Taking the first steps to a long-term benefits strategy

Many companies are struggling in the search to find cost-effective, successful employee benefits strategies that HR professionals and finance professionals agree on. Read this blog post to learn more.


The quest for a cost-effective and successful employee benefits program can feel like a search for the Holy Grail. To most, it’s an elusive goal within the context of rising and unsustainable costs.

Unlike “Monty Python and the Holy Grail,” in which a comedy of errors made for a hilarious movie, nonsensical benefits strategies can have serious consequences.

One major challenge is that many HR and finance professionals have conflicting objectives. HR’s mission is to design a program that is competitive in the marketplace for human capital needs while supporting the organization’s culture. Finance, on the other hand, is charged with managing to a budget by controlling expenses to mitigate year-over-year increases. The result, in spite of best intentions, leaves organizations unable to commit to a multi-year plan and opt in favor of living year-to-year.

So, how do you overcome this challenge?

Step 1Key HR and finance stakeholders need to align on goals and objectives. They also need to remain engaged in the process throughout the year (not just at renewal). Once you achieve alignment, these objectives should be memorialized into a benefits philosophy. Why? So the collective team has guiding principles for future decisions.

Step 2: Identify the cost drivers of the program. Many employers have little line of sight into how their plan is performing until it’s too late. Once you are staring down the barrel of a 25% increase, an organization may be forced to make swift changes to soften the blow to their bottom line rather than follow a strategic approach that comes with preparation. Unfortunately, this type of knee-jerk reaction only temporarily relieves the pressure and may create unintended consequences to the employee value proposition.

Step 3Understand where you were, where you are and where you want to be. After 25 years in the consulting industry, one thing I know for certain is there are only so many levers you can pull to rein in escalating benefit costs. Identify the levers and how far you want to pull them.

Step 4: Determine success metrics. I’ve seen many organizations implement new tactics, such as a health savings account. When I ask them if it was successful, they can’t answer because they didn’t set an internal bar for success. That barometer will help you gauge success and determine what changes need to be made to your approach to achieve your goal.

Step 5Commit the plan to writing and review it periodically. Just like your company’s overall business plan, you will need to make adjustments along the way as your business changes.

Regardless of strategy, I recommend employers take steps toward a self-funding benefits model. Historically, self-funding was for groups with 1,000 lives and above. But that’s no longer the case. Self-funding provides that all-important line of sight into cost drivers because of access to claims data. Having a deeper understanding of the “why” behind costs allows an organization to implement a data-driven approach to the overarching benefits strategy. Self-funding also provides more plan design flexibility and eliminates the internal costs that an insurance carrier builds into a plan for profit.

It’s more effective to create a benefits strategy that is sustainable over time, so when you inevitably endure a higher-than-normal renewal cycle, typically every three to five years, you are prepared to stay the course.

Consider timing. When you make changes to a benefit plan is just as important as what changes you make. Evaluate the timing of benefit changes, how they are implemented and how adjustments will impact your workforce now and in the future.

For example, if you plan to add new voluntary benefits, such as indemnity plans, it may make sense to run them “off cycle” from the core medical benefits open enrollment season. This gives employees more time to conduct research about the new product option and make an educated decision.

Strive for simplicity. I can’t stress this enough. The Affordable Care Act, an increase in voluntary benefit options, new funding models and benefit trends have created an enormous amount of noise in the insurance industry. Tune it out and simplify your process as much as you can. Your HR and Finance teams are overwhelmed and so are your employees. Instead of throwing new benefits at them each year, focus on educating them and making choices simple. In fact, any long-term benefits plan worth its weight always includes an education and communications component.

Benefit illiteracy is rampant, and confusion over options at open enrollment can have consequences for the employee throughout the plan year. If your employees choose their benefits online, spend the open enrollment meeting educating them on how to buy and consume insurance, rather than just what the benefit choices are for the plan year, or how to use the online enrollment tool. You should also communicate throughout the year, rather than just at open enrollment to support employees’ understanding of their benefits program.

Identify other areas where employees might struggle. One trend is to offer transparency tools to help them choose a doctor or specialist. But be aware that the sheer number of doctors in a given list can be overwhelming. Rather than offering employees a choice of 50 doctors, narrow it down to five providers with the best healthcare outcomes.

Making it simpler for employees to be better consumers of healthcare will help you cut costs and get on the right path to a long-term benefit strategy. Of course, you’ll have to check in each year and consider making small adjustments to the program, and data will help guide these changes. Adjustments should all be in service of a long-term plan. If you begin your long-term plan by asking the question, “Where were we, where are we now and where do we want to be in the future?” you’re halfway there. You may eventually find that your Holy Grail is within reach.

SOURCE: Bloom, A. (14 May 2019) "Taking the first steps to a long-term benefits strategy" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/taking-the-first-steps-to-a-long-term-benefits-strategy


Workout - Girl - Stretching - Pixabay

Exercise and Health: The Mind-Body Connection

Did you know: There are physiological reasons why you get an overall feeling of well-being after taking a long walk, shoveling snow, dancing, etc. Read this blog post from UBA to learn more.


Ever notice how you can get an overall feeling of well-being after taking a long walk, shoveling snow, dancing, or playing Frisbee with the kids? It’s not just because you can check “get some physical activity” off your to-do list. Turns out, there are physiological reasons why you get that feeling. And for people who suffer from a mental health condition like depression, anxiety or ADHD, exercise can relieve symptoms almost as well as medications, and can sometimes help certain symptoms from coming back.

How does it work? Researchers aren’t completely sure. But we do know that physical activity causes certain substances that affect brain function to kick in. These include:

  • Endorphins– brain chemicals that reduce stress or pain and increase feelings of well-being
  • Serotonin– a brain chemical that affects mood
  • Glutamate and GABA– chemicals that influence parts of the brain that affect emotions and mental clarity
  • BDNF(brain-derived neurotropic factor) – a protein that protects nerve cells in the brain that help control depression-like symptoms

Many people have found that exercise helps keep anger, stress, and muscle tension at bay and can help you sleep, which helps lessen stress, boost concentration, and improve self-esteem. In addition, it can help you cope with challenges in a healthier way, instead of turning to behaviors like drinking alcohol, which can actually make symptoms worse.

Recommendations for physical activity are the same for mental health benefits as they are for physical benefits: try for at least 150 minutes per week. But even one hour a week has been shown to help with mood disorders like depression and anxiety and even substance use disorder. But people suffering from mental health conditions may find it hard to do even that small amount. No matter how much you try to convince yourself to get up and move, you just can’t get motivated.

If this happens, remind yourself that just a walk around the block is a great start. Don’t set yourself up for failure by telling yourself you “should” be doing more. Just start somewhere, and hopefully the benefits you start to notice will keep you motivated to build up from there. Finding an activity you actually enjoy can really help you stay motivated.

There’s no doubt that physical activity is beneficial for mind and body. And even just short spurts are helpful. But if you are having symptoms of depression, anxiety or another mental health condition, physical activity may not be enough. Always talk to your doctor or a therapist if your symptoms are troublesome — you may benefit from medication and/or talk therapy.

Whatever you do to boost your activity level – even taking the smallest of steps – give yourself lots of props. Getting started isn’t easy and staying motivated can be challenging. But try. It just might leave you feeling great.

Sources:

Anxiety and Depression Association of America. Exercise for stress and anxiety. https://adaa.org/living-with-anxiety/managing-anxiety/exercisestress-and-anxiety (Accessed 3/1/19)

Helpguide.org. The mental health benefits of exercise. November 2018. https://www.helpguide.org/articles/healthy-living/the-mental-healthbenefits-of-exercise.htm (Accessed 3/1/19)

Mental Health America. Exercise. http://www.mentalhealthamerica.net/conditions/fitness-4mind4body-exercise  (Accessed 3/1/19)

Mental Health America. Get physically active. http://www.mentalhealthamerica.net/get-physically-active (Accessed 3/1/19)

Mayo Clinic. Depression and anxiety: Exercise eases symptoms. September 27, 2017. https://www.mayoclinic.org/diseases-conditions/

depression/in-depth/depression-and-exercise/art-20046495 (Accessed 3/1/19)

SOURCE: Olson, B. (23 May 2019) "Exercise and Health: The Mind-Body Connection" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/exercise-and-health-the-mind-body-connection


Are you offering the right benefits? Look to benchmarking, surveys for answers

With unemployment at historic lows, benefits have become a big differentiator for employers. Continue reading this blog post for more on benchmarking your employee benefits plan.


With unemployment at a 50-year low, benefits have become a big differentiator for employers, which means they need to be competitive to attract and retain employees. What are competitive benefits? Ask 100 employers and you’ll get 100 answers.

It’s no longer affordable to offer Cadillac plans with low employee contributions. How do employers offer attractive yet affordable benefits that will draw potential employees in? They turn to benchmarking and employee surveys to build and validate benefit plans.

“High cost” has become so synonymous with “healthcare benefits” that it’s hard to separate one from the other. As benefits become more costly, they also become more complicated to manage. Add today’s shift to the need for competitive programs and the whole thing begins to look like a slog through quicksand.

Here’s the thing: The employer must strike a balance between what employees want and what they’ll use. That means zeroing in on what they find valuable. While it may be tempting to follow benefit trends by offering pet insurance or creating in-office perks like beer and pizza, research suggests that most employees value more traditional coverages and benefits. What gets them in the door — and keeps them engaged — is likely going to be paid leave, flexible/remote work options and professional development.

To determine what your employees want and what peer employers are offering in your industry, look to benchmarking and employee surveys as two of the sharpest arrows in your plan design quiver.

Benchmarking tells you what you’re competing against. While certain employee benefits are more popular in some industries than others, it’s vital to know who you’re competing against to attract and retain employees. For example, nonprofit organizations historically provide modest employee salaries but rich benefits. While that benefits model may work for most of your workforce, it’s important not to overlook other industry standards. A large nonprofit hiring employees for its IT department is not only competing against other nonprofits for talent, but they’re also competing against tech-industry talent, which may put more of a focus on salary and bonuses than rich benefits.

The best way to identify who you’re competing against and what types of benefits they’re offering is to undertake a benchmarking study. Benchmarking your benefits package can provide insight into what your competition offers across industries, regions and company size so you can ensure your plan design stands up against the competition. Benchmarking studies yield details like:

  • Medical plan type
  • Employee premium cost
  • Employee premium contribution
  • Medical copay
  • Prescription drug copay
  • Office visit copay
  • Emergency room copay
  • Voluntary benefits offerings
  • Salary ranges
  • Paid sick leave

Armed with that data, you can decide where you should aim your focus and whether you’re offering a competitive benefits package.

Surveys tell you what employees value. The best way to understand what your employees value is to ask them. Employee surveys can help you find out which benefits your employees love, which ones they don’t like and where you can make improvements.

When developing an employee benefits survey, pay close attention to how questions are written in order to elicit the best responses from employees. It might make sense to reach out to a survey organization to ensure it’s done right. Benefit brokers often have experience with surveys, too.

When the survey is complete, put together a communications plan so you can get the highest number of responses about what your employees love and what needs improvement. It’s a best practice to survey employees every plan year to stay on top of changes across the workforce. (Just not at open enrollment time).

It’s an inexpensive undertaking that could lead to serious cost savings from changes to the plan and increased employee retention. So basically, a survey is worth the time and effort.

Benchmarking and surveys are important components of a benefits strategy. They can put you on a more direct path to a plan design with options that are right for your culture and workforce.

SOURCE: Newman, H. (17 May 2019) "Are you offering the right benefits? Look to benchmarking, surveys for answers" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/hr-review-surveys-for-employee-benefits-trends


Bringing Design Thinking to HR

Design thinking has continued to rise in popularity across many industries. Continue reading this blog post from UBA for things to keep in mind when implementing design thinking processes.


Across industries, design thinking has continued its rise in popularity. At its core, design thinking is about centering people in the creation of products. Whatever you’re designing, whether a process or a tool, connecting your work to the people who will use it makes a better solution.

As HR Executive points out, design is more than logos and graphics. It’s the plan for anything produced, including the policies, tools, and systems of an HR Department. Ensuring those are designed with intention for today’s busy workforce means a better chance of them being successful. While HR in the past has been all about adoption, today’s departments have to think toward more than just first use to continued use. This means not just understanding, but connecting with, the people who will be using the tools, following the policies, and using the systems. The sheer number of workplace components HR manages, from compensation to workforce experience to productivity also means HR creates an immense amount of data. When that data is rooted in design thinking approaches, it becomes more valuable to the company as a whole.

If you’re already convinced of the value of design thinking, the Harvard Business Review has a few things to keep in mind to help ensure implementing design thinking processes goes smoothly.

  1. Encourage your team to think differently. Not just differently, but divergently. Outlier ideas, big reaches, and unexpected notions are more than useful, they’re essential.
  1. Empower your team to fail, more than once. Iteration and testing are parts of the design process and lead to improvements that don’t come from running with a safer idea.
  1. Embrace it yourself. For HR teams used to having clear directions and focusing on efficiency, these are new experiences so it’s up to managers to lead the way.

Read more:

The Right Way to Lead Design Thinking

How to Incorporate Design Thinking into HR Processes

SOURCE: Olson, B. (9 May 2019) "Bringing Design Thinking to HR" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/bringing-design-thinking-to-hr


Changes are coming to paid leave. Here’s what employers should know

With multiple states and local governments enacting their own paid leave policies, employers are finding it difficult to navigate employee paid leave. Continue reading this blog post for what employers should know about the coming changes for paid leave.


A growing number of states and local governments are enacting their own paid leave policies. These new changes can be difficult for employers to navigate if they don’t understand the changes that are happening.

Adding to the confusion among employers, paid sick leave and paid family leave are often used interchangeably, when in fact there are some important distinctions. Paid sick leave is for a shorter time frame than paid family leave and allows eligible employees to care for their own or a family member’s health or preventative care. Paid family leave is more extensive and allows eligible employees to care for their own or a family member’s serious health condition, bond with a new child or to relieve family pressures when someone is called to military service.

The best-known type of employee leave is job-protected leave under the Family Medical Leave Act, where employees can request to take family medical leave for their own or a loved one’s illness, or for military caregiver leave. However, leave under FMLA is unpaid, and in most cases, employees may use available PTO or paid leave time in conjunction with family medical leave.

Rules vary by state, which makes it more difficult for multi-state employers to comply. The following is an overview of some new and changing state and local paid leave laws.

Paid sick leave

The states that currently have paid sick leave laws in place are Arizona, California, Connecticut, Maryland, Massachusetts, New Jersey, Oregon, Rhode Island, Vermont and Washington. There are also numerous local and city laws coming into effect across the country.

In New Jersey, the Paid Sick Leave Act was enacted late last year. It applies to all New Jersey businesses regardless of size; however, public employees, per diem healthcare employees and construction workers employed pursuant to a collective bargaining agreement are exempt. As of February 26, New Jersey employees could begin using accrued leave time, and employees who started after the law was enacted are eligible to begin using accrued leave 120 days after their hire dates.

Michigan’s Paid Medical Leave Act requires employers with 50 or more employees to provide paid leave for personal or family needs as of March.

Under Vermont’s paid sick leave law, this January, the number of paid sick leave hours employees may accrue rose from 24 to 40 hours per year.

In San Antonio, a local paid sick leave ordinance passed last year, but it may not take effect this August. The ordinance mirrors one passed in Austin that has been derailed by legal challenges from the state. Employers in these cities should watch these, closely.

Paid family leave

The five states that currently have paid family leave policies are California, New Jersey, Rhode Island, New York, Washington and the District of Columbia.

New York, Washington and D.C. all have updates coming to their existing legislation, and Massachusetts will launch a new paid family program for employers in that state. In New York, the state’s paid family leave program went into effect in 2018 and included up to eight weeks of paid family leave for covered employees. This year, the paid leave time jumps to 10 weeks. Payroll deductions to fund the program also increased.

Washington’s paid family leave program will begin on January 1, 2020, but withholding for the program started on January 1 of this year. The program will include 12 weeks of paid family leave, 12 weeks of paid medical leave. If employees face multiple events in a year, they may be receive up to 16 weeks, and up to 18 weeks if they experience complications during pregnancy.

The paid family leave program in Massachusetts launches on January 1, 2021, with up to 12 weeks of paid leave to care for a family member or new child, 20 weeks of paid leave for personal medical issues and 26 weeks of leave for an emergency related to a family member’s military deployment. Payroll deductions for the program start on July 1.

The Paid Leave Act of Washington, D.C. will launch next year with eight weeks of parental leave to bond with a new child, six weeks of leave to care for an ill family member with a serious health condition and two weeks of medical leave to care for one’s own serious health condition. On July 1, the district will begin collecting taxes from employers, and paid leave benefits will be administered as of July 1, 2020.

Challenging times ahead

An employer must comply with all state and local sick and family leave laws, and ignorance of a law is not a defense. Employers must navigate different state guidelines and requirements for eligibility no matter how complex, including multi-state employers and companies with employees working remotely in different jurisdictions.

These state paid leave programs are funded by taxes, but employers must cover the costs of managing the work of employees who are out on leave. While generous paid leave policies can help employers attract talent, they simply don’t make sense for all companies. For example, it can be difficult for low-margin businesses to manage their workforces effectively when employees can take an extended paid leave.

Not only must employers ensure compliance with state and local rules, but they also must make sure that their sick time, family and parental leave policies are non-discriminatory and consistent with federal laws and regulations. That’s a lot to administer.

Employers should expect to see the changes in paid sick leave and family leave laws to continue. In the meantime, companies should make sure they have the people and internal processes in place right now to track these changes and ensure compliance across the board.

SOURCE: Starkman, J.; Johnson, D. (2 May 2019) "Changes are coming to paid leave. Here’s what employers should know" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-employers-need-to-know-about-changing-paid-leave-laws?brief=00000152-14a7-d1cc-a5fa-7cffccf00000


Is it Time for Unlimited Time off?

More and more employee benefits are being designed around employee health, wellness and happiness, but many of them are designed to keep employees at work. Continue reading this blog post from UBA to learn more.


While more and more perks — catered lunches, on-site gyms, immunizations programs — are about employee health, wellness, and happiness, they ultimately are also designed to keep workers at work. A recent article in Quartz at Work points out that more than anything, employees want more time off and out of the office. Unlimited time off, to be exact.

Once the perk of tech firms and startups, more companies are beginning to explore unlimited paid time off. And, though still rare at only one to two percent of companies, it’s a popular request in part because workforce demographics continue to shift. Nearly half of employees are Millennials, whose priorities are changing the benefits conversation. For this group, finding more balance and having more control of their time are key. In part, this may be because time off has fundamentally changed. Well and Good looks at the fact that, with near-constant connectedness, vacation days often still involve checking email and getting other notifications.

Add to that cultural and workplace expectations of accessibility and availability, and workers are at risk for burnout. One in four workers report feeling burned out all the time and almost half feel burned out sometimes. This burnout can cost employers in lost productivity, and employees in terms of health and happiness. Today, someone doesn’t need to psychically spend 90 hours a week at the office to be working 90 hours. With our always-on lives, restorative time off is rarer but still as important to prevent burnout.

That doesn’t mean every business is jumping on the unlimited time off bandwagon. Want other ideas? A writer for The Guardian suggests a middle ground, with more days off the longer an employee has worked at a company. And, while rollover sounds generous, it may make employees less likely to use it. Want to give it a try but concerned about misuse? Business Management Daily suggests it’s also more than reasonable to consider limits on unlimited and critical to set sound guidelines around pay as well as whether days off can be all in a row.

For many employees, unlimited time off offers the extra flexibility for life’s challenges and can aid satisfaction and retention. Before HR Departments worry the system will be abused, research shows that people take significantly less time off when it’s unlimited. In fact, what may be more impactful is a minimum number of days off may be required so as to ensure employees take advantage of a benefit meant to restore and replenish their energy, creativity, and engagement. To work, it needs to be modeled by managers and other higher-ups, as a CEO details in a Chicago Daily Herald article.

Read more:

The Benefit Workers Want Most is Less Work

Vacation Time and Being Off Work Are No Longer the Same, so Avoiding Burnout Is Trickier than Ever

What Could be Better than Unlimited Paid Vacation? Well, this …

Unlimited Vacation -- the One Benefit Workers Want More than Anything

Ask These Questions when Considering Unlimited PTO

SOURCE: Olson, B. (7 May 2019) "Is it Time for Unlimited Time off?" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/is-it-time-for-unlimited-time-off


Compliance Recap - April 2019

Compliance Recap

April 2019

April was a busy month in the employee benefits world.

The Centers for Medicare & Medicare Services (CMS) issued its parameters for the defined standard Medicare Part D prescription drug benefit for 2020. In the court case challenging the Patient Protection and Affordable Care Act’s constitutionality, the court will hear oral arguments during the week of
July 8, 2019.

CMS released its 2020 Benefit Payment and Parameters final rule and fact sheet. The Department of Labor (DOL) started its appeal of the court case that invalidated portions of the DOL’s association health plans final rule. The DOL also released a statement regarding its enforcement of the final rule.

The Department of Health and Human Services (HHS) issued a notice that all Health Insurance Portability and Accountability Act of 1996 (HIPAA) enforcement actions will be governed by lower interim civil monetary penalty amounts as a matter of HHS’ enforcement discretion, pending rulemaking to change the current civil monetary penalty limits.

The Internal Revenue Service (IRS) released a memorandum regarding S corporation 2-percent shareholders’ deduction of group health plan coverage premiums paid or reimbursed by an S corporation.

UBA Updates

UBA released one new Advisor: Final 2020 Benefit Payment and Parameters Rule

UBA also updated existing guidance: Updates on DOL’s Association Health Plans Final Rule

 

 

CMS Releases 2020 Parameters for Medicare Part D Prescription Drug Benefit

The Centers for Medicare and Medicaid Services (CMS) released the following parameters for the defined standard Medicare Part D prescription drug benefit for 2020:

Deductible

$ 435

Initial coverage limit

$ 4,020

Out-of-pocket threshold

$ 6,350

Total covered Part D spending at the out-of-pocket threshold (for beneficiaries who are ineligible for the coverage gap discount program)

$ 9,719.38

Minimum cost-sharing in catastrophic coverage portion of the benefit

$ 3.60 for generic/preferred multi-source drugs

$ 8.95 for all other drugs

 

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

Status of Court Case Challenging ACA Constitutionality

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

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

The appeals court will hear oral arguments during the week of July 8, 2019.

CMS Publishes 2020 Benefit Payment and Parameters Final Rule

The Centers for Medicare and Medicaid Services (CMS) published its final rule and fact sheet for benefit payment and parameters for 2020. Although the final rule primarily affects the individual market and the Exchanges, the final rule addresses the following topics that may impact employer-sponsored group health plans:

  • The 2020 maximum annual limitation on cost sharing is $8,150 for self-only coverage and $16,300 for other-than-self-only coverage.
  • For fully-insured plans, any indication of a reduction in the generosity of a benefit for individuals that is not based on clinically indicated, reasonable medical management practices is potentially discriminatory.
  • Amounts paid toward cost sharing using direct support by drug manufacturers (for example, coupons) to insured patients to reduce or eliminate immediate out-of-pocket costs for specific prescription brand drugs that have a generic equivalent are not required to be counted toward the annual limitation on cost sharing.
  • Federally Facilitated Small Business Health Options Programs (FF-SHOPs) may operate a toll-free hotline rather than a more robust call center.

The final rule is effective on June 24, 2019. The final rule generally applies to plan years beginning on or after January 1, 2020.

Read more about the final rule.

DOL Appeals Association Health Plan Court Case

On March 28, 2019, the U.S. District Court for the District of Columbia (Court) found that the DOL’s association health plans final rule exceeded the statutory authority delegated by Congress under the Employee Retirement Income Security Act (ERISA) and that the final rule unlawfully expands ERISA’s scope. In particular, the Court found the final rule’s provisions – defining “employer” to include associations of disparate employers and expanding membership in these associations to include working owners without employees – were unlawful and must be set aside.

On April 26, 2019, the Department of Justice (DOJ) filed a notice of appeal. On April 29, 2019, the DOL issued a statement regarding its enforcement policy regarding the final rule. In light of the court’s decision, the DOL will not take enforcement action against:

  • employers and associations for potential violations stemming from actions taken before the court’s decision:
  • if the employer or association relied in good faith on the AHP final rule’s validity and
  • as long as the employers (and association) meet their responsibilities to association members and their participants and beneficiaries to pay health benefit claims as promised.
  • existing AHPs for continuing to provide benefits – to members who enrolled in good faith reliance on the AHP rule’s validity before the court’s order – through the remainder of the plan year or contract term that was in force at the time of the court’s decision.

This means that the DOL will not enforce potential violations that may have occurred before March 28, 2019. However, the DOL will enforce violations that occur on or after March 28, 2019. Because the DOL has not asked for a stay of the court order, associations cannot form self-funded AHPs under the final rule and existing AHPs must not market to new enrollees or sole proprietors.

Employers and their employees who are currently participating in an insured AHP under the final rule can generally maintain their coverage through the later of the end of the plan year or contract term. However, at the end of the plan year, the issuer will only be able to renew coverage for an employer if the coverage complies with the relevant market requirements for that employer’s size, rather than the association’s size.

For example, if a small employer and a sole proprietor joined an insured AHP under the final rule, then at renewal, an insurer can only sell coverage that complies with the small group market rules to the small employer and that complies with the individual market rules to the sole proprietor.

In the upcoming months, the U.S. Court of Appeals for the District of Columbia Circuit will consider the legal arguments in this case. Employers in AHPs should keep apprised of future developments in this case.

Read more about DOL’s enforcement of the final rule.

HHS Issues Notification Regarding the HIPAA Civil Monetary Penalty Tiers

On April 30, 2019, the Department of Health and Human Services (HHS) issued a notice that all Health Insurance Portability and Accountability Act of 1996 (HIPAA) enforcement actions will be governed by the following interim penalty tiers as a matter of HHS’ enforcement discretion:

Culpability

Penalty per violation

Annual limit

No knowledge

$100 – $50,000

$25,000

Reasonable cause

$1,000 – $50,000

$100,000

Willful neglect – corrected

$10,000 – $50,000

$250,000

Willful neglect – not corrected

$50,000

$1,500,000

 

The notice doesn’t legally bind HHS and doesn’t create legal rights for covered entities such as employers’ group health plans.

Practically speaking, the penalty amounts have not changed. The civil monetary penalties under HIPAA, as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, continue to be:

Culpability

Penalty per violation

Annual limit

No knowledge

$114 – $57,051

$1,711,533

Reasonable cause

$1,141 – $57,051

$1,711,533

Willful neglect – corrected

$11,410 – $57,051

$1,711,533

Willful neglect – not corrected

$57,051

$1,711,533

 

However, HHS may exercise discretion to impose a lower penalty amount if a covered entity, such as a health plan, is facing enforcement for violating HIPAA or HITECH.

HHS plans to engage in rulemaking to revise the penalty amounts. If and when final regulations are issued, then the revised penalty amounts will become law.

IRS Releases Memo on 2-percent Shareholders’ Health Coverage Deductions

The Internal Revenue Service (IRS) released a memorandum to confirm that a person who is a 2-percent shareholder (through Internal Revenue Code §318’s attribution rules) in an S corporation is entitled to a deduction for the amounts paid by the S corporation under a group health plan.

For the 2-percent shareholder to deduct the health insurance premium amounts, the S corporation must report the health insurance premiums paid or reimbursed as wages on the 2-percent shareholder’s Form W-2 in that same year. Also, the shareholder must report the premium payments or reimbursements from the S corporation as gross income on the Form 1040, U.S. Individual Tax Return.

Question of the Month

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

 

5/1/2019


4 benefits messages to send employees in May

With tax season over, and summer right around the corner, now is a great time to beef up communications about certain employee benefits. Read on for four benefits messages employers should send their employees this May.


With tax season behind us, summer right around the corner and the second half of the year coming up, now is a great time of year for employers to beef up communications about certain benefits.

That’s because there are a number of important messages that are specific to this time of year, including saving money for summer vacations and putting more money into a health savings account so employees can plan for healthcare expenses for the remainder of the year.

Here are four messages employers should share with their employers this month.

1. Think about putting more money in your HSA.

May is a great time for your employees to take stock of their healthcare costs from January to April, and plan ahead for the second half of the year. Here’s a breakdown you can send to help them save money and have more cash available through December to pay their bills.

  1. Add up this year’s out-of-pocket health care costs thus far.
  2. Make a new estimate of your upcoming expenses (padding that estimate for unexpected expenses that may pop up.).
  3. Add your estimated costs to what you’ve already spent.
  4. Compare that total with how much you’ll have in your HSA account at the end of the year as it is now.
  5. If there’s a gap, you can increase your contribution rate now to make up the difference.

2. Adjust your W-4s.

Tax season has passed, which means it’s an excellent time to…think a little more about taxes.

The tax law changes that went into effect at the start of 2018 might have made your employees’ existing W-4s less accurate. If they didn’t update their withholding amount last year, they might have been surprised by a smaller refund, a balance due, or even by a penalty owed — and chances are, they don’t feel too happy about it.

Let your employees know that they can prevent unexpected surprises like this next tax season with a visit to this IRS tax withholding calculator. There, they can estimate their 2019 taxes and get instructions on how to update their W-4 withholdings to try and avoid any surprises next year. If they can update their W-4 online, send them the link along with clear step-by-step instructions. And if they need to fill out a paper form, explain where to find it and how to submit it.

3. Revisit your budgeting tools.

Summer is almost here, and your employees are likely starting to think about hitting the beach, road-tripping across the country or eating their weight in ice cream. Since having fun costs money, May is a good time to serve up some ideas on how to squirrel away a little extra cash in the next few months.

Employers should share tips for saving money on benefits-related expenses, like encouraging high-deductible health plan employees to use sites like GoodRx.com for cheaper prescription costs, or visiting urgent care instead of the emergency room for non-life-threatening issues. Also, consider making employees aware of apps like Acorns, Robinhood, Stash, Digits and Tally, which round up credit or bank card expenses to the next dollar, and automatically deposit the extra money into different types of savings accounts.

4. Double-check out-of-network coverage.

While you’re on the subject of summer fun, remind your employees to take a quick peek at their health plan’s out-of-network care policies before they head out of town. If they need a doctor (or ice cream headache cure) while they’re away, they’ll know where to go, how to pay, and how to get reimbursed.

Employers should remind employees that their HSA funds never expire, and they’re theirs for life. So if they put in more than they need this year, it will be there for them next year.

SOURCE: Calvin, H. (1 May 2019) "4 benefits messages to send employees in May" (Web Blog Post). Retrieved from https://www.benefitnews.com/list/4-benefits-messages-to-send-employees-in-may


What to consider before adding a genetic testing benefit

Did you know: Eighteen percent of employers provide health-related genetic testing benefits, according to new statistics from the Society of Human Resource Management (SHRM). Read on for what employers should consider before adding a genetic testing benefit to their benefits package.


As employers look for new voluntary benefits to help attract and retain employees, a growing number are turning to direct-to-consumer genetic testing for all employees to their benefits plans. According to the latest statistics from the Society for Human Resource Management, 18% of employers provide a health-related genetic testing benefit, an increase of 6% over the previous year.

For the most part, it can be a smart move: Not only can the benefit differentiate one employer from others vying to hire from the same employee pool, genetic testing providers market the benefit as a way to potentially lower healthcare costs and increase employee wellness.

This type of testing can be valuable for employees at an increased risk for certain types of cancer, such as breast and ovarian cancer related to mutations of the BRCA1 and BRCA2 genes, those considering having a child who have risk factors for genetic conditions such as cystic fibrosis and Tay Sachs disease, those who have a family history of conditions like high cholesterol, and those who take medications such as blood thinners and anti-depressants. There also are tests that look for genes associated with conditions such as Parkinson’s disease, Alzheimer’s disease and celiac disease.

But employers also have to realize that genetic testing for all employees, regardless of family history and risk factors, comes with potential downsides. In fact, some physicians believe that widespread genetic testing of this type may even present a risk of harm. There’s also the issue of regulation and oversight of direct-to-consumer genetic testing. The industry is not currently regulated, which, some researchers have found, can lead to inaccurate or varying results. One study found that when the same genetic variant was provided to nine different labs for analysis, the answers provided were different 22% of the time, highlighting the risk of false positive and false negative results.

So for employers who offer — or are considering adding — a genetic benefit, make sure to think about the potential outcomes that can occur by doing so.

The potential for lower costs as well as unnecessary healthcare spending

If an employee’s genetic test is positive for a mutation that’s associated with cancer or another disease, he or she may be more proactive about screening for the disease and may make lifestyle changes that may lower the risk of developing the disease. There are potential healthcare cost savings to early detection of some conditions. For example, by some estimates, the cost for treating early-stage breast cancer is more than 50% less than the cost to treat the same cancer at an advanced stage.

For employees who undergo testing related to how effective a blood thinner or antidepressant will be, there can be better health outcomes as well as cost savings. One study found that when physicians prescribed the blood thinner Warfarin based on pharmacogenomic testing, adverse events decreased by 27%. Avoiding adverse events and making sure employees are taking the medications that can most effectively treat their conditions can help keep them healthy, out of the hospital and productively on the job, all of which has a positive financial impact.

But when you’re screening people who don’t have risk factors or a family history of these conditions, a positive test result can lead to unnecessary testing and medical procedures, potential complications from those procedures and the costs associated with that testing and care.

Before and after testing, education

Employers who offer genetic testing without a physician referral need to take steps to ensure that employees understand the risks and benefits of these tests upfront and that they know what a genetic test can and cannot tell them about their health now and in the future. The first step is for any employer offering genetic testing to provide education for employees.

Many employees don’t realize that having a gene mutation that’s associated with a disease does not mean that he or she will ever develop that disease. The risk associated with most genetic variations is, in fact, relatively small. Because of that misunderstanding, employees may experience needless worry or, if the test is negative for mutations related to a disease, may forgo screenings like mammograms, colonoscopies and cholesterol tests that can help detect health problems earlier when they are often more treatable. In the case of genetic testing for mutations associated with cancer, employees may not be aware that most cancers are not caused by a mutation in the single gene that the test screens for.

For some of the conditions that genetic tests screen for, like Alzheimer’s disease, there are currently no treatments. This can again cause anxiety for employees and their families. Genetic tests also have implications that reach beyond the specific employee who is tested. A positive test can affect siblings and children as well, opening the question of whether the employee wants or feels compelled to share the results with other family members who may also be at risk.

Employers who offer employees genetic testing should ensure that all employees who choose to undergo testing are guided by experienced genetic counselors who can help them interpret and understand the results of their test and can connect them with other healthcare providers for additional testing or treatment as needed.

SOURCE: Varn, M. (3 May 2019) "What to consider before adding a genetic testing benefit" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-to-consider-before-adding-a-genetic-testing-benefit


Background Screenings and Second Chance Employment - 3 Tips for Success

Nearly seven out of 10 companies reported that they conduct criminal background checks on all job candidates, according to a 2012 SHRM survey. Read this blog post from SHRM to learn more.


Today’s employers may choose to run background checks on job applicants for variety of reasons. Concerns about negligent hiring, verifying a candidate’s honesty and accountability, and other safety- or performance-related issues may all play a part in this decision. In fact, according to SHRM's 2012 survey, nearly 7 out of 10 companies report that they conduct criminal background checks on all job candidates.

Understandably, employers want to do everything they can to protect their businesses and to ensure (as much as possible) that they’re also protecting their employees. And while an interview is an important opportunity to learn about a job candidate’s character and experience, a background screen provides tangible and practical verification of a candidate’s past, and that is reassuring. What’s important to keep in mind is that background screens are most effective when they’re used judiciously and carefully. Here are a few suggestions to consider.

  1. Tailor background screens to search for information relevant to the specific responsibilities of the job. While it can be tempting to want to know all the information available about a candidate’s past, the ethical and legal use of background screens means that a motor vehicle report, for example, isn’t relevant for a candidate who won’t be driving as part of their job. Limiting searches to the information that is most relevant to the execution of the job functions will keep you in EEOC compliance and will yield more effective background screens.
  1. Use a professional background screening company to assist you. There are many excellent and affordable screening companies to choose from, and we at Dave’s Killer Bread Foundation have had great experiences in our work with Occuscreen, GoodHire, and Checkr, among others. A professional background screening company can help you get the most out of your background checks and can work with you to ensure you’re soliciting the right information for the right purpose. Additionally, quality background screening companies are able to verify information through court runners and other means, which improves accuracy and reduces the likelihood that you’ll see or use irrelevant data (arrest records not leading to convictions, for example).
  1. Remember to be consistent. If you have two or more applicants applying for the same job, you should be requesting the same information about them when you run their backgrounds. Varying types of job responsibilities and roles might require varying levels of inquiry, but if multiple candidates are applying for the same job with the same title, it’s important to keep your process consistent. This will help you avoid the appearance of discrimination or favoritism.

And remember, background screens may involve some level of technological or human error. The information provided from a background screen is a valuable tool to help you in your hiring decision, but it is only one tool. Thoughtfully integrating this information—with your intuition, your experiences with the candidate in the interview, and your willingness to suspend bias or assumptions about an applicant’s character based on their past—can help you to make the best hiring choice every time.

Have questions about how to proceed with a report’s findings? Many employers aren’t criminal code experts, and don’t have to be. Dave’s Killer Bread Foundation is here to help. Get in touch.

SOURCE: Martin, G. (16 April 2019) "Background Screenings and Second Chance Employment - 3 Tips for Success" (Web Blog Post). Retrieved from https://blog.shrm.org/blog/background-screenings-and-second-chance-employment-3-tips-for-success


Dave’s Killer Bread Foundation is the nation’s only nonprofit foundation dedicated to inspiring and equipping employers to embrace Second Chance Employment

This post is part of a series for Second Chance Month, which highlights the need to improve re-entry for citizens returning to society and reduce recidivism. One of the primary ways to do this is by providing an opportunity for gainful employment. To sign the pledge and access the toolkit with information on how to create second chances at your company, visit GettingTalentBacktoWork.org