Data Note: Changes in 2017 Federal Navigator Funding

Are you looking for a run-down on Navigator programs and their funding? In this article from the Kaiser Family Foundation, we are offered an informative peak of the 2017 changes in federal Navigator funding within the Affordable Care Act (ACA).


Read the original article here.

Source:

Pollitz K., Tolbert J., Diaz M. (11 October 2017). "Data Note: Changes in 2017 Federal Navigator Funding" [Web Blog Post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/data-note-changes-in-2017-federal-navigator-funding/

 

The Affordable Care Act (ACA) created Navigator programs to provide outreach, education, and enrollment assistance to consumers eligible for coverage through the Marketplaces and through Medicaid and requires that they be funded by the marketplaces.  For the past two years, the Centers for Medicare and Medicaid Services (CMS) has funded Navigator programs in the 34 states that use the federal marketplace through a multi-year agreement that was expected to continue for the current budget year.  In August, CMS officials announced significant reductions to Navigator funding for the 2018 budget year.  These funding reductions coming so close to the start of the 2018 open enrollment period will affect the help many Navigators can provide to consumers seeking to enroll in coverage.

This data note analyzes funding changes and discusses the implications for Navigators and consumers.  It presents results of a Kaiser Family Foundation online survey of federal marketplace (FFM) Navigator programs conducted from September 22, 2017 – October 4, 2017 about 2017 funding awards (for the 2018 open enrollment period), the relationship between funding amounts and program performance, and the likely impact of funding changes on programs and the consumers they serve. It also includes insights from a roundtable meeting of more than 40 Navigators co-hosted by the Robert Wood Johnson Foundation and Kaiser Family Foundation held on September 15, 2017, as well as analysis of administrative data.

BACKGROUND

In 2015, CMS signed three-year agreements with Navigator organizations to provide consumer assistance to residents of federal marketplace states.  The multi-year agreements promoted continuity and experience among Navigator professionals.  Multi-year agreement also spared CMS and Navigators the time and expense involved in reissuing grants during critical weeks leading up to open enrollment.  Under the agreements, Navigator programs in the FFM states are required to set goals and report performance data throughout the year relating to specific duties and activities.

Funding amounts under the multi-year agreements have been determined annually — $60 million for the first budget year (which runs September through August), and $63 million for the second budget year.  CMS notified continuing programs of the grant amount available to them for the coming year in late spring; programs then submitted work plans, budgets, and performance goals based on that amount.  Once CMS approved these plans, final awards were made in late August.

In May 2017, continuing Navigator programs were notified of available third-year funding amounts, which totaled $60 million, with grants for most programs similar to the year-two funding amount. In June, programs submitted their work plans and budgets corresponding to these amounts. The Navigator programs expected final Notice of Awards (NOA) by September 1, 2017.

On August 31, one day prior to the end of the second budget period of the grants, CMS announced it would reduce Navigator funding by more than 40%. CMS issued a bulletin stating that funding for the third year would be based on program performance on its enrollment goals for the second budget period.  On September 13, 2017, two weeks into the third budget year of the grant, FFM Navigator programs received preliminary NOAs for third-year funding, which totaled $36.8 million, or 58% of the year-two awards. (See Appendix A for funding awards by program.)

2017 NAVIGATOR FUNDING REDUCTIONS

CMS notified Navigator program of their preliminary 2017 grant awards on September 13, 2017.  The full list of preliminary awards was obtained and released by a third party (see Appendix A). This section summarizes funding changes based on information from that list.

Funding changes at the state level for 2017 were uneven across states.  Three FFM states (Delaware, Kansas, and West Virginia) received no net reduction in year-three Navigator funding.  Among the other 31 FFM states, the funding reductions ranged from 10% in North Carolina to 80% or more in Indiana, Nebraska, and Louisiana (Table 1).

Table 1: 2016 Federal Navigator Funding Awards  and Preliminary 2017 Awards as of  September 13, 2017, by State
State 2016 Funding Award 2017 Preliminary Funding Award Percent Change
Alabama $1,338,335 $1,036,859 -23%
Alaska $600,000 $446,805 -26%
Arizona $1,629,237 $1,167,592 -28%
Delaware $600,000 $600,000 0%
Florida $9,464,668 $6,625,807 -30%
Georgia $3,682,732 $1,433,936 -61%
Hawaii $334,510 $185,143 -45%
Illinois $2,581,477 $1,792,170 -31%
Indiana $1,635,961 $296,704 -82%
Iowa $603,895 $226,323 -63%
Kansas $731,532 $731,532 0%
Louisiana $1,535,332 $307,349 -80%
Maine $600,000 $551,750 -8%
Michigan $2,228,692 $627,958 -72%
Mississippi $907,579 $382,281 -58%
Missouri $1,815,514 $729,577 -60%
Montana $495,701 $374,750 -24%
Nebraska $600,000 $115,704 -81%
New Hampshire $600,000 $456,214 -24%
New Jersey $1,905,132 $720,545 -62%
North Carolina $3,405,954 $3,061,034 -10%
North Dakota $636,648 $208,524 -67%
Ohio $1,971,421 $568,327 -71%
Oklahoma $1,162,363 $798,000 -31%
Pennsylvania $3,073,116 $1,988,501 -35%
South Carolina $1,517,783 $511,048 -66%
South Dakota $600,000 $236,947 -61%
Tennessee $1,772,618 $1,497,410 -16%
Texas $9,217,235 $6,110,535 -34%
Utah $902,681 $394,862 -56%
Virginia $2,187,871 $1,108,189 -49%
West Virginia $600,000 $600,000 0%
Wisconsin $1,338,306 $749,215 -44%
Wyoming $605,847 $183,654 -70%
Total $62,882,140 $36,825,245 -41%
Source: List of preliminary grant awards was obtained and released by a third party, not by CMS.

When the multi-year agreement was established, federal funding was allocated across FFM states based on the state’s share of the number of uninsured people, with a minimum amount ($600,000) reserved for each of the smallest states.  This allocation formula no longer seems to apply.  For example, total funding for Navigators in Indiana ($290,000) was less than that for Navigators in Alaska ($447,000) despite the fact that there are four times as many uninsured residents in Indiana compared to Alaska (422,000 vs 95,600 in 2016).  Similarly, funding for Navigators in Ohio was less than that for Navigators in Oklahoma ($568,000 vs $798,000) though there are more uninsured residents in Ohio (631,000 vs 409,000).1

Overall, the funding reductions varied widely across individual Navigator programs. The vast majority (82%) of Navigator programs experienced reductions, while 18% of programs saw their funding stay the same or increase compared to funding levels in 2016. Forty-nine percent of programs had their funding reduced by more than half and more than one-quarter experienced funding reductions of over 75% (Figure 1).

Figure 1: Changes in Navigator Program Funding, 2016-2017

NAVIGATOR PROGRAM FUNDING VERSUS PERFORMANCE

This section summarizes findings from the KFF Survey of FFM Navigators about 2017 funding changes and program performance on certain metrics during the second year of the multi-year agreement.  All Navigator programs were contacted, and 51% participated in the survey.

Navigators say the basis for 2017 funding decisions has not been clear.  Nearly half (49%) of respondents said that the rationale for the funding notice they received on September 13 was not provided at all, and another 40% said it was unclear (Figure 2).

Figure 2: Navigator Program Perception of Clarity of CMS Funding Rationale

The August 31 CMS bulletin indicated that funding for the Navigators would be based on performance against year-two “enrollment goals.” According to the bulletin, “a grantee that achieved 100 percent of its enrollment goal for plan year 2017 will receive the same level of funding as last year, while a grantee that enrolled only 70 percent of its enrollment goal would receive 70 percent of its previous year funding level, a reduction of 30 percent. The new funding formula will ensure accountability within the Navigator program.”

It is not clear what metric CMS used to determine funding levels since Navigators have been required to track a number of activities relative to goals, all of which could result in or contribute to enrollment in health coverage.  These include:

  • Number of consumers assisted with qualified health plan (QHP) selection/enrollment (including reenrollment);
  • Number of one-on-one interactions with consumers, including both general and specific inquiries; and
  • Number of consumers assisted with applying for Medicaid/CHIP, including referral of consumers in non-expansion states to the state Medicaid office;
  • Number of consumers reached through outreach and public education activities.2
NAVIGATOR-ASSISTED QUALIFIED HEALTH PLAN SELECTION METRIC

The number of consumers assisted with QHP selections is the most direct measure of marketplace enrollment tracked by Navigators, although as discussed below, it does not capture all marketplace enrollments that involved Navigator assistance.

There are two measures of Navigator-assisted QHP selections, one self-reported by the programs and one based on data collected by healthcare.gov – the Multidimensional Information and Data Analytics System, or MIDAS data.  The healthcare.gov online application includes a field where Navigator staff can enter their identification number for each consumer whom they assist. Navigators report that program staff have not been trained on this data entry and did not consistently enter it. Several weeks after the start of the fourth open enrollment period, some Navigator programs said they were encouraged by their CMS project officers to improve consistency of staff identification numbers on applications.  Some say they subsequently received reports from CMS staff during the project year comparing MIDAS and self-reported data on QHP selections that did not match – in some cases by a factor of two – and programs did not know why.  Other programs said they did not receive reports from CMS on their MIDAS data.  Navigators expressed concern about the accuracy of data counting QHP selections, especially if this will become the basis for future funding decisions.

The survey asked Navigators to provide both their goal and self-reported performance data for Navigator-assisted QHP selections as reported to CMS for the second budget period. Navigator performance relative to the goal was compared to the change in funding from 2016 to 2017.  Among programs that provided the performance data, findings include:

For 22.5% of programs, 2017 funding matches performance on the self-reported QHP selection metric (Figure 3).  Included in this group were:

  • 15.0% of programs that exceeded or met at least 95% of the goal and whose 2017 funds were not reduced; and
  • 7.5% of programs that did not meet the goal and had funding reduced by the same or similar percentage (+/- 5%).

For 77.5% of programs, 2017 funding does not reflect performance on the QHP selection metric.  Included in this group were:

  • 22.5% of programs that exceeded or met at least 95% of the goal and whose 2017 funds were reduced;
  • 27.5% of programs that did not meet the goal and had funding reduced by a greater percentage; and
  • 27.5% of programs that did not meet the goal and had funding changed by a smaller percentage.

Figure 3: Change in Navigator Funding Compared to Performance on QHP Selection Metric

The QHP selection metric tends to undercount enrollment that is connected to assistance provided by Navigators. Through the survey and at the roundtable, Navigators expressed concern that the QHP selection measure does not reflect the number of consumers whom they help and who ultimately enroll in marketplace health plans.  This metric, as defined by CMS, counts only those consumers who select a plan in the Navigator’s presence, a fraction of the total number of individuals who enroll in coverage and who were helped by Navigators.  For example, if a Navigator helped a consumer complete her application and reviewed plan choices, but the consumer went home to consider her options and made a final selection that evening, that visit could not be reported as a Navigator-assisted plan selection.3 According to the Kaiser Family Foundation 2016 Survey of Health Insurance Marketplace Assister Programs and Brokers, 18% of assister programs reported that nearly all consumers they helped who were determined eligible to enroll in a QHP made their plan selection during the initial visit. Thirty-five percent said they knew the final plan selection of all or nearly all such consumers whom they helped.

OTHER NAVIGATOR PERFORMANCE METRICS

Funding changes for 2017 also do not appear to align with performance on other metrics.  Navigators reported goals and performance data on other key metrics that relate to enrollment (Figure 4). Most programs met or exceeded these goals, so these metrics do not appear to be related to the funding reductions.  Among programs that answered these questions, Eight in ten programs (83%) met their goals for one-on-one consumers interactions, 71% met their goals for helping consumers enroll in Medicaid or CHIP, and three quarters met their outreach and education event goal.

Figure 4: Most Navigators Met Other Enrollment-Related Goals

One-on-one assistance: The most comprehensive measurement required by CMS is the number of consumers provided one-on-one assistance.  A one-on-one encounter can involve helping a consumer with any step along the process that ends with enrollment:  educating consumers about the availability of plans and assistance, completing a marketplace application for financial assistance, appealing a marketplace decision, reviewing and understanding plan options, or selecting a QHP.  Navigators also provide one-on-one assistance to consumers after they enroll so that they can remain covered.  Such help includes answering tax reconciliation questions, resolving premium payment disputes, and referring consumers for help with denied claims.  Once they have resolved the problem they came in with, many consumers leave and complete the enrollment process on their own.  The one-on-one assistance metric would also count consumers who are helped but who do not enroll in coverage.  On average, the number one-on-one encounters Navigators reported was 15 times higher than the number of QHP selections.

Medicaid/CHIP enrollment assistance or referrals: The ACA requires a “no wrong door” application process through which consumers can apply through the marketplace, using a single streamlined application, for either private health insurance subsidies or Medicaid/CHIP.  Navigators are required to help all consumers with the application.  Navigators from Medicaid expansion states noted that most consumers who sought help were ultimately determined Medicaid eligible.  At the roundtable, some commented that, when the August 31 bulletin was released, they assumed CMS would base funding on enrollment under both types of coverage.

Outreach and public education: Four years after implementation, the public’s understanding of ACA benefits and requirements remains limited.  For example, many consumers continue to be unaware that signups for private non-group health insurance, generally, must take place during open enrollment.4  Turnover in marketplace plans is high, as most participants need non-group coverage only while they are between jobs or other types of coverage.  Navigators report that consumers are less likely to seek, or be receptive to, information about the marketplace until they actually need it.

IMPACT OF NAVIGATOR FUNDING REDUCTIONS

This section summarizes findings from the KFF Navigator survey as well as insights from the Navigator Roundtable meeting on program changes that may result from the funding reductions.

Most Navigator programs say they will continue to operate in 2018 despite the funding reductions.However, three programs said they will terminate work for year-three.  These include two programs – one statewide and one nearly statewide5 – that had been the only Navigator service providers for consumers in most areas of their respective states.  Their decision to withdraw was based on the level and timing of funding reductions.  The September 13 NOA directed that no more than 10% of the grantee’s award could be spent by programs pending CMS review and approval of the final budget and work plan.  Because the preliminary award was announced two weeks into the plan year with final awards scheduled to be made as late as October 28, grantees were faced with maintaining staff payroll and other expenses for as long as two months without assurances they would be reimbursed. The terminating programs, both operated by nonprofits, determined this was not feasible.

Most programs report they will likely reduce their geographic service area and limit help to rural residents. Among programs whose funding was reduced, 45% of statewide programs and two-thirds of regional programs said it is somewhat or very likely they will have to limit the territory their program will serve in year three. Programs emphasized their inability to afford the same level of travel expenses and/or the cost of satellite offices that they had previously incurred in order to offer in-person help to consumers living farther away.  Consumers living in rural communities may be the most affected.  Most (55%) statewide Navigator programs and 72% of regional programs expect to limit services to rural residents this year (Figure 5).

Figure 5: Navigator Programs Reducing Geographic Service Area and Services in Rural Areas

Nearly all programs (89%) expect to lay off staff as a result of funding reductions (Figure 6).  Some programs expect to cut Navigator staff by 75% or more.  The KFF 2016 Assister Survey found that continuity among staff has been high to date.  One advantage of the multi-year agreement was to allow staff experience to grow over time.  To fill in the gaps left by staff lay-offs, some programs plan to rely more heavily on less experienced volunteers.

Figure 6: Navigator Program Response to Funding Reductions

Most Navigator programs expect to reduce services in other ways, as well.  Nearly all programs (81%) say they will likely reduce outreach and public education activities as a result of budget reductions.  In addition, 89% of programs say they will likely reduce spending on marketing and advertising. Nearly six in ten programs (57%) said they will likely reduce the number of months in which they offer Navigator assistance.  Some programs expect to close following open enrollment, others will cut back to a skeletal staff.  As a result, consumers who need assistance at tax time, or help with special enrollments or post-enrollment problems during the year, may have difficulty finding it.

Over four in ten programs say it is likely they will curtail help to consumers related to Medicaid.  At the roundtable, some discussed a strategy of pre-screening consumers during open enrollment to identify those likely eligible for Medicaid/CHIP.  These consumers might be asked to come back at a later date, if they do not have an immediate medical or coverage need, because Medicaid and CHIP enrollment is year round.  Other expressed concern that, if CMS bases future funding on QHP plan selections, Navigators in Medicaid expansion states could be disadvantaged.

In addition, 57% of programs say they will likely limit time staff can devote to helping consumers with complex cases.  These cases include consumers experiencing identity proofing problems (for example, faced by young adults who have not previously filed income tax returns or established credit ratings).6  They also include consumers with income data-matching problems (for example, self-employed individuals who have difficulty estimating income for the coming year).  People who cannot resolve identity or other data verification problems within 90 days risk losing their marketplace coverage or subsidies.

Another 54% of programs say they will likely limit the number of limited English proficiency (LEP) consumers they can serve.  Programs often pay a premium for bi-lingual staff, an expense they may no longer be able to afford with reduced funding.

Consumers who need these kinds of assistance may have difficulty finding it elsewhere.  Many consumers seek help from other types of marketplace assister programs.  Federally qualified health centers (FQHCs) also receive funding from the federal government to provide in-person enrollment assistance, although the authorization for most federal funding expired September 30 and has yet to be extended.  In addition, Certified Application Counselor (CAC) programs provide in-person help in the marketplace, though are not paid by the marketplace.  The KFF 2016 Assister Survey found that all three types of programs play an important role in helping consumers.  They also tend to differ from Navigator programs in some key respects.  In particular, Navigator programs typically undergo a higher level of training; they are more likely to operate statewide, sponsor outreach and enrollment events, handle complex cases, and provide help throughout the year.

The KFF 2016 Assister Survey also found that agents and brokers are less likely than marketplace assister programs to serve consumers who need translation services, help with complex cases, and help with Medicaid applications. Brokers and agents are also less likely to help uninsured consumers, immigrants, and consumers who lack internet at home.

DISCUSSION

The Administration’s decision to reduce funding for Navigator programs comes at a challenging time for consumers who rely on coverage through the marketplaces. High-profile insurer exits from the marketplaces, rising premiums, and uncertainty over the federal commitment to funding the cost sharing subsidies are likely sowing confusion among consumers about whether coverage and financial assistance remain available. This confusion, coupled with a shortened open enrollment period, increases demand for the consumer education and in-person enrollment assistance Navigators provide. At a time when more help may be needed, the funding reductions are likely to reduce the level of in-person help available to consumers during this fall’s open enrollment and throughout the 2018 coverage year.

Navigator programs generally report that they do not understand the basis for the funding decisions, and our survey results suggest that there is not a clear link between funding and performance of programs relative to goals on the measures they are required to track and self-report. This ambiguity makes it difficult for programs to plan for the future.

Both the magnitude of the reductions and the timing has caused disruption to Navigator program planning and operations.  Programs plan to adopt various strategies in response to the reductions, including reducing their geographic service area and cutting services, such as outreach and assisting with complex cases. Three programs report they will terminate operations, leaving consumers in their states with very limited access to in-person help. While consumers may be able to turn to other assister programs or brokers, less in-person assistance will be available in some areas, especially for people with complex situations or who live in remote or rural communities.

 

Read the original article here.

Source:

Pollitz K., Tolbert J., Diaz M. (11 October 2017). "Data Note: Changes in 2017 Federal Navigator Funding" [Web Blog Post]. Retrieved from address https://www.kff.org/health-reform/issue-brief/data-note-changes-in-2017-federal-navigator-funding/


New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women


You can read the original article here.

Source:

Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/

The Trump Administration has issued new regulations that significantly broaden employers’ ability to be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement.  The regulation opens the door for any employer or college/ university with a student health plan with objections to contraceptive coverage based on religious beliefs to qualify for an exemption. Any nonprofit or closely-held for-profit employer with moral objections to contraceptive coverage also qualifies for an exemption. Their female employees, dependents and students will no longer be entitled to coverage for the full range of FDA approved contraceptives at no cost.

On October 6, 2017, the Trump Administration issued two new regulations greatly expanding the types of employers that may be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement.  These regulations are a significant departure from the Obama-era regulations that only granted an exception to houses of worship.  One of the regulations allows nonprofits or for-profit employer with an objection to contraceptive coverage based on religious beliefs to qualify for an exemption and drop contraceptive coverage from their plans.  The other regulation also exempts all but publicly traded employers with moral objections to contraception from rule. These new policies, effective immediately, also apply to private institutions of higher education that issue student health plans. The immediate impact of these regulations on the number of women who are eligible for contraceptive coverage is unknown, but the new regulations open the door for many more employers to withhold contraceptive coverage from their plans.

New regulations from the Trump administration greatly expand exemption from #ACA contraceptive coverage rule

Contraceptive coverage under the ACA has made access to the full range of contraceptive methods affordable to millions of women. This provision is part of a set of key preventive services that has been identified by the Health Resources and Services Administration (HRSA) for women that must be covered without cost-sharing. Since it was first issued in 2012, the contraceptive coverage provision has been controversial. While very popular with the public, with over 77% of women and 64% of men reporting support for no-cost contraceptive coverage, it has been the focus of litigation brought by religious employers, with two cases (Zubik v Burwell and Burwell v Hobby Lobby)  reaching the Supreme Court. This brief explains the contraceptive coverage rule under the ACA, the impact it has had on coverage, and how the new regulations issued by the Trump Administration change the contraceptive coverage requirement for employers and affect women’s coverage.

How do the new regulations change contraceptive coverage requirements for employers?

Since they were announced in 2011, the contraceptive coverage rules have evolved through litigation and new regulations. Most employers were required to include the coverage in their plans. Houses of worship could choose to be exempt from the requirement if they had religious objections. This exception meant that women workers and female dependents of exempt employers did not have guaranteed coverage for either some or all FDA approved contraceptive methods if their employer had an objection. Religiously affiliated nonprofits and closely held for-profit corporations were not eligible for an exemption, but could choose an accommodation. This option was offered to religiously affiliated nonprofit employers and then extended to closely held for-profitsafter the Supreme Court ruling in Burwell v. Hobby Lobby. The accommodation allowed these employers to opt out of providing and paying for contraceptive coverage in their plans by either notifying their insurer, third party administrator, or the federal government of their objection. The insurers were then responsible for covering the costs of contraception, which assured that their workers and dependents had contraceptive coverage while relieving the employers of the requirement to pay for it.

As of 2015, 10% of nonprofits with 5,000 or more employees had elected for an accommodation without challenging the requirement. This approach, however, has not been acceptable to all nonprofits with religious objections.1 In May 2016, the Supreme Court remanded Zubik v. Burwell, sending seven cases brought by religious nonprofits objecting to the contraceptive coverage accommodation back to the respective district Courts of Appeal. The Supreme Court instructed the parties to work together to “arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage.”2

On October 6, 2017, the Trump Administration issued new regulations greatly expanding eligibility for the exemption to all nonprofit and closely-held for-profit employers with objections to contraceptive coverage based on religious beliefs or moral convictions, including private institutions of higher education that issue student health plans (Figure 1).  In addition, publicly traded for-profit companies with objections based on religious beliefs also qualify for an exemption. There is no guaranteed right of contraceptive coverage for their female employees and dependents or students. Table 1 presents the changes to the contraceptive coverage rule from the Obama Administration in the new Interim Final regulations issued by the Trump Administration.

Figure 1: Employers Objecting to Contraceptive Coverage: Exemptions and Accommodations Under the Trump Administration Regulations

The accommodation will be available to employers that previously qualified for the accommodation.  They now will also have the choice of an exemption. The federal departments issuing the regulations posit that these new rules will have limited impact on the number of women losing contraceptive coverage.   However, it is not clear how many employers previously utilizing the accommodation will now opt for an exemption, resulting in the loss of contraceptive coverage for their employees and dependents.  In addition, there are also an unknown number of organizations that were not previously eligible for either the accommodation or exemption that may now opt for an exemption. These new regulations create two new categories of employers who can now qualify for an exemption or can voluntarily chooses an accommodation:  1) publicly traded for-profit companies with a religious objection and 2) nonprofit and closely held for-profit employers who have a moral objection to contraceptives, a considerably larger pool of employers than when the exemption was available only to those who were employees of a house of worship or who were eligible for an accommodation in the past.

Table 1: Summary of Changes in the Contraceptive Coverage Regulations for Objecting Entities
  Obama Administration
August 2012 to October 5, 2017
Trump Administration
Effective October 6, 2017
What types of contraceptives must plans cover without cost-sharing? At least one of each of the 18 FDA approved contraceptive methods for women, as prescribed, along with counseling and related services must be covered without cost-sharing. No change
Are any employers “exempt” from the contraceptive mandate?
  • Religious institutions defined as “houses of worship”
  • Grandfathered plans
  • No notice to employees is required. Women workers and female dependents must pay for their own contraceptives.
  • Religious institutions defined as “houses of worship”
  • Grandfathered plans
  • Nonprofit or  for-profit employers (including publicly traded companies), insurers, or private colleges or universities that issue student insurance plans with a religious objection to contraceptive coverage
  • Nonprofit or closely held for-profit employers, insurers, or private colleges or universities that issue student insurance plans with a moralobjection to contraceptive coverage
  • Notice is only required if the plan previously included contraceptive coverage. Women workers and female dependents must pay for their own contraceptives.
Who pays for contraceptive coverage for employees of organizations receiving an exemption?
  • The cost of contraceptives is borne by women workers and female dependents.
  • There is no guarantee of contraceptive coverage for employees of an exempt organization.
  • The employer may choose to cover some methods, but has no obligation to cover all 18 FDA methods without cost sharing
No change

What type of employers may seek an “accommodation” to avoid paying for contraceptives in their plans?  
  • Closely held for-profit corporations and religiously affiliated nonprofits with religious objections to contraception can opt out of providing and paying for contraceptive coverage
  • Notice must be provided to either their insurer, third party administrator, or the federal government of their objection.
  • Women workers and female dependents receive no cost contraceptive coverage.
  • Any entity (except for houses of worship) eligible for an exemption can choose the accommodation instead of the exemption.
  • Notice must be provided to either their insurer, third party administrator, or the federal government of their objection.
  • Women workers and female dependents receive no cost contraceptive coverage.
Who pays for contraceptive coverage for employees of organizations receiving an accommodation?
  • Insurance companies of firms obtaining an accommodation must pay for contraceptive coverage.
  • Third-party administrators (TPA) of self-funded health plans must cover the costs of contraceptives for employees. The costs of the benefit are offset by reductions in the fees the TPA pays to participate in the federal exchange.
No change
When can entities change from an accommodation to an exemption? N/A
  • When an employer or private college or university currently using the accommodation opts for an exemption, the revocation of contraceptive coverage will be effective on the first day of the first plan year that begins 30 days after the date of the revocation or 60 days notice may be given in a summary of benefits statement.
  • The issuer or third party administrator is responsible for providing the notice to the beneficiaries.

How has the contraceptive coverage rule affected women?

Contraceptive use among women is widespread, with over 99% of sexually-active women using at least one method at some point during their lifetime.3 Contraceptives make up an estimated 30-44% of out-of-pocket health care spending for women.4 Since the implementation of the ACA, out-of-pocket spending on prescription drugs has decreased dramatically (Figure 2). The majority of this decline (63%) can be attributed to the drop in out-of-pocket expenses on the oral contraceptive pill for women.5 One study estimates that roughly $1.4 billion dollars per year in out-of-pocket savings on the pill resulted from the ACA’s contraceptive mandate.6  By 2013, most women had no out-of-pocket costs for their contraception, as median expenses for most contraceptive methods, including the IUD and the pill, dropped to zero.7

Figure 2: The Contraceptive Coverage Policy Has Had a Large Impact on Out-Of-Pocket Spending in a Short Amount of Time

This provision has also influenced the decisions women make in their choice of method. After implementation of the ACA contraceptive coverage requirement, women were more likely to choose any method of prescription contraceptive, with a shift towards more effective long-term methods.8  High upfront costs of long-acting methods, such as the IUD and implant, had been a barrier to women who might otherwise prefer these more effective methods.  When faced with no cost-sharing, women choose these methods more often9, with significant implications for the rate of unintended pregnancy and associated costs of childbirth.10

Finally, decreases in cost-sharing were associated with better adherence and more consistent use of the pill. This was especially true among users of generic pills.  One study showed that even copayments as low as $6 were associated with higher levels of discontinuation and non-adherence,11 increasing the risk of unintended pregnancy.

Do states with no-cost contraceptive coverage laws allow exemptions to objecting entities?

The federal standards under Affordable Care Act created a minimum set of preventive benefits that applied to most health plans regulated by the federal government (self-funded plans, federal employee plans) and states (individual, small and large group plans), including contraceptive coverage for women with no cost-sharing.  States have also historically regulated insurance, and many have had mandated minimum benefits for decades. State laws, however, have more limited reach in that they only apply to state regulated fully insured plans, do not have jurisdiction over self-funded plans, where 61% of covered workers are insured.12 In self-funded plans, the employer assumes the risk of providing covered services and usually contracts with a third party administrator (TPA) to manage the claims payment process. These plans are overseen by the Federal Department of Labor under the Employer Retirement Income Security Act (ERISA) and are only subject to federally established regulations.13  The ACA sets a minimum standard of coverage for preventive services for all plans. However, state laws regulating insurance, including contraceptive coverage, can require fully insured plans to provide coverage beyond the federal standards.

Eight states have strengthened and expanded the federal contraceptive coverage requirement (CA, IL, MD, ME, NV, NY, OR, VT).  Another 20 states have contraceptive equity laws that require plans to cover contraceptives if they also provide coverage for prescription drugs but they do not necessarily require coverage of all FDA-approved contraceptives or ban cost-sharing (Figure 3).

Figure 3: Many States Have Contraceptive Coverage Requirements

Many of the 28 states that have passed contraceptive coverage laws (both equity and no-cost coverage) have a provision for exemptions, but the laws vary from state to state and only apply to fully insured plans.  This means that there may be a conflict between the state and federal requirements when it comes to religious exemptions.  In some states with a contraceptive coverage requirement, some employers who are eligible for an exemption under federal law will not qualify for an exemption under state law (Table 2). Employers in those states will have to have to meet the standards established by their state even though they may qualify for an exemption based on the new federal regulations.  This conflict may set the stage for future litigation.

Table 2: State Requirements for No-Cost Contraceptive Coverage
StateDate Effective Applies to Coverage required without cost sharing Exemptions allowed
  Private plans Medicaid With RX all FDA approved OTC Vasectomy Religious Moral
CaliforniaJanuary 2015 X MCOs X Narrowly defined nonprofit religious employers None
IllinoisJanuary 2017 X X X
except male condoms
Any employer, or insurer with a religious objection Any employer, or insurer with a moral objection
MarylandJanuary 2018 X X X X X Religious organizations if the coverage conflicts with the organization’s bona fide religious beliefs and practices None
MaineJanuary 2019 X X Narrowly defined nonprofit religious employers None
NevadaJanuary 2018 X X X Insurers affiliated with a religious organization None
New YorkAugust 2017 X X Narrowly defined nonprofit religious employers* None
OregonAugust 2017 X X X Narrowly defined nonprofit religious employers None
VermontOctober 2016 X X – and all other public health assistance programs X X None None
NOTES: *Requires the insurer to offer a rider to policyholders so that women will have contraceptive coverage.
SOURCE: Kaiser Family Foundation analysis of state laws and regulations.

Conclusion

The Trump Administration’s new regulations substantially expand the exemption to nonprofit and for-profit employers, as well as to private colleges or universities with religious or moral objections to contraceptive coverage. It is unknown how many of these employers and colleges will maintain coverage through the accommodation as before and how many will now opt for the exemption leaving their students, employees and dependents without no-cost coverage for the full range of contraceptive methods. As a result of the new regulation, choices about coverage and cost-sharing will be made by employers and private colleges and universities that issue student plans. For many women, their employers will determine whether they have no-cost coverage to the full range of FDA approved methods.  Their choice of contraceptive methods may again be limited by cost, placing some of the most effective yet costly methods out of financial reach.

You can read the original article here.

Source:

Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/


Employer Premiums Rise Nearly 7% in 2017; Employees Absorb More of the Health Insurance Cost

On October 26th, UBA released the following press release on the UBA Health Plan Survey:


Increased prescription drug costs for employees with 5- and 6-tier plans; increased out-of-network deductibles and out-of-pocket maximums, especially for singles; self-funding on the rise

Premium renewal rates (the comparison of similar plan rates year over year) for employer sponsored health insurance rose an average of 6.6%—a significant increase from the five-year average increase of 5.6%, according to the 2017 United Benefit Advisors (UBA) Health Plan Survey, released today. Two states saw record premium increases: Connecticut saw a 24% increase in premiums in 2017, up to $655 from $530; New York also saw a large increase of 14%, up to $712 in 2017 over $624 in 2016.

On the other side, some states saw decreases in premiums, such as Arizona and Washington which saw 2% and 10% decreases, respectively.

Percent Premium Increase Over Time

Average employee premiums for all employer-sponsored plans rose from $509 in 2016 for single coverage to $532 in 2017 and from $1,236 to $1,272 for family coverage (a 4.5% and 3% increase respectively). Average annual total costs per employee increased from $9,727 to $9,935. However, the employee share of total costs rose 5% from $3,378 to $3,550, while the employer’s share rose less than 1%, from $6,350 to $6,401.

“Premiums have been holding relatively steady the last few years. And while this year’s increases are not astronomical, their departure from the trend does warrant attention. To mitigate these rising costs, employers are shifting more premium onto employees, offering more lower-cost consumer directed health plans (CDHPs) and health maintenance organization (HMO) plans, increasing out-of-network deductibles and out-of-pocket maximums, and leveraging continued extensions on the ability to “grandmother,” says Peter Weber, President of UBA. “We’ve also seen reductions in prescription drug coverage to defray increasing costs even further.”

Prescription Drug Plans—For a second year, prescription drug plans with four or more tiers are exceeding the number of plans with one to three tiers. Almost three-quarters (72.6%) of prescription drug plans have four or more tiers, while 27.4% have three or fewer tiers. Even more surprising is that the number of six-tier plans has surged, accounting for 32% of all plans, when only 2% of plans were using this design only a year ago.

“While employers chose to hold contributions, copays and in-network benefits steady, they dramatically shifted prescription drug costs to employees. By increasing tiering and adding coinsurance (vs. copays), employers were able to contain costs,” says Weber.

Out-of-Pocket Costs—Median in-network deductibles for singles and families across all plans remain steady at $2,000 and $4,000, respectively. Single out-of-network median deductibles saw a 13% increase in 2016, and a 17.6% increase in 2017, from $3,400 to $4,000. Both singles and families are facing continued increases in median in-network out-of-pocket maximums (up by $560 and $1,000, respectively, to $5,000 and $10,000).

Self-Funding—The number of employers using self-funding grew 48% for employers with 25 to 49 employees in 2017 (5.8% of plans), and 13.4% for employers with 50 to 99 employees (9.3% of plans).

Overall, 12.8% of all plans are self-funded, up from 12.5% in 2016, while almost two-thirds (60.9%) of all large employer (1,000+ employees) plans are self-funded.

“Self-funding has always been an attractive option for large groups, but we see self-funding becoming increasingly desirable to all employers as a way to avoid various cost and compliance aspects of health care reform,” says Weber. “For small employers with healthy populations, self-funding may be particularly attractive since fully insured community-rated plans under the ACA don’t give them any credit for a healthy group.”

The 2017 UBA Health Plan Survey Executive Summary is available now at http://bit.ly/2017UBASurvey. For interviews, contact Carina Sammartino, Media Relations, csammartino (at) hrmarketer.com or 760-331-3547.

About the 2017 UBA Health Plan Survey
The 2017 UBA Health Plan Survey contains the validated responses of 20,099 health plans and 11,221 employers, who cumulatively employ over two and a half million employees and insure more than five million total lives. While other surveys primarily target large employers, the focus of the UBA survey is to report results that are applicable to the small and mid-size companies that represent the overwhelming majority of the nation’s employers, while also including a mix of large companies in rough proportion to their actual prevalence, nationally. This is an important distinction compared to other national surveys.

You can read the original article here.

Source:

Mukhtar G. (26 October 2017). "Employer Premiums Rise Nearly 7% in 2017; Employees Absorb More of the Health Insurance Cost" [Web Blog Post]. Retrieved from address http://blog.ubabenefits.com/news/employer-premiums-rise-nearly-7-in-2017-employees-absorb-more-of-the-health-insurance-cost


IRS Releases Draft Forms and Instructions for 2017 ACA Reporting

Here are the latest updates in ACA Reporting, including the released IRS draft forms and instructions.


Read the original article here.

Source:

Capilla D. (5 October 2017). "IRS Releases Draft Forms and Instructions for 2017 ACA Reporting" [Web Blog Post]. Retrieved from address http://blog.ubabenefits.com/irs-releases-draft-forms-and-instructions-for-2017-aca-reporting-1

 

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees.

Reporting is required by employers with 50 or more full-time (or full-time equivalent) employees, insurers, or sponsors of self-funded health plans, on health coverage that is offered in order for the Internal Revenue Service (IRS) to verify that:

  • Individuals have the required minimum essential coverage,
  • Individuals who request premium tax credits are entitled to them, and
  • ALEs are meeting their shared responsibility (play or pay) obligations.

2017 Draft Forms and Instructions

Draft instructions for both the 1094-B and 1095-B and the 1094-C and 1095-C were released, as were the draft forms for 1094-B1095-B1094-C, and 1095-C. There are no substantive changes in the forms or instructions between 2016 and 2017, beyond the further removal of now-expired forms of transition relief.

In past years the IRS provided relief to employers who make a good faith effort to comply with the information reporting requirements and determined that they will not be subject to penalties for failure to correctly or completely file. This did not apply to employers that fail to timely file or furnish a statement. For 2017, the IRS has unofficially indicated that the “good faith compliance efforts” relating to reporting requirements will not be extended. Employers should be ready to fully meet the reporting requirements in early 2018 with a high degree of accuracy. There is however relief for de minimis errors on Line 15 of the 1095-C.

The IRS also confirmed there is no code for the Form 1095-C, Line 16 to indicate an individual waived an offer of coverage. The IRS also kept the “plan start month” box as an optional item for 2017 reporting.

Employers must remember to provide all printed forms in landscape, not portrait.

When? Which Employers?

Reporting will be due early in 2018, based on coverage in 2017.

For calendar year 2017, Forms 1094-C, 1095-C, 1094-B, and 1095-B must be filed by February 28, 2018, or April 2, 2018, if filing electronically. Statements to employees must be furnished by January 31, 2018. In late 2016, a filing deadline was provided for forms due in early 2017, however it is unknown if that extension will be provided for forms due in early 2018. Until employers are told otherwise, they should plan on meeting the current deadlines.

All reporting will be for the 2017 calendar year, even for non-calendar year plans. The reporting requirements are in Sections 6055 and 6056 of the ACA.

 

For an at-a-glance chart of all reporting requirements, as well as information on penalties for failure to file, 6055 requirements and instructions for certain boxes/lines on 1095C, request UBA’s ACA Advisor, “IRS Releases Draft Forms and Instructions for 2017 ACA Reporting“.

 

Read the original article here.

Source:

Capilla D. (5 October 2017). "IRS Releases Draft Forms and Instructions for 2017 ACA Reporting" [Web Blog Post]. Retrieved from address http://blog.ubabenefits.com/irs-releases-draft-forms-and-instructions-for-2017-aca-reporting-1


HRL - Employees - Happy

Who’s using what in P&C insurance

With the emergence of 21st century technology, there are bountiful risks for the cyber lives of millions. In this article written by PROPERTYCASUALTY360, learn how different companies grow to combat the threat of employer risk.

You can read the original article here.


Guidewire Software, Inc. has entered into a definitive agreement to acquire Cyence, a software company that applies data science and risk analytics to enable P&C insurers to grow by underwriting “21st century risks” that have gone underinsured or uninsured. These emerging risks include cyber, reputation, and new forms of business interruption risk. “As traditional actuarial approaches struggle to address the unique characteristics of emerging risks like cyber, Cyence’s next-generation approach will enable insurers to broaden the scope and value of the products their policyholders need,” , Guidewire Software CEO and Co-Founder Marcus Ryu said in a press release.

In other news from Guidewire: MetLife Auto & Home has begun deploying Guidewire’s InsurancePlatform™ in a new cloud environment for customers using its MetLife Auto & Home MyDirect portal. MetLife Auto & Home is the first P&C insurer in the United States to offer a 100-percent digital experience from quoting to claim service. Rollout of the platform is expected to continue over the next several quarters.

Hearsay Systems recently announced a strategic alliance with Microsoft to help financial services firms empower advisors to be both high-tech and high-touch at scale in the digital age. The companies will focus on addressing the specific challenges faced by financial institutions, including the need for compliant advisor-client engagement technology that will enable advisors to better manage client relationships and grow business. The alliance will bring together the data-driven relationship insights from Microsoft Dynamics 365 with the financial industry-specific workflows, data and compliance capabilities from Hearsay, allowing advisors to more effectively acquire, convert and deepen client relationships.

Allianz Global Corporate & Specialty® (AGCS) has teamed up with Silicon Valley-based software company Zeguro, whose mission is to simplify and streamline cyber security and risk management  in small to medium-sized businesses (SMBs). Through its easy-to-use platform, Zeguro will serve as a virtual Chief Information Security Officer (CISO) to those who purchase Allianz’s cyber insurance coverage to further manage their cyber exposure and decrease the overall risk of financial loss following a cyberattack.

Accenture and Duck Creek Technologies recently teamed up to create several new digital and emerging technology solutions for P&C insurers that are designed to improve efficiency and value. The companies have integrated Accenture’s IoT and analytics technologies with Duck Creek’s core platform and launched a blockchain proof-of-concept for medical bill auditing. “These new tools are the product of our focus on providing a new generation of digital solutions to our insurance clients working in collaboration with our joint venture partners,” Cindy DeArmond, managing director and P&C Core Platforms Lead for Accenture in North America, said in a press release.

Louisiana-based Aparicio Walker & Seeling, Inc. (AWS Insurance) is live on TechCanary’s insurance platform replacing its outdated legacy agency management system.  TechCanary’s breadth and depth of insurance functionality built in Salesforce and flexibility to easily customize it further were key to the decision.

Speedpay, Inc., a Western Union company, and Nordis Technologies recently announced an alliance to offer cloud-based customer communications management services to Speedpay clients. This strategic agreement provides current and future Speedpay clients with the opportunity to add Expresso®, an easy-to-use, self-service application to organize, automate and execute print and electronic communications. Nordis also delivers print/mail and email production services, thus enabling a seamless end-to-end communications solution.

 

You can read the original article here.

Source:

PropertyCasualty360 (9 October 2017). "Who’s using what in P&C insurance" [Web Blog Post]. Retrieved from address http://www.propertycasualty360.com/2017/10/09/whos-using-what-in-pc-insurance-oct-9-2017?t=agency-technology?ref=channel-news


High-Performing ACA Navigators Mystified By Deep Cuts Less Than Year After Being Touted As ‘Superstars’

What's the latest on the effects of President Trump's executive order on health care? We pulled this article from Kaiser Health News, which includes multiple sources for information. Check them out and stay up-to-date with us!


You can read the original article here.

Source:

Kaiser Family Foundation (10 October 2017). "High-Performing ACA Navigators Mystified By Deep Cuts Less Than Year After Being Touted As ‘Superstars’" [Web Blog Post]. Retrieved from address https://khn.org/morning-breakout/high-performing-aca-navigators-mystified-by-deep-cuts-less-than-year-after-being-touted-as-superstars/

 

“We have yet to receive any explanation of the cut. We have met or exceeded every one of our performance metrics. There was never any feedback that gave us any indication that we were not going to receive the same amount,” says Lisa Hamler-Fugitt, the executive director of the Ohio Association of Foodbanks. The Trump administration slashed funding for theses navigators by more than 40 percent nationally, with some places seeing cuts of nearly 90 percent.

The New York Times: Trump’s Cuts To Health Law Enrollment Efforts Are Hitting Hard
Michigan Consumers for Health Care, a nonprofit group, has enrolled thousands of people in health insurance under the Affordable Care Act and was honored last year as one of the nation’s top performers — a “super navigator” that would serve as a mentor to enrollment counselors in other states. So the group was stunned to learn from the Trump administration that its funds for assisting consumers ahead of the open enrollment period that begins Nov. 1 would be cut by 89 percent, to $129,900, from $1.2 million. (Pear, 10/9)
Meanwhile, in other health law news —
The Hill: Trump Could Make Waves With Health Care Order 
President Trump's planned executive order on ObamaCare is worrying supporters of the law and insurers, who fear it could undermine the stability of ObamaCare. Trump’s order, expected as soon as this week, would allow small businesses or other groups of people to band together to buy health insurance. Some fear that these Association Health Plans (AHPs) would not be subject to the same rules as ObamaCare plans, including those that protect people with pre-existing conditions. (Sullivan, 10/10)
Politico: Republicans Privately Admit Defeat On Obamacare Repeal
For the first time, rank-and-file Republicans are acknowledging Obamacare may never be repealed. After multiple failures to repeal the law, the White House and many GOP lawmakers are publicly promising to try again in early 2018. But privately, both House and Senate Republicans acknowledge they may never be able to deliver on their seven-year vow to scrap the law. (Haberkorn, 10/9)
You can read the original article here.Source:Kaiser Family Foundation (10 October 2017). "High-Performing ACA Navigators Mystified By Deep Cuts Less Than Year After Being Touted As ‘Superstars’" [Web Blog Post]. Retrieved from address https://khn.org/morning-breakout/high-performing-aca-navigators-mystified-by-deep-cuts-less-than-year-after-being-touted-as-superstars/


HRL - Office - Collaboration - Write - Paper

Better risk management means balancing old, new skills

What changes are happening within the P&C industry? Read this informative article written by  STEVEN R. CULP  and DUNCAN BARNARD of Property Casualty 360 degrees to find out!

You can read the original article here.


The P&C industry is undergoing fundamental change, with significant consequences for the risk function. New approaches to data, the workforce, partners and customers are changing the way insurers operate.

The stakes are high, and with interest rates low, revenue streams are under threat while new competitors are entering from all sides.

At the same time, insurers are encountering new obstacles — from regulatory uncertainty to reduced demand among millennials.  The Internet of Things, autonomous vehicles and other major shifts present major challenges along with large opportunities.

P&C insurers and insurance professionals can use these AI tools right now to run smarter, faster — and ahead of...

To survive — let alone thrive — insurers need to evolve. The scale of the evolution could be challenging, but many of the changes that are needed should add significant long-term value. For example, the availability of real-time data allows P&C insurers to think about new products and propositions to unlock predictive and opportunistic strategies.

 

Insurers are also rethinking their relationships with all stakeholders, becoming a "partner" to customers, brokers and other intermediaries while establishing deeper ties in adjacent industries such as automotive and home security. An openness to new technologies also demands a broader ecosystem of supply partners, including technology companies, insurtech firms, venture capitalists and digital specialists.

As we have done in alternate years since 2009, Accenture conducted extensive research in 2017 among nearly 500 global risk management executives in the financial services industry, including 190 in insurance.

We wanted, in part, to understand how insurers view the challenges facing the risk management function. We found that P&C insurers are facing the world with a bit more confidence than their life insurance counterparts. For example, only 61 percent of P&C respondents saw balancing the responsibilities for control and compliance with the need for effective customer service as a major impediment to effectiveness, versus 84 percent of insurers. And only 65 percent of P&C respondents reported being hampered by shortages of skills in new and emerging technologies, versus 71 percent of life insurers.

However, while there were some differences from sector to sector, we found that both P&C and life insurers are taking a more progressive approach to risk management when compared to our earlier research. They are investing to develop their risk functions in three key areas

Innovation is everywhere in insurance.

Innovation is everywhere in insurance. (Photo: iStock)

Harnessing digital innovation

Advances in big data and analytics are helping insurers better understand risk, build stronger predictive models and tailor customer relationships to suit personal preferences and risk attitudes.  At the same time, robot brokers are on the rise, new platforms are providing micro-pooling “social insurance” models, and sensors allow insured cargo to report every bump, scrape and drop impact it endures in transit. In parallel, some of the most transformative technologies are being implemented deep in the back offices of the world’s leading insurers.

P&C insurers and insurance professionals can use these AI tools right now to run smarter, faster — and ahead of...

The cloud is a great example. Our 2017 Global Risk Management Study finds that cloud technology is virtually ubiquitous—91 percent of insurers are using it — but just 26 percent are highly proficient in using cloud within their organization, 36 percent are not using it to its full potential, and 29 percent are only just introducing it. Respondents want to improve efficiency in response to cost pressures, and cloud is the top choice in this regard, with 77 percent indicating their risk function uses it to reduce costs.

Balancing old and new skills

New tools and processes change how risk teams interact with the business, alliances, regulators, customers and other external stakeholders, requiring new skills and a better balance of attributes across teams. Beyond quantitative skills, the risk management function needs to be able to deliver value by providing economic insights, generating new ideas and building strong relationships throughout the organization in pursuit of the overall strategic objectives.

To support these goals, some insurers are bringing staff into the risk function from other areas of the business to enhance credibility and facilitate relationships. Others are hiring from diverse disciplines, including economics, the law and engineering. There are few professionals who possess every skill the risk function needs. From general quantitative competencies to technology acumen, industry knowledge, niche risk specialties, communication skills, creativity and management experience, candidates with the whole package are extremely rare.

Integrating across the business

Currently, 54 percent of insurance respondents say there is limited coordination between risk management activities at the local level and the group level. While some aspects of centralization are desirable to enable a more aggregated and consistent picture for analysis and evaluation, the reality is that risk exists everywhere in the business and risk professionals need to be engaged throughout the business — not only at an aggregate level.

Central frameworks and tools help to provide a more standardized and coordinated response to regulation, a consistent set of rules for managing the portfolio of risks and the capability to perform complex and high-value calculations to measure risk exposure, liquidity and solvency. But decentralization is also valuable because local or specialized teams can focus on local regulatory requirements and market-specific topics. Any effective risk management function must be able to exist locally and centrally, being close to the business and connected across the organizational structure to manage the overall portfolio, including strategic and emerging risks.

As the study results indicate, the nature of risk is changing. It is up to P&C firms and their risk management functions to create and continually develop a dedicated emerging-risk working group that can identify and evaluate the nature of emerging risks and their potential impacts. That may be the best way to address the constant and disruptive change confronting the industry.

 

You can read the original article here.

Source:

Culp S., Barnard D. (6 October 2017). "Better risk management means balancing old, new skills" [Web Blog Post]. Retrieved from address http://www.propertycasualty360.com/2017/10/06/better-risk-management-means-balancing-old-new-ski?t=commercial-business%3Fref%3Dchannel-feature&page=2


HRL - Man - Working - Laptop

Using data to identify high-intent consumers

Does your company struggle with acquiring high performing leads? Check out this article from Property Casualty 360 degrees written by JAIMIE PICKLES.

You can read the original article here.


For years, insurance companies and agents have acquired third-party internet leads as an efficient way to supplement their own lead generation efforts. But with the shift toward digital engagement and increasing regulatory compliance concerns, acquiring high performing leads has become a much more complicated venture.

According to a recent study by J.D. Power, 74% of auto insurance consumers use insurance brand or aggregators websites for obtaining quotes and information. This is something that holds true across almost all lines of insurance.

Regardless of device, the preferred platform for shopping is now digital.

But while brand websites generate a percentage of insurance leads, more consumers are choosing the choice model that internet lead generators and aggregators offer to research and obtain quotes. This is because more consumers prefer to have access to what they perceive as independent and unbiased sources for information and quotes.

 

Mitigate TCPA compliance risk

Compliance with the Telephone Consumer Protection Act (TCPA) has become more of a priority for insurance brands and their partners over the past few years. TCPA lawsuits filed by consumers are on the rise — growing by a factor of 1,273 percent since 2010 — and a number of large insurance brands have been part of multimillion-dollar TCPA settlements.

For example, in May 2017, a Florida-based insurer settled a class action TCPA lawsuit for $4.25 million. And that does not include the court costs and legal fees or the cost to counter bad the bad PR and lost brand reputation from the case.

Knowing definitively that a consumer has given consent to be contacted is a must. Ted Todd Insurance is a multi-office agency in Florida which generates leads on its own website and buys online leads from third party lead generators. They assure TCPA compliance by using a SaaS-based solution to track and verify consumer consent.

CEO Charley Todd says, "the technology tracks and assures the existence of the consumer’s consent, delivering a positive first experience for every new customer, and provides persuasive evidence in the event of a consumer complaint or lawsuit."

 

Analyze the right data

With the overabundance of data that insurance brands have, from internal and external sources, it is not always easy to make sense of it all. Even with a sophisticated data science and analytics program, the key is getting access to the right data at the right time, to help optimize your marketing programs.

In the case of customer acquisition, that begins with having access to data that you can  use to help score, prioritize and route higher-performing leads. By knowing the origin and history of your leads, you’ll be able to mitigate TCPA compliance risk and prioritize selection of and engagement with higher-intent consumers.

The majority of the top ten insurance companies in the United States are doing just that — connecting the dots and using sophisticated technology and data — to gain real-time intelligence into the origin, history and intent of the leads they are acquiring. Such solutions enable insurance companies and agents to follow consumers in real time on their buying journeys until the end when consumers purchase a policy, helping insurers observe and access behavioral data which they can use to analyze the intent of the consumer.

When marketers gain the ability to identify and take action on consumer behavioral data, buying low-intent leads is no longer part of the "cost of doing business" in lead management and analysis. Brands that leverage these insights gain efficiencies and can better focus their precious time and budgets on productive leads.

 

Optimize lead acquisition and marketing

In implementing technology solutions, here are five tips to supercharge your lead generation.

  1. Know the age of your leads. If you’re measuring speed-to-lead from the moment you received a lead post, you are missing a key data point. It’s not about when you received the lead, but rather when the consumer actually submitted the inquiry.
  1. Be proactive in avoiding fraudulent leads and those that are not TCPA compliant. Consumers who didn’t fill out the form or who filled it out six months ago have no intent to buy from you. Also, these leads put you at risk for TCPA complaints. Only purchase leads that are TCPA compliant. You don’t want to damage your brand and reputation, or take on the costs if you are sued by a consumer. You need a vendor who can help you identify, in real-time, that your leads are compliant and provide persuasive proof that a consumer gave consent to be contacted.
  1. Don’t get dupedMany marketers assume that a duplicate is the result of recycled data. They think that the same consumer means it is the same inquiry. In fact, it could very likely be the same consumer with a brand new inquiry, which is actually indicative of a high-intent consumer. Know the difference.
  1. Understand if leads are shared vs. exclusive. Know if your leads are being shared with some of your competitors. If they are, you need to determine how many other competitors that lead is being shared with and whether you are the first or last to receive it.
  1. Right price your leads. If you find a vendor who will help you identify low intent leads, you can reallocate that spend and pay more for higher intent leads. This is a key strategy to quickly and notably improve lead conversion.

 

You can read the original article here.

Source:

Pickles J. (9 October 2017). "Using data to identify high-intent consumers" [Web Blog Post]. Retrieved from address http://www.propertycasualty360.com/2017/10/09/using-data-to-identify-high-intent-consumers?ref=hp-news


SHRM Connect: Mental Health Issues in the Workplace - What Would You Do?

Are you a SHRM member and/or HR professional? In this article from SHRM by Mary Kaylor, she dives into what SHRM Connect is and how you can get involved!

You can read the original article here.


SHRM Connect is an online community where SHRM members can ask questions and get answers on a variety of HR topics. It’s a great place to network with other HR professionals and share solutions.

The conversation topics range from “HR Department of One” to Employment Law, are always insightful, and deal with some of the most pressing issues that HR professionals face in the workplace today.

While some of the conversations take on a more serious tone, others will deliver a bit of comic relief -- and on Fridays, I’ll be highlighting a conversation or two in hopes that you’ll take some time to visit. You may want to "lurk"… perhaps respond, but you’ll always learn something.

It’s a great community and I highly recommend checking it out.

While May is officially Mental Health Awareness month, HR must deal with employee mental health issues, and their effects on the workplace, all year long. This week’s highlighted conversations involve a few different scenarios. What would you do?

Subject: Self Harming

In the General HR area, a poster asks for advice on how to handle about a perceived case of self harming:

We have a new(er) employee that was observed by another employee to have cuts up and down her arm. The employee brought it to our attention out of concern. We thanked the employee and asked that she keep it confidential. We do not offer an EAP.

My thought is to speak with the employee that is self harming and let her know what was observed and just check in and see if she is ok. If she says everything is good, just leave it at that. If she mentions something is going on...or if she needs to seek treatment etc, go down that road.

For those of you who have experience with this, is this an ok approach? Is it best to not address it with the employee? Any other resources, since an EAP is not an option?

Thanks!

To read/respond to this conversation, please click here.

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Subject: Alcohol and Discussion of Suicide

In the General HR area, another poster asks for advice on monitoring an employee:

Know of an employee with an alcohol problem who has gone through treatment and released to return to work by the treating facility. Prior to admittance, she talked about suicide. What follow-ups by the employer would you suggest, other than a monitoring agreement for a period of time?

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Subject: WWYD

In the General HR area, yet another poster is wondering how others would handle a case of an employee with anxiety – and lots of absences:

I was hoping to get opinions on this situation, and I believe I know the correct way to follow up but I was interested to see what others would say.

We hired a non-exempt employee in July of this year. Since that time, this employee had 6 unexcused absences, and two preplanned days off. We accrue and allow employees to use their vacation leave from day one, and this employee essentially used all the time throughout the end of the year. Sick time is not available for employees until they've been employed for 90 days. This employee stated about a month ago after one of their absences that they has very bad anxiety, but does not have insurance they are unable to get medication or see a doctor. This employee never asked for any type of accommodation, and we actually even provided resources to assist with their anxiety. All of the times they called out after that conversation were simply because "i feel bad and can't come in". I received copies of the texts and they're pretty vague. They called out again on Tuesday after having a pre-planned half day off on Friday, and we decided to give the employee a final written warning with a 60 day timeframe to improve their attendance. Unfortunately the employee called out again yesterday with a very vague explanation and stated that 'I still feel pretty bad'.

After speaking with the managers over this department, we decided to terminate employment due to excessive absences. I explained that to the employee in the phone call and gave them an opportunity to explain themselves. I tried to create a dialogue in the event that we were missing something, but I just got 'heh. oh okay.'

Now this morning, I received a page long email stating this employee has rights under HIPAA that they didn't have to disclose the anxiety disorders that they have (we never asked, they disclosed it voluntarily). Also stated that they would have expected a written warning for their excessive absenteeism but not the fact we separated employment. They go on to blame us for other areas of lacking (training, etc) but said we amplified the anxiety problem because of the amount of training we were giving them.

I feel like this employee is looking for anyone to blame. It's an unfortunate situation but as an employer, we cannot read employees minds. If an employee needs an accommodation due to a medical condition, aren't they supposed to request it? How are we supposed to help with vague callouts?

Thoughts?

You can read the original article here.

Source:

Taylor M. (22 September 2017). "SHRM Connect: Mental Health Issues in the Workplace - What Would You Do?" [Web Blog Post]. Retrieved from address https://blog.shrm.org/blog/shrm-connect-mental-health-issues-in-the-workplace-what-would-you-do


What You Need to Know about Health Flexible Spending Accounts

Are you having a hard time figuring out how a FSAs works? Take a look at this great article from our partner, United Benefit Advisors (UBA) by Danielle Capilla and found out everything you need to know about FSAs.


A health flexible spending account (FSA) is a pre-tax account used to pay for out-of-pocket health care costs for a participant as well as a participant's spouse and eligible dependents. Health FSAs are employer-established benefit plans and may be offered with other employer-provided benefits as part of a cafeteria plan. Self-employed individuals are not eligible for FSAs.

Even though a health FSA may be extended to any employee, employers should design their health FSAs so that participation is offered only to employees who are eligible to participate in the employer's major medical plan. Generally, health FSAs must qualify as excepted benefits, which means other nonexcepted group health plan coverage must be available to the health FSA's participants for the year through their employment. If a health FSA fails to qualify as an excepted benefit, then this could result in excise taxes of $100 per participant per day or other penalties.

Contributing to an FSA

Money is set aside from the employee's paycheck before taxes are taken out and the employee may use the money to pay for eligible health care expenses during the plan year. The employer owns the account, but the employee contributes to the account and decides which medical expenses to pay with it.

At the beginning of the plan year, a participant must designate how much to contribute so the employer can deduct an amount every pay day in accordance with the annual election. A participant may contribute with a salary reduction agreement, which is a participant election to have an amount voluntarily withheld by the employer. A participant may change or revoke an election only if there is a change in employment or family status that is specified by the plan.

Per the Patient Protection and Affordable Care Act (ACA), FSAs are capped at $2,600 per year per employee. However, since a plan may have a lower annual limit threshold, employees are encouraged to review their Summary Plan Description (SPD) to find out the annual limit of their plan. A participant's spouse can put $2,600 in an FSA with the spouse's own employer. This applies even if both spouses participate in the same health FSA plan sponsored by the same employer.

Generally, employees must use the money in an FSA within the plan year or they lose the money left in the FSA account. However, employers may offer either a grace period of up to two and a half months following the plan year to use the money in the FSA account or allow a carryover of up to $500 per year to use in the following year.

See the original article Here.

Source:

Capilla D. (2017 August 29). What you need to know about health flexible spending accounts [Web blog post]. Retrieved from address http://blog.ubabenefits.com/what-you-need-to-know-about-health-flexible-spending-accounts-1