All That Glitters Is Not Gold in Employee Benefits

Great article from our partner, United Benefit Advisors (UBA) about how not everything is what it seems in the world of employee benefits by Michael A. Fleck

The Magpie Effect

Why does a magpie decorate its nest with shiny objects? The randomly gathered trinkets serve no practical purpose. Scientists suggest, and it seems likely, that these most intelligent of animals simply like the way they look.

When something is pleasing to the eye, we – like magpies – are drawn to it. Beauty can, and often does, cloud our critical assessment. This occurs in the world of benefits and benefits technology when we assume the outward appearance of an object (what we see) and what’s beneath the surface (what we get) are the same.

Indeed, the Internet has changed the world. Today’s buyers tend to judge the capabilities of a system by the “prettiness” of its user interface (UI): The Magpie Effect.

But, we’ve all learned the hard way that choices made on appearances alone can lead to disappointment.

The Big Three

As the creators and managers of Benefits Passport – United Benefit Advisor’s (UBA) open architecture exchange – understanding what goes into highly successful relationships between benefit advisors and the employers they serve is essential to our work. That’s because our primary purpose is to give benefits advisors more freedom to create and deliver value to their clients, while we empower employers to take maximum advantage of that value. In our quest for greater understanding, we have found three things you need to know:

  1. The Magpie Effect! Sometimes (too often, actually), what advisors offer and what employers find attractive are not things upon which highly successful relationships can be built.
  2. All employer/advisor relationships go through a life cycle.
  3. An outcome-based relationship is essential for the successful navigation of the life cycle and optimal ROI for every dollar spent on employee benefits.

Let’s take a closer look at why The Magpie Effect occurs and the damage it can cause. I will explore the life cycle and outcome-based relationships in parts two and three of this blog.

Technology For Technology’s Sake

Being part of an HR company that develops and delivers technology has made me acutely aware of how often technology is seen as a panacea. With insufficient – if any – critical assessment, advisors sell and employers buy a shiny new online portal featuring enrollment, multimedia employee education, and FAQ-driven issues resolution. With a sexy user interface, paperwork-replacing-automation, and anytime, anywhere accessibility … it’s all very bedazzling and it’s easy to see why The Magpie Effect is so powerful. That’s why being aware of The Magpie Effect adds even more validity to that old, old adage, “caveat emptor” (i.e., let the buyer beware).

Let the buyer beware means it is up to the employer to critically assess what their benefits advisor is offering. It also means that lying beneath the shiny surface of traditional employer/advisor relationships are some less than attractive things. When the buyer must beware, the relationship is not built on sound decision-making driven by verifiable, relevant facts and mutually beneficial outcomes. Instead, it’s an adversarial relationship driven by sentiment, opinion and, too often, opposing goals.

A Culture of Convenience and Commodities

Two powerful cultural forces give weight and power to what lies below the shiny surface of traditional employer/advisor relationships.

One is the belief we are entitled to more and more convenience. Developers, marketers, and sellers have long preyed on the images of a technological utopia deeply embedded in our collective consciousness … think the Jetsons. In the case of employee benefits, this belief has contributed to the rise of a “set-it-and-forget-it” attitude; simply set the technology in place and forget about it as it does the job of keeping employees happy.

In addition to the demand for convenience is the perception that health insurance is a commodity. This perception leads to an environment where the price is the dominating focus of the annual renewal selling/buying conversation. Made increasingly acute by unsustainable annual premium increases, the focus on price precludes all but the most cursory discussions about why benefits are being offered in the first place. There is little room for any thought of aligning the benefit program with the employer’s strategic, social, and ethical goals.

Beauty Gets into the Eyes of the Beholder

Beauty (a beautiful UI) lures us along an easy decision-making shortcut that stifles awareness and bypasses logic. Bright and shiny sells because it makes it easier for us to convince ourselves we are making a wise choice. By giving us an excuse, and permission, to not critically assess our current reality and honestly appraise the true value – the outcomes we can expect. Beauty too often leads to getting far less than we paid for … and, far, far less than what we need to be truly successful.

Admittedly, breaking free of The Magpie Effect is not easy. Becoming fully aware of what is actually happening and why – and our complicity in making it so – can be painful and embarrassing. And, embracing logic before beauty compels us to look at the root causes of the problems we are seeking to solve. Embracing logic means being honest about the challenges we must be prepared to face on the road to our dreams.

Say, “Bye-Bye Birdy!”

There are many examples of employers who have broken free from the cultural conditioning that continues to trap the vast majority in a win/lose relationship with their benefits. The catalyst in these cases is the relationship they’ve developed with their advisor – one focused on the relationship and not on selling solutions. The best advisors know their job is to navigate the employer-advisor relationship life cycle starting with a deep understanding of their client’s world. And the most progressive employers partner with advisors who have the courage to have open, honest conversations with clients about the outcomes that count. Fueling their success is a relentless commitment to playing an essential role in making those outcomes happen.

In parts two and three of this blog, I will share what we’ve learned about how to best navigate the client relationship life cycle and how you can initiate and sustain a relationship based on the outcomes that count.

See the original article Here.

Source:

Fleck M. (2017 January 19). All that glitters is not gold in employee benefits [Web blog post]. Retrieved from address http://blog.ubabenefits.com/all-that-glitters-is-not-gold-in-employee-benefits


IRS may have big ACA employer tax woes, advocate says

IRS may play a big part in your company's ACA tax filing. Checkout this article from Benefits Pro about what the IRS will be looking for in companies ACA filings this year by Allison Bell

An official who serves as a voice for taxpayers at the Internal Revenue Service says the IRS may be poorly prepared to handle the wave of employer health coverage offer reports now flooding in.

The Affordable Care Act requires "applicable large employers" to use Form 1095-C to tell their workers, former workers and the IRS what, if any, major medical coverage the workers and former workers received. Most employers started filing the forms in early 2016, for the 2015 coverage year.

This year, the IRS is supposed to start imposing penalties on some employers who failed to offer what the government classifies as solid coverage to enough workers.

If Donald Trump's promise holds true, the Affordable Care Act could be on its way out. Along with it may...

Nina Olson, the national taxpayer advocate, says the IRS was not equipped to test the accuracy of ACA health coverage information reporting data before the 2016 filing season, for the 2015 coverage year. The IRS expected to receive just 77 million 1095-C forms for 2015, but it has actually received 104 million 1095-C's, and it has rejected 5.4 percent of the forms, Olson reports.

"Reasons for rejected returns include faulty transmission validation, missing (or multiple) attachments, error reading the file, or duplicate files," Olson says.

Meanwhile, the IRS has had to develop a training program for the IRS employees working on employer-related ACA issues on the fly, and it was hoping in November to provide the training this month, Olson says.

"The training materials are currently under development," Olson says. She says her office did not have a chance to see how complete the training materials are, or how well they protect taxpayer reports.

Olson discusses those concerns about IRS efforts to administer ACA tax provisions and many other tax administration concerns in a new report on IRS performance. The Taxpayer Advocate Service prepares the reports every year, to tell Congress how the IRS is doing at meeting taxpayers' needs.

In the same report, Olson talks about other ACA-related problems, such as headaches for ACA exchange plan premium tax credit subsidy users who are also Social Security Disability Insurance program users, and she gives general ACA tax provision administration data.

APTC subsidy

The ACA premium tax credit subsidy program helps low-income and moderate-income exchange plan users pay for their coverage.

Exchange plan buyers who qualify can get the tax credit the ordinary way, by applying for it when they file their income tax returns for the previous year. But about 94 percent of tax credit users receive the subsidy in the form of an "advanced premium tax credit."

When an exchange plan user gets an APTC subsidy, the IRS sends the subsidy money to the health coverage issuer while the coverage year is still under way, to help cut how much cash the user actually has to pay for coverage.

When an APTC user files a tax return for a coverage year, in the spring after the end of the coverage year, the user is supposed to figure out whether the IRS provided too little or too much APTC help. The IRS is supposed to send cash to consumers who got too little help. If an APTC user got too much help, the IRS can take some or all of the extra help out of the user's tax refund.

Another ACA provision, the "individual shared responsibility" provision, or individual coverage mandate provision, requires many people to obtain what the government classifies as solid major medical coverage or else pay a penalty.

Individual taxpayers first began filing ACA-related tax forms in early 2015, for the 2014 coverage year. Early last year, individual taxpayers filed ACA-related forms for the second time, for the 2015 coverage year.

Only 6.1 million taxpayers told the IRS they owed individual mandate penalty payments for 2015, down from 7.6 million who owed the penalty for 2014.

But, in part because the ACA designed the mandate penalty to get bigger each year for the first few years, the average penalty payment owed increased to $452 for 2015, from $204 for 2014.

The number of households claiming some kind of exemption from the penalty program increased to 8.6 million, from 8.4 million.

The number of filers who said they had received APTC help increased to 5.3 million for 2015, up from 3.1 million for 2014. And the amount of APTC help reported increased to $18.9 billion for 2015, from $11.3 billion in APTC subsidy help for 2014.

That means the 2015 recipients were averaging about $3,566 in reported subsidy help in 2015, down from $3,645 in reported help for 2014.

Olson says her office helped 10,910 taxpayers with ACA premium tax credit issues in the 12-month period ending Sept. 30, 2016, up from 3,318 in the previous 12-month period.

One of her concerns is how the Social Security Disability Insurance program, which is supposed to serve people with severe disabilities, interacts with the ACA provision that requires people who guess wrong about their income during the coverage year to pay back excess APTC subsidy help.

SSDI lump-sum payment headaches

Some Social Security Disability Insurance recipients have to fight with the Social Security Administration for years to qualify for benefits. Once the SSDI recipients win their fights to get benefits, the SSA may pay them all of the back benefits owed in one big lump sum.

The big, lump-sum disability benefits payments may increase the SSDI recipients' income for a previous year so much they end up earning too much for that year to qualify for ACA premium tax credit help, Olson says in the new report.

The SSDI recipients may then have to pay all of the ACA premium tax credit help they received back to the IRS, Olson says.

So far, IRS lawyers have not figured out any law they can use to protect the SSDI recipients from having to pay large amounts of premium tax credit help back to the government, Olson says.

For now, she says, her office is just trying to work on a project to warn consumers about how accepting any lump-sum payment, including an SSDI lump-sum benefits payment, might lead to premium tax credit headaches.

See the original article Here.

Source:

Bell A. (2017 January 16). IRS may have big ACA employer tax woes, advocate says [Web blog post]. Retrieved from address http://www.benefitspro.com/2017/01/16/irs-may-have-big-aca-employer-tax-woes-advocate-sa?page_all=1


FIVE TRENDS IN TALENT

Do you know what is needed to attract new talent to your company? Here's a great article from SHRM about 5 trends that new hires are looking for in 2017 by Shonna Waters & Alex Alonso

1. A VERY COMPETITIVE TALENT MARKETPLACE
Labor market improvements and skills shortages have combined to create a very competitive talent marketplace. Sourcing talent is now as much about how organizations represent themselves to the world as it does about digging deeper to find new pockets of talent. Not only is sourcing talent a real and relevant problem for HR, but according to a 2015 SHRM survey of non-HR executives, it is the defining issue for ensuring organizational sustainability. As we look to the future, organizations that can find talent in non-traditional pockets or manufacture their talent through partnerships with educational institutions and NGOs will continue to build competitive advantage.
2. DATA & ANALYTICS WILL DRIVE HUMAN CAPITAL DECISIONS
Big data and analytics trends have not spared HR. Today's competitive landscape requires HR professionals to be able to tie talent investments to business objectives. Metrics such as cost-per-hire and time-to-fill are no longer sufficient. New trends in workforce analytics call for meta-metrics like return on workforce investment and assessing opportunity costs associated with workforce processes. Moreover, truly astute consumers of these meta-metrics will also blend in marketing tools like net promoter scores to enhance the information gathered about the organization's effectiveness when promulgating brand and consumer value propositions. All this to say, when looking at workforce analytics we can safely say, "it isn't your grandfather's analytics anymore."
3. INTEGRATED PERFORMANCE MANAGEMENT
In part thanks to increased attention on business outcomes (or lack thereof) of traditional performance appraisal systems, organizations are responding to an overwhelming imbalance between what they invest in appraisal systems and the outcomes they receive by eliminating or significantly re-conceptualizing performance management (e.g., General Electric, Deloitte, Adobe, Microsoft, Gap, Inc.). Despite overwhelming frustration with appraisal systems, they are here to stay. HR professionals will have to take on new ways of designing these systems to move beyond administrative processes to business impact. The most successful organizations will focus on strengthening the performance culture to embed performance management behaviors such as feedback and coaching into the day-to-day work rather than crafting it as a separate and administrative process.
4. PARENTAL LEAVE
Heavy workplace demands and an increasingly complex, global environment can lead to burnout, low productivity, dissatisfaction, and stress-related illnesses across organizational levels. Increased research demonstrating the importance of employee well-being, an increasingly transparent and competitive talent market, and media attention on both gender equality and paid leave policies across the globe have made paid parental, maternity, and paternity leave a top trend for 2017. Although only about a quarter of organizations currently offer this type of paid leave, competitive organizations will be taking a hard look at their policies next year to ensure their benefits packages appeal to their target employees.
5. THE GIG ECONOMY & ADAPTIVE LEADERSHIP
Two other trends, the contingent workforce and leader development, are worth watching. The gig economy is here to stay. Employees can no longer be easily parsed into full-time and part-time, exempt and non-exempt. HR professionals will need to grapple with how to orient and socialize gig workers, while staying in compliance with evolving laws and regulations. Rapid changes within the business environment are also threatening the old command and control management structures and styles. As a result, new models of leadership and leader development methods are required to build complex, adaptable leaders who can handle ambiguity and constant change and motivate their employees to do the same by focusing on meaning and purpose.

See the original article Here.

Source:

Waters S., Alonso A. (2017 January 5). Five trends in talent [Web blog post]. Retrieved from address http://blog.shrm.org/blog/five-trends-in-talent


Feds pump out even more Obamacare instructions

Have you heard about the recent changes coming to the ACA? If not take a look at this great article from HR Morning about the recent changes that will be going into effect for the ACA by Jared Bilski

If you believe Republicans on Capitol Hill, the Affordable Care Act (ACA) isn’t long for this world. Still, the Obama administration continues to clarify how businesses are supposed to comply with the law’s many provisions. 

The Department of Labor (DOL), Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS) just put their heads together for the 35th time to address questions surrounding Obamacare reforms.

Here’s some of the most useful info to come out of this latest FAQ:

Qualified small employer HRA

As HR Morning reported previously, the 21st Century Cures Act, among other things, allows certain small employers to offer a general purpose stand-alone health reimbursement arrangement (HRA) without violating the ACA. It is also referred to as a “qualified small employer health reimbursement arrangement” — or QSEHRA.

The FAQ touches on how this new law jibes with the ACA and clarified that in order to be a QSEHRA, the structure of the plan must:

  • be funded entirely by an eligible employer — one with fewer than 50 full-time equivalent employees in the prior year and that doesn’t offer a group health plan to any of its employees
  • provide payment to, or reimbursement of, an eligible employee for medical care under Code section 213(d)
  • not reimburse more than $4,950 for eligible expenses for individuals or $10,000 for families, and
  • be provided to all eligible employees of the employer offering the HRA.

One thing the 21st Century Cures Act (and the feds’ FAQ) doesn’t address: Whether the Employee Retirement Income Security Act (ERISA) applies to a QSEHRA.

Special Enrollment & HIPAA

The FAQ also addressed special enrollment for group health plans under the Health Insurance Portability and Accountability Act (HIPAA). Because HIPAA generally allows current employees and dependents to enroll in a company’s group health plan if the employees/dependents lose their previous coverage, they must be offered the same special enrollment option if they lose individual market coverage (i.e., health coverage they obtained through the individual Obamacare marketplace — or “exchanges”).

This could happen to individual market participants if an insurer that was covering an employee/dependent decides to stop offering that individual market coverage. As we saw last year, several major insurers have taken that step.

One exception to this special enrollment: If the loss of coverage is due to a failure to pay premiums in a timely manner — or “for cause.”

Updated women’s preventive services

As you know, under the ACA, non-grandfathered health plans are required to provide recommended preventives services for women without any cost-sharing.

Those services are listed in the Health Resources and Services Administration’s (HRSA) guidelines, and the guidelines were just updated on December 20, 2016. The updated guidelines bolster many of the existing covered preventive care services for women in the areas of:

  • breast cancer
  • cervical cancer
  • gestational diabetes
  • HIV, and
  • domestic violence.

The services in the updated guidelines must be covered — without cost-sharing — for plan years beginning on or after December 20, 2017 (Jan. 1, 2018 for calendar year plans). Until then, plans can keep using the previous HRSA guidelines.

See the original article Here.

Source:

Bilski J. (2017 January 6). Feds pump out even more Obamacare instructions [Web blog post]. Retrieved from address http://www.hrmorning.com/feds-pump-out-even-more-obamacare-instructions/


DOL and IRS want a closer look at your retirement plan

Are you worried that your company's retirement plan is not up to government standards? If so take a look at this article from HR Morning about what the DOL and IRS are looking for in retirement plans by Jared Bilski

Two of the most-feared government agencies for employers — the DOL and IRS — have decided there’s a real problem with the way retirement plans are being run, and they’re ramping up their audits to find out why that is.

In response to the many mistakes the agencies are seeing from retirement plan sponsors, the IRS and DOL will be increasing the frequency of their audits.

What does that mean for you? According to experts, plan sponsors can expect the feds to dig deep into the minute operations of plans. That means the unfortunate employers who find themselves in the midst of an audit can expect to be asked for heaps of plan info.

Linda Canafax, a senior retirement consultant with Willis Towers Watson, put it like this:

“The DOL and IRS are truly diving deep into the operations of the plans. We have seen a deeper dive into the operations of plans, particularly with data. Plans may be asked for a full census file on the transactions for each participant. Expect the DOL and IRS to do a lot of data mining.”

What to watch for

Ultimately, it’s impossible to completely prevent an audit. But employers can — and should — do certain things to safeguard themselves in the event the feds come knocking.

First, a self-audit is always a good idea. It’s always better for you to discover any problems before the feds do. Next, you’ll want to be on the lookout for the types of errors that can lead the feds to your workplace in the first place.

The most common errors the IRS and the DOL are looking for:

  • Untimely remittance of employee deferrals (i.e., contributions)
  • Incorrect compensation definition (plan documents dictate which types of comp employees are eligible to contribute from)
  • Not following the plan’s own directives, and
  • Not having a good long-term system (20-30 years out) for tracking and paying benefits to vested participants.

See the original article Here.

Source:

Bilski J. (2017 January 6). DOL and IRS want a closer look at your retirement plan[Web blog post]. Retrieved from address http://www.hrmorning.com/dol-and-irs-want-to-take-a-closer-look-at-your-retirement-plan/


How to encourage increased investment in financial wellbeing

Is financial wellness an important part of your company culture? By promoting financial wellness among your employees', employers can reap the benefits as well. Check out this great article from Employee Benefits Advisor about the some of the effects that promoting financial wellness can have. By Cort Olsen

Financial wellness has come to the forefront of employers’ wellbeing priorities. Looking back on previous years of participation in retirement savings programs such as 401(k)s, employers are not satisfied with participation, an Aon study shows.

As few as 15% of employers say they are satisfied with their workers’ current savings rate, according to a new report from Aon Hewitt. In response, employers are focused on increasing savings rates and will look to their advisers to help expand financial wellbeing programs.

Aon surveyed more than 250 U.S. employers representing nearly 9 million workers to determine their priorities and likely changes when it comes to retirement benefits. According to the report, employers plan to emphasize retirement readiness, focusing on financial wellbeing and refining automation as they aim to raise 401(k) savings rates for 2017.

Emphasizing retirement readiness
Nearly all employers, 90%, are concerned with their employees’ level of understanding about how much they need to save to achieve an adequate retirement savings. Those employers who said they were not satisfied with investment levels in past years, 87%, say they plan to take action this year to help workers reach their retirement goals.

“Employers are making retirement readiness one of the important parts of their financial wellbeing strategy by offering tools and modelers to help workers understand, realistically, how much they’re likely to need in order to retire,” says Rob Austin, director of retirement research at Aon Hewitt. “Some of these tools take it a step further and provide education on what specific actions workers can take to help close the savings gap and can help workers understand that even small changes, such as increasing 401(k) contributions by just two percentage points, can impact their long-term savings outlook.”

Focusing on financial wellbeing
While financial wellness has been a growing trend among employers recently, 60% of employers say its importance has increased over the past two years. This year, 92% of employers are likely to focus on the financial wellbeing of workers in a way that extends beyond retirement such as help with managing student loan debt, day-to-day budgeting and even physical and emotional wellbeing.

Currently, 58% of employers have a tool available that covers at least one aspect of financial wellness, but by the end of 2017, that percentage is expected to reach 84%, according to the Aon Hewitt report.

“Financial wellbeing programs have moved from being something that few leading-edge companies were offering to a more mainstream strategy,” Austin says. “Employers realize that offering programs that address the overall wellbeing of their workers can solve for myriad challenges that impact people’s work lives and productivity, including their physical and emotional health, financial stressors and long-term retirement savings.”

The lessons learned from automatic enrollment are being utilized to increase savings rates. In a separate Aon Hewitt report, more than half of all employees under plans with automatic enrollment default had at or above the company match threshold. Employers are also adding contribution escalation features and enrolling workers who may not have been previously enrolled in the 401(k) plan.

“Employers realize that automatic 401(k) features can be very effective when it comes to increasing participation in the plan,” Austin says. “Now they are taking an automation 2.0 approach to make it easier for workers to save more and invest better.”

See the original article Here.

Source:

Olsen C. (2017 January 16). How to encourage increased investment in financial wellbeing [Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/news/how-to-encourage-increased-investment-in-financial-wellbeing?feed=00000152-1377-d1cc-a5fa-7fff0c920000


Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too

Great article from Health Affairs about the effects of ACA repeal on employer healthcare by JoAnn Volk

Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.5 million people likely to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market. Overlooked in the declarations of who stands to lose under plans to “repeal and replace” the ACA are those enrolled in employer-sponsored health plans — the primary source of coverage for people under 65.

Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan.

It’s easy to understand the focus on the individuals who gained access to coverage thanks to the health reform law. ACA drafters targeted most of the law’s insurance reforms at the individual and small-group markets, where consumers and employers had the greatest difficulty finding affordable, adequate coverage prior to health reform. The ACA’s market reforms made coverage available to those individuals with pre-existing conditions who couldn’t obtain coverage in the pre-ACA world, and more affordable for those low- and moderate-income families who couldn’t afford coverage on their own.

Less noticed, but no less important, the ACA also brought critical new protections to people in large employer plans. Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals—particularly those with costly, chronic health conditions—with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses.

Preventive Services Without Cost-Sharing

The ACA requires all new health plans, including those sponsored by employers, to cover recommended preventive services without cost-sharing, bringing new benefits to 71 million Americans. That means individuals can get the screenings, immunizations, and annual check-ups that can catch illness early or prevent it altogether without worrying about meeting a costly deductible or co-payment. With that peace of mind, it’s no wonder it’s one of the most popular provisions of the ACA. Women employees can also access affordable contraception, making available a wider variety of contraceptive choices and increasing use of long-term contraceptive methods.

Pre-Existing Condition Exclusions

Under the ACA, employers cannot impose a waiting period for coverage of a pre-existing condition. Prior to the ACA, individuals who became eligible for an employer plan—for example, once hired for a new job—might have to wait up to 12 months for the plan to cover pre-existing health conditions. You could “buy down” that waiting period with months of coverage under another plan, so long as it was the right kind of plan and you didn’t go without coverage for 63 days or more. But if you lost your job, couldn’t afford COBRA, went a few months without coverage and then were lucky enough to get another job with benefits, you might find the care you needed wasn’t covered under your plan for an entire year.

Dependent Coverage To Age 26

The ACA requires all health plans, including those sponsored by large employers, to cover dependents up to age 26. Prior to the ACA, one of the fastest growing groups of uninsured was young adults — not because they turned down coverage offered to them, but because they were less likely to have access to employer-based plans or other coverage. The result has been a dramatic increase in the number of insured young adults, particularly among those with employer-sponsored coverage. This ACA requirement is one provision President-elect Trump and many anti-ACA legislators have pledged to retain.

Annual Out-Of-Pocket Limit

The ACA requires all new health plans, including those sponsored by employers, to cap the amount individuals can be expected to pay out-of-pocket each year. Prior to the ACA, even those with the security of coverage on the job couldn’t count on protection from crippling out-of-pocket costs.

Prohibition On Annual And Lifetime Limits

The ACA prohibits employer plans from having an annual or lifetime dollar limit on benefits. Prior to the ACA, employer plans often included a cap on benefits; when employees hit the cap, the coverage cut off. For individuals who needed costly care, like a baby born prematurely or those with hemophilia or multiple sclerosis, that often meant a desperate scramble to find new coverage options as one after another benefit limit was reached.

External Review

The ACA guarantees individuals the right to an independent review of a health plan’s decision to deny benefits or payment for services, regardless of whether the employer plan is insured or self-funded. Prior to the ACA, only workers in insured plans had the right to an independent review of a denied claim. But more than 60 percent of workers are in self-funded plans, and the only option for those workers to hold their plan accountable was to sue, an expensive and lengthy process.

If you’re one of the 150 million people who get their coverage through an employer plan, you may want to pay attention to the prognostications of what’s to become of the ACA. Your access to high-quality, affordable health care will depend on the outcome.

See the original article Here.

Source:

Volk J. (20174 January 11). Get health insurance through your employer? ACA repeal will affect you, too [Web blog post]. Retrieved from address http://healthaffairs.org/blog/2017/01/11/get-health-insurance-through-your-employer-aca-repeal-will-affect-you-too/


Health Law Sleepers: Six Surprising Health Items That Could Disappear With ACA Repeal

Does ACA repeal have you worried? Look into this great article from Kaiser Health News about some of things that could disappear with ACA repeal by Julie Appleby and Mary Agnes Carey

The Affordable Care Act of course affected premiums and insurance purchasing. It guaranteed people with pre-existing conditions could buy health coverage and allowed children to stay on parents’ plans until age 26. But the roughly 2,000-page bill also included a host of other provisions that affect the health-related choices of nearly every American.

Some of these measures are evident every day. Some enjoy broad support, even though people often don’t always realize they spring from the statute.

In other words, the outcome of the repeal-and-replace debate could affect more than you might think, depending on exactly how the GOP congressional majority pursues its goal to do away with Obamacare.

No one knows how far the effort will reach, but here’s a sampling of sleeper provisions that could land on the cutting-room floor:

CALORIE COUNTS AT RESTAURANTS AND FAST FOOD CHAINS

Feeling hungry? The law tries to give you more information about what that burger or muffin will cost you in terms of calories, part of an effort to combat the ongoing obesity epidemic. Under the ACA, most restaurants and fast food chains with at least 20 stores must post calorie counts of their menu items. Several states, including New York, already had similar rules before the law. Although there was some pushback, the rule had industry support, possibly because posting calories was seen as less onerous than such things as taxes on sugary foods or beverages. The final rule went into effect in December after a one-year delay. One thing that is still unclear: Does simply seeing that a particular muffin has more than 400 calories cause consumers to choose carrot sticks instead?  Results are mixed. One large meta-analysis done before the law went into effect didn’t show a significant reduction in calorie consumption, although the authors concluded that menu labeling is “a relatively low-cost education strategy that may lead consumers to purchase slightly fewer calories.”

PRIVACY PLEASE: WORKPLACE REQUIREMENTS FOR BREAST-FEEDING ROOMS

Breast feeding, but going back to work? The law requires employers to provide women break time to express milk for up to a year after giving birth and provide someplace — other than a bathroom — to do so in private. In addition, most health plans must offerbreastfeeding support and equipment, such as pumps, without a patient co-payment.

LIMITS ON SURPRISE MEDICAL COSTS FROM HOSPITAL EMERGENCY ROOM VISITS

If you find yourself in an emergency room, short on cash, uninsured or not sure if your insurance covers costs at that hospital, the law provides some limited assistance. If you are in a hospital that is not part of your insurer’s network, the Affordable Care Act requires all health plans to charge consumers the same co-payments or co-insurance for out-of-network emergency care as they do for hospitals within their networks. Still, the hospital could “balance bill” you for its costs — including ER care — that exceed what your insurer reimburses it.

If it’s a non-profit hospital — and about 78 percent of all hospitals are — the law requires it to post online a written financial assistance policy, spelling out whether it offers free or discounted care and the eligibility requirements for such programs. While not prescribing any particular set of eligibility requirements, the law requires hospitals to charge lower rates to patients who are eligible for their financial assistance programs. That’s compared with their gross charges, also known as chargemaster rates.

NONPROFIT HOSPITALS’ COMMUNITY HEALTH ASSESSMENTS

The health law also requires non-profit hospitals to justify the billions of dollars in tax exemptions they receive by demonstrating how they go about trying to improve the health of the community around them.

Every three years, these hospitals have to perform a community needs assessment for the area the hospital serves. They also have to develop — and update annually — strategies to meet these needs. The hospitals then must provide documentation as part of their annual reporting to the Internal Revenue Service. Failure to comply could leave them liable for a $50,000 penalty.

A WOMAN’S RIGHT TO CHOOSE … HER OB/GYN

Most insurance plans must allow women to seek care from an obstetrician/gynecologist without having to get a referral from a primary care physician. While the majority of states already had such protections in place, those laws did not apply to self-insured plans, which are often offered by large employers. The health law extended the rules to all new plans. Proponents say direct access makes it easier for women to seek not only reproductive health care, but also related screenings for such things as high blood pressure or cholesterol.

AND WHAT ABOUT THOSE THERAPY COVERAGE ASSURANCES FOR FAMILIES WHO HAVE KIDS WITH AUTISM?

Advocates for children with autism and people with degenerative diseases argued that many insurance plans did not provide care their families needed. That’s because insurers would cover rehabilitation to help people regain functions they had lost, such as walking again after a stroke, but not care needed to either gain functions patients never had, such speech therapy for a child who never learned how to talk, or to maintain a patient’s current level of function. The law requires plans to offer coverage for such treatments, dubbed habilitative care, as part of the essential health benefits in plans sold to individuals and small groups.

See the original article Here.

Source:

Appleby J., Carey M. (2017 January 12). Health law sleepers: six surprising health items that could disappear with ACA repeal [Web blog post]. Retrieved from address http://khn.org/news/health-law-sleepers-six-surprising-health-items-that-could-disappear-with-aca-repeal/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=40532225&_hsenc=p2ANqtz-8vl0H_K8CNgaURbqgYS5m3isu1NUGrj0FRIdsUX8JCwcifTDRV-UvKdu6lZGvB06FTyhENvPFLaOMOsIrr2IBVBTNWQg&_hsmi=40532225


What medical conditions are driving employer healthcare costs?

Do you which medical conditions are driving your healthcare cost? Check out this great article from Employee Benefits Advisor about the cost associated with your employer healthcare by Phil Albinus

Healthcare costs surrounding diabetes reached $101 billion in diagnoses and treatments over the past 18 years — and the cost grew 36 times faster than the cost of ischemic heart disease, the leading cause of death in the U.S. Further, out of 155 medical conditions, only 20 accounted for half of all medical spending, according to a JAMA analysis of 2013 healthcare costs.

The third-most expensive medical condition, low back and neck pain, primarily strikes adults of working age while diabetes and heart disease is primarily found in people 65 and older.

The JAMA study found total health spending for these conditions totaled $437 billion in 2013. Diabetes, heart disease, low back and neck pain, along with hypertension and injuries from falls, comprise 18% of all personal health spending. All in all, 20 conditions make up more than half of all spending on healthcare in the U.S.

These stark figures shed light on the rising healthcare costs that employers pay when addressing their workforce’s ailments.

According to Francois Millard, senior vice president and chief actuarial officer for Vitality Group, one of the study’s sponsors, this is the first study to dig into the details of the leading ailments of the U.S. and its costs to employers and families as they deal with the conditions.

“In absolute terms, most money for care is in the working age population,” he says. “It impacts households and employers and contributes to the financial burden of families.”

“What we see is the financial burden increases as the disease increases, and while the paper doesn’t go into detail, we already have a significant knowledge of diabetes and heart condition. It is related to modifiable behavior.”

The JAMA study noted the differences between public health program spending from personal health spending, including individual out-of-pocket costs and spending by private and government insurance programs.

“While it is well known that the U.S. spends more than any other nation on healthcare, very little is known about what diseases drive that spending,” said Dr. Joseph Dieleman, lead author of the paper and assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington, in a press statement. “IHME is trying to fill the information gap so that decision-makers in the public and private sectors can understand the spending landscape, and plan and allocate health resources more effectively.”

Despite using figures from 2013, the information can help employers as they identify where their healthcare dollars are going.

“Given the biggest increases in healthcare spending on impact working age populations, it requires employers to improve their work environments and facilitate good health. And [this study can] help increase the transparency of health within their populations,” says Millard.

“Employers need to think what they do that impacts beyond the four walls of the employers and create a symbiotic relationship with health within their societies,” he adds.

The study can also boost transparency into the healthcare data. “This study is also an accountability and outcome of the money they are spending on health treatment,” Millard says. “Is it sufficient to still pay for services or can we push for more accountability for health outcomes? The other thing this facilities is that employers get the adequate level of data. They can ask the right questions and determine accountability for the huge amounts of healthcare.”

He adds, “With all the uncertainty around 2017, perhaps this transparency will give employers a voice to all of the money that they are spending.”

The top 10 most costly health expenses in 2013:

1. Diabetes – $101.4 billion
2. Ischemic heart disease – $88.1 billion
3. Low back and neck pain – $87.6 billion
4. Hypertension – $83.9 billion
5. Injuries from falls – $76.3 billion
6. Depressive disorders – $71.1 billion
7. Oral-related problems – $66.4 billion
8. Vision and hearing problems – $59 billion
9. Skin-related problems, such as cellulitis and acne – $55.7 billion
10. Pregnancy and postpartum care – $55.6 billion

See the original article Here.

Source:

Albinus P. (2017 January 12). What medical conditions are driving employer healthcare costs?[Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/news/what-medical-conditions-are-driving-employer-healthcare-costs?brief=00000152-1443-d1cc-a5fa-7cfba3c60000


Qualified Small Employer Health Reimbursement Arrangements and ERISA

Make sure to stay up-to-date with the most recent compliance alerts from our partners at United Benefits Advisors (UBA).

Starting on January 1, 2017, certain small employers have the option to reimburse individual health coverage premiums up to a dollar limit through Qualified Small Employer Health Reimbursement Arrangements (QSE HRAs) under the 21st Century Cures Act (Cures Act).

The Cures Act amends the Employee Retirement Income Security Act of 1974 (ERISA) to exclude QSE HRAs from the ERISA definition of group health plan; however, the Cures Act does not specifically exclude QSE HRAs from the rest of ERISA.

Small employers that plan to offer QSE HRAs should be cautious before presuming that ERISA would not apply to a reimbursement arrangement. ERISA generally covers employee welfare benefit plans that are established or maintained by any employer engaged in interstate commerce or in any industry or activity affecting interstate commerce.

Under the Cures Act, QSE HRAs are excluded from one of ERISA’s two definitions of “group health plan.” QSE HRAs are excluded from the definition of group health plan that applies only to ERISA’s Title I, Part 7, that governs group health plan requirements. In summary, Part 7 includes requirements relating to portability, access, renewability, mother/newborn benefits, parity in mental health and substance use disorder benefits, reconstructive surgery, dependent student coverage, and additional market reforms.

Outside of the group health plan definition above, ERISA provides a broader definition of an employee welfare benefit plan: generally, it is any plan, fund, or program established or maintained by an employer to provide participants or their beneficiaries with medical, surgical, or hospital care or benefits, through the purchase of insurance or otherwise.

Further, in the legislative history of QSE HRA’s exclusion from ERISA’s group health plan definition, the House Committee on Ways and Means’ Report stated, as part of recommending the bill’s passage: “While these arrangements are not considered group health plans for purposes of the employer penalty, H.R. 5447 is not intended to change the extent to which these plans are employee welfare benefit plans under ERISA.”

Because QSE HRAs are new, the issue of whether the remainder of ERISA applies to QSE HRAs remains undetermined by an administrative agency or court. In consideration of the limited ERISA group health definition exclusion and the law’s legislative history, a risk-averse small employer should treat a QSE HRA as an employee welfare benefit plan covered under ERISA and comply with applicable ERISA requirements such as having a written plan document and summary plan description as well as following ERISA’s fiduciary and other rules.

A small employer who intends to offer a QSE HRA without complying with ERISA’s employee welfare benefit plan requirements should consult with its attorney before proceeding

Download the release here.