By: Ken Cole
As healthcare costs continue to rise, employers are seeking creative ways to reduce
their healthcare expenditures. Lately, I have come across more employers that have
tried implementing a medical gap. Some successful, some not.
What is medical gap insurance? Pretend John Doe Manufacturing historically provided
employees medical coverage with a $500 deductible and $20 copay. With expensive
premiums of $900 per-employee-per-month, the company decides to increase the
deductible to $5,000 to lower premiums and then provide a $4,000 medical gap to “buy
down” the deductible and out-of-pocket costs for employees.
The new medical premium of $500 and medical gap of $150 per employee per month,
nets a $250 per month savings per employee to John Doe Manufacturing. Employees
receive a medical gap insurance card, and claims are now filed to both their gap carrier
and major medical carrier.
Medical gap plans do not come without challenges to implement:
First it must be communicated clearly and employees educated!
Employees need to know claims must be processed by both carriers.
Some physicians’ practices do not know what a medical gap is or how to submit claims.
A gap plan should be paired with a copay plan, not a high deductible health plan (HDHP)!
Many gap plans do not reimburse services the same (or at all) based on the place of service.
Fully-insuring the deductible with a gap may still be more expensive than selffunding a health reimbursement account.
Instead of fully-insuring the deductible with a medical gap, John Doe Manufactur
By: David Slade
In many instances, employers work with multiple insurance brokers for their Employee Benefits, Property and Casualty, and Liability Programs. In some cases, existing relationships or different decision makers have trumped trying to partner with one firm for all risk management needs.
The next time you’re reviewing your exposure to risk, consider the following:
Employees are your most important asset – We hear this all the time. Organizations are only as successful as their talent. As a result, there’s a lot of synergy between wellness programs and workplace safety. An investment into improving the health of employees should lead to a safer workplace with fewer accidents. Why not leverage health and wellness programs with workplace safety?
The more a firm understands your operation, the better job they can do for you. While competitive premiums and cost are critical, you need to choose an insurance broker the same way you choose an attorney or accountant. Seeking multiple quotes from multiple vendors rarely leads to successful long-term relationships. If someone represents you in all areas of your business, they will know much more about your goals, objectives and challenges than multiple vendors.
If something goes wrong, it’s always easier to deal with one firm. In certain instances, employers cannot determine if a claim is related to workers compensation or health benefits. Since the onset of the Affordable Care Act, we’ve seen an increase in claims bleeding over into workers compensation. It’s easier on you if one firm rather than two is addressing this market trend.
The bottom line is employers want to prevent claims by having a healthy workforce and a safe
By: Abby Russell
I recently read BlueZones by Dan Buettner, a National Geographic fellow who studied the regions of the world with the most centenarians. He studied the lifestyles of individuals in these various regions and found common elements that existed among the groups. These regions have been named blue zones.
In his book, Buettner highlights lessons from these blue zones that he has coined the nine power principles. These power principles can easily translate to each of us within our homes, communities, and even workplaces. In sharing these principles with you I hope you will consider incorporating these principles in your own lives and even become role models in your workplaces.
Move Naturally - The world’s longest-lived people don’t pump iron or run marathons. Instead, their environments nudge them into moving without thinking about it.
Purpose - Why do you wake up in the morning? Knowing your sense of purpose is worth up to seven years of extra life expectancy. And while purposeful and meaningful work is important, it cannot be the sole determinant of purpose.
Down Shift - Stress leads to chronic inflammation, associated with every major age-related disease. The world’s longest-lived people have routines to shed that stress.
80% Rule - “Hara hachi bu” – the Okinawans say this mantra before meals as a reminder to stop eating when their stomachs are 80 percent full.
Plant Slant - The cornerstone of most centenarian diets? Beans. They typically eat meat—mostly pork—only five times per month. Eat an array of fruits and vegetables.
Wine @ 5
By: Mary Long
I’ve never written a blog about what I do all day every day. I don’t write technical blogs or how-to articles. Why?
I’ve been rolling that question around in my head for some time now and I’ve come to a conclusion. What I do, what an enrollment system consultant should do, is understand the big picture of an organization, its culture, its benefits administration requirements, and the company’s goals. We are strategic as well as technical. I build enrollment websites, yes, but I’d like to think that we at Rosenfeld Einstein do more than that. We customize the enrollment experience for employers and their employees. We consult with our administrators on the ways in which they plan to meet ACA reporting requirements. We work to reduce paper and streamline workflows.
Selecting a benefits enrollment vendor is just as much about strategy as it is about the enrollment
experience. As you consider different enrollment systems, ask a few questions:
How can this system help me manage the reporting and administrative requirements of the Affordable Care Act?
Will this solution help reduce or eliminate dual entry between enrollment system and payroll?
Does this system have a reporting feature that I will be able to easily use?
Can the enrollment system collect e-signatures?
Is there a knowledgeable and accessible team in place to help you when you need assistance.
Employee benefits administration is rapidly changing. W-2 reporting, ACA reporting, measurement periods… just when you think you understand the new landscape, the sands shift. Have you partnered with an enrollment system and payroll vendor that will help your organization meet its goals?
By: Mary Cloonan
Data. Such a generic word for something that contains important and specific information about your business and workforce. It’s a word that gets thrown around a lot and means something different for every organization. One thing is certain: data and Human Resources go together like a leaf on a tree, and that connection is only going to become more substantial in the future as data analytics continues to drive Human Resources processes and strategies.
By now you have heard all about how a benefits administration system can streamline your workflow in onboarding employees and getting their elections to your carriers. That system also contains pertinent data on your full-time, benefits eligible workforce that can be pulled into reporting you can use in a myriad of ways. If you want to stay on top of overage dependents that need to come off employee coverages, there’s a report for that. If you want to ensure that requests for additional life insurance coverages have the subsequent evidence of insurability form completed and sent to the carrier, there is a report that will identify those employees that need to send in the form. You can create a custom report that is specific to your organizational tracking needs and schedule it to be sent to you however often you want. The point is, your benefits administration system holds data that is not only key for carriers to receive but can record certain information that you need to know or would like to know about your workforce for different reasons.
If you currently have a benefits administration system, great, you are ahead of the game. If you don’t have one, start looking, especially for large employers (50+ full-time employees) or if you self-insure your medical plan(s); the Affordable Care Act (ACA) reporting requirements in 2016 are a doozy and having a benefits administration sy
By: Ken Cole
In 2016 community rating hits employers with up to 100 employees. So far only employers with up to 50 employees have dealt with individual age-banded rates. Next year employers with 50-99 employees will experience the pleasure.
Under community rating, the employee’s rate is primarily based upon their age and the community in which they reside, which is determined by zip code. A third factor is tobacco use where a carrier can charge 20% more for the individual.
Employee Bob covers his family of five, and employee Jane covers her family of three. Bob’s rates for five people are completely different than Jane’s, and any individual’s rate might increase on their birthdate. Imagine the headache for the employer of payroll deductions varying for every employee. Additionally, Bob could be the same age as Jane but lives in a town 30 minutes away whose community hospital costs more – so his monthly rates are $100 more per person. Multiply this by 99 employees!
As healthcare reform becomes fully implemented, self-insuring with alternative funding platforms will come downstream and become attractive for employers with under 100 employees.
Alternate funding or “level funding” is a platform that looks and feels fully insured, but is actually self-insured with stop loss coverage to protect you from large claims. Monthly premium equivalents are paid to the carrier to cover maximum liability, providing consistent budgeting. At the end of the plan year, you and the carrier square up. If your claims are good and you have overfunded your plan, a refund is received. A few advantages might include:
By: David Slade
As employers grapple with managing Payroll, HR and Benefits data, it’s critical to find the best technology partners to meet your needs. The ACA will make this a more daunting task with new compliance requirements. For example, employers will be required to submit Section 6055 & 6066 data to the IRS in early 2016. There are hundreds of payroll and benefits administration systems to evaluate with thousands of features and capabilities.
Below are some helpful steps in the process to evaluate HR and Benefits Administration technology:
• Discovery - Perform a detailed assessment of your technology needs. You may not be aware of all your needs so it’s critical to utilize the right consultant or adviser to assist. Make sure you understand all your current processes in order to streamline steps and improve efficiency.
• Search - Determine the provider review process. Don’t automatically assume a current vendor has the best solution in another area.
• Selection - Analyze proposals, schedule demos and review agreements.
• Negotiate - Utilize your buying power with a vendor to get the best pricing. In certain instances, carriers may subsidize the cost of benefit administration systems that simplify their processing of enrollment and eligibility data. Make sure you know who will be paying the cost of carrier file feeds and if there are additional programming fees.
• Implementation - This is where the rubber meets the road. A client’s experience is made or broken during this phase. Make sure you know who will be building your system and where they’re located. How much leverage does your consultant or adviser have with your vendor? If work is shipped off to a remote locati
By: Mary “MC” Chesson
Almost everywhere you go these days, you can bet on seeing someone using their smartphone in some capacity (even while driving...eeek!). From gaming to scheduling to browsing and much more, there seems to be an endless list of what you can do on a smartphone.
It’s no big surprise that smartphone users typically access their mobile device for reasons other than placing a call. Earlier this year the news hit that Internet usage accessed by mobile devices has now exceeded Internet usage via PCs (you can access one online article on this topic here). This is due considerably to the fact that many businesses have embraced the use of mobile technology in both internal transactions as well as what they offer to clients and consumers. The term “mobile app” has become a common phrase on websites, TV and radio commercials and billboard ads. Businesses want their consumers to know that information about their product can be accessed anywhere they go as long as there is an Internet connection present. Banks have embraced “mobile banking” where a customer can do virtually anything via a bank app rather than having to show up at a bank location and do business the old way. You can even deposit a check into your account without having to talk to a teller.
So what does any of this have to do with employee benefits? Well, a lot actually. Now that benefits technology is moving full steam ahead and engaging consumers through a true shopping experience using decision support tools and defined contribution set by employers, it’s obvious that the next step is to make their platforms available via mobile apps. By now consumers are pretty used to shopping, banking, scheduling, browsing and
By: Abby Russell
On July 14, 2014, the Equal Employment Opportunity Commission (EEOC) issued new guidelines under the Pregnancy Discrimination Act (PDA) and the Americans with Disabilities Act (ADA). One particular update is lactation and breastfeeding are now pregnancy related medical conditions protected under the PDA. Expectations of the employer continue to increase as our society evolves and the working parent demographic changes.
The Bureau of Labor reported in 2013 that about 70 percent of mothers with children under the age of 18 are a part of today’s workforce. Yet, mothers with younger children are less likely to be in the labor force than mothers with older children at a difference of almost 10 percent.
Working Mother Magazine just announced their 2014 Working Mother 100 Best Companies. These companies go above and beyond offering not only fully paid leave but also child care support, flexible schedules, telecommuting, and advancement programs to help women continue to succeed in their careers. Many of the top 100 companies are making an effort to keep up with their employees’ changing needs whether its same-sex couples raising kids or adoptions and surrogacy. Now there is much more for the employer to consider. Barbara Wankoff, national director of workplace solutions at KPMG says “There is no one way to have a family. We want to support all our people, and are very careful to create policies to be all-inclusive.” More companies are adopting new policies along with changes to support modern day families.
As employers consider policy updates and chan
By: Ken Cole
“My business is mostly part-time employees, and I have less than 50 full time staff. Reporting for healthcare reform doesn’t apply to me.” Au contraire mon frère!
If you are an Applicable Large Employer (ALE) beginning January 2015, you will be required to provide the government with information about your employees and health plans. IRS Sections 6055 and 6056 are designed to capture information from employers in order to enforce the individual mandate and employer shared-responsibility mandate.
What is an ALE?
Any business that employs 50 or more full time equivalents (FTE) is considered an applicable large employer. It’s not just your full-time staff. All part-time employee hours are aggregated to determine how many full time staff they represent. A business with 25 full-time and 90 part-time may equate to a total of 60 full-time equivalents.
What is 6055?
This report is required of insurers and self-insured plans, and will assist the government in determining whether individuals are complying with the individual mandate. Information such as the name, address, and social security number for each individual covered (including spouse and dependents) will be required.
What is 6056?
This report is for all ALE employers, fully or self-insured, to report on their plans and offerings to employees, spouses and dependents. It will assist the government in determining compliance with the employer mandate and identify individuals not eligible for subsidies in the individual marketplace. ALEs will also have to certify significant changes were not made to their plan in order to qualify for transitional relief. Like 6055, this report will require a great amount of inf
By: David Slade
With the recent enrollment of 7 million people in public health exchanges, there’s a lot of excitement about private exchanges in the employer community. Surveys show half of employers will explore a private exchange in the next few years. The attraction of a defined contribution approach is driving most of this interest as benefit budgets are under attack in a highly competitive economy.
When reviewing private exchanges, it’s critical to evaluate the following so you understand true advantages from hype:
Pricing – Carriers underwrite risk the same way in or out of a private exchange. You won’t immediately benefit from discounted pricing by joining an exchange.
Technology – Think of an exchange as a technology solution to change the way employees select Benefits. As a result, make sure you understand the technology of the benefits administration system and how it integrates with payroll, HRIS and time & attendance. Your Benefits Enrollment Portal should make it simpler for employees to choose benefits and for you to administer them with connected carriers and administrators.
Employee Engagement – The average employee spends 20 minutes per year reviewing Benefit options during Open Enrollment. This is woefully inadequate especially when Benefits amount to 25-30% of total compensation. Exchanges re-define the shopping experience and present the employer contribution upfront as a bucket of money. Employees make selections and see how they reduce their benefits allowance. This is much like going onto Amazon® and shopping online.
Decision Support Tools &nda
By: Susie Eoute
Am I covered by Medicare while I travel outside the U.S.?
There’s much to do besides checking your passport and packing! You never plan on needing health coverage while on vacation. However; there are three very important items to consider:
· Does Medicare provide healthcare coverage while traveling abroad?
· Which countries are considered US territories?
· Will I need additional healthcare coverage?
You know you are covered in the United States for healthcare. When you travel outside the U.S (including Mexico and Canada) it’s important to know how Medicare works.
Guam, U.S. Virgin Islands, Puerto Rico, American Samoa and Northern Mariana Islands are considered U.S. territories. Outside of this, there is no Medicare coverage except in rare instances. Read these important points on Medicare.gov to understand in what situations Medicare would cover you while traveling internationally.
What about my Medicare Supplement? Some supplements have limited emergency coverage. To be sure your policy provides benefits, do a little research first!
It is a good idea to purchase an International Travel Policy prior
By: Abby Russell
No one likes to hear me say that summer is the time to start planning for next year’s wellness program, but that doesn’t make it any less true. Ideally, beginning of the summer is when I start planning for next year’s programming. One reason for this early planning is establishing the budget for the coming year. For most organizations running on a calendar year, budgets are due end of summer. Preparing and managing a budget is critical to the success of a wellness & health promotion program. The planning stage is also the time to revisit any recent assessments and to evaluate your previous year’s worth of programming and initiatives.
While planning a program and corresponding budget remember that like most investments the more comprehensive and thus expensive, the greater the potential return. A 2013 article in Society for Human Resource Management (SHRM) referenced a study by the Center for Studying Health System Change (HSC), which reported that one-size-fits-all programs are not effective. Instead a program that is customized to the organization will realize the best outcomes. HSC stated, “wellness programs must also be integrated, comprehensive, diversified, strongly linked to the organization’s business strategy and championed by senior leadership and managers.”
Keep in mind a few key elements from Sibson’s Healthy Enterprise Study. A strategic focus, which incorporates leadership, shared vision, collaboration, and a benefits strategy, correlated most with an effective program. Defining and evaluating measurable objectives, increasin
By: Mary Long
The sandwich generation is the group of folks that are stuck in the middle of taking care of children and aging parents. Hi, my name is Mary and I’m one of them.
I think the most important part of being a sandwich generation caretaker is the ability to be your own advocate and being an educated consumer. We know that the days of passively accepting the word of doctors are gone. Gone are the days of medical plans with low deductibles and minimal copays. We have to be willing to research our care options and understand how our insurance coverage will help with those choices.
The idea of consumer education has settled into the employee benefits arena too. Part of this trend is a new development called Private Health Insurance Exchanges. Imagine an employee benefits equivalent to Amazon. A private exchange offers participating employers and their employees a virtual insurance marketplace for benefits, complete with online enrollment and greatly expanded benefit selections. With more choice, however, comes the need to better understand what our options are.
The sandwich generation is used to arming themselves with knowledge, but any caretaker will tell you that understanding choices can be daunting. Technology is stepping up to the plate, however, when it comes to marketplace benefit selection. Tools are built into the marketplace enrollment process to determine what is important to the employee and what their needs are. The enrollment process then guides the employee to the coverage choice that is best for them.
The landscape of healthcare has changed and decisions regarding healthcare and insurance are only going to become increasingly complex. Technology is here to help educate us and guide us through the decision making process.