Digital health revolution: What we’ve learned so far

The effectiveness of digital health devices is being called into question by recent studies. Digital health devices provide personalized feedback to users, helping improve their health. Read this blog post to learn more.


The promise of the digital health revolution is tantalizing: a multitude of connected devices providing personalized feedback to help people improve their health. Yet, some recent studies have called into question the effectiveness of these resources.

While still evolving, many compelling use-cases are starting to emerge for digital health, including a set of best practices that can help guide the maturation of this emerging field. In the near future, many people may gain access to individual health records, a modern medical record that curates information from multiple sources, including electronic health records, pharmacies and medical claims, to help support physicians in care delivery through data sharing and evidence-based guidelines.

As these advances become a reality, here are several digital health strategies employers, employees and healthcare innovators should consider.

Micro-behavior change.

Part of the power of digital health is the ability to provide people with actionable information about their health status and behavior patterns. As part of that, some of the most successful digital health programs are demonstrating an ability to encourage daily “micro-behavior change” that, over time, may contribute to improved health outcomes and lower costs. For instance, wearable device walking programs can remind people to move consistently throughout the day, while offering objective metrics showcasing actual activity patterns and, ideally, reinforcing positive habits to support sustained change. Technology that encourages seemingly small healthy habits — each day — can eventually translate to meaningful improvements.

Clinical interventions.

Big data is a buzz word often associated with digital health, but the use of analytics and technology is only meaningful as part of a holistic approach to care. Through programs that incorporate clinical intervention and support by care providers, the true value of digital health can be unlocked to help make meaningful differences in people’s well-being. For instance, new programs are featuring connected asthma inhalers that use wirelessly enabled sensors to track adherence rates, including frequency and dosage, and relay that information to healthcare professionals. Armed with this tangible data, care providers can counsel patients more effectively on following recommended treatments. Rather than simply giving consumers the latest technologies and sending them along, these innovations can be most effective when integrated with a holistic care plan.

Real-time information.

One key advantage of digital resources, such as apps or websites, is the ability to provide real-time information, both to consumers and healthcare professionals. This can help improve how physicians treat people, enabling for more customized recommendations based on personal health histories and a patient’s specific health plan. For instance, new apps are enabling physicians to know which medications are covered by a person’s health plan and recommend lower-cost alternatives (if available) before the patient actually leaves the office. The ability to access real-time information — and act on it — can be crucial in the effort to use technology to empower healthcare providers and patients.

Financial incentives.

Nearly everyone wants to be healthy, but sometimes people need a nudge to take that first step toward wellness. To help drive that engagement, the use of financial incentives is becoming more widespread by employers and health plans, with targeted and structured rewards proving most effective. From using mobile apps and comparison shopping for healthcare services to encouraging expectant women to use a website to follow recommended prenatal and post-partum appointments, financial incentives can range from nominal amounts (such as gift cards) to hundreds of dollars per year. Coupling digital health resources with financial rewards can be an important step in getting — and keeping — people engaged.

The digital health market will continue to grow, with some studies estimating that the industry will exceed $379 billion by 2024. To make the most of these resources, healthcare innovators will be well served to take note of these initial concepts.

SOURCE: Madsen, R. (14 March 2019) "Digital health revolution: What we’ve learned so far" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/digital-health-revolution-what-weve-learned-so-far?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001


Goodbye, suits and ties. Hello, sneakers

What do your employees wear to work each day? As the workplace evolves, one thing many managers have in common is that they are throwing out their traditional business dress code. Read on to learn more.


Casual Friday? Try casual Monday through Friday.

As the modern U.S. workplace evolves, one thing many office managers have in common is that they are throwing the traditional business dress code out the window.

About 88% of employers today offer some type of casual dress benefit, up from 81% five years ago, according to the 2018 employee benefits survey from the Society for Human Resource Management.

The most recent company to join the ranks of the suit-and-tie-less workplace is banking giant Goldman Sachs. The decision — once believed unthinkable for such a straight-laced organization — comes as the company looks to keep up with “changing nature of workplaces,” according to a Goldman memo last week.

“Casual dress attire at work is just one of the many ways employers are trying to retain and attract top talent in this competitive job market,” says Amelia Green-Vamos, an employer trends analyst with Glassdoor. “The unemployment rate is at a historic low, and casual dress attire is an inexpensive perk creating a more approachable and comfortable culture for new and existing employees.”

All employers want to attract the best possible talent and in today’s job market that talent is younger. Indeed, more than 75% of Goldman Sachs’ employees are members of the millennial or Gen Z generations. When it comes to hiring younger talent the more traditional companies — such as big banks — are competing against tech giants and hedge funds that are offering a different kind of workplace.

Facebook, for example, has had a relaxed dress code since the beginning. “We don’t want our people to have a work self and a personal self,” says Facebook spokesman Kyle Gerstenschlager. “That aspect of our culture extends to our lack of a formal dress code.”

Google is another company with a simple dress policy. “You must wear clothes,” was the response Susan Wojcicki — current CEO of YouTube — gave in a 2007 interview with Bay area media outlet The Mercury News. She was VP of ad services at Google at the time.

But, it’s not just the Silicon Valley tech companies that have embraced a more laid back attire policy. When Mary Barra — current CEO of General Motors — was vice president of global human resources at the automaker, she set out to replace the company’s 10-page dress code exposition with two words: “Dress appropriately.”

It’s a simple idea, but Barra was perplexed when she received pushback from HR and one of her senior-level directors, she explained at the 2018 Wharton People Analytics Conference. But this actually led to what Barra called an “ah-ha” moment, giving her better insight into the company and teaching her a lesson about making sure managers feel empowered.

Office culture has been evolving for decades, with offices with sleep pods and ping-pong tables now commonplace. But it’s practicality rather than entitlement that is leading offices to adapt their dress codes.

“I have a hard time imagining a position where wearing a tie could be considered an essential part of the job’s responsibilities,” says SHRM member Mark Marsen, director of human resources at Allies for Health + Wellbeing. “Even using arguments that it contributes to or enhances corporate image, client perceptions, or establishing a form of respect. What matters at the end of all, for everyone concerned, is that a successful service was rendered.”

SOURCE: Shiavo, A. (12 March 2019) "Goodbye, suits and ties. Hello, sneakers" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/goldman-sachs-embraces-casual-dress


Shifting from Employee Engagement to Employee Experience

When it comes to the busy workplace, it is not uncommon for employees to get bogged down in their daily tasks and overlook several key elements surrounding their healthcare and personal needs. Fortunately, there are ways to gather all your eggs in one basket and alleviate stress and surprise.

In this installment of CenterStage, Tonya Bahr, a benefits advisor at Hierl Insurance, Inc., weighs in on three key things employers and HR professionals should keep in mind when establishing their agenda:

  • Offering employees an experience when it comes to their benefits
  • How to sweeten your current coverage options to attract new talent
  • How to control the mental well-being of your employees

How Does Investing in Employee Experience vs Employee Engagement Offer a Leg-Up on Competition?

If customer experience is the total of all interactions that customers will have with your company, then employee experience is your workforce’s relationship with your business. This encompasses all interactions they will have with you, from their potential recruit to their final days as an employee. A happier workforce is just the tip of the iceberg when it comes to the benefits of embracing employee experience rather than simply engaging or “urging” them to comply with the standard company operating procedures. Tonya noted employees forget their benefits if they have not utilized them in a while.

A survey from Gallup discovered 87% of employees worldwide are not engaged, but companies with high engagement outperform their competitors by 147% in earnings per share (HR Exchange Survey). As a result, companies that are looking to gain an edge on the competition should consider the importance of their employees when it comes to getting ahead. For those looking for a place to start, Tonya recommended the following:

About Your Expert:

Tonya has a passion for educating business owners and employees on benefit options, helping them make decisions that best fit their personal and financial objectives.

Tonya Bahr,
Benefits Advisor

01. Creating A Dialogue

Improving employee experience is a two-way conversation – it requires the need to listen to your people and have that conversation regularly. Companies need to look beyond outdated practices and toward annual surveys in favor of creating a community and having regular ongoing dialogue that drives the kind of engagement that employees want.

Gathering employees and visiting topics such as the utilization of telehealth and discounted urgent care visits are two ways to get employees talking. This not only provides the open feedback that thrives within a strong work environment but also triggers other employees to explore their plans and see if they receive the same options.

Sparking conversation within your company will additionally encourage employees to shop around for lower cost alternatives to hospital and doctor visits. Unlike buying a new car or searching for a new TV to purchase, Tonya noted employers and employees just aren’t doing their homework for the best options available – ultimately costing them in unnecessary expenses.

02. Go Beyond the “Feel Good” Offerings

Perks such as gym memberships and free lunches have become common practice for companies looking to brand themselves as a great employer. However, it is important to understand these tactics aren’t the answer when it comes to employee experience but rather an engagement strategy. Modern employees want to work in a great environment and want to know their contributions are valued through benefit offerings like discounted healthcare.

For anyone looking to unlock the power of employee engagement through benefits, the time to act is now. With the number of companies catching on to the importance of customer experience, it will not only help you gain an edge on your competition but make your company a favorable place to work – the definition of a ‘win-win’.

Why Hierl?

At Hierl Insurance, we love what we do, and this includes a partnership with you in mind. We understand the demands of each client are unique, so we craft your options to fit your business perfectly, creating a different story for each client.

We believe it is okay to like your experts, such as Tonya Bahr, who is standing by waiting to greet you with a warm welcome. Together, we can devise a blueprint to turn your company’s dreams into reality.

To speak with Tonya, contact her today at (920) 921-5921 or by email at tbahr@hierl.com.


Pay transparency: A new tool to boost employee engagement

How does your company treat pay disclosure? Generally, employees are free to discuss their pay rates as part of their rights under the National Labor Relations Act. Read this blog post to learn how pay transparency could be used as a tool to boost employee engagement.


For many companies, discussing salaries has always been taboo. Some firms even required new hires to sign an agreement swearing they wouldn’t disclose their pay to co-workers. 

This “loose lips sink ships” approach is largely illegal, of course: Employees are generally free to talk about pay rates as part of their rights under the National Labor Relations Act.

Nonetheless, for years, companies held salary information very close to the vest.

But times are changing. Many firms have now gone to a policy of transparency in matters of compensation.

2 separate approaches

Stephanie Thomas, program director of the Institute for Compensation Studies at Cornell University, writes that pay transparency comes in two flavors: salary disclosure and pay process transparency.

1. Salary disclosure: In this approach, the company distributes a spreadsheet listing employees, their titles and their salaries.

This approach can be tricky. There are always going to be cases where an employee asks, “Why is Stephanie paid more than me? We have the same title and the same duties.”

Whole Foods explains the rationale for adopting its policy in a statement on its website:

“Salary information for all –including the company’s leadership – is available to all inquiring team members. Wage transparency helps promote inclusiveness and ensures our compensation system is fair.”

2. Pay process transparency: The second approach explores how compensation decisions are made, and explains to individuals why they’re making what they are and what they need to do to earn more.

This involves having detailed discussions with employees, either individually or in a group, about the overall compensation plan – salary ranges and midpoints, goals and objectives that need to be met, performance metrics, etc. Most companies prefer this approach because it focuses the conversation away from rankings of employees toward individual performance.

Both approaches signal a new trend in employee engagement – helping workers understand the inner workings of their organizations.

SOURCE: Mucha, R. (15 February 2019) "Pay transparency: A new tool to boost employee engagement" (Web Blog Post). Retrieved from http://www.hrmorning.com/pay-transparency-a-new-tool-to-boost-employee-engagement/


Dispelling the stigma around mental health disorders in the workplace

The Anxiety and Depression Association of America stated that nearly six in 10 U.S. workers reported that anxiety impacts their performance in the workplace. Read this blog post to learn more about the stigma associated with mental health disorders in the workplace.


It’s no secret that poor mental health impacts employee performance. Anxiety disorders, for example, affect 40 million adults in the U.S. each year, and nearly six in 10 American workers report that anxiety impacts their workplace performance, according to the Anxiety and Depression Association of America.

But because of the stigma often associated with mental health disorders, employees might not be using the benefits and programs clients have in place to help address the problem. That’s why just having programs in place isn’t enough, experts say. Instead, employers need to help remove the stigma of mental health conditions by creating a culture of inclusiveness in the workplace and forming employee resource groups.

Employers including Johnson & Johnson, Trulia and Verizon Media are doing just that, company executives said during a webinar last week hosted by the National Alliance of Healthcare Purchaser Coalitions.

When Margaux Joffe, associate director of accessibility and inclusion at Verizon Media, started working on a proposal to form a mental health-focused employee resource group (ERG), dispelling stigma and empowering workers was one of her first priorities.

“We wanted to create a paradigm shift,” she said, speaking as part of the webinar. “Growing up, you’re taught to think you’re ‘normal or not normal;’ you’re mentally ill or you’re not. We started with the idea there is no such thing as a ‘normal brain’ as we’re increasingly understanding neurodiversity in the human race.”

A lot of people with mental health issues don’t necessarily identify with the word disability, added Meredith Arthur, content marketing manager at Trulia.

“We struggled around removing the word disability because there was a desire to face the stigma and take it on,” she said of Trulia’s ERG. “Ultimately, we wanted to reach as many people as we could. We wanted to be sharper in our focus on mental health.”

Trulia expanded its ERG statement of purpose from just focusing on mental health education and awareness to advocating for the needs of different abilities.

Joffe said putting in place an ERG for mental health at Verizon was done with the support of senior leadership. “We’ve been lucky to get a lot of support from the company for ERG,” she said. “A common challenge that exists across the board is lack of organization readiness.”

Readiness is a huge component of success in mental health programs, added Kelly Greenwood, founder and CEO of Mind Share, a nonprofit organization addressing the culture of workplace mental health.

“It is so important to achieve true culture change,” she said. “Oftentimes we work with leadership first and do workshops for executive teams before rolling them out to the company to really get that buy-in and understanding from the top down to build a transparent culture.”

At Johnson & Johnson, it took the company about nine months to get its ERG program up and running. “There was a lot of conversation internally if it should be its own ERG for mental health or integrated into another employee resource group,” said Geralyn Giorgio, talent acquisition change management communications and training lead at the pharmaceutical and consumer packaged goods manufacturing company.

At that time, she said, the company had an ERG called the alliance for disability leadership. The decision was made to put mental health under that ERG umbrella. “Since than happened, there were a lot of [employees] not seeing themselves in this ERG. We felt strongly we had to rebrand the ERG, and we went live last year, using the name alliance for diverse abilities to make it more inclusive,” she said.

This year, Giorgio said, the company will work to empower managers to handle mental health conversations.

“If you have a manager open to the conversation, [employees] have a different experience than someone whose manager is ill-informed,” she said. “That’s something we need to focus on this year — helping our managers feel more comfortable with having the conversation.”

SOURCE: Otto, N. (12 March 2019) "Dispelling the stigma around mental health disorders in the workplace" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/dispelling-workplace-mental-health-stigma?brief=00000152-146e-d1cc-a5fa-7cff8fee0000


Compliance Recap - February 2019

February was a quiet month in the employee benefits world.

The Internal Revenue Service (IRS) released an information letter addressing when an employer may seek recoupment of contributions made to an employee’s HSA.

A U.S. District Court held that the State of Maryland could not ask for a declaration that the Patient Protection and Affordable Care Act (ACA) is constitutional and enforceable. Four states and the U.S. House of Representatives joined the appeal of the court case that held the ACA to be unconstitutional.

The Department of the Treasury, Department of Labor (DOL), and the Department of Health and Human Services (HHS) issued a request for information regarding grandfathered group health plans.

UBA Updates

UBA released one new advisor: Compliance Recap – 2018 Year in Review

UBA updated or revised existing guidance: State Guide to COBRA Supplemental Requirements

IRS Releases Information Letter on Returning HSA Contributions to an Employer

Generally, a person’s interest in a health savings account (HSA) is nonforfeitable. However, in the past, the Internal Revenue Service’s Notice 2008-59 described limited circumstances under which an employer may recoup contributions made to an employee’s HSA.

The Internal Revenue Service (IRS) recently released Information Letter 2019-0033 (Letter), clarifying that IRS Notice 2008-59 was not intended to provide an exclusive set of circumstances in which an employer can recoup contributions made to an HSA. If there is clear evidence of an administrative or process error, an employer may request that the contributions it made to an employee’s HSA be returned. This correction should put the employer and employee in the same position that they would have been in if the error had not occurred.

The Letter lists the following examples of when an employer may recoup HSA contributions:

  • An amount withheld and deposited in an employee’s HSA for a pay period is greater than the amount shown on the employee’s HSA salary reduction election.
  • An employee receives an employer contribution that the employer did not intend to contribute but the amount was transmitted because an incorrect spreadsheet is accessed or because employees with similar names are confused with each other.
  • An employee receives an incorrect HSA contribution because it is incorrectly entered by a payroll administrator (whether in-house or third-party) causing the incorrect amount to be withheld and contributed.
  • An employee receives a second HSA contribution because duplicate payroll files are transmitted.
  • An employee receives as an incorrect HSA contribution because a change in employee payroll elections is not processed timely so that amounts withheld and contributed are greater than (or less than) the employee elected.
  • An employee receives an incorrect HSA contribution because an HSA contribution amount is calculated incorrectly, such as a case in which an employee elects a total amount for the year that is allocated by the system over an incorrect number of pay periods.
  • An employee receives an incorrect HSA contribution because the decimal position is set incorrectly resulting in a contribution greater than intended.

Status of Court Case Challenging ACA Constitutionality

There is recent activity in the court case regarding the Patient Protection and Affordable Care Act’s constitutionality.

As background, in February 2018, twenty states filed a lawsuit asking the U.S. District Court for the Northern District of Texas (Court) to strike down the Patient Protection and Affordable Care Act (ACA) entirely. The lawsuit came after the U.S. Congress passed the Tax Cuts and Jobs Act in December 2017 that reduced the individual mandate penalty to $0, starting in 2019.

On December 14, 2018, the Court issued a declaratory order that the individual mandate is unconstitutional and that the rest of the ACA is unconstitutional. The Court granted a stay of its December 2018 order, which prohibits the order from taking effect while it is being appealed in the Fifth Circuit Court of Appeals (appeals court).

On February 1, 2019, the U.S. District Court for the District of Maryland held that the State of Maryland could not ask for a declaration that the ACA is constitutional and enforceable because the federal government will continue to enforce the ACA while the appeal proceeds.

On February 14, 2019, the appeals court granted the U.S. House of Representatives’ request to intervene as a party to the lawsuit to defend the ACA. Also, on February 14, the appeals court granted the request of the states of Colorado, Iowa, Michigan, and Nevada to intervene as parties to the lawsuit to defend the ACA. The appeals court denied these intervenor states’ request for expedited briefing. The federal government’s brief is due on March 25, the twenty states’ brief is due on April 24, and reply briefs are due on May 15.

Agencies Issue Request for Information on Grandfathered Health Plans

On February 25, 2019, the Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) issued a request for information (RFI) regarding grandfathered group health plans. The RFI contains two sets of questions concerning: (1) maintaining (or relinquishing) grandfathered status and (2) general information about grandfathered group health plans and group health insurance coverage.

As background, under the ACA, group health plans that were in existence on March 23, 2010, are excused from some of the ACA’s requirements. Under the Departments’ prior guidance, certain changes can cause a plan to lose its grandfathered status.

The RFI is intended to help the Departments understand issues related to grandfathered health plans and to estimate the impact of any potential changes to the rules governing group health plans’ retention of grandfathered status. The RFI also seeks to determine whether there are opportunities for the Departments to assist group health plans with maintaining grandfathered status.

Question of the Month

Q: When must IRS reporting Forms 1094-C, 1095-C, 1094-B, and 1095-B be electronically filed for the 2018 calendar year?

A: If filing electronically, Forms 1094-C, 1095-C, 1094-B, and 1095-B must be filed by April 1, 2019. Employers may file Form 8809 to receive an automatic 30-day extension of this due date for forms due to the IRS. Form 8809 must be filed by April 1, 2019 for employers that are filing electronically.

3/1/2019


3 ways anxiety can hold back your employees’ careers

Nearly six in 10 American workers report anxiety impacts their workplace performance, according to the Anxiety and Depression Association of America. Read this blog post to learn more about workplace anxiety.


Employers want their employees to grow and succeed at their jobs. Unfortunately, there are a variety of external and psychological obstacles that can stand in the way of employees reaching their full potential. While most workers would like nothing better than to perform well on the job, anxiety can prevent them from doing so.

Anxiety disorders are extremely common: They affect 40 million adults in the U.S. each year, and nearly six in 10 American workers report anxiety impacts their workplace performance, according to the Anxiety and Depression Association of America. A study in the academic journal Anxiety found the economic effects of this mental health condition are huge — costing employers almost $35 billion from lost or reduced productivity in the workplace, the study says. The good news is 80% of employees treated for mental health problems report improvements in their job satisfaction and productivity.

For employers to mitigate the impact anxiety has on their employees, it’s important to understand the form it takes in the workplace. Anxiety often takes shape in various thinking traps that can sabotage an employee’s growth. Three of the most common traps are social comparisons, personalization and overmagnification.

To explore how these thinking traps manifest in the workplace, let’s consider a scenario in which an employee sees a co-worker gets a promotion instead of them.

The social comparison trap. The research is clear that comparing yourself to others is bad for your mental health. However, that doesn’t stop people — especially those with anxiety — from doing just that. A co-worker’s promotion can lead an employee to leap to the conclusion they must be inferior to their colleague. In reality, there’s no way employees can fairly compare themselves to a co-worker. Their experiences, personalities and skills are different. Employees able to avoid that comparison trap might, instead, keep the focus on themselves, evaluating the growth they’ve achieved over the past year and determining how they can continue to improve in the year ahead.

The personalization trap. It’s hard for some employees to recognize not everything is about them. The co-worker who earned the promotion may have gotten the job because they were simply a better fit; that doesn’t diminish the talents and abilities of those who weren’t chosen for the position. Rather than assume the worst of themselves, employees could look at the situation more objectively and recognize that their co-worker may not be better than them, just different.

The overmagnification trap. Blowing things out of proportion is another thinking pattern with a destructive effect. Being passed over for a promotion can expand to a sense of being permanently, hopelessly, bad at one’s job. Instead of being able to parse out the specific reasons why the promotion didn’t go their way, employees who overmagnify convince themselves that they are not only unqualified for the promotion, but they’ll never get a promotion and their career is doomed — so why even try? To keep those overblown feelings at bay, a better approach is to stay focused on the specific and transient nature of what has just happened. Being passed over hurts now, but it won’t hurt forever. Not getting this particular job says nothing about the person’s ability to get other jobs. It may mean that they are missing certain skills or experience, but it doesn’t mean they will always lack them.

Workplace culture and practices can either exacerbate or diminish the self-sabotaging thinking traps that go hand in hand with anxiety. Some effective strategies that can help foster a positive work environment for all employees, but especially those who tend toward anxiety, include:

Create a collaborative workplace. Workplace collaboration helps employees feel valued for their contributions and allows them to see how their skills are important to achieving success for their team or company. It also provides the opportunity to learn from other employees and appreciate what they bring to the table, rather than viewing them as their competition.

Promote transparency. Employees who are kept in the loop, who understand their role, the criteria for what promotions are based on, and understand what they can do to get to the next level are more trusting of their leaders. Be particularly sensitive to what employees may be experiencing during annual performance reviews and make sure to overcommunicate during those times.

Offer tools and services. Providing programs and services to help reduce stress and anxiety can be beneficial for all employees. These can include subsidizing gym memberships, offering yoga classes, encouraging “mind vacation” breaks throughout the day, providing online programs that guide employees through mindful meditations or other well-being exercises.

Model self-care. Employees are more likely to engage in self-care at work if they see their supervisors practicing it, not just encouraging it. If a meditation class is offered in the workplace, employees are more likely to take part if their managers are taking time out of their day to participate as well. Similarly, organization-wide activities, such as a mid-day walk, allow employees to see management promote the message that self-care is a workplace priority.

Given the high number of working Americans with anxiety conditions, easing their anxieties and helping them avoid those thinking traps is good for business. It will improve employees’ overall well-being, workplace satisfaction and professional growth.

SOURCE: Parks, A. (5 March 2019) "3 ways anxiety can hold back your employees’ careers" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/3-ways-anxiety-can-hold-back-your-employees-careers


IRS Releases Information Letter on Returning HSA Contributions to an Employer

An informational letter was recently released by the Internal Revenue Service (IRS) clarifying that IRS Notice 2008-59 was not intended to provide an exclusive set of circumstances in which employers could recoup contributions made to employee HSAs. Continue reading this blog post from UBA to learn more.


Generally, a person’s interest in a Health Savings Account (HSA) is nonforfeitable. However, in the past, the Internal Revenue Service’s Notice 2008-59 described limited circumstances under which an employer may recoup contributions made to an employee’s HSA.

The Internal Revenue Service (IRS) recently released Information Letter 2019-0033 (Letter), clarifying that IRS Notice 2008-59 was not intended to provide an exclusive set of circumstances in which an employer can recoup contributions made to an HSA. If there is clear evidence of an administrative or process error, an employer may request that the contributions it made to an employee’s HSA be returned. This correction should put the employer and employee in the same position that they would have been in if the error had not occurred.

The Letter lists the following examples of when an employer may recoup HSA contributions:

  • An amount withheld and deposited in an employee’s HSA for a pay period is greater than the amount shown on the employee’s HSA salary reduction election.
  • An employee receives an employer contribution that the employer did not intend to contribute but the amount was transmitted because an incorrect spreadsheet is accessed or because employees with similar names are confused with each other.
  • An employee receives an incorrect HSA contribution because it is incorrectly entered by a payroll administrator (whether in-house or third-party) causing the incorrect amount to be withheld and contributed.
  • An employee receives a second HSA contribution because duplicate payroll files are transmitted.
  • An employee receives as an incorrect HSA contribution because a change in employee payroll elections is not processed timely so that amounts withheld and contributed are greater than (or less than) the employee elected.
  • An employee receives an incorrect HSA contribution because an HSA contribution amount is calculated incorrectly, such as a case in which an employee elects a total amount for the year that is allocated by the system over an incorrect number of pay periods.
  • An employee receives an incorrect HSA contribution because the decimal position is set incorrectly resulting in a contribution greater than intended.

SOURCE: Hsu, K. (14 March 2019) "IRS Releases Information Letter on Returning HSA Contributions to an Employer" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/irs-releases-information-letter-on-returning-hsa-contributions-to-an-employer


4 questions to ask before adding biometric screenings

Fifty-two percent of large firms that provide employee health benefits offer workers the opportunity to complete a biometric screening, according to the Kaiser Family Foundation (KFF). Read this blog post to learn more.


A growing number of employers are adopting workplace wellness programs to improve employee health and subsequently lower their health insurance spend. As they do, benefit managers are tasked with vetting options that will deliver meaningful health and financial results for their companies.

This vetting process typically involves answering questions that range from which types of participation incentives their organization should offer to what type of wellness programs will yield the greatest health-improvement outcomes.

But there’s a problem: Very few benefits managers ask for details about wellness biometric testing, even though most programs are, at least in theory, designed around the information that screening provides. Biometric screening typically involves one or more laboratory tests as well as physical readings, such as blood pressure and body weight, to identify markers of health risks if not an actual disease.

According to the Kaiser Family Foundation, 52% of large firms that provide employee health benefits offer workers the opportunity to complete a biometric screening.

Just as workplace wellness programs are not all the same, biometric screening can vary. Failure to question the specific details of a proposed biometric screening program can lead to suboptimal results.

Before moving forward with biometric screenings as part of a workplace wellness program, benefit managers should pause to ask themselves certain questions. Doing so will enhance the likelihood of favorable outcomes — both for employee wellness and the financial bottom line.

1. Why should we screen?

It sounds simple, but setting clear goals for biometric screening is a step too many benefits managers overlook. This may be because they do not know how to anticipate the kind of actions that will be available to them and their employees given the results.

Based on my experience, the most compelling reason to provide biometric screening as part of a wellness program is to help individuals identify risks for several chronic conditions that, if caught early, may be prevented. With insights from a biometric screening, an individual may be better able to take steps to reduce health risks. Common goals may be to reduce body weight, exercise more or visit a physician for treatment.

Biometric screening often can reveal disease risks an individual may not otherwise know. A study published in the peer-reviewed journal PLoS ONE, for instance, found that one in three first-time participants in a company-sponsored, lab-based wellness program by Quest Diagnostics were not aware they were at risk for a serious medical condition, such as diabetes or heart disease, according to biometric screening results. Many of these individuals were in a health plan, suggesting that healthcare access alone does not guarantee preventive care to identify risk for common chronic health conditions.

Biometric screening also can help an employer identify programs to target at-risk employee segments based on the type of risk with appropriate interventions. Reliable insight into disease risks for a workforce population may also aid the prediction of future healthcare costs.

2. What should we screen for?

Ideally, biometric screening should provide enough information into disease risks for both individuals and the employer in order to take meaningful actions. Here, many employers miss the mark by implementing bare bones biometric screening options. The result is potentially misleading results — and missed opportunities to identify individuals at risk.

Take diabetes screening, for instance. A non-fasting fingerstick glucose screening really doesn’t tell us anything considering the variety of food individuals might have eaten, and how that may have affected their measurement.

A fasting fingerstick glucose test may help identify diabetes risk in some individuals and be less costly to perform than a hemoglobin A1c test, which involves a venipuncture blood draw. However, a study from Quest Diagnostics found that some individuals in a workforce population with normal fasting glucose results were still at higher risk for diabetes, and a glycated hemoglobin (HbA1c) test identified them.

In a similar manner, many employers overlook screening for chronic kidney disease, one of the major causes of kidney transplantation. Eighty-nine percent of participants identified as at risk for chronic kidney disease did not know it, according to the aforementioned PLoS ONE study. The estimated glomerular filtration rate (eGFR) lab test can help identify this condition very cost-effectively, but it’s often absent in biometric screening programs. Other conditions that laboratory tests can help identify include metabolic disorders, thyroid disease, and colorectal cancer, among others.

3. How often should we screen?

Annual biometric screening reinforces the importance of management places on employee wellness. It can also help identify health risks in individuals who are new to the organization. An annual program also provides a regular cadence of engagement that is not too onerous on employees while minimizing the confusion that can occur when screening happens less frequently.

Annual screening has an added benefit of allowing the employee to track her progress over time. Quest provides graphic charts that show changes in an individual’s numbers year over year. This is a powerful motivator for those who have adopted healthful behaviors to stay the course. And longitudinal changes also can reveal patterns, like modest annual weight gain, that the individual may otherwise dismiss until they see the cumulative effect.

4. How can we connect employees to care and intervention?

Screening is just one facet of a successful wellness program. Some individuals who identify health risks may proactively modify their behavior or consult a physician. But not all will. Employers can improve the odds of at-risk employees accessing the care they need following biometric screening.

Most employees in biometric programs receive a personalized report of their screening results. Additionally, many participants can consult over the phone with a third-party administered physician.

At Quest, for instance, we offer programs that help at-risk employees access behavioral change programs. If an individual’s screening results suggest evidence of prediabetes, that employee may participate free of charge in a 16-week, CDC-based diabetes prevention program that includes coaching and lifestyle modification. An individual with a problematic cholesterol result may be able to access a similar program for heart disease prevention.

Biometric screenings can be a powerful facet of an employee wellness program. Understanding the reasons to screen, which methods to use and how often to use them, and the paths to connect employees to care are key. Benefit managers who do this well will be rewarded with a wellness program that results in healthier employees and lower healthcare costs over time.

SOURCE: Goldberg, S. (21 February 2019) "4 questions to ask before adding biometric screenings" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/4-questions-to-ask-before-adding-biometric-screenings


The benefit you may not be offering to employees — but should be

Did you know: Seventeen percent of full-time workers act as caregivers. The costs, gaps in care and stress associated with serious, long-term illness can negatively impact the health and productivity of your workforce. Read this blog post to learn more.


When it comes to getting better value for their healthcare dollars, employers and other healthcare purchasers may be overlooking a significant cost driver that negatively impacts the health and productivity of their workforce.

It’s the costs, gaps in care and stress associated with serious, long-term illness. In addition to the roughly 11.4 million adults and children living with serious illness, about 17% of full-time workers are also caregivers. And while a caregiving role is rewarding, it’s also been shown to reduce work productivity by more than 18%, costing U.S. businesses up to $33 billion annually. Given this, it’s surprising that palliative programs are not nearly as widespread as they should be.

Employers should give serious consideration to offering palliative care as a benefit to employees. Here are two misconceptions that can get in the way of implementing palliative care programs — and two reasons why serious illness care may be right for your organization.

First, the misconceptions:

It’s not the same as hospice care. While hospice care is a part of palliative care, they’re not synonymous. Palliative care is specialized medical care for people living with a serious illness that is appropriate at any age and any stage of their disease and can be provided along with curative treatment. It focuses on providing patients with relief from the symptoms, pain and stress of their medical condition(s) — whatever the diagnosis.

The goal is to improve quality of life for both the patient and their family. Those who would greatly benefit from access to palliative care face conditions such as diabetes with complications, metastatic cancer or chronic obstructive pulmonary disease.

It doesn’t affect my population. While people with a serious illness typically represent only a small proportion of the commercial population — roughly 2% to 3% — and up to 10% of retiree populations, they consume a disproportionate amount of healthcare resources. By addressing the needs of those living with serious illness, helping them avoid unnecessary, unwanted, and even potentially harmful care, employers can make a big impact on employees’ lives and the bottom line. Moreover, palliative care also greatly benefits caregivers, who can experience stress, negative impacts on their own health, and lessened productivity and presenteeism at work, even when they find their role fulfilling.

Now, why should employers offer palliative care benefits?

Quality can generate cost-savings. Palliative care’s focus on improving the quality of life of patients and their families means it leads with quality. The logic of “quality first” applies to many high-value healthcare strategies including accountable care organizations, centers of excellence (COEs) and second opinion programs. And like those other strategies, leading with quality can lead to lower costs. For instance, by providing access to high-quality care for certain services or conditions at a COE, employers hope that costly complications from low quality or inappropriate care can be avoided, just as introducing a palliative care team to a treatment plan can help patients better manage their symptoms, such as severe pain, proactively and lead to fewer trips to the emergency room.

Employers can make a big difference for patients and caregivers. Employers and other healthcare purchasers can play a powerful role in improving care for people living with serious illness by demanding certain capabilities and services from contracted health plans, other vendors and healthcare providers.

These include:

· Proactive identification of the population of patients living with a serious illness
· Training all healthcare providers in basic communication and symptom management skills
· Access to certified specialty palliative care teams across care settings
· Access to appropriately trained case managers
· Specific benefits that include home-based services and support for caregivers

To change the healthcare system, it’s important for purchasers to be on the same page with each other to ensure that providers and plans are on board with providing this type of care. After all, at the end of the day, it’s about the patient and their family. In focusing on palliative care, along with other key areas, purchasers have the power and influence to make a difference in the quality and affordability of care their employees receive.

SOURCE: Delbanco, S. (6 March 2019) "The benefit you may not be offering to employees — but should be" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/the-benefit-employers-may-not-be-offering-to-employees?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001