Assure Elite: Small Employers' New Favorite Healthcare Program

Employers of multi-generational employees often fret about the delicate and difficult balance of offering health coverage. The typical generalization is that younger employees tend to cost less to insure, while older employees cost more. The truth is, not every young employee is going to require less health coverage because they are presumed to be young and healthy. Likewise, not all older employees are going to cost an arm and a leg to insure. With each employer comes unique employees, and therefore, there is a need to have options to benefit and reward small employers and their employees alike – enter the Assure Elite program. In this installment of CenterStage, Tonya Bahr, a Benefits Advisor at Hierl Insurance, has highlighted the game-changing aspects of this unique healthcare program.

What Exactly is Assure Elite?

Assure Elite is a small employer focused healthcare program aimed at offering the best options for small employers who want to take control of their healthcare spending. “As a partnership between Hierl Insurance, Network Health and Agnesian Healthcare (SSM Health), employers can have peace of mind knowing their healthcare options are backed by three local companies who know healthcare expenses are out of hand in our community,” explained Tonya. Through this partnership, Hierl creates unique plan designs with deep discounts reflected in the premium costs, placing money back in the pockets of employers and employees. 

What sets Assure Elite apart is actualization, not generalization. Among other issues facing the modern healthcare scene, age of employees plays a large factor in coverage pricing. The tendency is to believe older employees will cost an employer more to insure due to a greater prone to injury, sickness and other ailments. On the other hand, younger employees are in better shape and theoretically removed from any costly health issues.

However, not always is this the case. By working with a partnership established around the goal of providing the most cost-effective and honest coverage for small employers, Assure Elite bases pricing on the overall health of the employee. Taking age out of the equation and replacing it with health ensures the proper coverage is received.

How Does the Program Work?

Assure Elite is a level-funded program, meaning premium is based on actual healthcare utilization rather than age. Healthier overall groups will pay less than a group who is unhealthy (or high users of healthcare). Being a level funded program, Assure Elite is a hybrid between a traditional, fully-insured medical plan and a partially self-funded plan. With a fully-insured plan, employers are paying a fixed monthly premium for coverage, meaning the amount only fluctuates when the number of employees on the plan changes. Often, employers are unaware they are overpaying in premium due to claims paid out by the insurance carrier are less than the premium paid in by the employer. With a partially self-funded plan, an employer still faces fixed costs, (much lower than a fully-insured plan), but also pays for medical claims as the employees incur expenses. Therefore, groups don’t overpay like they do on fully-insured plans because the cost of the claim is what the group’s actual expense is. Cash flow fluctuation can arise from this, and many smaller employers do not prefer this risk. A level funded plan like Assure Elite offers the best of both worlds: providing the fixed monthly premium costs of a fully-insured plan, but at the end of the year, offering the employer 50% of the balance back if the amount paid in is less than the amount paid out by the carrier. Many different options are available to choose from; both EPO and POS, as well as traditional and HDHPs. Employers can dual choice up to 4 plan options. Adherence generic prescriptions are $0 copay and office visits are only $10. Low cost, convenient virtual visits are available, as well. All plan options come with a wellness component offered through Agnesian’s Know & Go program, which includes health risk assessment questionnaires, biometric screenings, coaching, and an employee portal with educational materials, food and exercise trackers, online workshops, a blog, a mobile site and more – all at no additional charge.

How Do I Go About Getting a Quote?

The application process is completely pain-free. Base rates for Assure Elite are released after a current census statement, billing statement and wage and tax statement are received. Employers wishing to move forward with the process would go through medical underwriting to obtain final rates. This includes the completion of a three-page application covering basic demographic information and a brief medical questionnaire. Some groups choose to go through underwriting immediately rather than receiving base rates first, but each decision is unique to each employer. Despite remaining largely competitive for groups having 2 to 49 employees, discounts are still acquirable for group sizes up to 100.

To begin your journey toward optimal employee healthcare coverage, speak with Tonya at Hierl Insurance, Inc. With a passion for educating employees who may not understand their insurance, misuse their coverage and spend more than they need, Tonya is ready to assist in discovering cost-effective care without any missteps. You can reach her at 920.921.5921 or at tbahr@hierl.com.


Horchata with Cindy Contreras

Every month, one of our amazing employees provides us with their favorite recipe and local restaurant. For this month’s Dish, Cindy Contreras has given us her favorite Dine In and Dine Out choices. Check them out below!

Dine In

Cindy’s favorite Dine In recipe to enjoy with her family is Horchata, also called Rice Water.

“Horchata is my favorite Mexican drink. It’s made out of rice, milk, vanilla, and cinnamon. It’s so easy to make and is DELICIOUS!”

Ingredients:

  • 1 1/3 cup uncooked long-grain white rice
  • 2 cinnamon sticks
  • 4 cups water
  • 1 ½ cups milk
  • 2 teaspoons vanilla extract
  • 2 teaspoons ground cinnamon
  • 1/3 – ½ cup sugar, to taste

Preparation:

  1. Add rice, 2 cups of water, and 2 cinnamon sticks to a blender
  2. Blend about for 2 minutes or until the rice and cinnamon sticks are roughly ground. Add the remaining water and blend again.
  3. Pour contents into a pitcher or container with a fitted lid and place on your countertop overnight (or for at least 8 hours).
  4. Pour the rice mixture into a fine mesh strainer, into a pitcher. Discard the rice.
  5. Stir in the milk, vanilla, cinnamon, and sugar (to your preference). Chill until ready to serve. Stir well before serving and serve over ice.

Dine Out

Cindy’s favorite place to eat out is Gino’s Italian Restaurant in Fond du Lac, Wisconsin. Her favorite dish is their Chicago style deep dish pizza!

“My personal favorite is their Chicago style deep dish pizza!”

You can visit their website here.

View their menu.

584 W Johnson St
Fond du Lac, WI 54935

Thanks for joining us for this month’s Dish! If you try a recipe or restaurant, be sure to let us know. Don’t forget to come back next month for more yummy favorites!


The Dish with Nicole Sumner

Welcome to our monthly Dish segment. This month, we asked Nicole Sumner to provide us with her favorite Dine In and Dine Out choices. Check them out below and let us know if you give them a try!

A Little Bit About Nicole

Nicole is a Fond du Lac native, who joins Hierl as an honors graduate from Moraine Park Technical College in Fond du Lac with an Associates degree in Applied Sciences.

Outside of work, she can be found spending time with her friends, family and beloved dog, Spike. During the summer, camping trips to Shawano, WI are a favorite past time…Read her full bio.


Cookie Dough Brownies

“My favorite family recipe would have to be the Cookie Dough Brownies my mom makes.”

Ingredients

BROWNIES

  • 1 box of brownie mix
OR
  • 1/2 cup butter melted
  • 1 1/2 cups white sugar
  • 1 1/2 teaspoons vanilla extract
  • 2 eggs
  • 3/4 cups all-purpose flour
  • 1/2 cup unsweetened cocoa powder
  • 1/2 teaspoon salt
  • 1/2 cup chocolate chips
COOKIE DOUGH LAYER
  • 1/2 cup butter softened
  • 1/4 cup sugar
  • 1/3 cup brown sugar
  • 2 tablespoons milk
  • 3/4 cup flour
  • 1/2 cup mini chocolate chips
TOPPING
  • 1 cup semi-sweet chocolate chips
  • 2/3 cup heavy cream
  • 1 tablespoon butter

Directions

BROWNIES

  1. Prepare brownies according to box directions
OR
  1. Preheat oven to 350 degrees. Lightly grease a 9×9 pan.
  2. In a large bowl, combine the butter, sugar, & vanilla. Beat in the eggs.
  3. Combine flour, cocoa powder, & salt. Add a little at time to the egg mixture just until combined. Fold in chocolate chips and pour into prepared pan.
  4. Bake about 22-26 minutes or just until done (do not overbake). Remove and cool.
COOKIE DOUGH LAYER
  1. Cream butter, white sugar and brown sugar with mixer on med-high. Add in milk. Add in flour a bit at a time until fully incorporated. Stir in chocolate chips with a spoon. Spread mixture over cooled brownies.
TOPPING
  1. Bring heavy cream and butter just to a boil. Pour over chocolate chips and let sit 4 minutes without stirring. Stir until completely combined.
  2. Pour over the cookie dough layer. Let cool at room temperature for 30 minutes (this keeps the topping shiny). Refrigerate to set.

 

This recipe was provided by Spend with Pennies. If you’d like to visit the original source, please click here.


2059 Witzel Ave, Oshkosh, WI 54904

When It’s a Great Time to Go Out

Nicole’s favorite restaurant is HuHot Mongolian Grill in Oshkosh, Wisconsin. 

“My favorite thing to do is customize my meal and take it to the grill!”

View their website.

Check out their menu.

Thank-you for joining us for this month’s Dish! Don’t forget to come back next month for a new one.


Your Cyber Liability Policy & Handling Data Breaches Like A Pro

In the digital age we live in, it has never been more critical to have a focused, working cyber liability policy. A data breach for a company is a bad dream but having to tell their customers they’ve undergone a data breach is a nightmare. For this month’s CenterStage, Hierl’s wonderful VP of Property & Casualty, Cathleen (Cathy) Christensen, has brought you some helpful, informative advice on securing a reliable cyber liability policy, enabling you to handle data breaches like a pro.

About Cathleen

Cathleen Christensen is the current Vice President, Property & Casualty of Hierl Insurance, Inc. Cathy’s expertise lends itself well to helping local businesses with their commercial insurance and risk management needs. She attended Alverno College in Milwaukee, WI before her career in insurance. In her 25 years of experience in the industry, she has worked on the insurance company side as an underwriting manager, as well as on the agency side as an account executive. Cathy has also been an entrepreneur herself, which enables her to understand the demands businesses face today.

So, let’s get into it: how do you choose a successful cyber liability policy and avoid business fatal data breaches?

The 3 Big Issues of a Data Breach & How a Cyber Liability Policy Comes In Handy

When it comes to cyber liability, three issues plague business. First, there are 47 states in the United States that have separate data breach laws that regulate what business owners must do when a data breach has occurred. Companies that stretch across more than one state have the complication of knowing and going by these laws. Second, there is the public relation issue – attempting to share you’ve had a data breach with customers in a way that won’t completely destroy your company. The leak of private, customer information can lead to lawsuits, too, which leads us to what’s next. Finally, there is the price tag:

“In 2016, the average cost for each lost or stolen record containing sensitive and confidential information is a hundred and forty-one dollars. This is down ten percent from the previous year, but still incredibly significant.” -Ponemon Data Breach Study

When all three of these issues become a certain reality for your business, you are past the point of being able to protect yourself. You need third-party cyber liability experts to step in and help you handle the laws, the PR, and the price tag. Cyber liability insurance policies are tailored to meet your company’s specific needs and as part of their data breach coverage can include forensic, legal and public relations support. It is important to remember that in today’s environment, no company is immune to the possibility of being a victim of cyber crime. However, there are some things you can do to lower your risk of a data breach.

  1. Employee Corporate Security Policy Education. Did you know it’s more common for an employee to unintentionally leak information than it is to be hacked? This is why it’s crucial to educate your employees on cyber risks, but also to have a clear, focused Corporate Security Policy in place.
  2. Encrypt ALL Confidential Data. Even the simplest of things should be encrypted. Plus, don’t use the same password on EVERYTHING. Have different passwords or codes for as many things as possible. That way, if someone were to hack you, then they can’t unlock everything. If you’re someone who forgets your passwords easily, have a notebook or binder where your company information resides and keep it under lock and key without expressed permission to use.
  3. Backup, Backup, Backup. Let’s say your company’s entire computer system is shut down by a virus and you lose everything. That’s a frightening scenario, right? So, avoid it by having backups and many of them. A general rule of thumb is having three solid backup methods. Perhaps you have a couple online storages where you keep files and an external hard drive. It doesn’t matter – just make sure you have it backed up!

There are also a couple of relevant, key issues Cathy wanted to update employers on:

  • Ransomware & Social Engineering Fraud. The biggest scams of today are these two cyber crimes. Both work to steal company information by acting as perfectly normal requests, surveys or even Facebook personas. Employees fall into their traps, giving out company information freely, not realizing it was under false pretenses. Never, ever give out company information – even on something that seems like an official document – without consulting your manager or boss, first.
  • Federal Communications Commission (FCC). The FCC provides a tool for small businesses that can create and save a custom cyber security plan for your company, choosing from a menu of expert advice to address your specific business needs and concerns. It can be found at www.fcc.gov/cyberplanner.

Don’t sit back and wait for cyber doomsday. Take your policy into your own hands, set company standards, and consider cyber liability insurance to help protect your business from the cost of a cyber attack.

At Hierl, Property & Casualty coverage is a partnership; not a product. We look at your entire organization, listen to you, assess your risk, develop a complete strategy and deliver a full-service solution. Our team of experts start by looking at your risk and helping you to gain Insight™ into what is in store for tomorrow. If you have any questions or are interested in knowing if Hierl’s cyber liability solutions is a good fit for you, please contact Cathy at 920.921.5921.


What's the Dish? Taylor Cerminara's Homemade Chocolate Ice Cream with Peanut Butter Swirls

Prior to joining our team, Taylor earned her Associates of Applied Sciences in Human Services and gained experience through her work at a skilled nursing facility.

In her free time, she enjoys the outdoors and when it's colder out, she loves to curl up with a good book.Some of her favorite hobbies include skiing, hiking, kayaking and canoeing...Read her full bio.

Dine In

Taylor loves making her Homemade Chocolate Ice Cream with Peanut Butter Swirls when she's dining in. Want to try it out? Try out her recipe below: 

• 3/4 cup sugar

• 1/3 cup unsweetened cocoa powder

• 3 tbsp cornstarch

• 2 1/2 cups whole milk

• 3/4 cup heavy cream

• 1 cup semisweet chocolate chips, divided

• Peanut butter filling

• 3/4 cup smooth peanut butter

• 1 tbsp plus 1 tsp heavy cream

• Pinch of salt

In a small bowl whisk together the sugar, cocoa powder and cornstarch.

In a heavy bottom saucepan, warm milk over medium heat.

Add the sugar mixture to the warm milk and whisk out any lumps.

Continue to heat over a medium flame until the mixture just starts to boil.

It will be thick, close to the consistency of chocolate pudding.

Pour the chocolate mixture through a fine-mesh strainer into a large bowl.

Add the heavy cream and 3/4 cup of the chocolate chips to the bowl.

Stir the cream and chips into the chocolate mixture until everything melts and is a smooth consistency.

Put plastic wrap directly over the chocolate mixture – making sure it touches the mix. This keeps a thick skin from forming on your ice-cream base.

Refrigerate at least two hours, overnight if possible.

While the chocolate base is cooling, make your peanut butter swirl. You want to make the peanut butter swirl the same day you will be churning your ice cream.

In a small bowl, whisk together the peanut butter, heavy cream and salt. Cover with plastic wrap and set aside at room temperature.

When your chocolate mixture is completely cool, churn it according to your ice cream makers instructions.

When completely churned, add the remaining 1/4 cup chocolate chips into the mixture, stirring to completely incorporate the chips throughout the ice cream.

Spoon into a freezer-friendly container.

Add the peanut butter mixture by dropping spoonfuls on top of the chocolate ice cream and swirling it through with a butter knife or stiff spatula.

Be careful not to stir too much so you don’t completely incorporate the peanut butter, but have thick swirls of it running through the ice cream.

Cover and freeze for several hours before serving.

Dine Out

When Taylor isn't dining in, her favorite place to go is Trepanier's Backyard Grill & Bar. Click here for directions.

Don't forget to check in next month for another edition of Dish!

Looking for an experienced advisor who can help you build a better employee benefits strategy? Visit this page.


Cathleen Christensen's Easy White Chicken Chili

Every month, we are happy to celebrate a new recipe from one of our outstanding employees. In this month’s Dish, we feature Cathleen Christensen and her delicious, easy-to-cook White Chicken Chili! For this month’s Dish, Cathleen Christensen has given us her Dine In and Dine Out choices. Check them out below!

Dine In

Cathleen’s favorite Dine In recipe to enjoy with her family is Easy White Chicken Chili. Though it’s a great treat anytime, she especially loves it during cooler weather. Heres how she makes it:

Easy White Chicken Chili

Yield: 6-8 servings

Ingredients

  • 1 onion, chopped (about 1 1/2 cups)
  • 1 Tablespoon olive oil
  • 3 cups chicken broth
  • 3 (15-1/2 ounces) cans Great Northern beans, drained and rinsed (other white beans can be substituted like cannellini)
  • 2 cups cooked chicken, shredded
  • 1 (4 ounce) can diced green chiles, drained
  • 1 teaspoon ground cumin
  • 1/2 teaspoon garlic powder
  • 3/4 teaspoon dried oregano
  • 1/8 teaspoon pepper
  • 3/4 cup sour cream
  • 1 1/2 cups shredded Monterey Jack cheese
  • (optional) Tabasco sauce

Instructions

  1. In a large stockpot over medium heat, sauté onions in oil until tender. Stir in remaining ingredients except sour cream and cheese.
  2. Simmer for 30 minutes, stirring frequently, until heated through. Shortly before serving, add sour cream and cheese. Stir until cheese is melted. If you like a little kick add a few shakes of Tabasco sauce.

Dine Out

Cathleen’s favorite place to eat out is Ala Roma Restaurant. Ala Roma offers delicious and authentic food, made from scratch using high quality ingredients.

You can visit their website here.

171 N Pioneer Rd, Fond du Lac, WI 54935

Thanks for joining us for this month’s Dish! If you try a recipe or restaurant, be sure to let us know. Don’t forget to come back next month for more yummy favorites!


Protect Yourself From Cyber Attacks

In today's world, a day does not pass without a large company being featured on the news because they are suffering from a data breach or hacking incident that has threatened personal information.

Cyber security is a concept that has become a high priority in the past five years. Since this issue is fairly new, demand for cyber insurance is emerging, since most cyber related claims are currently not covered under a standard insurance program. The questions that arise the most regarding cyber security and liability are about understanding the level of exposure a company's data faces and knowing what cyber coverage encompasses.

VP, Property & Casualty

Large companies are not the only ones at risk, it is often small businesses that are most vulnerable simply because they are not prepared. Most small (under 250 employees) businesses do not have the IT staff necessary to help protect a business. Even manufacturing companies are at risk because while credit card information is a large component, it is not the only type of attack. can you afford the risk of not protecting your employee, client and company data?

With 10+ years of experience addressing cyber risks, Hierl's process of approaching cyber security begins with an assessment of client's risk and exposure. This involves knowing what data a client has, who has access to it, how it's stored and how they are backing it up. Hierl can expertly evaluate the coverage that is necessary to keep an organization secure. 

Because it is an emerging coverage, cyber insurance plans are not standard. Hierl advises a three-fold type of coverage including:

  • Business coverage for customers and employees
  • Protection for your company and the data it houses
  • PR assistance of a security breach occurs 

The best policies offer assistance to help you to work through things if something was to ever happen, as well as forensic and technical assistance to determine how the breach occurred.

"Many Organizations that have suffered cyber-crime are sophisticated, big businesses. If they can't stop these attacks from happening, most other businesses can't either."

If it determined quickly that a breach has happened and a good backup exists a company can recover quickly and the attack is much less damaging. However, when a company's data gets out in the wild is when attacks become most expensive.

The 2016 Ponemon Institute Cost of Data Breach study reported that the average cost of a los record rose form $154 in 2015 to $158 in 2016. Even if, you only have 20 employees now and that doesn't seem all that bad... you need to think about how many employee records do you have from the past 10 years? Cyber-attacks don't just affect current records nor do they only target employee data  but client and company data too. This type of insurance is becoming a must have coverage for businesses because of how sophisticated these attacks have become.

Three reasons to explore cyber coverage for your business:

  1. There is a higher incidence of cyber crime
  2. The longer it takes to detect an contain a data breach, the costlier it becomes
  3. Effects of a cyber-attack extend beyond monetary and data losses to losing businesses and customers 

If you'd like to know more about protecting your company from a cyber breach, please reach out to Cathleen at 920.921.5921 or send her an email via cchristensen@hierl.com.

To download the full PDF click here.


Compliance Recap April 2018

April was a busy month in the employee benefits world.

The Internal Revenue Service (IRS) modified the 2018 health savings account (HSA) family contribution limit back to $6,900. The U.S. Department of Labor (DOL), U.S. Department of Health and Human Services (HHS), and the Treasury released proposed frequently asked questions regarding mental health parity. The Centers for Medicare and Medicaid Services (CMS) released the 2019 parameters for the Medicare Part D prescription drug benefit, a 2019 Benefit and Payment Parameters final rule, a transitional policy extension for non-grandfathered coverage in the small group and individual health insurance markets, and an assignment schedule for new Medicare beneficiary identifiers. The IRS released frequently asked questions on the employer credit for paid family medical leave. The Congressional Research Service (CRS) published a summary of federal requirements that apply to the private health insurance market.

 

UBA Updates
UBA released one new advisor: 2019 Benefit and Payment Parameters Final Rule
UBA updated existing guidance: Sample Open Enrollment Notices Packet

 

IRS Changes 2018 HSA Family Contribution Limit
The Internal Revenue Service (IRS) recently released Revenue Procedure 2018-27 to modify the 2018 health savings account (HSA) family contribution limit back to $6,900. This is the second, and likely final, change in limit during 2018. As background, in May 2017, the IRS released Revenue Procedure 2017-37 that set the 2018 HSA family contribution limit at $6,900.

However, in March 2018, the IRS released Revenue Procedure 2018-10 that adjusted the annual inflation factor for some tax-related formulas from the Consumer Price Index (CPI) to a new factor called a “chained CPI.” As a result, the 2018 HSA family contribution limit was lowered to $6,850 from $6,900, retroactively effective to January 1, 2018. Stakeholders informed the IRS that the lower HSA contribution limit would impose many unanticipated administrative and financial burdens. In response and in the best interest of sound and efficient tax administration, the IRS will allow taxpayers to treat the originally published $6,900 limit as the 2018 HSA family contribution limit.

Excess Contribution Tax Treatment if Employee Received Distribution Based on Earlier Limit

DOL, HHS, and Treasury Release Proposed FAQs on Mental Health Parity
The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively,
the “Departments”) released proposed FAQs About Mental Health and Substance Use Disorder Parity

Implementation and the 21st Century Cures Act Part XX.
The Departments respond to FAQs as part of implementing the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

Generally, the MHPAEA requires that the financial requirements (for example, coinsurance and copays)
and treatment limitations (for example, visit limits) imposed on mental health or substance abuse disorder
(MH/SUD) benefits cannot be more restrictive than the predominant financial requirements and treatment
limitations that apply to substantially all medical/surgical benefits in a class.

Similarly, a group health plan or issuer cannot impose a nonquantitative treatment limitation (NQTL) on
MH/SUD benefits that is more stringent than a comparable limitation that is applied to medical/surgical
benefits.

The MHPAEA regulations include express disclosure requirements. For example, if a participant requests
the criteria for medical necessity determinations regarding MH/SUD benefits, then the plan administrator
must make the information available to the participant.

To assist plan sponsors with disclosure requests, DOL released a revised draft Mental Health and
Substance Use Disorder Parity Disclosure Request that plan sponsors may provide to individuals who
request information from an employer-sponsored health plan regarding treatment limitations.

To assist plan sponsors in determining whether a group health plan complies with MHPAEA, the DOL
released its Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act.

 

CMS Releases 2019 Parameters for Medicare Part D Prescription Drug Benefit
The Centers for Medicare and Medicaid Services (CMS) released the following parameters for the defined
standard Medicare Part D prescription drug benefit for 2019:


Generally, group health plan sponsors must disclose to Part D eligibility individuals whether the
prescription drug coverage offered by the employer is creditable. Coverage is creditable if it, on average,
pays out at least as much as coverage available through the defined standard Medicare Part D
prescription drug plan.

 

CMS Issues 2019 Benefit and Payment Parameters Final Rule
The Centers for Medicare and Medicaid Services (CMS) published its 2019 Benefit and Payment
Parameters final rule. The rule primarily affects the individual health insurance market inside and outside
of the Exchange, the small group health insurance market, issuers, and the states.

Within the rule, three items most directly affect employers and their group health plans:
• Maximum annual out-of-pocket limit on cost sharing for 2019
• New methods for changing state EHB-benchmark plans
• New requirements for employers and issuers participating in the Small Business Health Options
Program (SHOP) Marketplace

 

CMS Issues Transitional Policy Extension
The Centers for Medicare and Medicaid Services (CMS) issued a bulletin extending its transitional policy.

As background, in November 2013, CMS announced a transitional policy for non-grandfathered coverage
in the small group and individual health insurance markets. Under its policy, health insurance issuers may
choose to continue certain coverage that would otherwise be cancelled because of noncompliance with
Patient Protection and Affordable Care Act (ACA) and Public Health Service Act (PHS Act). Further,
affected small businesses and individuals may choose to re-enroll in such coverage.

Under its policy, non-grandfathered health insurance coverage in the small group and individual health
insurance markets will not be considered to be out of compliance with the following ACA and PHS Act
market reforms if certain criteria are met:
• Fair health insurance premiums
• Guaranteed availability of coverage
• Guaranteed renewability of coverage
• Prohibition of pre-existing condition exclusions or other discrimination based on health status,
with respect to adults, except with respect to group coverage
• Prohibition of discrimination against individual participants and beneficiaries based on health
status), except with respect to group coverage
• Non-discrimination in health care
• Coverage for individuals participating in approved clinical trials
• Single risk pool requirement

Under CMS’ transitional policy, states may permit issuers that have renewed policies under the
transitional policy continually since 2014 to renew such coverage for a policy year starting on or before
October 1, 2019. However, any policies renewed under this transitional policy must not extend past
December 31, 2019.

 

CMS Starts Assigning New Medicare Beneficiary Identifiers
The Centers for Medicare and Medicaid Services (CMS) started issuing new Medicare cards with a
Medicare Beneficiary Identifier (MBI) or Medicare number. The MBI will replace the Social Security
number-based Health Insurance Claim Number (HICN) for Medicare transactions such as billing, eligibility
status, and claim status.

New enrollees will be among the first to get these new cards. Current Medicare beneficiaries will get their
new cards on a rolling basis over the next few months.

Employers who are currently capturing the HICN for their active employee or retirees should update their
systems to accept the new MBIs.

 

IRS Releases FAQ on Employer Credit for Paid Family Medical Leave
The IRS released an FAQ that primarily reiterates the Tax Cuts an Jobs Act’s provisions that provide a
new federal credit for employers that provide paid family and medical leave to their employees.

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.

The IRS adds this definition of “paid family and medical leave” that, for purposes of the credit, includes
time off for:
• Birth of an employee’s child and to care for the child.
• Placement of a child with the employee for adoption or foster care
• To care for the employee’s spouse, child, or parent who has a serious health condition
• A serious health condition that makes the employee unable to perform the functions of his or
her position
• Any qualifying exigency due to an employee’s spouse, child, or parent being on covered active
duty (or having been notified of an impending call or order to covered active duty) in the Armed
Forces.
• To care for a service member who is the employee’s spouse, child, parent, or next of kin

The FAQ also explains that, in the future, the IRS intends to 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 whether an employee has been employed for “one year or more”
• The impact of state and local leave requirements
• Whether members of a controlled group of corporations and businesses under common control
are treated as a single taxpayer in determining the credit

 

CRS Publishes Federal Requirements on Private Health Insurance Plans
The Congressional Research Service (CRS) published Federal Requirements on Private Health
Insurance Plans, which summarizes federal requirements that apply to the private health insurance
market, including a table that indicates whether a particular federal requirement applies to a fully-insured
large group plan, fully-insured small group plan, self-funded plan, or individual coverage.

Question of the Month
Q. What are the penalties for failing to comply with Section 125 requirements, such as failing to follow a
cafeteria plan document’s terms?

A. An operational failure occurs when a plan fails to follow its cafeteria plan document’s terms. There are
several potential penalties for operational failures, including:
• Cafeteria plan disqualification
• Requiring the cafeteria plan to comply with Section 125 and its regulations, including reversing
transactions that caused noncompliance
• Imposing employment tax withholding liability and penalties on the employer regarding pre-tax
salary reductions and elective employer contributions
• Imposing employment and income tax liability and penalties on employees regarding pre-tax
salary reductions and elective employer contributions

5/15/2018

Download the full recap here.


Bettering Health Plan Management Through Modern Healthcare Technology

Taking advantage of modern technology is part of the reason why Hierl excels in providing the best results for our clients. In this installment of CenterStage, we asked our Executive Vice President, Scott Smeaton, to give an in-depth overview of how we use our technological resources to create customized, high-quality, low-cost health plans for our clients.

Technology and Data

There are three steps to developing plans for our clients, when using technology and data. The first step is to identify the client’s cost drivers within their health program(s). For example, we may look at a client’s claims data and find their highest dollar claims are musculoskeletal – such as hip and knee replacements – identifying whether health plan members are going to the higher cost, lower quality provider. These are becoming much more prevalent and are among most plans top cost drivers. With the technology at Hierl, we can import our client’s data – medical and prescription claims and health screening results from wellness – and aggregate it into one technology platform. Doing so, will help keep our clients’ members updated on physician requests and advice.

Competitive Advantage

The second step beyond identifying our client’s cost drivers is to implement management programs and plan designs to address their health plan issues. This kind of technology is newer to the healthcare industry. It can be a great resource and tool that larger employers can use to their advantage. Think about Netflix. They analyze their viewer’s behaviors and apply predictive modeling in a way that they know what their viewers like to watch and when they want to watch it, incorporating those preferences into the ads their customers see. That kind of technology is coming to healthcare, allowing us to look at all claims and behaviors and predict where the next large claim will come from. This helps plan administrators fully understand what’s driving their health plan costs and do something about it through plan design changes, provider relations and contracting, member incentives, and member education and engagement.

Employee Betterment

After identifying areas that can be improved upon and creating a plan to address these cost drivers as discussed above, our third and final step is to create a communication program that will engage and educate employees. Our goal is to help employees understand that, within a healthcare system, there are some providers who perform better than others and cost less. When we give employees the tools and resources they need to be better healthcare consumers, everyone wins. Employer sponsored health plans have lower overall costs. This means their employees and their families lower their out-of-pocket costs, save healthcare dollars for the future, and have better outcomes. Not to mention that a happier, healthier employee is also a more productive employee at work and in the community. Hierl accomplishes this with our “Why Matters” program, which is a custom designed, year-round member education and communication program using a variety of mediums to reach our clients’ members. Through Why Matters, Hierl builds a custom (intranet) and mobile app for our clients to access basic information about their benefits 24/7. Think of it as a homepage to one of your favorite websites that you bookmark in your browser. This is where your members go to research, make decisions, educate themselves on your benefit offerings and how to be a better healthcare consumer. Based on the cost drivers identified through the process above we build out a 12-month calendar of communication materials specifically addressing the areas we’ve identified as a concern and can be delivered via paper, email, mobile app, etc.

Hierl strives to bring our clients the best possible solutions that result in high-quality, low-cost benefits. If you think your company needs to take this step toward improvement, please contact Scott Smeaton at 920.921.5921 or send him an email at ssmeaton@hierl.com.


LIMRA aims to shape benefits data exchange standard

How will LIMRA shape the benefits data exchange standard? Find out in this article from Benefits Pro.

LIMRA wants to help develop electronic data transmission standards for the employee benefits market.

The life and health market research group, has formed an alliance with the Object Management Group (OMG), a nonprofit technology standards group based in Needham, Massachusetts.

LIMRA has been working on the benefits market data standards issue for more than a year.

To help benefits market players develop standards, OMG has set up a Workplace Benefits Domain Task Force. The chairs of the new task force are Edie Bice of Unum; InAh Chambers of LIMRA; and Aaron Roby of Texas Life.

The task force organizers hope to develop data exchange standards for non-medical, non-retirement benefits.
The standards could apply both to group benefits and to individual benefits products sold at the worksite.

Organizers say the new task force will be open to benefits brokers, independent benefit plan administrators, benefits administration technology vendors, and insurers that offer non-medical, non-retirement employee benefits products.

The task force will start its first face-to-face meeting June 18, in Boston.

Source:
Bell A. (4 May 2018). "LIMRA aims to shape benefits data exchange standard" [web blog post]. Retrieved from address http://bit.ly/2wfIZey