Contributions

The Internal Revenue Service (IRS) recently released a letter regarding retroactive Medicare coverage and health savings account (HSA) contributions.

As background, Medicare Part A coverage begins the month an individual turns age 65, provided the individual files an application for Medicare Part A (or for Social Security or Railroad Retirement Board benefits) within six months of the month in which the individual turns age 65. If the individual files an application more than six months after turning age 65, Medicare Part A coverage will be retroactive for six months.

Individuals who delayed applying for Medicare and were later covered by Medicare retroactively to the month they turned 65 (or six months, if later) cannot make contributions to the HSA for the period of retroactive coverage. There are no exceptions to this rule.

However, if they contributed to an HSA during the months that were retroactively covered by Medicare and, as a result, had contributions in excess of the annual limitation, they may withdraw the excess contributions (and any net income attributable to the excess contribution) from the HSA.

They can make the withdrawal without penalty if they do so by the due date for the return (with extensions). Further, an individual generally may withdraw amounts from an HSA after reaching Medicare eligibility age without penalty. (However, the individual must include both types of withdrawals in income for federal tax purposes to the extent the amounts were previously excluded from taxable income.)

If an excess contribution is not withdrawn by the due date of the federal tax return for the taxable year, it is subject to an excise tax under the Internal Revenue Code. This tax is intended to recapture the benefits of any tax-free earning on the excess contribution.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

Under Internal Revenue Code Section 105(h), a self-insured medical reimbursement plan must pass two nondiscrimination tests. Failure to pass either test means that the favorable tax treatment for highly compensated individuals who participate in the plan will be lost. The Section 105(h) rules only affect whether reimbursement (including payments to health care providers) under a self-insured plan is taxable.

When Section 105(h) was enacted, its nondiscrimination testing applied solely to self-insured plans. Under the Patient Protection and Affordable Care Act (ACA), Section 105(h) also applies to fully-insured, non-grandfathered plans. However, in late 2010, the government delayed enforcement of Section 105(h) against fully-insured, non-grandfathered plans until the first plan year beginning after regulations are issued. To date, no regulations have been issued so there is currently no penalty for noncompliance.

Practically speaking, if a plan treats all employees the same, then it is unlikely that the plan will fail Section 105(h) nondiscrimination testing.

What Is a Self-Insured Medical Reimbursement Plan?

Section 105(h) applies to a “self-insured medical reimbursement plan,” which is an employer plan to reimburse employees for medical care expenses listed under Code Section 213(d) for which reimbursement is not provided under a policy of accident or health insurance.

Common self-insured medical reimbursement plans are self-funded major medical plans, health reimbursement arrangements (HRAs), and medical expense reimbursement plans (MERPs). Many employers who sponsor an insured plan may also have a self-insured plan; that self-insured plan is subject to the Section 105 non-discrimination rules. For example, many employers offer a fully insured major medical plan that is integrated with an HRA to reimburse expenses incurred before a participant meets the plan deductible.

What If the Self-Insured Medical Reimbursement Plan Is Offered Under a Cafeteria Plan?

A self-insured medical reimbursement plan (self-insured plan) can be offered outside of a cafeteria plan or under a cafeteria plan. Section 105(h) nondiscrimination testing applies in both cases.

Regardless of grandfathered status, if the self-insured plan is offered under a cafeteria plan and allows employees to pay premiums on a pre-tax basis, then the plan is still subject to the Section 125 nondiscrimination rules. The cafeteria plan rules affect whether contributions are taxable; if contributions are taxable, then the Section 105(h) rules do not apply.

What Is the Purpose of Nondiscrimination Testing?

Congress permits self-insured medical reimbursement plans to provide tax-free benefits. However, Congress wanted employers to provide these tax-free benefits to their regular employees, not just to their executives. Nondiscrimination testing is designed to encourage employers to provide benefits to their employees in a way that does not discriminate in favor of employees who are highly paid or high ranking.

If a plan fails the nondiscrimination testing, the regular employees will not lose the tax benefits of the self-insured medical reimbursement plan and the plan will not be invalidated. However, highly paid or high ranking employees may be adversely affected if the plan fails testing.

What Are the Two Nondiscrimination Tests?

The two nondiscrimination tests are the Eligibility Test and Benefits Test.

The Eligibility Test answers the basic question of whether there are enough regular employees benefitting from the plan. Section 105(h) provides three ways of passing the Eligibility Test:

  1. The 70% Test – 70 percent or more of all employees benefit under the plan.
  2. The 70% / 80% Test – At least 70 percent of employees are eligible under the plan and at least 80 percent or more of those eligible employees participate in the plan.
  3. The Nondiscriminatory Classification Test – Employees qualify for the plan under a classification set up by the employer that is found by the IRS not to be discriminatory in favor of highly compensated individuals.

The Benefits Test answers the basic question of whether all participants are eligible for the same benefits.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

Qualified Small Employer Health Reimbursement Arrangements and ERISA | Ohio Benefit Advisors

Categories: Benefits, Blog, ERISA, HRA, Small Employer
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Certain small employers have the option to reimburse individual health coverage premiums up to a dollar limit through Qualified Small Employer Health Reimbursement Arrangements (QSE HRAs) under the 21st Century Cures Act (Cures Act).

The Cures Act amends the Employee Retirement Income Security Act of 1974 (ERISA) to exclude QSE HRAs from the ERISA definition of group health plan; however, the Cures Act does not specifically exclude QSE HRAs from the rest of ERISA.

Small employers that plan to offer QSE HRAs should be cautious before presuming that ERISA would not apply to a reimbursement arrangement. Because QSE HRAs are new, the issue of whether the remainder of ERISA applies to QSE HRAs remains undetermined by an administrative agency or court. In consideration of the limited ERISA group health definition exclusion and the law’s legislative history, a risk-averse small employer should treat a QSE HRA as an employee welfare benefit plan covered under ERISA and comply with applicable ERISA requirements such as having a written plan document and summary plan description as well as following ERISA’s fiduciary and other rules.

Request UBA’s Compliance Advisor, “Qualified Small Employer Health Reimbursement Arrangements and ERISA for a discussion of ERISA’s definitions of “group health plan,” as well as the law’s legislative history governing exclusions. A small employer who intends to offer a QSE HRA without complying with ERISA’s employee welfare benefit plan requirements should consult with its attorney before proceeding.

By Danielle Capilla
Originally Posted By www.ubabenefits.com

Your organization has 312 employees, which means you have 312 different needs for well-being support. Well-being strategies should not be a one-size-fits-all approach. Developing a set of flexible and responsive well-being strategies that meet changing individual needs throughout an employee’s tenure is a critical way to both attract and retain talent. A few case studies to illustrate:

Jordan is serving in an entry-level position. This single, gender fluid, 20-something is eager to learn and grow. In conversations with HR, Jordan has also indicated a high level of overall stress due to a burdensome education loan and is barely able to make loan payments on top of rent and other monthly expenses. Jordan’s outlook on saving for retirement is grim. At the same time, he is an active member of the local young professional network and keeps fit while playing in a competitive Ultimate league.

Anvi has been in an executive leadership role with the organization for seven years. She is a gifted and valued trailblazer who keeps the organization nimble in a climate of constant change. Despite spending long hours at work, her colleagues know little about Anvi’s family and personal life, as she is rather private. From time to time though, Anvi demonstrates affection for her team by sharing artfully created meals that illustrate her diverse cooking skills and interests.

Mark has been a dedicated, career-long, mid-level employee in accounting. Although lately he shows declining interest in his once-beloved work. Colleagues have noticed in Mark a new tendency to decline offers to share lunch or coffee breaks. Last year, Mark led the company volunteerism committee, but has recused himself from this duty, citing a conflict of interest with his role as a finance officer for a local non-profit organization.

Each of these individuals show up to the workplace with a unique set of values, talents, beliefs, interests, and resources. At the same time, all employees benefit from a workplace culture that attends to each person’s sense of purpose, plus physical, social, financial and community well-being. It can be a daunting challenge to meet such diverse needs and interests, which is why we must build programs and policies with employees, listening to what they want and seeking out ways to efficiently design a system of supports. The first step to any thoughtful program is to conduct a needs assessment. Turn up the volume on your curiosity and lead with the question: What do employees want? Consider gathering responses by survey, current HR data sources, and focus groups. Be sure to gather demographic information that will help segment the findings. The results may confirm your beliefs about employee wishes or reveal interesting surprises, as noted in this example.

In a 2015 survey of 1,647 folks across 11 diverse organizations, the American Institute of Preventative Medicine found the following:

  • Incentive strategies: Almost unanimously, employees favored reduced health insurance premium (34 percent) and cash (25 percent) as incentives to get healthier. However, 53 percent of those age 70 and older noted they do not need an incentive to be healthier.
  • Well-being topics of interest: Nutrition (78 percent) and physical activity (77 percent) topics were of highest interest by those age 18 to 69. These same age groups also favored stress management topics more than colleagues age 70 and older. Moderate interest in depression was common among all age groups, and all age groups showed the least interest in tobacco cessation. Compared with colleagues of older age groups, the youngest cohort (18 to 24) indicated high interest in sleep enhancement.
  • Program offerings: All age groups favored health risk assessments (26 percent) and health challenges (25 percent) over other well-being program offerings. Furthermore, older groups (50 to 69 and 70 and older) prefer in-person educational seminars, and younger employees (18 to 24) were more likely to engage in weight loss programs.
  • Fitness devices: The oldest individuals were more likely than all younger individuals to report owning a personal fitness tracking device such as a Fitbit or pedometer, 40 percent age 70 and older, 37 percent age 50 to 69, 31 percent age 33 to 49, 29 percent age 25 to 32, and 17 percent age 18 to 24.

A small-scale needs and interest study like this can challenge our biases about certain groups within our employee population and reveal key details about the value employees hold for well-being programs. Results should inform design of a well-being strategy that accurately and cost-effectively meets a range of needs in the workplace. After all, “research is formalized curiosity. It is poking and prying with purpose,” said Zora Neale Hurston. The pursuit of growing a cost-effective culture of well-being and individual value for programmatic supports will be more beneficial to organizational health than a hard measure of return on investment.

By Lindsay Simpson
Originally Posted By www.ubabenefits.com

Your wellness program seems to have it all – biometric screenings, lunch and learns, and weight loss challenges. So, why do you struggle with engagement, or to see any real results? While traditional wellness components are still a large part of plans today, emerging trends, coupled with generational differences, make for challenges when designing an impactful program.

As wellness programs begin to be viewed as a part of the traditional benefits package, the key differentiator is creating a culture and environment that supports overall health and well-being. Visible engagement and support from front-line and senior leadership drives culture change. By prioritizing health through consistent communication, resource allocation, personnel delegation, and role modeling/personal health promotion practices, employers gain the trust of their employees and develop an environment situated around wellness. When employees recognize the importance of wellness in the overall company strategy and culture, and feel supported in their personal goals, healthy working environments begin to develop, resulting in healthier employees.

Looking beyond traditional wellness topics and offering programs that meet the goals of your employees also leads to higher engagement. The American Heart Association CEO Roundtable Employee Health Survey 2016 showed improving financial health, getting more sleep, and reducing stress levels are key focus areas for employees as part of overall wellness. More so, employees see the benefits of unplugging and mentoring, two new topics in the area of overall well-being. While most employers feel their employees are over surveyed, completing an employee needs or preference survey will ensure your programs align with your employees’ health and wellness goals – ultimately leading to better engagement.

Wellness programs are not immune to generational differences, like most other facets of business. While millennials are most likely to participate and report that programs had an overall impact, they prefer the use of apps and trackers along with social strategies and team challenges. Convenience and senior level support are also important within this group. Generation X and baby boomers show more skepticism toward wellness programs, but are more likely to participate when the programs align with their personal goals. Their overall top health goal is weight loss. Ultimately, addressing the specific needs of your member population and providing wellness through various modalities will result in the greatest reward of investment.

Evaluation and data are the lynchpins that hold a successful program together. Consistent evaluation of the effectiveness of programs to increase participation, satisfaction, physical activity, and productivity – all while reducing risk factors – allow us to know if our programs are hitting the mark and allow for additional tailoring as needed.

By Jennifer Jones
Originally Posted By www.ubabenefits.com

In a world of insurance and acronyms, the term “HRA” is thrown around a lot, but it has a variety of meanings.

HRA can mean health reimbursement account, heath reimbursement arrangement, or health risk assessment, and all of those mean something different. I want to be clear that in the following article I am going to be discussing the use of health reimbursement accounts with fully-insured health plans. We can leave the other meanings of HRA for another time.

An HRA can be “wrapped” with a high-deductible, fully-insured health plan and this can lead to savings for an employer over offering a traditional health plan with a lower deductible.

Offering a high-deductible health plan and self-funding, the first $2,000, or $3,000, in claims on behalf of the employees can translate to significant savings because the employer is taking on that initial risk instead of the insurance carrier. Unlike a consumer-driven health plan (CDHP) that has a high deductible and can be paired with a health savings account (HSA) where an employer can contribute funds to an employee’s HSA account that can be used to pay for qualified medical expenses, an employer only has to pay out of the HRA if there is a claim.

With an HSA that is funded by the employer, the money goes into the HSA for their employees and then those funds are “owned” by the employee. The employer never sees it again. Under an HRA, if there are no claims, or not a high number of claims, the employer keeps those unused dollars in their pocket.

An HRA component to a health plan is subject to ERISA and non-discrimination rules, meaning everyone that is eligible should be offered the plan, and the benefits under the HRA should be the same for everyone enrolled. It is advisable that an HRA be administered by a third-party that pays the claims to the providers, or reimburse plan enrollees under the terms of the plan, in order to keep employees’ and their dependents’ medical information private from the employer as to avoid potential discrimination.

The HRA component of a health plan is essentially self-funded by the employer, which gives the employer a lot of flexibility and can be tailored to their specific needs or desired outcomes. The employer can choose to fund claims after the employee pays the first few hundred dollars of their deductible instead of the employer paying the claims that are initially subject to the high deductible. An employer can have a step arrangement, for example, the employer pays the first $500, the employee the second $500, the employer pays the next $500, and the employee pays the final $500 of a $2,000 deductible.

If an employer has a young population that is healthy, they may want to use the HRA to pay for emergency room visits and hospital in-patient stays, but not office visits so they can help protect their employees from having to pay those “large ticket items,” but not blow their budget. While an employer with a more seasoned staff, or diverse population, may want to include prescription drugs as a covered benefit under the HRA, as well as office visits, hospital in-patient stays, outpatient surgery, etc. Or, if an employer needs to look at cost-saving measures, they may want to exclude prescriptions from being eligible under the HRA.

Keep in mind, all of these services are essential health benefits and would be covered by the insurance carrier under the terms of the contract, but an employer can choose not to allow the HRA to be used to pay for such services, leaving the enrollee to pay their portion of the claims. In any case, the parameters of what is eligible for reimbursement from the HRA is decided and outlined at the beginning of the plan year and cannot be changed prior to the end of the plan year.

If you are thinking about implementing a high-deductible health plan with an HRA for your employees, be sure you are doing it as a long-term strategy. As is the case with self-funding, you are going to have good years and bad years. On average, a company will experience a bad, or high claims, year out of every four to five years. So, if you implement your new plan and you have a bad year on the first go-round, don’t give up. Chances are the next year will be better, and you will see savings over your traditional low-deductible plan options.

With an HRA, you cap the amount you are going to potentially spend for each enrollee, per year. So, you know your worst-case scenario. While it is extremely unlikely that every one of your employees will use the entire amount allotted to them, it is recommended that you can absorb or handle the worst case scenario. Don’t bite off more than you can chew!

HRA administrators usually charge a monthly rate per enrollee for their services, and this should be accounted for in the budgeting process. Different HRA third-party administrators have different claims processes, online platforms, debit cards, and business hours. Be sure to use one that offers the services that you want and are on budget.

Another aspect of offering a high-deductible plan with an HRA that is often overlooked is communication. If an employee does not know how to utilize their plan, it can create confusion and anger, which can hurt the overall company morale. The plan has to be laid out and explained in a way that is clear, concise, and easy to understand.

In some cases, the HRA is administered by someone other than the insurance carrier, and the plan administrator has to make sure they enroll all plan enrollees with the carrier and the third-party administrator.

The COBRA administrator also has to offer the HRA as part of the COBRA package, and the third-party administrator must communicate the appropriate premium for the HRA under COBRA. Most COBRA enrollees will not choose to enroll in the HRA with their medical plan, as they are essentially self-funding their deductible and plan costs through the HRA instead of paying them out of their pocket, but many plan administrators make the mistake of not offering the HRA under COBRA, as it is mandated by law.

Offering a high-deductible plan with an HRA is a way for small employers to save over offering a low-deductible health plan, and can be a way for an employer to “test the waters” to see if they may want to move to a self-funded plan, or level-funded plan, in the future.

By Elizabeth Kay
Originally Posted By www.ubabenefits.com

Workplace wellness programs have increased popularity through the years. According to the most recent UBA Health Plan Survey, 49 percent of firms with 200+ employees offering health benefits in 2016 offered wellness programs. Workplace wellness programs’ popularity also brought controversy and hefty discussions about what works to improve population health and which programs comply with the complex legal standards of multiple institutions that have not really “talked” to each other in the past. To “add wood to the fire,” the Equal Employment Opportunity Commission (EEOC) made public some legal actions that shook the core of the wellness industry, such as EEOC vs. Honeywell International, and EEOC vs. Orion Energy Systems.

To ensure a wellness program is compliant with the ACA, GINA and the EEOC, let’s first understand what each one of these institutions are.

The Affordable Care Act (ACA) is a comprehensive healthcare reform law enacted in March 2010 during the Obama presidency. It has three primary goals: to make health insurance available to more people, to expand the Medicaid program, and to support innovative medical care delivery methods to lower the cost of healthcare overall.1 The ACA carries provisions that support the development of wellness programs and determines all rules around them.

The Genetic Information Nondiscrimination Act of 2008 (GINA) is a federal law that protects individuals from genetic discrimination in health insurance and employment. GINA relates to wellness programs in different ways, but it particularly relates to the gathering of genetic information via a health risk assessment.

The U.S. Equal Employment Opportunity Commission (EEOC) is a federal agency that administers and enforces civil rights laws against workplace discrimination. In 2017, the EEOC issued a final rule to amend the regulations implementing Title II of GINA as they relate to employer-sponsored wellness program. This rule addresses the extent to which an employer may offer incentives to employees and spouses.

Here is some advice to ensure your wellness program is compliant with multiple guidelines.

  1. Make sure your wellness program is “reasonably designed” and voluntary – This means that your program’s main goal should be to promote health and prevent disease for all equally. Additionally, it should not be burdensome for individuals to participate or receive the incentive. This means you must offer reasonable alternatives for qualifying for the incentive, especially for individuals whose medical conditions make it unreasonably difficult to meet specific health-related standards. I always recommend wellness programs be as simple as possible, and before making a change or decision in the wellness program, identify all difficult or unfair situations that might arise from this change, and then run them by your company’s legal counsel and modify the program accordingly before implementing it. An example of a wellness program that is NOT reasonably designed is a program offering a health risk assessment and biometric screening without providing results or follow-up information and advice. A wellness program is also NOT reasonably designed if exists merely to shift costs from an employer to employees based on their health.
  2. Do the math! – Recent rules implemented changes in the ACA that increased the maximum permissible wellness program reward from 20 percent to 30 percent of the cost of self-only health coverage (50 percent if the program includes tobacco cessation). Although the final rules are not clear on incentives for spouses, it is expected that, for wellness programs that apply to employees and their spouses, the maximum incentive for either the employee or spouse will be 30 percent of the total cost of self-only coverage. In case an employer offers more than one group health plan but participation in a wellness program is open to all employees regardless of whether they are enrolled in a plan, the employer may offer a maximum incentive of 30 percent of the lowest cost major medical self-only plan it offers. As an example, if a single plan costs $4,000, the maximum incentive would be $1,200.
  3. Provide a notice to all eligible to participate in your wellness program – The EEOC made it easy for everyone and posted a sample notice online at https://www.eeoc.gov/laws/regulations/ada-wellness-notice.cfm. Your notice should include information on the incentive amount you are offering for different programs, how you maintain privacy and security of all protected health information (PHI) as well as who to contact if participants have question or concerns.
  4. If using a HRA (health risk assessment), do not include family medical history questions – The EEOC final rule, which expands on GINA’s rules, makes it clear that “an employer is permitted to request information about the current or past health status of an employee’s spouse who is completing a HRA on a voluntary basis, as long as the employer follows GINA rules about requesting genetic information when offering health or genetic services. These rules include requirements that the spouse provide prior, knowing, written, and voluntary authorization for the employer to collect genetic information, just as the employee must do, and that inducements in exchange for this information are limited.”2 Due to the complexity and “gray areas” this item can reach, my recommendation is to keep it simple and to leave genetic services and genetic counseling out of a comprehensive wellness program.

WellSteps, a nationwide wellness provider, has a useful tool that everyone can use. Their “wellness compliance checker” should not substituted for qualified legal advice, but can be useful for a high level check on how compliant your wellness program is. You can access it at https://www.wellsteps.com/resources/tools.

I often stress the need for all wellness programs to build a strong foundation, which starts with the company’s and leaders’ messages. Your company should launch a wellness program because you value and care about your employees’ (and their families’) health and well-being. Everything you do and say should reflect this philosophy. While I always recommend companies to carefully review all regulations around wellness, I do believe that if your wellness program has a strong foundation based on your corporate social responsibility and your passion for building a healthy workplace, you most likely will be within the walls of all these rules. At the end, a workplace that does wellness the right way has employees who are not motivated by financial incentives, but by their intrinsic motivation to be the best they can be as well as their acceptance that we all must be responsible for our own health, and that all corporations should be responsible for providing the best environment and opportunities for employees to do so.

By Valeria S. Tivnan
Originally Posted By www.ubabenefits.com

 

While the health care affordability crisis has become so significant, questions still linger—will private exchanges become a viable solution for employers and payers, and will they will continue to grow? Back in 2015, Accenture estimated that 40 million people would be enrolled in private exchange programs by 2018; the way we see this model’s growth today doesn’t speak to that. So, what is preventing them from taking off as they were initially predicted? We rounded up a few reasons why the private exchange model’s growth may be delayed, or coming to a halt.

They Are Not Easy to Deploy

There is a reason why customized benefits technology was the talk of the town over the last two years; it takes very little work up-front to customize your onboarding process. Alternatively, private exchange programs don’t hold the same reputation. The online platform selection, build, and test alone can get you three to six months into the weeds. Underwriting, which includes an analysis of the population’s demographics, family content, claims history, industry, and geographic location, will need to take place before obtaining plan pricing if you are a company of a certain size. Moreover, employee education can make up a significant time cost, as a lack of understanding and too many options can lead to an inevitable resistance to changing health plans. Using a broker, or an advisor, for this transition will prove a valuable asset should you choose to go this route.

A Lack of Education and a Relative Unfamiliarity Revolves Around Private Exchanges

Employers would rather spend their time running their businesses than understanding the distinctions between defined contribution and defined benefits models, let alone the true value proposition of private exchanges. With the ever-changing political landscape, employers are met with an additional challenge and are understandably concerned about the tax and legal implications of making these potential changes. They also worry that, because private exchanges are so new, they haven’t undergone proper testing to determine their ability to succeed, and early adoption of this model has yet to secure a favorable cost-benefit analysis that would encourage employers to convert to this new program.

They May Not Be Addressing All Key Employer and Payer Concerns

We see four key concerns stemming from employers and payers:

  • Maintaining competitive benefits: Exceptional benefits have become a popular way for employers to differentiate themselves in recruiting and retaining top talent. What’s the irony? More options to choose from across providers and plans means employees lose access to group rates and can ultimately pay more, making certain benefits less. As millennials make up more of today’s workforce and continue to redefine the value they put behind benefits, many employers fear they’ll lose their competitive advantage with private exchanges when looking to recruit and retain new team members.
  • Inexperienced private exchange administrators: Because many organizations have limited experience with private exchanges, they need an expert who can provide expertise and customer support for both them and their employees. Some administrators may not be up to snuff with what their employees need and expect.
  • Margin compression: In the eyes of informed payers, multi-carrier exchanges not only commoditize health coverage, but perpetuate a concern that they could lead to higher fees. Furthermore, payers may have to go as far as pitching in for an individual brokerage commission on what was formerly a group sale.
  • Disintermediation: Private exchanges essentially remove payer influence over employers. Bargaining power shifts from payers to employers and transfers a majority of the financial burden from these decisions back onto the payer.

It Potentially Serves as Only a Temporary Solution to Rising Health Care Costs

Although private exchanges help employers limit what they pay for health benefits, they have yet to be linked to controlling health care costs. Some experts argue that the increased bargaining power of employers forces insurers to be more competitive with their pricing, but there is a reduced incentive for employers to ask for those lower prices when providing multiple plans to payers. Instead, payers are left with the decision to educate themselves on the value of each plan. With premiums for family coverage continuing to rise year-over-year—faster than inflation, according to Forbes back in 2015—it seems private exchanges may only be a band-aid to an increasingly worrisome health care landscape.

Thus, at the end of it all, change is hard. Shifting payers’, employers’, and ultimately the market’s perspective on the projected long-term success of private exchanges will be difficult. But, if the market is essentially rejecting the model, shouldn’t we be paying attention?

By Paul Rooney
Originally Posted By www.ubabenefits.com