3 things you should be telling employees about HSAs

HSAs can seem to be complicated but can save your employees an additional 20 percent on average compared to paying out of their pockets. Here are 3 tips for an employer to keep in mind about HSAs.


Everyone wants to spend less on health care, but many employees don’t realize that an HDHP plan with an HSA might be the best deal they can get. Some people get scared off by an HDHP’s big deductible, some are accustomed to FSAs, and some just think an HSA seems too complicated.

But using an HSA to pay for health expenses can save your employees an additional 20 percent on average compared to paying out of their pocket. HSAs give them a way to pay for current and future medical expenses, and every dollar they save in their HSA saves you money on payroll taxes.

Here are three things you should be communicating about your HSAs:

1. FSAs are rubber, HSAs are glue

Many employees familiar with FSAs will expect that all health care accounts follow the “use it or lose it” rule. To them, saving a lot of money on health care will seem like a gamble since with an FSA, it can be better to save too little rather than way too much.

Make sure your employees understand that there’s no “use by” date on their HSA. The money they save will stick with them until they need it — this year, next year, or twenty years from now. Emphasize that the HSA is their account, and they’ll carry it with them even if they change jobs or retire. And speaking of retirement…

2. HSAs are a great way to save for retirement

Employees who understand their HSA may still only think of them as a way to cover their current medical expenses. The sobering reality is that the average couple will have over $240,000 in medical expenses during retirement. An HSA offers a great way to save for those expenses and other retirement costs.

Explain to your employees that HSA savings can be invested like a 401(k) and can grow year-after-year. An HSA actually offers better tax savings than an 401(k) when it’s used to cover medical expenses. Reassure your employees that there’s no downside to saving too much, because once they turn 65, their HSA savings can be spent on non-medical expenses, so they can use that HSA money to buy themselves those senior-discount skydiving lessons. And speaking of treating themselves…

3. You can pay yourself back with an HSA (thanks, self!)

Many employees worry that they’ll get no benefit from an HSA if they run into medical expenses before they’ve saved enough, so they choose an FSA, since their FSA annual contribution would be available immediately.

Let them know that they can use their HSA to “reimburse themselves” for any out-of-pocket money they spend on medical expenses. So if they spend $100 out-of-pocket on an X-ray in January, they can save some pre-tax money in their HSA during February, and write themselves a check for $100. Just remind them the medical expense has to be from afterthey opened the HSA—so setting it up right away is critical.

HSAs can save everybody money; employees just need to know how to make it work. Having a solid understanding of the benefits and flexibility of HSAs can help employees realize how easy it is to lower their taxes, cover their medical expenses, and save for the future.

SOURCE:
Schneider, C (2 July 2018) "3 things your clients should be telling employees about HSAs" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/07/02/3-things-your-clients-should-be-telling-employees/


3 ideas to ease the transition to a high-deductible world

With high-deductible health plans rising to substantial heights, employers may not be thinking about the extreme changes happening ahead. Here are some tips on how to make a painless transition into a high deductible world.


We’re all familiar with the necessary evils of today’s society: paying taxes, going to the dentist and sitting in rush-hour traffic. Now, there’s another one to add to the list — high deductible health plans (HDHPs). They’re on the rise due to increasingly unmanageable health care costs caused by factors such as increased carrier and hospital consolidation, unregulated pharmaceutical prices, and a lack of financial awareness among medical providers.

In response, prudent employers who want to continue providing health benefits but can’t keep up with the costs are turning to HDHPs to share the financial burden with employees and encouraging those employees to become more disciplined shoppers. This is predictably being met with resistance.

But there’s a more urgent matter at hand: until we find a way to flip the health-care system on its head, we’re anticipating a future where networks get narrower and significantly limit options and deductibles rise to catastrophic heights.

Employers may not be thinking ahead for these drastic changes, which is why brokers can be instrumental in helping clients guide their employees toward the necessary mental and financial preparations. Here are a few ideas to get them started.

1. Shift gears to plan beyond the calendar year.

For most, health care is an infrequent experience that’s handled reactively: you get sick, you go to the doctor, your insurance foots the bill. However, now that employees are on the hook for potentially thousands of dollars, it’s crucial that they plan ahead.

To facilitate this shift in mindset, employers should encourage employees to:

  • Utilize a health savings account (HSA):When it comes to HSAs, people tend to fall into one of two schools of thought: “HSAs are a silver bullet” or “HSAs are a terrible excuse by politicians to allow the existence of HDHPs.” Rarely is a situation so black and white, and this one is no exception. HSAs aren’t the best choice for everyone. Certain demographics can’t afford to juggle the high costs of health care (and life) while also contributing funds to an account. However, it’s important to keep in mind that as costs continue to rise, more people will be pushed above the HSA qualification line and having an account may be the only life raft available when drowning in high deductibles — a trend we’re already starting to see.In an ideal world, the HSA wouldn’t exist. Out-of-control health care costs bear the blame for solutions like HDHPs — and the HSA is our consolation prize. The reason I advocate the utilization of these accounts for long-term planning is because they are the only health care benefit we have that encourages people to think beyond 12 months. Unlike the flexible spending account (FSA), the money in an HSA rolls over every year and grows over time, so it lets people save for years down the road (maybe when the pediatrician bills pile up, or you finally have that major surgery) vs. scrambling to spend their funds before the end of the year. Also, if an employer is contributing to an employee’s HSA, it’s leaving money on the table not to sign up for an account.
  • Shop for the best “deals”:Unless someone is a frequent flyer in the health care system, they might brush off shopping for healthcare since it seems like a lot of effort for a single doctor’s visit. However, considering the fact that the cost of an ACL surgery can vary as much as $17,000, those numbers certainly add up over time. (Even more so if a patient fails to find care that’s in network.) Helping employees understand this concept, and pairing it with an easy-to-use transparency solution, can save them tons of money in the long run — especially if the cost savings from each doctor’s visit are deposited into an HSA for future use.

2. Recognize that options are still available.

I’m not going to try to frame high deductibles in a positive light. It’s not the ideal situation for consumers or employers. But sometimes, just knowing there are options in a seemingly bleak situation can provide temporary relief. Here are some tips for employers to share with employees when they’re frustrated about their HDHPs:

  • Ask questions:Employees shouldn’t be afraid to ask questions. Healthcare is known for being convoluted, so it’s likely they’re not alone in any confusion they experience. They should start with health insurance and take time with the HR manager to understand the specifics of their coinsurance, copays, deductibles, and benefits so they’re aware of all their options, such as free preventive services. Another great place for questions is at the doctor’s office. Asking about and negotiating costs (yes, you can do that!) can have huge payoffs — Consumer Reports found that only 31 percent of Americans haggle with doctors over medical bills but that 93 percent of those who did were successful, with more than a third of those saving more than $100.
  • Stay educated:“Education” can be a tired term for brokers and employers. Employees never seem to read the emails and collateral materials that teams painstakingly curate each year. While disheartening, I think the focus on education is a long but ultimately rewarding process. Consider the 401(k). These plans struggled through the recessions in the early 2000s, but through constant behavioral reinforcement (helped largely by policies such as The Pension Protection Act, which made it easier for companies to automatically enroll their employees in 401(k) plans) and continued efforts by employers, 401(K)s bounced back and hold $4.8 trillion in assets today.The same lesson can be applied to your education efforts as well. That is, eventually the education will stick. So help create a new ecosystem for employees to navigate by getting timely information and resources out there about maximizing HDHPs and utilizing HSAs.

3. Stay optimistic because change is coming.

This point is a bit more abstract. Worrying about health care costs is exhausting, and things are likely to get worse before they get better. However, there’s been a lot of news in the health care space that should bring a glimmer of optimism.

For instance, we heard about the partnering of three industry powerhouses to create a new health care company for their employees. It’s been fascinating to see how much chatter this announcement has already generated and will likely keep traditional employer health care vendors on their toes.

While the trend of employers building coalitions to tackle health care costs is nothing new and it’s too early to tell how successful this initiative will be, the bigger point is that this is a strong signal that change is desperately needed. More and more companies — regardless of what industry they’re in — are starting to realize that they’re all in the business of health care. And as we gain power in numbers, I believe we will build the momentum to create some serious change.

It’s tough to win in today’s health care world, and it’s likely going to get even more challenging over the next few years.  But if brokers and employers can provide the right level of guidance, education, and resources, they can help employees better mentally and financially manage their high-deductible futures.

SOURCE:
Vivero, D (2 July 2018) "3 ideas to ease the transition to a high-deductible world" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/02/08/3-ideas-to-ease-the-transition-to-a-high-deductibl/


The Importance of Business Continuity Planning

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Rarely do we ever get advanced notice that a disaster is prepared to strike. Weather, network failures, epidemics and violence are just a few of the disasters that could have an impact on a company’s reputation. Every incident is unique due to the challenges it presents. However, implementing a business continuity plan (BCP) can help give your organization the best shot at success both during and after a disaster. A current, tested plan in the hands of all personnel responsible can help mitigate the potential impact. The absence of a plan doesn’t just mean your organization will take longer than necessary to recover from a crisis – you could go out of business. In this installment of CenterStage, Cathleen Christensen, our VP of Property and Casualty, discusses what a BCP is, why it matters, keeping one in place, and how Hierl can help you build a strategy that works with it.

What is a Business Continuity Plan?

Business continuity refers to maintaining business functions or resuming them in a timely manner in the event of a crisis. Examples of crises include natural disasters such as weather, fire, or an epidemic outbreak like the flu, but also include events involving company reputation, violence and network breaches. A business continuity plan outlines the procedures and instructions an organization must follow in the face of such disasters. The plan not only identifies the internal and external needs of an organization after a catastrophic loss but lays out the path for recovery. Cathleen explains, “A business continuity plan can be the difference between successfully recovering or going out of business.”

Why Does Business Continuity Planning Matter?

The importance of having a business continuity plan cannot be stressed enough. Truth is, 1 in 5 organizations do not recover following a crisis. Severity vs. probability must be factored into the management of your organization. The purpose of having a business continuity plan is not only to prepare for a disaster both during and after, but to mitigate the potential danger and lessen the odds of attack for your organization. Serving as the ultimate disaster plan, it is vital that preparation information is made common knowledge amongst all levels of the organization - from the highest level down. To ensure a healthy and effective BCP, craft a plan following these seven steps:

1. Initial Response

Disruption in the day-to-day operations should trigger everyone to not only know what is wrong, but what – if anything – to do to resolve it immediately. Planning and exercising this element of the plan will eliminate the rush of, “What do I do,” from employees. Proper communication will allow there to be no holes in the plan.

The initial response should also provide a clear sense of who is in ‘charge’ when disaster strikes. Whether it be at a corporate level, regionally or locally, knowing who is overseeing the process towards recovery is vital to the success of a BCP.

2. Stabilization

Regardless of cause, every disruption needs containment to prevent a bad situation from getting worse. It is important to know what happened to cause the event and the potential impact it may bring if left unchecked. Assess the impact, know how to stop the bleeding and devise short and medium-term goals to appropriately address the situation.

3. Activation

Following an impact assessment, identify what services need to be restored. Additionally, note who is responsible for the plan – what will they do, where will they do it and with whom will they do it?

4. Communication

In the event of a disaster, stakeholders might initiate various actions to stabilize or restore services. Timely communication between various respondents is critical to an effective incident response. Communication during an incident should be geared towards management, employees, customers and others who have a stake in the business. The goal is to keep them updated regarding the current state of restoration activities and collaboration with responders.

5. Planned Response

These are the initial response activities that need to be taken to limit the loss of life and property in the time immediately before, during, and after a crisis. Items that could be included are:

  • What types of incidents or crisis situations activate the plan?
  • Who has authority to activate it?
  • Details regarding the incident response team
  • Evacuation procedures
  • Contact lists

6. Extended Response

Actual recovery may take days, weeks, months or even longer. After the initial response the recovery plan outlines the steps you will need to take to get your business running again after an incident or crisis. It includes a realistic time frame in which you can get your operations back on track to minimize financial losses. Forcing yourself to rely heavily on your initial or planned response will only worsen recovery efforts. Be knowledgeable about your staff and the direction the road to recovery is going.

7. Return to Normal

When disruption ends, questions will still need to be answered. These are not limited to questions such as, Is the return to ‘normal’ a ‘new normal’. Other questions could include, “How will work between ‘normal’ operations and post-catch up tasks be managed? How will my information for insurance purposes be collected?”

Maintaining a Business Continuity Plan

With a plan in place, efforts do not cease. To remain disaster ready, you must remain active in your preventative efforts. As the world around us changes, so should your BCP to remain up to date and effective in all threats. Communicating any changes that may have occurred with initial plan to employees is a must. There is no way for all members of your organization to remain ‘in the know’ if they are kept uninformed. With effective communication of the BCP comes proper training. As critical as communicating clearly is with employees, instructing them in a hands-on potential scenario leaves nobody in the dark on recovery execution when disaster strikes.

How Can Hierl Help Business Continuity Planning?

At Hierl, we offer the necessary tools for creating an effective BCP. By working hand-in-hand with your business/organization, we offer the resources to locate and analyze potential risks and to create a team within your business to properly manage disasters. To get started, speak with Cathleen today at 920-921-5921 or cchristensen@hierl.com.

 

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HSA How-To

Health Savings Accounts can be tricky, employees have the control, employers and insurance companies are there to guide them in the right direction. Here is a how to helping guide to assist your customers to the right HSA plan.


If an employer wants to offer employees pretax payroll deferrals to their health savings accounts, the employer needs to first create a Section 125 plan or cafeteria plan that allows HSA deferrals.

A cafeteria plan is the only way for employers to offer employees a choice between taxable and nontaxable benefits, “without the choice causing the benefits to become taxable,” the IRS says. “A plan offering only a choice between taxable benefits is not a Section 125 plan.”

Here are five things to know about HSAs and Section 125 plans.

1. A Section 125 plan is just one of several ways for employers to help employees with funding their HSAs.

Employers offering HDHPs face the choice of whether and how to help their employees with the funding of the employees’ HSAs. The options include the following:

  • Option 1 – Employee after-tax contributions.Employers are not required to help with the employees’ HSAs and may choose not to. In this case, employees may open HSAs on their own and receive the tax deduction on their personal income tax return. This option allows for income tax savings, but not payroll taxes. A variation on this option is for employers to allow for post-tax payroll deferral (basically, direct deposit of payroll funds into an HSA without treating the deposit any differently than other payroll which may also be directly deposited into an employee’s personal checking account).This does not change the tax or legal situation, but it does provide convenience for employees and will likely increase HSA participation and satisfaction.
  • Option 2 – Employee pretax payroll deferral.Employers can help employees fund their HSAs by allowing for HSA contributions via payroll deferral. This is inexpensive and can be accomplished by adding a Section 125 cafeteria plan with HSA deferrals as an option. Employers benefit by not having to pay payroll taxes on the employees’ HSA contributions. Employees save payroll taxes as well. Plus, HSA contributions are not counted as income for federal, and in most cases, state income taxes. Setting up automatic payments generally simplifies and improves employee savings.
  • Option 3 – Employer-funded contributions.Employers may make contributions to their employees’ HSAs without a Section 125 plan if the contributions are made directly. The contributions must be “comparable,” basically made fairly (with a lot of rules to follow). This type of contribution is tax deductible by the employer and not taxable to the employee (not subject to payroll taxes or federal income taxes and in most cases, not subject to state income taxes either).
  • Option 4 – Employer and employee pretax funding.Employers can combine options 2 and 3, where the employer makes a contribution to the employees’ HSAs and the employer allows employees to participate in a Section 125 plan and enabling them to defer a portion of their pay pretax into an HSA. This is a preferred approach for a successful HDHP and HSA program, as it ensures that employees get some money into their HSA through the employer contribution and allows for the best tax treatment to allow for employees to contribute more on their own through payroll deferral.
  • Options for more tax savings.Some employers go beyond these options to increase tax savings even more. Although a number of strategies exist to increase tax savings, using a limited-purpose FSA (or HRA) is a common one. Generally, FSAs are not allowed with HSAs; however, an exception exists for limited-purpose FSAs. Limited-purpose FSAs are FSAs limited to payments for preventive care, vision and dental care. This provides more tax savings and employees use the FSA to pay for the limited-purpose expenses (dental and vision) and save the HSA for other qualified medical expenses.

HRAs can also be used creatively in connection with HSA programs. The HRA cannot be a general account for reimbursement of qualified medical expenses, but careful planning can allow for a limited-purpose HRA, a postdeductible HRA, or other special types of HRAs.

2. There are several benefits for an employer using a Section 125 plan combined with an HSA.

  • Employees can make HSA contributions through payroll deferral on a pretax basis.
  • Employees may pay for their share of insurance premiums on a pretax basis.
  • Employers and employees save payroll taxes (7.65 percent each on FICA and FUTA for contributions).
  • Employers avoid the “comparability” rules for HSA contributions although employers are subject to the Section 125 plan rules.

3. The employer is responsible for administering the Section 125 plan.

For payroll deferral into an HSA through a Section 125 plan, the employer must reduce the employees’ pay by the amount of the deferral and contribute that money directly into the employees’ HSA.

The employer may do this administration itself or it may use a payroll service or another type of third-party administrator. In any case, the cost of the Section 125 plan itself and the ongoing administration are generally small and offset, if not entirely eliminated, by employer savings through reduced payroll taxes.

Another administrative element is the collection of Section 125/HSA payroll deferral election forms from employees. Employers that have offered Section 125 plans prior to introducing an HSA program are familiar with this process.

Unlike other Section 125 plan deferral elections, which only allow annual changes, the law allows for changes to the HSA deferral election as frequently as monthly.

Although frequent changes to the elections create a small administrative burden on the employer, the benefit to employees is significant. Employers are not required to offer changes more frequently than annually.

The full extent of the administrative rules for Section 125 plans is beyond the scope of this discussion.

4. Contributions to HSAs under Section 125 plans are subject to nondiscrimination rules.

A cafeteria plan must meet nondiscrimination rules. The rules are designed to ensure that the plan is not discriminatory in favor of highly compensated or key employees.

For example, contributions under a cafeteria plan to employee HSAs cannot be greater for higher-paid employees than they are for lower-paid employees. Contributions that favor lower-paid employees are not prohibited.

The cafeteria plan must not: (1) discriminate in favor of highly compensated employees as to the ability to participate (eligibility test), (2) discriminate in favor of HCEs as to contributions or benefits paid (contributions and benefits test), and (3) discriminate in favor of HCEs as measured through a concentration test that looks at the contributions made by key employees (key employee concentration test). Violations generally do not result in plan disqualification, but instead may cause the value of the benefit to become taxable for the highly compensated employees or key employees.

The nondiscrimination rules predate the creation of HSAs and how the rules apply to HSA contributions is an area where additional government guidance would be welcome.

5. An employer needs a Section 125 plan to allow for HSA contributions through payroll deferral.

Can an employer allow for HSA contributions through payroll deferral without a Section 125 plan? No, not if the goal is to save payroll taxes. Employers can offer HSA payroll deferral on an after-tax basis without concern over the comparability rules or the Section 125 plan rules. Amounts contributed under this method are treated as income to the employee and are deductible on the employee’s personal income tax return. The lack of any special tax treatment for this approach makes it unattractive for most employers and with just a small additional investment of money and time, a Section 125 plan could be added allowing for pretax deferrals.

Here is an example: Waving Flags, Inc. does not offer health insurance or a Section 125 plan to its employees. Waving Flags does provide direct deposit services to its employees that provide it with their personal checking account number and bank routing number. Maggie, an employee of Waving Flags, Inc., approaches the human resources person and asks to have her direct deposit split into two payment streams with $100 per month being directly deposited to her HSA and the balance of her pay being deposited into her personal checking account. She provides Waving Flags the appropriate account and routing numbers and signs the proper election forms.

Waving Flags is not subject to the Section 125 nondiscrimination rules for pretax payroll deferral, nor is Waving Flags subject to the HSA comparability rules. Waving Flags is simply paying Maggie by making a direct deposit into her HSA. The $1,200 Maggie elects to have directly deposited to her HSA in this manner will be reflected in Box 1 of her IRS Form W-2 from Waving Flags as ordinary income. She will be subject to payroll taxes on the amount. She can claim an HSA deduction on line 25 of her IRS Form 1040 when she files her tax return.

Maggie benefits from this approach by setting up an automatic contribution to her HSA, which often improves the commitment to savings. Most HSA custodians will offer a similar system that HSA owners can set up on their own by having their HSA custodian automatically draw a certain amount from a personal checking account at periodic intervals. Employer involvement is not necessary. Individuals with online banking tools available to them may be able to set it from their personal checking account as well to push money periodically to an HSA.

SOURCE:
Westerman, P (2 July 2018) "HSA How-To" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/01/01/hsa-how-to/


Amazon has just entered the drug-distribution business

Amazon is the king, knocking big competitors out one by one. Today, they take down pharmacies by offering online health-care services. See what Amazon has in store here.


Amazon.com Inc. agreed to buy the online pharmacy startup PillPack, jumping into the health-care business with a deal that will give the retail giant an immediate nationwide drug network.

The move represents a formidable threat to pharmacy chains including Walgreens Boots Alliance Inc., which earlier Thursday reported tepid U.S. same-store sales, and rival CVS Health Corp. Walgreens was down 10 percent at 10:18 a.m. in New York, while CVS shares shed 8.9 percent.

Terms of the deal weren’t disclosed. The transaction is expected to close in the second half of 2018, according to a statement from the companies.

The U.S. market for prescription medicine is huge. In 2016, U.S. consumers spent $328.6 billion on retail prescription drugs, according to the U.S. government. CVS reported prescription sales of $59.5 billion last year, and Walgreens sold $57.8 billion worth of drugs in its fiscal 2017.

PillPack has mail-order pharmacy licenses in all 50 U.S. states, which could allow Amazon to expand quickly. PillPack also has relationships with most major drug-benefit managers, including Express Scripts and CVS, and says it works with most Medicare Part D drug plans. Those ties will give Amazon access to much of the prescription drug market in the U.S.

PillPack sells pre-sorted packets of prescriptions drugs, delivering them to customers in their homes. The closely held firm has software that automates many routine pharmacy tasks, such as verifying when a refill is due, determining co-pays, and confirming insurance. That eliminates much of the manual work that pharmacists often are saddled with now.

The pact follows months of speculation about Amazon’s plans to get into the pharmacy or drug-distribution business. Despite the retailer’s vast reach, entering the market presented a daunting logistical challenge in terms of licensing and dealing with a range of private and government payers. Acquiring PillPack’s networks helps Amazon surmount those hurdles.

Michael Rea, chief executive officer of Rx Savings Solutions, said PillPack could transform the industry and that employers and health plans would benefit from the deal, which he called a “sign of the times.”

“This move signals just how big of a market opportunity there is to change the pharmacy landscape,” Rea said in an email.

Amazon has been disrupting businesses from electronics to household staples and even package delivery. Pharmacy and health-benefits companies have long fretted that they’d be next. Chief Executive Officer Jeff Bezos signaled his interest in health-care earlier this year when he teamed up with Berkshire Hathaway Inc.’s Warren Buffett and JPMorgan Chase & Co.’s Jamie Dimon to form a health-care company to manage the health plans of their more than 1 million employees.

The selloff in drugstore stocks was reminiscent of the food-industry swoon that resulted in June 2017 when Amazon said it was buying Whole Foods Market Inc. Kroger Co., the biggest U.S. supermarket chain, saw $2 billion in market value wiped out in one day. Big packaged food stocks also took a hit.

“When Amazon sneezes, everybody else catches a cold,” said Joseph Feldman, an analyst with Telsey Advisory. “And I think that that’s more likely than not what you’re going to see today.”’

Long time coming

Prescription drugs sales are largely intertwined with groceries and personal items like makeup and shampoo and Amazon already sells bulk packs of latex gloves, bed pads and syringes. It recently began selling medical devices and instruments, as well.

Bezos has been thinking about the drug business for nearly two decades; in 1999, Amazon purchased a stake in Drugstore.com. That effort ultimately failed and Walgreens purchased the money-losing startup in 2011 and ultimately shut it down.

Pharmacist TJ Parker and computer scientist Elliot Cohen founded PillPack in 2013 after meeting at a medical-technology program at the Massachusetts Institute of Technology. The company raised more than $118 million from brand-name investors including Accel, Sherpa Capital and New York rapper Nas’s Queensbridge Venture Partners.

A September 2016 funding round valued the Boston-based startup at around $360 million, according to venture-capital database PitchBook. In April, CNBC reported Walmart Inc. was in talks to buy the company for “under $1 billion,” citing unnamed sources.

Standing firm

For now, Walgreens indicated that it was in no hurry to find a deal to respond to Amazon, despite the damage to its stock. On an earnings conference call, Walgreens CEO Stefano Pessina faced multiple questions from analysts about the PillPack deal.

“It is a declaration of intent from Amazon,” said Pessina.

He said Walgreens knew that PillPack was for sale as “it had been for sale for a while,” but that the retailer wouldn’t do deals based on emotions or make moves that could destroy value. Pessina insisted that physical pharmacies would continue to be “very important.”

The slump in Walgreens shares weighed on the Dow Jones Industrial Average, which added the stock to its index of 30 companies this month, replacing General Electric Co.

SOURCE:
Langreth R and Tracer Z (29 June 2018) "Amazon has just entered the drug-distribution business" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/06/28/amazon-has-just-entered-the-drug-distribution-busi/


3 Ways to Reshape How You Communicate About Benefits with Millennials

Communicating the benefit needs amongst generations and can cause confusion when keeping up with the satisfaction of your younger employees. Ensure millennial happiness with these tips on their unique benefit standards.


As two millennials ourselves, we know what most people think about Generation Y. Many use terms like “techy,” “entitled” and maybe even “lazy” to describe our generation.

But, the reality is today’s millennials are more global, civic-minded and, though you may not expect it,financially conscious than any other generation. And, according to the Pew Research Center, we now represent 35 percent of today’s workforce.

Millennials are also now getting married and starting families. And yes, purchasing more benefits products through their employers as a result.

As we millennials grow up, it’s important to reconsider how you communicate with us about benefits—because it’s a lot different than how you’ve communicated with other employees in the past.

For example, consider your Gen X and Baby Boomer employees for a moment. When you communicate about benefits with them, it’s relatively straightforward. You probably use tools like email, in-person meetings, flyers and newsletters. And messaging probably revolves around safety, reducing risk and explaining the finer points of the benefits themselves.

But when you’re talking about benefits to millennials, things should be a little different. We’re more digitally fluent than other generations. We’re demanding more flexibility—in our work and family lives. And, we’re increasingly cost-conscious.

It’s a different approach. And, we want to talk about three key ways you can start to reshape how talk with millennials more effectively when it comes to benefits:

For millennials, it’s all about the emotion and sense of responsibility.One of the most interesting findings we’ve picked up over the last few years when communicating with millennials has been to focus messaging on making an emotional connection. Highlight the peace of mind benefits will provide. Discuss the fact that purchasing benefits like disability, life and critical illness insurance through their employer is the right, and responsible, thing to do.

In a recent survey conducted on behalf of Trustmark Voluntary Benefit Solutions “providing peace of mind” was the number one reason millennials gave for why they enrolled in key benefit areas. While this was true across all generations in the study, millennials chose “it’s the responsible thing to do” more than others as a secondary reason for purchase. That emotional connection tied in with responsibility is absolutely key when talking to this demographic.

Millennial stereotypes don’t apply.If you’re communicating with millennials, most people would think digital technologies like text messages and social media would be the way to go. However, that’s not the case. According to Trustmark research, millennials listed “meeting in person” and “calling a representative” as their top preferred channels for communicating during enrollment periods—followed by digital communications channels. Surprising, right? It probably shouldn’t be, given millennials’ desire for more personalization in multiple facets of their lives.

Value, convenience and high-level messaging are key.Through our research, we found that millennials react favorably to messaging around value and convenience—so be sure to hit on those points throughout the enrollment process. For instance, explain why coverage is needed or why an employer-paid policy is not enough. Talk about benefit policy costs in comparison to other low-cost items, like a daily cup of coffee. Discuss the value of employer contributions—and what those contributions can mean to millennials’ bottom lines. Also, make sure to share the convenience and ease of payroll deductions; how their employer is simplifying things by making the deduction and payment for them.

Finally, remember, when it comes to benefits, millennials aren’t as concerned about the details of their insurance plans. They want to understand the basics—what’s covered, how much it costs, and why they might consider a specific offering over another. Resist the urge to focus on the fine print, and keep messaging at the higher levels.

Magic number 3

One more thing that may help reshape your approach to communicating with millennials: The number three. That’s the minimum number of times you should be communicating with millennials during your enrollment process. Our research found that employees remembered and appreciated benefits more when they saw three or more distinct communications. In fact, 72 percent of employees who received three types of benefits communication rate themselves “likely” or “very likely” to recommend their employer based specifically on their benefits program.

Does that help give you some ideas for how to reshape your approach to communicating with millennials about benefits? Overall, just make sure to remember that we millennials are looking for personal and professional offerings from our employers that are unique to us—including benefits. And be sure you’re ready to talk with millennials using the right messaging, the right tools and the right cadence to ensure success.

SOURCE:
Dahlinger, M and Moser, C (27 June 2018) " 3 ways to reshape how you communicate about benefits with millennials" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2018/06/27/3-ways-to-reshape-how-you-communicate-about-benefi/


3 questions advisers should ask about the potential CVS-Aetna deal

In a rapid changing market, stay ahead of the curve by asking these three questions on the potential CVS-Aetna deal to help determine how it will impact the health insurance industry.


The news that CVS has reportedly launched a $66 billion bid to buy Aetna shows that once unimaginable mergers are becoming the norm. But it also raises some important questions for brokers about the future of group benefits, and how to operate in a fast-moving and constantly changing landscape.

Here are three questions to ask when determining how this potential business deal will impact the employer-based health insurance market:

1) Will this move give Aetna a competitive advantage in the group space?

How are other carriers going to feel about having to compete with an insurer that has pharmacy data on the majority of Americans? Anthem may be at the top of the list with worries, as the company just last week announced that it will partner with CVS to launch its own pharmacy benefits manager called IngenioRx.

2) Are healthcare companies too focused on M&A?

A year ago, Aetna was trying to acquire Humana, and Anthem was trying to buy Cigna. Brokers everywhere were concerned about carrier consolidation and what a lack of competition would do to group prices. How have things pivoted to pharmacy so quickly?

The CVS deal may represent gains for both parties. The deal would give Aetna a new avenue for business growth, and CVS would gain some much needed ground against Amazon’s rumored entrance into the drug business.

But what does this emphasis on inorganic, M&A growth say about the healthcare industry? Healthcare consolidation has been a trend for years, but it hasn’t always worked in consumers’ favor, which could leave brokers wary of this deal.

3) Why should employers care?

What impact will this deal have on prescription prices for employers? Prescription drug costs are one of the largest drivers of employer healthcare spend, so the question is critical. Will Aetna and CVS be able to improve efficiencies and lower costs, or monopolize their group markets?

Another point of interest for employers is the possibility of narrowed prescription options. With narrowing provider networks becoming standard, this deal could result in limited consumer options when it comes to prescription drugs.

On the other hand, the deal could spark cost-saving changes in healthcare delivery. It’s not hard to imagine CVS augmenting their MinuteClinic operations with Aetna’s volume.

Employees might find they like having retail access to primary care at a lower price point, with after-hours service, easy-to book appointments, and pharmacy services built right in. This partnership may be the push retail healthcare needs to become a cornerstone of the primary care model.

SOURCE:
Tolbert, B (22 June 2018) "3 questions advisers should ask about the potential CVS-Aetna deal" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/opinion/3-questions-advisers-should-ask-about-the-potential-cvs-aetna-merger


How faking your feelings at work can be damaging

Putting up a fake smile on Monday morning is sometimes unavoidable. There could be consequences to carrying a heavy emotional labor load to get over the Monday Blues.


Imagine yourself 35,000 feet up, pushing a trolley down a narrow aisle surrounded by restless passengers. A toddler is blocking your path, his parents not immediately visible. A passenger is irritated that he can no longer pay cash for an in-flight meal, another is demanding to be allowed past to use the toilet. And your job is to meet all of their needs with the same show of friendly willingness.

For a cabin crew member, this is when emotional labour kicks in at work.

A term first coined by sociologist Arlie Hochschild, it’s the work we do to regulate our emotions to create “a publicly visible facial and bodily display within the workplace”.

Simply put, it is the effort that goes into expressing something we don’t genuinely feel. It can go both ways – expressing positivity we don’t feel or suppressing our negative emotions.

Unhelpful attitudes such as ‘I’m not good enough’ may lead to thinking patterns in the workplace such as ‘No-one else is working as hard as I seem to be’ or ‘I must do a perfect job’, and can initiate and maintain high levels of workplace anxiety -  Leonard

Hochschild’s initial research focused on the airline industry, but it’s not just in-flight staff keeping up appearances. In fact, experts say emotional labour is a feature of nearly all occupations in which we interact with people, whether we work in a customer-facing role or not. The chances are, wherever you work, you spend a fair portion of your working day doing it.

When research into emotional labour first began, it focused on the service industry with the underlying presumption that the more client or customer interaction you had, the more emotional labour was needed.

However, more recently psychologists have expanded their focus to other professions and found burnout can relate more closely to how employees manage their emotions during interactions, rather than the volume of interactions themselves.

Perhaps this morning you turned to a colleague to convey interest in what they said, or had to work hard not to rise to criticism. It may have been that biting your lip rather than expressing feeling hurt was particularly demanding of your inner resource.

But in some cases maintaining the façade can become too much, and the toll is cumulative. Mira W, who preferred not to give her last name, recently left a job with a top airline based in the Middle East because she felt her mental wellbeing was at stake.

In her last position, the “customer was king”, she says. “I once got called 'whore' because a passenger didn't respond when I asked if he wanted coffee. I’d asked him twice and then moved to the next person. I got a tirade of abuse from the man.”

“When I explained what happened to my senior, I was told I must have said or done something to warrant this response… I was then told I should go and apologise.”

“Sometimes I would have to actively choose my facial expression, for example during severe turbulence or an aborted landing,” she says. “Projecting a calm demeanour is essential to keep others calm. So that aspect didn't worry me. It was more the feeling that I had no voice when treated unfairly or extremely rudely.”

During her time with the airline, she encountered abuse and sexism – and was expected to smile through it. “I was constantly having to hide how I felt.

Over the years and particularly in her last role, handling the stress caused by suppressing her emotions became much harder. Small things seemed huge, she dreaded going to work and her anxiety escalated.

“I felt angry all the time and as if I might lose control and hit someone or just explode and throw something at the next passenger to call me a swear word or touch me. So, I quit,” she says.

She is now seeing a therapist to deal with the emotional fallout. She attributes some of the problems to isolation from family and a brutal travel schedule, but has no doubt that if she hadn’t had to suppress her emotions so much, she might still be in the industry.

Mira is not alone. Across the globe, employees in many professions are expected to embrace a work culture that requires the outward display of particular emotions – these can including ambition, aggression and a hunger for success.

The way we handle emotional labour can be categorised in two ways – surface acting and deep acting

A few years ago, the New York Times wrote a “lengthy piece about the “Amazon Way”,describing very specific and exacting behaviour the retail company required of its employees and the effects, both positive and negative, that this had on some of them. While some appeared to thrive in the environment, others struggled with constant pressure to show the correct corporate face.

“How we cope with high levels of emotional labour likely has its origins in childhood experience, which shapes the attitudes we develop about ourselves, others and the world,” says clinical and occupational psychologist Lucy Leonard.

“Unhelpful attitudes such as ‘I’m not good enough’ may lead to thinking patterns in the workplace such as ‘No-one else is working as hard as I seem to be’ or ‘I must do a perfect job”, and can initiate and maintain high levels of workplace anxiety,” says Leonard.

Workers are often expected to provide good service to people expressing anger or anxiety – and may have to do this while feeling frustrated, worried or offended themselves.

“This continuous regulation of their own emotional expression can result in a reduced sense of self-worth and feeling disconnected from others,” she says.

Hochschild suggests that the way we handle emotional labour can be categorised in two ways – surface acting and deep acting – and that the option we choose can affect the toll it takes on us.

Take the example of a particularly tough phone call. If you are surface acting you respond to the caller by altering your outward expression, saying the appropriate things, listening while keeping your actual feelings entirely intact. With deep acting you make a deliberate effort to change your real feelings to tap in to what the person is saying – you may not agree with the manner of it but appreciate the aim.

Both could be thought of as just being polite but the latter approach – trying to emotionally connect with another person’s point of view – is associated with a lower risk of burnout.

Jennifer George’s role as a liaison nurse with a psychiatric specialism in the Accident & Emergency department at Kings College London Hospital puts her at the sharp end of health care. Every day she must determine patients’ needs – do they genuinely need to be admitted, just want to be looked after for a while or are they seeking access to drugs?

“It’s important to me that I test my own initial assumptions,” she says. “As far as I can, I tap into the story and really listen. It’s my job but it also reduces the stress I take on.”

“Sometimes I’ll have an instinctive sense that the person is trying to deceive, or I can become bored with what they’re saying. But I can’t sit there and dismiss something as fabrication and I don’t want to.”

This process can be upsetting, she says. Sometimes she has to say no “in a very direct way”, and the environment can be noisy and threatening. “I stay as much as I can true to myself and my beliefs. Even though I need to be open to what both fellow professionals and would-be and genuine patient cases say to me, I will not say anything I don’t believe and that I don’t believe to be right. And that helps me,” she says.

When things get tough, she talks to colleagues to unload. “It’s the saying it out loud that allows me to test and validate my own reaction. I can then go back to the person concerned,” she says.

Ruth Hargrove, a former trial lawyer based in California, also faces tricky interactions in her work representing San Diego students pro bono in disciplinary matters. “Pretty much everyone you are dealing with in the system can make you labour emotionally,” she says.

One problem, says Hargrove, is that some lawyers will launch personal attacks based on any perceived weakness – gender, youth – rather than focusing on the actual issues of the case.

“I have dealt with it catastrophically in the past and let it eat at my self-esteem,” she says. “But when I do it right, I realise that I can separate myself out from it and see that [their attack] is evidence of their weakness.”

Rather than refuting specific, personal allegations, she simply sends back a one-line email saying she disagrees. “Not rising to things is huge,” she says. “It’s a disinclination to engage in the emotional battle that someone else wants you to engage in. I keep in sight the real work that needs to be done.”

Those who report regularly having to display emotions at work that conflict with their own feelings are more likely to experience emotional exhaustion

Hargrove also has to deal with the expectations of clients who believe – sometimes unrealistically – that if they have been wronged, justice will prevail. She understands their feelings, even as she has to set them straight.

“I empathise here, as a parent, with their thought that there should be a remedy, even when I know it’s not going to be achievable. It helps me that this feeling is also true to me.”

Remaining true to your feelings appears to be key – numerous studies show those who report regularly having to display emotions at work that conflict with their own feelings are more likely to experience emotional exhaustion.

Of course, everybody needs to be professional at work and handling difficult clients and colleagues is often just part of the job. But what’s clear is that putting yourself in their shoes and trying to understand their position is ultimately of greater benefit to your own well-being than voicing sentiments that, deep down, you don’t believe.

Leonard says there are steps individuals and organisations can take to prevent burnout. Limiting overtime, taking regular breaks and tackling conflict with colleagues through the right channels early on can help, she says, as can staying healthy and having a fulfilling life outside work. A “climate of authenticity” at work can be beneficial.

“Organizations which allow people to take a break from high levels of emotional regulation and acknowledge their true feelings with understanding and non-judgemental colleagues behind the scenes tend to fare better in the face of these demands,” she says.

Such a climate can also foster better empathy, she adds, by allowing workers to maintain emotional separation from those with whom they must interact.

Where it is possible, workers should be truly empathetic, be aware of the impact the interaction is having on them and try to communicate in an authentic way. This, she says, can “protect you from communicating in a disingenuous manner and then feeling exhausted by your efforts and resentful of having to fake it”.

SOURCE:
Levy, K (25 June 2018) "How faking your feelings at work can be damaging" [Web Blog Post]. Retrieved from http://www.bbc.com/capital/story/20180619-why-suppressing-anger-at-work-is-bad


Compliance Recap May 2018

May was a relatively busy month in the employee benefits world.

The Internal Revenue Service (IRS) released the indexed threshold that employers will use in 2019 to determine coverage affordability. The IRS also issued inflation adjusted amounts that will apply to health savings accounts for 2019.

The IRS released guidance on its play-or-pay penalty response acknowledgement letters. The IRS published a proposed rule that would expand mandatory electronic filing of information returns. The IRS also released a tax reform tip, frequently asked questions about the family and medical leave credit, and a fact sheet on determining whether an employer is a large employer.

The Equal Employment Opportunity Commission filed a status report in a wellness program court case. The U.S. Department of the Treasury released its updated priority guidance plan. The U.S. Department of Health and Human Services released a blueprint for lowering drug prices and reducing out-of-pocket costs. The U.S. Securities and Exchange Commission issued a bulletin on health savings accounts.

UBA Updates

UBA released four new advisors:

  • Proposed FAQs About Mental Health and Substance Use Disorder Parity
  • IRS Changes HSA Limit for 2018
  • Understanding Your IRS Play-or-Pay Assessment Letter
  • IRS Issues Proposed Rule to Expand Mandatory Electronic Filing

UBA updated existing guidance:

  • 2018 Annual Benefit Plan Amounts card
  • Federal Tax Credit for Employer-Provided Paid Family and Medical Leave
  • Understanding Wellness Programs and their Legal Requirements
  • Court Modifies Order Regarding EEOC Wellness Rules
  • The Play-or-Pay Penalty and Counting Employees under the ACA
  • Nondiscrimination Rules for Cafeteria Plans
  • HRAs, HSAs, and Health FSAs – What’s the Difference?

IRS Releases ACA Indexed Affordability Threshold for 2019

The Internal Revenue Service (IRS) released its Revenue Procedure 2018-34 that makes an indexing adjustment to the required contribution percentage that is used to determine whether employer- sponsored health coverage is affordable. For 2019, the percentage will be 9.86 percent.

This means that if an employer is using the federal poverty level (FPL) affordability safe harbor, then the maximum monthly self-only contribution will be $99.75. [9.86% of $12,140 (the 2018 contiguous U.S. FPL for one person), divided by 12, equals $99.75.]

IRS Releases 2019 Limits on Health Savings Accounts

The Internal Revenue Service (IRS) released its Revenue Procedure 2018-30 that provides the 2019 inflation adjusted amounts for health savings accounts (HSAs).

For 2019, the annual limitation on deductions for an individual with self-only coverage under a high deductible health plan is $3,500. For 2019, the annual limitation on deductions for an individual with family coverage under a high deductible health plan is $7,000.

For 2019, a “high deductible health plan” is defined as a health plan with an annual deductible that is notless 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 $6,750 for self-only coverage or $13,500 for family coverage.

IRS Releases Guidance on its Play-or-Pay Penalty Response Acknowledgment Letters

In late 2017, the Internal Revenue Service (IRS) started mailing Letter 226J to inform large employers of their potential liability for an employer shared responsibility payment (ESRP) for the 2015 calendar year.The IRS’ determination of an employer’s liability and potential payment is based on information reportedto the IRS on Forms 1094-C and 1095-C and information about the employer’s full-time employees that were allowed the premium tax credit.

The letter contains Form 14764 (ESRP Response) which is the form that the employer must use to file its response by the deadline listed in the letter. The employer uses Form 14764 to indicate that it agrees ordisagrees with the IRS’ letter. If an employer disagrees with the proposed liability, then it must provide a full explanation of its disagreement using Form 14765.

The IRS will acknowledge the employer’s response with a Letter 227 that describes the further actions that an employer can take. The IRS’ recently released Understanding Your Letter 227 describes the versions of Letter 227 that an employer may receive:

  • Letter 227-J acknowledges receipt of the signed agreement Form 14764, ESRP Response, and that the penalty will be assessed. After the IRS issues this letter, the case will be closed. No response is required.
  • Letter 227-K acknowledges receipt of the information provided and shows the penalty has been reduced to zero. After the IRS issues this letter, the case will be closed. No response is required.
  • Letter 227-L acknowledges receipt of the information provided and shows the penalty has been revised. The letter includes an updated Form 14765 and revised calculation table. The employer can agree or request a meeting with the manager and/or appeals.
  • Letter 227-M acknowledges receipt of information provided and shows that the penalty did not change. The letter provides an updated Form 14765 and revised calculation table. The employer can agree or request a meeting with the manager and/or appeals.
  • Letter 227-N acknowledges the decision reached in appeals and shows the penalty based on the appeals review. After the IRS issues this letter, the case will be closed. No response is required.

If, after receiving Letter 227, the employer agrees with the proposed penalty, then the employer would follow the instructions to sign the response form and return it with full payment in the envelope provided.

If, after receiving Letter 227, the employer disagrees with the proposed or revised shared employer responsibility payment, the employer must provide an explanation of why it disagrees or indicate changes needed, or both, on Form 14765. Then the employer must return all documents as instructed in the letter by the response date. The employer may also request a pre-assessment conference with the IRS Office of Appeals within the response date listed within Letter 227, which will be generally 30 days from the date of the letter.

If the employer does not respond to either Letter 226J or Letter 227, the IRS will assess the amount of the proposed employer shared responsibility payment and issue a notice and demand for payment.

IRS Issues Proposed Rule to Expand Mandatory Electronic Filing

The Internal Revenue Service (IRS) published a proposed rule that would affect most employers who are required to file information returns, such as Forms W-2, Forms 1095-B, Forms 1095-C, and forms in the 1099 series.

Currently, employers are not required to electronically file their returns with the IRS unless they are required to file at least 250 returns during the calendar year. The IRS uses a non-aggregation rule in applying this 250-return threshold. Essentially, it uses a separate total for each type of information return filed and each type of corrected information return filed. This means that if an employer files 150 Forms W-2 and 100 Forms 1095-C this year, then the employer is not required to file electronically.

Under the proposed rule, the IRS would determine whether an employer meets the 250-return threshold by aggregating its information returns. Using the example above, under the proposed rule, the employer would meet the 250-return threshold and would be required to electronically file its information returns.

Corrected returns would not be included in the calculation of whether an employer meets the 250-return threshold. However, the proposed rule would require an employer to electronically file its corrected returns if the original returns were electronically filed.

If finalized, these regulations will apply to employers’ information returns filed after December 31, 2018.

IRS Releases Tax Reform Tax Tip and FAQs Regarding Family and Medical Leave Credit

The Internal Revenue Service (IRS) released its Tax Reform Tax Tip 2018-69: How the Employer Credit for Family and Medical Leave Benefits Employers and its updated Section 45S Employer Credit for Paid Family and Medical Leave FAQs that primarily reiterates the Tax Cuts and Jobs Act’s provisions thatprovide a new federal credit for employers that provide paid family and medical leave to their employees.

In its Tax Tip, the IRS explains that an employer must reduce its deduction for wages or salaries paid or incurred by the amount determined as a credit. Also, any wages taken into account in determining any other general business credit may not be used in determining this credit.

In its FAQs, the IRS indicates that, in the future, it will address when the written policy must be in place, how paid family and medical leave relates to an employer’s other paid leave, how to determine whetheran employee has been employed for one year or more, the impact of state and local leave requirements, and whether members of a controlled group of corporations and businesses under common control are treated as a single taxpayer in determining the credit.

IRS Releases Fact Sheet on Determining Whether an Employer is a Large Employer

The Internal Revenue Service (IRS) released Publication 5208 – Affordable Care Act: Determining if you are an applicable large employer that provides a three-step process for employers to determine whether they are an applicable large employer for purposes of the employer shared responsibility provisions.

Although this one-page fact sheet doesn’t provide new information about counting employees, it may be ahelpful guide for those employers who have fewer than 50 full-time or full-time equivalent employees and who are growing their staff numbers.

Wellness Program Court Case Update

In August 2017, the United States District Court for the District of Columbia held that the U.S. Equal Employment Opportunity Commission (EEOC) failed to provide a reasoned explanation for its decision to adopt 30 percent incentive levels for employer-sponsored wellness programs under both the Americans with Disabilities Act (ADA) rules and Genetic Information Nondiscrimination Act (GINA) rules.

In December 2017, the court vacated the EEOC rules under the ADA and GINA effective January 1, 2019, and ordered the EEOC to promulgate any new proposed rules by August 31, 2018.

In January 2018, the EEOC asked the court to reconsider the portion of the court’s order that required the EEOC to promulgate new proposed rules by August 31, 2018. The court vacated that portion of its order. The EEOC recently reported that it had not decided whether to promulgate new regulations. The court’s order to vacate the portions of the EEOC’s wellness rules under the ADA and GINA as of January 1,2019, remains.

For 2019 and until the EEOC issues final rules regarding incentive limits, risk-averse employers should consider discontinuing wellness programs that require a medical exam, biometric screening, or health risk assessment for participants to receive an incentive. When the ADA and GINA incentive limits are vacated, the less restrictive ACA-amended HIPAA regulations will continue to apply. However, using these less restrictive incentive limits may be risky because these regulations predated the EEOC’s wellness regulations.

Treasury Releases its Updated Priority Guidance Plan and Opens Public Comment for Next Priority Guidance Plan

The U.S. Department of the Treasury (Treasury) released its third quarter update to its 2017-2018 Priority Guidance Plan (Plan). The Plan identifies projects that the Treasury and the Internal Revenue Service (IRS) intend to complete during the 12-month period ending on June 30, 2018.

The Plan’s “Executive Compensation, Health Care and Other Benefits, and Employment Taxes” sectionlists the following items among its projects:

  • Guidance on issues under §4980H (the employer shared responsibility provisions)
  • Regulations under §4980I regarding the excise tax on high cost employer-provided coverage (“Cadillac tax”)
  • Guidance on qualified small employer health reimbursement arrangements (QSEHRAs)

The Treasury and IRS also issued Notice 2018-43 that invites public comment on recommendations for items that should be included on the agencies’ 2018-2019 Priority Guidance Plan. Although public comments may be submitted throughout the year, comments submitted by June 15, 2018, will be considered for inclusion on the original 2018-2019 Priority Guidance Plan.

HHS’ Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs

The U.S. Department of Health and Human Services (HHS) published its policy statement and released its American Patients First blueprint to lower drug prices and reduce out-of-pocket costs (collectively, the Blueprint).

Although most of the Blueprint focuses on reducing government health programs’ costs, some of theBlueprint’s goals may affect employers’ group health plans in the future. The Blueprint strives to:

  • Create incentives for pharmaceutical companies to lower list prices and reduce consumer out-of- pocket spending at the pharmacy and other case settings
  • Increase price transparency
  • Apply a substantial portion of rebates at the point of sale
  • Have a site-neutral payment policy for drug administration procedures
  • Have pharmacy benefit managers (PBMs) act solely in the interest of the employer (or consumer)for whom they are managing pharmaceutical benefits
  • Restrict the use of rebates
  • Prohibit contracted pharmacy gag clauses

SEC Issues Bulletin on Health Savings Accounts

The U.S. Securities and Exchange Commission (SEC) issued Investor Bulletin: Health Savings Accounts (HSAs) that provides investors with information about HSAs. Although the Internal Revenue Service (IRS) primarily regulates HSAs, the SEC’s bulletin addresses the savings, investment, and distribution options that may be available to an HSA accountholder.

Question of the Month
Q. For a high deductible health plan (HDHP) to qualify for health savings account (HSA) eligibility, what is the minimum amount that an embedded individual deductible can be?

A. For 2018, the embedded individual deductible must be at least $2,700. For an HDHP to qualify for HSA eligibility, an individual with family coverage would need to satisfy the required minimum
annual deductible for family HDHP coverage (which is at least $2,700 for 2018) before any amounts are paid from the HDHP.

5/31/2018

Download the full recap here.


Quality trumps convenience among employees

Convenience, or quality? Take a look into why researchers are saying quality of a doctors visit outshines convenience when scheduling the next appointment.


Faced with the choice between going to a conveniently located doctor’s office or a more qualified physician, group health plan members are four times more likely to embrace the better-perceived medical professional.

“Traditional metrics like patient ratings, prescribing rates and volume of patients seen were not nearly as compelling to respondents as more qualitative, contextualized statements about a doctor’s clinical expertise,” according to Nate Freese, senior director of data strategy at Grand Rounds, a healthcare service provider for employees in need of local and remote specialty care.

The data is based on a study of 1,100 members covered by Grand Rounds, which is headquartered in San Francisco.

While surprising, Freese says that result depends on the information and messaging that’s provided to employees. Just 14% of respondents based their choice on clinical expertise if they saw traditional physician profiles, whereas it was 69% if they saw contextualized profiles. Contextualized profiles offered more information in complete sentences compared to traditional profiles. These profiles also compared data against other doctors and specialists, such as appointment wait times, expertise and patient satisfaction.

Freese is encouraged by these findings, which were recently presented at the National Healthcare Ratings Summit. “Don’t sell employees short in terms of their ability to appreciate quality and willingness to sacrifice convenience,” he says.

Offering more subjective interpretation of hard quality metrics would be helpful, Freese explains, as long as employers and their advisers are careful not to “overstep what can be reasonably inferred based on available data.”

Another caveat to consider is that finding high quality providers may not be inherently more difficult in narrow networks. Rather, he says, the issue is when health plan members “lack the ability to identify them. And so, it’s more about presenting information in the right way.”

Providing compelling quality information can achieve the same results of a narrow network, he notes. But he hastens to add that even narrow networks must be sufficiently broad enough for members to have a reasonable amount of choice. Geography also plays a role. “You could be in the broadest network, but by virtue of where you live, have reduced choice,” he says.

Michael Hough, executive vice president and U.S. founder of Advance Medical, believes the quality metrics that are currently available are insufficient for several reasons. “We’re looking at things like frequency and whether the outcomes are horrible,” he says. “But just because the outcomes weren’t horrible doesn’t mean they were good, either.” Desired outcomes depend on what’s going on with patients and whether their objectives are being achieved.

The context of care is “extremely important,” Hough explains, noting the importance of relationships between the patient and a trained physician based on human interaction, as well as the delivery of services. Also, while he believes the rise of telemedicine and self-service “is good for many parts of our lives,” Hough cautions that it’s not necessarily true for healthcare because meaningful relationships trump convenience.

SOURCE:
Shutan, B (22 June 2018) "Quality trumps convenience among employees" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/news/quality-trumps-convenience-among-employees?tag=00000151-16d0-def7-a1db-97f0240f0000