The benefits issue that costs employers big: Ineligible dependents on company plans

Are you paying insurance premiums for dependents who are ineligible for your company health plan? Almost 10 percent of enrolled dependents are ineligible for the programs they are enrolled in. Read on to learn more.


Are you paying insurance premiums for people who aren’t qualified to be on your company plan?

For some employers, too often the answer is “yes.”

In our experience, we find that nearly 10% of dependents enrolled in employee health and welfare plans are not eligible to be in the program. And for a company with a couple of hundred employees that spends around $2 million a year on benefits, ineligible dependents can become a significant financial issue.

When employers pay for ineligible dependents, costs increase for them and employees. Unfortunately, it’s an all-too-common issue that employers need a solid strategy to combat.

So how do ineligible dependents get enrolled in the first place? There are a couple of common ways that employers end up paying health insurance premiums for ineligible dependents. The most basic factor is a change in a person’s situation — children pass the age of 26, spouses get jobs, people get divorced, etc. — and the employee is unaware of the need to notify the plan sponsor. Most often, these situations arise because the employer doesn’t have a process in place.

But some situations are more nefarious: An employee mischaracterizes someone as a dependent. They may claim that a nephew is a son, or that they’re still married to an ex-spouse. In either of these situations, the employer loses.

Prevent ineligible dependents with best practices

Prevent paying for ineligible dependents by putting into place best practices that begin when a new employee joins the company.

During onboarding, investigate each potential plan member when the employee applies for insurance coverage. That means seeking documentation — such as marriage certificates and birth certificates — to verify that a person is, in fact, married, or that their kids are their kids and not someone else’s. Following these processes at the outset prevents the awkwardness of having to question employees about their various family relationships. Nobody wants to ask a colleague if the divorce is final yet.

To make it easy for employees to verify everyone’s eligibility, provide access to a portal where they can upload scans or images of relevant documents. This will also make it easier to track—and keep track of—onboarding documents and dependent audits when the time comes.

Once this best practice is established, it’s important to conduct periodic dependent eligibility audits, as required by ERISA. The employer can conduct an audit or hire an external auditor. This decision is usually driven by the size of the workforce.

The most logical time to conduct an audit is during benefit enrollment. Employees are already considering options for the next plan year, and they likely won’t be confused by the need to submit verifying documents. (During this exercise, it’s also a good idea to ask plan participants to verify beneficiaries on employer-provided life insurance.)

Some employers — again, depending on the size of the workforce — will conduct random sample audits of 20-25% of their employee population. Obviously, the larger the sample size, the better. Benefits administration platforms typically streamline this process.

What happens when employers identify an ineligible dependent?

Many employers offer workers an amnesty period during which an employee can come forward to say they have someone that should be taken off the plan. If the plan sponsor identifies an ineligible dependent, employees are typically offered a one-time pass. Then, they must sign an affidavit attesting that they can be terminated if it happens again.

If the employer has processed insurance claims for an ineligible dependent, they can declare fraud and seek back payment of claims payouts. Again, most in this situation prefer a more benevolent approach and will ask the employee to make monthly differential payments until the account is even. Conducting regular dependent eligibility audits as part of the benefits administration process needs to be handled with finesse for the good of organizational culture.

Some employers may shy away from conducting audits out of concern for creating awkward situations. But frankly, it’s the plan sponsor’s job to help them navigate the waters, educate them and keep them engaged in the process by becoming their best advocates. This will not only help enhance the efficiency and accuracy of employee benefit offerings, but it will result in a smoother ride for everyone involved.

Ensuring that a health and welfare benefits program follows eligibility best practices is the responsibility of the plan sponsor. But employees have a share in that responsibility, too.

SOURCE: O'Connor, P.(28 November 2018) "The benefits issue that costs employers big: Ineligible dependents on company plans" (Web Blog Post). Retrieved from:


Poor employee health costs employers half trillion dollars a year

Poor employee health costs employers half a trillion dollars each year and almost 1.4 billion in missed work days, according to a recent report from the Integrated Benefits Institute. Read this blog post to learn more.


Poor employee health is costing employers in a big way — to the tune of half a trillion dollars and nearly 1.4 billion days of missed work each year.

That’s according to a new report from the Integrated Benefits Institute, which finds that employees miss around 893 million days a year from illness and chronic conditions, and another 527 million days because of impaired performance due to those illnesses. Those days add up to $530 billion in lost productivity.

“To put this in further context, the cost of poor health to employers is greater than the combined revenues of Apple, Amazon, Microsoft, Netflix, eBay and Adobe,” says Thomas Parry, president of Integrated Benefits Institute, an independent nonprofit that serves more than 1,250 employers including Amazon, Kroger, McDonald’s and Walmart.

The $530 billion price tag is on top of what employers already spend on healthcare benefits. Employers pay $880 billion in healthcare benefits for their employees and dependents, which means that poor health costs amount to “60 cents for every dollar employers spend on healthcare benefits,” according to the study.

“There’s not a CEO or CFO that can placidly accept their business expending the equivalent of almost two-thirds of their healthcare dollars on lost productivity,” Perry says. “Illness costs this country hundreds of billions of dollars, and we can no longer afford to ignore the health of our workforce.”

Employers invest in healthcare benefits to maintain a productive workforce. But this new study suggests that more needs to be done to keep employees healthy, or strategies need to be put in place to lower spending. Or both.

“It’s critical that employers understand how strategies for managing healthcare spend — such as cost- shifting to employees or ensuring better access and more cost-effective care — can impact the kinds of conditions that drive illness-related lost productivity,” says Brian Gifford, director of research and analytics at IBI.

The study broke down the estimated costs of poor health into several categories:

Wage and benefits (incidental absence due to illness, workers’ compensation and federal family and medical leave): $178 billion.

Impaired performance (attributed to chronic health conditions): $198 billion.

Medical and pharmacy (workers’ compensation, employee group health medical treatments, employee group health pharmacy treatments): $48 billion.

Workers’ compensation other costs (absence due to illness, reduced performance): $25 billion.

Opportunity costs of absence (missed revenues, costs of hiring substitutes, overtime): $82 billion.

For its study, IBI used 2017 data from the U.S. Bureau of Labor Statistics as well as its own benchmarking data from 66,000 U.S. employers.

SOURCE: Paget, S. (20 November 2018) "Poor employee health costs employers half trillion dollars a year" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/poor-employee-health-costs-employers-half-trillion-dollars-a-year?brief=00000152-14a7-d1cc-a5fa-7cffccf00000


What’s in store for voluntary benefits in 2019

What does the New Year have in store for voluntary benefits? Employee purchase programs allow employees to pay for items even if they don't have the funds or credit available. Read this blog post for more 2019 voluntary benefits trends.


Benefit managers are still catching their breath as the curtain closes on this year’s open enrollment season. But smart benefits managers are already evaluating new products and benefit changes for the 2019-2020 season.

Themes around cost-saving strategies concerning healthcare premiums will continue to resonate — but what else will happen in the upcoming year? Voluntary benefits will continue to hold the key for many benefit managers looking to lower costs and maintain value for employees by providing flexibility to a diverse workforce.

Voluntary benefits offer pivotal advantages to employers and employees alike. By offering these programs through an employer, employees often receive better pricing, plan designs and underwriting support compared to what is available on the individual market. Payroll deduction capability and enrollment as part of their normal core enrollment process and portability are also available.

Here are three voluntary benefits to watch in 2019.

Employee purchase programs.

Nearly one-quarter of all Americans do not have adequate emergency savings, according to a survey by consumer financial services company Bankrate. This means that if they need to make a significant purchase, they are likely to withdraw a loan from their 401(k) plan.

Employee purchase programs help employees pay for items they may need immediately, but may not have the funds or credit available. These programs generally allow employees to spread out the payments on the purchased products — such as appliances, car tires or computers — over a period of time through payroll deduction. Young employees who are trying to establish credit while managing student loan repayments — and may be strapped for cash — can especially benefit from an employee purchase programs.

Group legal insurance plans.

Group legal plans are not new, but they are still valuable for employees. For a cost that is less than a cup of coffee, group legal plans provide employees with access to attorneys for will preparation, estate planning, dealing with elderly parents, traffic violations, real estate purchases, and document review and preparation. These plans offset the expense of professional legal representation and the time it takes to locate the right representation to handle legal matters.

These plans may be especially valuable to employees who are thinking of buying a house, adopting a child or planning for their estate. Still, group legal insurance plans are available to all employees, and can provide a buffer for workers who may need to navigate identity restoration after a theft or combat an unforeseen traffic ticket. These plans also save employees time and money when the need for a legal professional arises.

Student loan benefits.

Student loan benefits have been one of the hottest topics in voluntary benefits in 2018 and it’s not going away any time soon. An IRS private letter ruling this past August allowed one company to amend its 401(k) plan to allow employer contributions of up to 5% to individuals who contribute at least 2% to their student loan. This may just be the start to more legislation concerning student loan debt solutions.

In the interim, as the tuition debt crisis grows, employers are seeking ways to support their employees. There are several strategies that can be employed.

Some solutions can be offered at no cost, while others have administrative charges and the cost of contributions to factor in. For employers who have the budget, a student loan repayment plan may be the answer. There are many vendors who can partner with an employer to help develop a plan that is designed to meet the company’s goals.

Employers without a budget can seek a student loan solution partner that offers comprehensive educational tools such as written materials, debt navigation tools, FAQs, one-on-one counselors and webinars. Another option is to offer student loan refinancing. These lenders can help employees manage their debt. Even though refinancing is not for everyone, well-vetted student loan refinancing partners should be considered as part of a comprehensive student loan debt solution strategy. Understanding the approval rate is important, as well as whether there are any other incentives, such as a welcome bonus, that may be applied to the loan principal.

SOURCE: Marcia, P. (28 November 2018) "What’s in store for voluntary benefits in 2019" (Web Blog Post). Retrieved from: https://www.benefitnews.com/opinion/whats-in-store-for-employers-and-voluntary-benefits-in-2019


2019: A Look Forward

A number of significant changes to group health plans have been made since the Affordable Care Act (ACA) was enacted in 2010. Many of these changes became effective in 2014 and 2015 but certain changes to a few ACA requirements take effect in 2019.

 Changes for 2019 

  1. Cost-sharing Limits – Non-grandfathered plans are subject to limitations on cost sharing for essential health benefits (EHB). The annual limits on cost sharing for EHB are $7,900 for self-only coverage and $15,800 for family coverage, effective January 1, 2019.
    • Health plans with more than one service provider can divide maximums between EBH as long as the combined amount does not exceed the out-of-pocket maximum limit for the year.
    • Beginning in 2016, each individual – regardless of the coverage the individual is enrolled – is subject to the self-only annual limit on cost sharing.
    • The ACA’s annual cost-sharing limits are higher than high deductible health plans (HDHPs) out-of-pocket maximums. For plans to qualify as an HDHP, the plan must comply with HDHP’s lower out-of-pocket maximums. The HDHP out-of-pocket maximum for 2019 is $6,750 for self-only coverage and $13,500 for family coverage.
  2. Coverage Affordability Percentages – If an employee’s required contribution does not exceed 9.5 percent of their household income for the taxable year (adjusted each year), then the coverage is considered affordable. The adjusted percentage for 2019 is 9.86 percent.
  3. Reporting of Coverage – Returns for health plan coverage offered or provided in 2018 are due in early 2019. For 2018, returns must be filed by February 28, 2019, or April 1, 2019 (if electronically filed). Individual statements must be provided by January 31, 2019.
    • ALEs are required to report information to the IRS and their eligible employees regarding their employer-sponsored health coverage. This requirement is found in Section 6056. Reporting entities will generally file Forms 1094-B and 1095-B under this section.
    • Every health insurance issuer, self-insured health plan sponsor, government agency that provides government-sponsored health insurance, and any other entity that provides MEC is required to finalize an annual return with the IRS, reporting information for each individual who is enrolled. This requirement is found in Section 6055. Reporting entities will generally file Forms 1094-C and 1095-C under this section.
    • ALEs that provide self-funded plans must comply with both reporting requirements. Reporting entities will file using a combined reporting method on Forms 1094-C and 1095-C.
    • Forms Used for Reporting – Reporting entities must file the following with the IRS:
      1. A separate statement for each individual enrolled
      2. A transmittal form for all returns filed for a given calendar year.
    • Electronic Reporting – Any reporting entity that is required to file 250 or more returns in either section must file electronically on the ACA Information Returns (AIR) Program. Reporting entities that file less than 250 returns can file in paper form or electronically on the ACA Information Returns (AIR) Program.
    • Penalties – Entities that fail to comply with the reporting requirements are subject to general reporting penalties for failure to file correct information returns and failure to furnish correct payee statements. Penalty amounts for failure to comply with the reporting requirements in 2019 are listed below:
Penalty Type Per Violation Annual Maximum Annual Maximum for Employers with up to $5 million in Gross Receipts
General $270 $3,275,500 $1,091,500
Corrected within 30 days $50 $545,500 $191,000
Corrected after 30 days but before August 1 $100 $1,637,500 $545,500
Intentional Disregard $540* None N/A

**Intentional disregard penalties are equal to the greater of either the listed penalty amount or 10 percent of the aggregate amount of the items required to be reported correctly. 

Expected Changes

  1. Health FSA Contributions – Effective January 1, 2018, health FSA salary contributions were limited to $2,650. The IRS usually announces limit adjustments at the end of each year. This limit does not apply to employer contributions or limit contributions under other employer-provided coverage.
  2. Employer Shared Responsibility Regulations – The dollar amount for calculating Employer Shared Responsibility 2 penalties is adjusted for each calendar year. Applicable large employers (ALEs) must offer affordable, minimum value (MV) healthcare coverage to full-time employees and dependent children or pay a penalty. If one or more full-time employees of an ALE receive a subsidy for purchasing healthcare coverage through an Exchange, the ALE is subject to penalties.
    • Applicable Large Employer Status – ALEs are employers who employ 50 or more full-time employees on business days during the prior calendar year.
    • Offering Coverage to Full-time Employees – ALEs must determine which employees are full-time. A full-time employee is defined as an employee who worked, on average, at least 30 hours per week or 130 hours in a calendar month. There are two methods for determining full-time employee status:
      1. Monthly Measurement Method – Full-time employees are identified based on a month-to-month analysis of the hours they worked.
      2. Look-Back Measurement Method – This method is based on whether employees are ongoing or new, and whether they work full time or variable, seasonal or part-time. This method involves three different periods:
        • Measurement period – for county hours of service
        • Administration period – for enrollment and disenrollment of eligible and ineligible employees
        • Stability period – when coverage is provided based on an employee’s average hours worked.
      3. Applicable Penalties – ALEs are liable for penalties if one or more full-time employees receive subsidies for purchasing healthcare coverage through an Exchange. One of two penalties may apply depending on the circumstances:
        • 4980H(a) penalty – Penalty for not offering coverage to all full-time employees and their dependents. This penalty does not apply if the ALE intends to cover all eligible employees. ALEs must offer at least 95 percent of their eligible employees’ health care coverage. Monthly penalties are determined by this equation:
          1. ALE’s number of full-time employees (minus 30) X 1/12 of $2,000 (as adjusted), for any applicable month
          2. The $2,000amount is adjusted for the calendar year after 2014:
          3. $2,080 – 2015; $2,160 – 2016; $2,260 – 2017; $2,320 – 2018
        • 4980H(b) penalty – penalty for offering coverage – ALEs are subject to penalties even if they offer coverage to eligible employees if one or more full-time employees obtain subsidies through an Exchange because:
          1. The ALE didn’t offer all eligible employees coverage
          2. The coverage offered is unaffordable or does not provide minimum value.
          3. Monthly penalties are determined by this equation: 1/12 of $3,000 (as adjusted) for any applicable month
            1. $3,120 – 2015; $3,240 – 2016; $3,390 – 2017; $3,480 – 2018

Contact one of our expert advisors for assistance or if you have any questions about compliance in the New Year.

SOURCES: www.dol.gov, www. HHS.gov, https://www.federalregister.gov/documents/2018/04/17/2018-07355/patient-protectionand-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2019, https://www.irs.gov/e-fileproviders/air/affordable-care-act-information-return-air-program


Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits

Have you heard of predictive analytics? Predictive analytics analyzes current and historical data to make predictions about unknown events. Read on to learn how this technology could be used to help fine-tune employee benefits offerings.


Last year’s World Series between the Houston Astros and the Los Angeles Dodgers came down to a seven-game battle based not only on talent, athleticism and coaching but also on data. Just as Sports Illustrated suggested back in 2014 via predictive data, the Astros were the victors.

The publication of Moneyball: The Art of Winning an Unfair Game spurred not only Major League Baseball teams to deploy predictive analytics, but also businesses to take a harder look at what their data means. It's no longer part of the hype cycle: Statista forecasts (paywall) that the predictive analytics market worldwide will reach $6.2 billion in 2018 and $10.95 billion in 2022.

I believe we are also at a transformational point in improving corporate employee benefits and our employees’ lives by embracing predictive analytics. HR is swimming in rich data. Instead of guesstimating needs across multiple generations of employees, employers can turn to their own data to fine-tune what they are offering as benefits solutions. Companies spend 25-40% of an employee’s salary on benefits. It simply makes strategic and financial sense to get it right.

Bring Employee Benefits Out Of The Dark Ages

Hiring and retaining great talent is at the very soul of almost every company’s strategy. Not surprisingly, more companies have turned to predictive analytics to give them a leg up in recruitment. However, HR benefits have lagged behind. As John Greenwood reported to Corporate Adviser, “More than half of reward and employee benefits professionals see predictive analytics as a game-changer, but 90 percent are still using spreadsheets to manage data, research from the Reward & Employee Benefits Association shows.”

One reason for benefits lagging behind recruitment in adopting predictive analytics is that the way companies choose new benefits varies greatly from business to business. Given that the majority of HR departments keep data in disparate spreadsheets, even if some HR departments conduct employee surveys or historical cost analyses, they often do not integrate the data about their workforce. If a new benefit offering is chosen based on a needs analysis, only some know the “why” behind a request from the workforce. Knowing how many employees are logging into a benefits platform is helpful; market standard benefit utilization reports provide this level of information. Yet they do not give insight into the underlying reason for an employee to utilize a benefit. The user of deeper analytics is required to look deeper into employees' behavior.

We have found firsthand that many HR departments do not have a full understanding of how their employees are utilizing their benefits across the entire offering suite. A one-size-fits-all or a one-off strategy no longer is effective. Companies must understand not only their employees’ needs but also the underlying data related to these needs to provide a valuable benefits offering.

Put Your Existing Data To Use

For the past five years, I have watched our clients glean valuable insights into what the real underlying issues are for their employees and what must be done to address these pressing needs. I also have been watching companies realize that what they thought were the core problems at hand sometimes were not.

For example, one of our national high-tech clients, with over 50,000 benefit-eligible employees, believed that a high number of their employees had children struggling with autism. This belief was initially based on input from some of their employees. After approximately 16 months, the client reviewed the masked utilization data from their benefit platform. The data illustrated that the overwhelming majority of employee families (tenfold) in fact faced challenges associated with youth anxiety, a concern that had never been expressed to HR previously. Once they reviewed what employees were doing within our platform, their results mirrored the National Institute of Mental Health’s report that approximately 31.9% of U.S. children ages 13-18 struggle with anxiety disorders.

Their own data helped them understand much more specifically where their employees’ stress lay, and their HR department was able to focus communications around it.

Getting Started

Mining and viewing use data across all benefits is ideal. This enables an employer to determine if the benefit suite is serving employees effectively. We have found that as quickly as year over year, users' behaviors shift. If a company solely chooses a benefit based on what they saw as most heavily utilized the previous year, they are not being strategic.

For that reason, HR should utilize past and current data to better predict future patterns of need for a truly strategic approach to benefit choice. With this insight, they can make better choices and serve their workforce more effectively.

Given the limitations across many employee benefit vendors today, to start initially:

1. Embrace KPIs. Agree upon them internally, and measure benefit vendors on them.

2. Work with your current vendors to determine what data they provide to support your internal analysis. Ensure you have access to all the data you need, and if not, consider a vendor change.

3. Hold possible new vendors to similar data standards, and create a transparent relationship from the start.

4. Collect current and historical data. Existing vendors can provide this history, so make sure to collect at least 2-3 years of information.

These analytics need to go deeper than basic demographics to show patterns of activity. In order to understand the benefit needs of your workforce, you'll want to analyze trends across multiple data sets: medical, pharmacy, worker's compensation, biometric screenings, utilization patterns, FMLA requests and demographic trends. From there, you can start to pinpoint what your employees need -- and the “whys” behind the needs -- in order to make a measurable impact.

While predictive analytics is still in the nascent phase in the benefits and vendor worlds, the easiest and most proactive thing any employer can do is to focus on other insights vendors can provide related to the workforce and benefit use beyond simple utilization. In doing so, you will be able to support your employees both in their work lives and their personal lives by providing them with the benefits they need to be at their best.

SOURCE: Goldberg, A. (2 October 2018) "Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits" (Web Blog Post). Retrieved from: https://www.forbes.com/sites/forbestechcouncil/2018/10/02/predictive-analytics-will-be-the-silent-game-changer-in-employee-benefits/#26648166e182


Employers Assess Risk Tolerance with Wellness Program Incentives

Are you currently designing your 2019 wellness programs? This year, employers must decide which approach to take on program incentives without EEOC guidance. Read this blog post to learn more.


Employers designing 2019 wellness programs must decide what approach to take on program incentives without Equal Employment Opportunity Commission (EEOC) guidance on the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).

The commission has a Notice of Proposed Rulemaking tentatively slated for January 2019. Last year, the U.S. District Court for the District of Columbia decided the commission's 2016 ADA and GINA wellness regulations were arbitrary and vacated them, effective Jan. 1, 2019.

Employers again are "in the uncomfortable position of not knowing with certainty whether and to what extent they can use incentives as part of a wellness program that involves medical examinations, disability-related inquiries and/or genetic information," wrote Lynne Wakefield and Emily Zimmer, attorneys with K&L Gates in Charlotte, N.C., in a joint statement.

The Society for Human Resource Management (SHRM) "has long advocated for proposals that will ensure consistency between the wellness rules that the EEOC has jurisdiction over, the ADA and GINA, with those provided under the ACA [Affordable Care Act]," said Nancy Hammer, SHRM vice president, regulatory affairs and judicial counsel. "While EEOC's 2016 rulemaking effort adopted the ACA's 30 percent incentive, it added new requirements that would have discouraged employers from providing wellness options for employees. We are hopeful that the EEOC is able to revisit the rules to ensure both consistency with existing rules and flexibility to encourage employers to adopt innovative programs to improve employee health and reduce costs."

ADA and GINA Requirements

Employers have long sought guidance over whether and when wellness program incentives—rewards or penalties for participating in biometric screenings and health risk assessments connected with the programs—comply with the ADA and GINA.

The ADA prohibits employers from conducting medical examinations and collecting employee medical history as part of an employee health program unless the employee's participation is voluntary, noted Ann Caresani, an attorney with Tucker Ellis in Cleveland and Columbus, Ohio.

GINA prohibits employers from requesting, requiring or purchasing genetic information from employees or their family members, unless the information is provided voluntarily.

The EEOC in 2000 asserted that for a wellness program to be voluntary, employers could not condition the receipt of incentives on the employee's disclosure of ADA- or GINA-protected information.

However, in 2016, the commission issued regulations providing that the use of a penalty or incentive of up to 30 percent of the cost of self-only coverage would not render involuntary a wellness program that seeks the disclosure of ADA-protected information. The regulations also permitted employers to offer incentives of up to 30 percent of the cost of self-only coverage for disclosure of information, in accordance with a wellness program, about the manifestation of a spouse's diseases or disorder, Caresani said.

Wakefield and Zimmer noted that the EEOC's 2016 wellness regulations applied to wellness programs that provided incentives tied to:

  • Biometric screenings for employees and spouses.
  • Disability-related inquiries directed at employees, which might include some questions on health risk assessments.
  • Family medical history questions, such as risk-assessment questions that ask about the manifestation of disease or disorder in an employee's family member and/or such questions about the disease or disorder of an employee's spouse.
  • Any other factors that involve genetic information.

Court Actions

The AARP challenged the 2016 rule, arguing that the 30 percent incentives were inconsistent with the voluntary requirements of the ADA and GINA. Employees who cannot afford to pay a 30 percent increase in premiums would be forced to disclose their protected information when they otherwise would choose not to do so, Caresani explained.

While the 30 percent cap was consistent with the Health Insurance Portability and Accountability Act (HIPAA) as amended by the ACA, the AARP said this was inappropriate, as HIPAA and the ADA have different purposes, noted Erin Sweeney, an attorney with Miller & Chevalier in Washington, D.C..

In addition, the change from prohibiting any penalty to permitting one of 30 percent was not supported by any data, according to the AARP.

In the summer of 2017, the U.S. District Court for the District of Columbia held that the EEOC's rule was arbitrary. The court sent the regulations back to the EEOC for further revisions.

In December 2017, the court vacated the 2016 rule after the EEOC initially said that the new rule would not be ready until 2021.

Conservative to Aggressive Approaches

Wakefield and Zimmer observed that employers may take several different approaches as they design wellness programs for next year:

  • No incentives (most conservative approach). These types of wellness programs can still include biometric screening and health risk assessments that employees and spouses are encouraged to complete, but no rewards or penalties would be provided in connection with their completion.
  • Modest incentives (middle-ground approach). A modest incentive is likely significantly less than 30 percent of the cost of self-only coverage, given the court's finding that the EEOC did not provide adequate justification for an incentive level up to 30 percent.
  • Up to 30 percent incentives (more aggressive approach). Although the court did not rule that a 30 percent incentive level would definitely cause a wellness program to be considered involuntary, incentives at this level after 2018 likely will expose employers to lawsuits, they wrote.

Multiple-Point Program

One good way to demonstrate compliance, they noted, is a multiple-point program in which participants engage in different activities and earn an incentive by participating in enough activities apart from biometric screenings, risk assessments or providing their spouse's health information.

For example, an employer could let employees take health care literacy quizzes or offer a program that measures a worker's activity as opposed to fitness, Caresani noted. She said, "Programs that are participatory are probably less effective than outcome-based programs, but they are more popular with employees and are less likely to pose litigation risks."

SOURCE: Smith, A. (1 August 2018) "Employers Assess Risk Tolerance with Wellness Program Incentives" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/risk-tolerance-wellness-program-incentives.aspx


HR’s recurring headache: Convincing employees to get a flu shot

The flu killed roughly 80,000 people last year, according to the Centers for Disease Control. Read this blog post to learn how HR departments are convincing their employees to get a flu shot.


Elizabeth Frenzel and her team are the Ford assembly line of flu shots: They can administer about 1,800 flu shots in four hours.

Frenzel is the director of employee health and wellbeing at the University of Texas MD Anderson Cancer Center, and with 20,000 employees, she is no stranger to spearheading large flu shot programs. The center where Frenzel administers flu shots has roughly a 96% employee vaccination rate. Back in 2006, only about 56% of employees got their shots.

“When you run these large clinics, safety is critically important,” she says.

Problems like Frenzel’s are not unique. Every fall, HR departments send mass emails encouraging employees to get vaccinated. The flu affects workforces across the country, costing U.S. companies billions of dollars in medical fees and lost earnings, according to The National Institute for Occupational Safety and Health. It is not only a cause of absenteeism but a sick employee can put their coworkers at risk. Last year the flu killed roughly 80,000 people, according to the Centers for Disease Control.

Even if an employer offers a flu shot benefit, the push to get employees to sign up for the vaccine can be a two-month slough, with reminder emails going unanswered. Moreover, companies often contend with misconceptions about the shot, such as the popular fallacy that shots will make you sick, running out of the vaccine, and sometimes just plain employee laziness.

In Frenzel’s case, increasing the number of employees who got flu shots weren’t just a good idea, but it was needed to protect the lives of the cancer patients they interact with every day. The most startling fact, she says, was that healthcare workers who interact with patients daily were less likely to get vaccinated.

“So that’s how we started down the path,” she says. “Really targeting these people who had the closest patient contact.”

Frenzel credits the significant increase in employee participation in the flu shot program to several factors. They made the program mandatory — a common move in the healthcare industry — but Frenzel says their improvement also was related to flu shot education. The center made it a priority to explain to staff members exactly why they should get vaccinated. Frenzel made it more convenient, offering the vaccine at different hours of the day, so all employees could fit it into their schedule. They also made it fun, offering stickers for employees to put on their badge once they got a shot. Every year, she says, they pick a new color.

Employers outside of the medical industry are focused on improving their flu shot programs, including Edward Yost, manager of employee relations and development at the Society for Human Resource Management, who helped organize a health fair and flu shot program for 380 employees.

Yost says onsite flu shot programs are more effective than vouchers that allow employees to get vaccinated at a primary care doctor or pharmacy. The more convenient you make the program, he says, the more likely employees will use it.

“There’s no guarantee that those vouchers are going to be used,” he says. “Most people aren’t running out to a Walgreens or a CVS saying, please stab me in the arm.”

Besides the convenience, employees are more likely to sign up for a shot when they see co-workers getting vaccinated, Yost says. If a company decides to offer an onsite program, planning ahead is key. Sometimes employees will not sign up in advance for the vaccine but then decide they want to get one once the vendor arrives onsite. Yost recommends companies order extra vaccines.

“Make sure that you’re building in the expectation that there's going to be at least a handful of folks who are more or less what you call walk-ins in that circumstance,” he says.

Incentivizing employees to get the flu shot is also important, Yost says. Some firms will offer a gym membership or discounted medical premiums if they attend regular checkups and get a biometric screening in addition to a flu shot. He recommends explaining to employees how a vaccine can help reduce the number of sick days they may use.

“Employees need to see that there’s something in it for them,” Yost says. “And quite honestly, being sick is a miserable thing to experience.”

Affiliated Physicians is one of the vendors that can come in and administer flu shots in the office. The company has provided various employers with vaccines for more than 30 years, including SourceMedia, the parent company of Employee Benefit News andEmployee Benefit Adviser. In the past 15 years, Ari Cukier, chief operating officer of the company, says there’s been an increase in the amount of smaller companies signing up for onsite vaccines. HR executives should be aware of the number of employees signing up for vaccinations when scheduling an onsite visit.

“We can’t go onsite for five shots, but 20-25 shots and up, we’ll go,” Cukier says.

Cukier agrees communication between human resources departments and employees is crucial in getting people to sign up for shots. Over the years, he’s noticed that more people tend to sign up for shots based on the severity of the previous flu season.

“Last year, as bad as it was, we have seen a higher participation this year,” he says.

Brett Perkisonassistant professor of occupational medicine at the University of Texas School of Public Health in Houston, says providing a good flu shot program starts from the top down. The company executives, including the CEO and HR executives, should set an example by getting and promoting the shots themselves, he says.

It’s also important to listen to employee concerns. Before implementing a program, if workers are taking issue with the shot, it’s best to hold focus groups to alleviate any worries before the shots are even being administered, he says.

Some employees may even believe misconceptions like the flu shot will make one sick or lead to long-term illnesses, he says. Others may question the effectiveness of the shot. Having open lines of communication with employees to address these concerns will ensure that more will sign up, Perkison says.

Regardless of the type of flu shot program, the most important part is preventing illness, SHRM’s Yost says. While missing work and losing money are important consequences of a flu outbreak, having long-term health issues is even more serious, he says. Plus, no one likes being sick.

“Who’s going to argue about that?” he says.

This article originally appeared in Employee Benefit News.

SOURCE: Hroncich, C (24 October 2018) "HR’s recurring headache: Convincing employees to get a flu shot" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/hrs-recurring-headache-convincing-employees-to-get-a-flu-shot


Oct. 15 Deadline Nears for Medicare Part D Coverage Notices

Are you ready for the Medicare Part D coverage notice deadline? Plan sponsors that offer prescription drug coverage must provide notices to Medicare-eligible individuals before October 15. Continue reading to learn more.


Plan sponsors that offer prescription drug coverage must provide notices of "creditable" or "non-creditable" coverage to Medicare-eligible individuals before each year's Medicare Part D annual enrollment period by Oct. 15.

Prescription drug coverage is creditable when it is at least actuarially equivalent to Medicare's standard Part D coverage and non-creditable when it does not provide, on average, as much coverage as Medicare's standard Part D plan.

The notice obligation is not limited to retirees and their dependents covered by the employers' plan, but also includes Medicare-eligible active employees and their dependents and Medicare-eligible COBRA participants and their dependents.

Background

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires group health plan sponsors that provide prescription drug coverage to disclose annually to individuals eligible for Medicare Part D whether the plan's coverage is creditable or non-creditable.

The Centers for Medicare & Medicaid Services (CMS) has provided a Creditable Coverage Simplified Determination method that plan sponsors can use to determine if a plan provides creditable coverage.

Disclosure of whether their prescription drug coverage is creditable allows individuals to make informed decisions about whether to remain in their current prescription drug plan or enroll in Medicare Part D during the Part D annual enrollment period.

Individuals who do not enroll in Medicare Part D during their initial enrollment period, and who subsequently go at least 63 consecutive days without creditable coverage (e.g., because they dropped their creditable coverage or have non-creditable coverage) generally will pay higher premiums if they enroll in a Medicare drug plan at a later date.

Who Must Receive the Notice?

The notice must be provided to all Medicare-eligible individuals who are covered under, or eligible for, the sponsor's prescription drug plan, regardless of whether the plan pays primary or secondary to Medicare. Thus, the notice obligation is not limited to retirees and their dependents but also includes Medicare-eligible active employees and their dependents and Medicare-eligible COBRA participants and their dependents.

Notice Requirements

The Medicare Part D annual enrollment period runs from Oct. 15 to Dec. 7. Each year, before the enrollment period begins (i.e., by Oct. 14), plan sponsors must notify Medicare-eligible individuals whether their prescription drug coverage is creditable or non-creditable. The Oct. 15 deadline applies to insured and self-funded plans, regardless of plan size, employer size or grandfathered status.

Part D eligible individuals must be given notices of the creditable or non-creditable status of their prescription drug coverage:

  • Before an individual's initial enrollment period for Part D.
  • Before the effective date of coverage for any Medicare-eligible individual who joins an employer plan.
  • Whenever prescription drug coverage ends or creditable coverage status changes.
  • Upon the individual's request.

According to CMS, the requirement to provide the notice prior to an individual's initial enrollment period will also be satisfied as long as the notice is provided to all plan participants each year before the beginning of the Medicare Part D annual enrollment period.

An EGWP exception

Employers that provide prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP) are not required to provide the creditable coverage notice to individuals eligible for the EGWP.

The required notices may be provided in annual enrollment materials, separate mailings or electronically. Whether plan sponsors use the CMS model notices or other notices that meet prescribed standards, they must provide the required disclosures no later than Oct. 14, 2017.

Model notices that can be used to satisfy creditable/non-creditable coverage disclosure requirements are available in both English and Spanish on the CMS website.

Plan sponsors that choose not to use the model disclosure notices must provide notices that meet prescribed content standards. Notices of creditable/non-creditable coverage may be included in annual enrollment materials, sent in separate mailings or delivered electronically.

What if no prescription drug coverage is offered?

Because the notice informs individuals whether their prescription drug coverage is creditable or non-creditable, no notice is required when prescription drug coverage is not offered.

Plan sponsors may provide electronic notice to plan participants who have regular work-related computer access to the sponsor's electronic information system. However, plan sponsors that use this disclosure method must inform participants that they are responsible for providing notices to any Medicare-eligible dependents covered under the group health plan.

Electronic notice may also be provided to employees who do not have regular work-related computer access to the plan sponsor's electronic information system and to retirees or COBRA qualified beneficiaries, but only with a valid email address and their prior consent. Before individuals can effectively consent, they must be informed of the right to receive a paper copy, how to withdraw consent, how to update address information, and any hardware/software requirements to access and save the disclosure. In addition to emailing the notice to the individual, the sponsor must also post the notice (if not personalized) on its website.

Don't forget the disclosure to CMS

Plan sponsors that provide prescription drug coverage to Medicare-eligible individuals must also disclose to CMS annually whether the coverage is creditable or non-creditable. This disclosure must be made no more than 60 days after the beginning of each plan year—generally, by March 1. The CMS disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that do not offer prescription drug coverage to retirees.

SOURCE: Chan, K.; Stover, R. (10 September 2018) "Oct. 15 Deadline Nears for Medicare Part D Coverage Notices" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/medicare-d-notice-deadline.aspx/


Safety Focused Newsletter - October 2018

Avoid Getting Sick at Work

It can be difficult to avoid getting sick at work, particularly if you work in close quarters. While you may not be able to avoid germs altogether, the following tips can help reduce your risk of getting sick:

  • Wash your hands. Germs can cling to many surfaces in the workplace, including elevator buttons, doorknobs and refrigerator doors. To protect yourself from illness, it’s important to wash your hands regularly, especially before you eat or after you cough, sneeze or use the restroom.
  • Keep your distance. Illnesses like the cold or flu can spread even if you aren’t in close contact with someone. In fact, experts say that the flu can spread to another person as far away as 6 feet. If you notice a co-worker is sick, it’s best to keep your distance.
  • Get a flu shot. Yearly flu shots are the single best way to prevent getting sick. Contrary to popular belief, flu vaccines cannot cause the flu, though side effects may occur. Often, these side effects are minor and may include congestion, coughs, headaches, abdominal pain and wheezing.

In addition to the above, it may be a good idea to avoid sharing phones, computers and food with your co-workers during flu season. Together, these strategies should help you stay healthy at work.

Parking Lot Safety Tips

Parking lots are common hazards for drivers and vehicles alike. Slips, falls, auto accidents, theft, harassment and assaults are just some of the risks individuals face while using parking lots.

Even the parking lots and garages at your place of employment can be dangerous. Thankfully, there are simple and effective precautions drivers can take to protect themselves and their vehicles:

  • Park in a well-lit area, preferably one with surveillance cameras and security patrol services.
  • Avoid parking near shrubbery or other areas that could conceal attackers.

  • Park as close to an exit as possible when using garages.
  • Lock your doors when leaving your vehicle.
  • Remain vigilant, and notify security or the authorities if you notice any suspicious behavior.
  • Lock all of your valuable items in your trunk and out of sight. Avoid leaving purses or wallets in your vehicle.
  • Walk confidently when leaving or returning to your vehicle. If you notice a potential threat, proceed to a safe place, like a public building or store.
  • Use the buddy system, and walk to your car with a co-worker.
  • Have your car keys ready when you near your vehicle.

Staying safe can be easy as long as you’re cautious and mindful of your surroundings.

Avoid Slips and Falls in Parking Lots:

Watch Out for Uneven Surfaces, Curbs and Potholes.

Beware of Ice During Colder Months.

Stay in Well-Lit Areas.

Walk, Don't Run.

Illnesses like colds or the flu can spread even if you aren’t in close contact with someone.

Download the Newsletter

A monthly safety newsletter from


Get Moving...To Live!

Are your employees sitting all day at work? Regardless of who you are and how often you exercise, if you're sitting for long periods of time, your chance of an early death increases. Read on to learn more.


The phrase: “If I’m lying, I’m dying” should be changed to: “If I’m sitting, I’m dying” even though it doesn’t rhyme. If you haven’t heard by now, sitting for long periods of time increases the chance that you’ll die early, regardless of your race, gender, age, body mass index (BMI), or even if you exercise. The longer you sit, the higher your risk of dying sooner rather than later.

See also: 7 wellness program ideas you may want to steal

Every morning, people get ready for work and then sit in their cars (or public transportation), then sit when they get to work, then sit again in their cars, then sit in from of the TV when they get home. It’s time everyone breaks that cycle and starts moving around more during the day and not just when they’re at the gym, assuming they even go.

Fortunately, in an article on CNN’s website titled, “Yes, sitting too long can kill you, even if you exercise,” reveals that taking “movement breaks” every 30 minutes basically cancels out this health problem. But it’s not as simple as just standing, there are two factors impacting this—frequency and duration. How often you sit during the day, and how long you sit each time, have an effect. The article references the American Heart Association’s message of “Sit less, move more,” but admonishes them for not telling people how they should move around, or for how long.

See also: Beyond wellness: Workplace health initiatives that work

The Centers for Disease Control and Prevention (CDC) has specific guidelines and recommendations for exercising, but none for sitting. For example, if you sit for 30 minutes, you should probably walk around for at least five minutes before sitting down again. And don’t assume that a “standing desk” is healthier than a traditional desk where you sit down. There isn’t enough evidence to say that a standing desk is better. It’s all about actual movement, which is why simply standing up isn’t enough.

Age is another factor that would seem to make a difference but actually doesn’t. The article discusses age, yet the same principles apply. Older adults who sat more often and for long durations were far more likely to die earlier than those who sat less.

See also: Top 10 Corporate Wellness Habits to Adopt During 2018

The message is clear. Regardless of who you are, what you do for a living, or how “fit” you may be, if you’re not moving around during the day and sitting for fewer than 30 minutes, you’d better get used to the fact that you may not be around as long as you expect, so get moving!

SOURCE: Olson, B. (18 September 2018) "Get Moving...To Live!" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/get-moving...to-live