10 tips for next generation benefits

Great article from Benefits Pro about ten tips to help improve your benefits for the next generation by Erin Moriarty-Siler,

If brokers and their clients want to continue to attract and, more importantly, retain millennials and other generations entering the workforce, they'll need to start rethinking benefits packages.

As part of our marketing and sales tips series, we asked our audience for their thoughts on the next generation and their benefits needs.

Here are the 10 tips we liked best.

1. Show appreciation

“Even if you don't have the time and resources to roll out the red carpet each time an employee joins your team, they should feel as if you do. Even something as simple as a team lunch to welcome them and a functioning computer can go a long way toward making a new employee feel valued and at home.” Sanjay Sathe, president & CEO, RiseSmart.

2. Real world benefits

“It's important for benefits professionals and brokers to transform their organizations’ benefits offerings to align better with what both the individual and the generational millennials value — benefits that reflect the real world in which all generations in today's workforce think about the interconnection between their careers, employers, and personal lives.” Amy Christofis, client account executive, Connecture, Inc.

3. A millennial world

“One can no longer think of millennials as the ‘kids in the office.’ They are the office.” Eric Gulko, vice president, Summit Financial Corporation

4. New normal

Millennials are no longer just data and descriptors in a PowerPoint slideshow about job recruitment. They are now the majority, and how they do things will soon be the norm. It's important to consider these implications.

5. Innovation

“If we want to build organization that can innovate time and again, we must recast our understanding of what leadership is about. Leading innovation is about creating the space where people are willing and able to do the hard work of innovative problem solving.” Linda Hill, professor of business administration, Harvard Business School

6. Don't make assumptions

“Just because millennials are comfortable using the internet for research doesn't mean they don't also like a personal touch. Employers need to be wary of relying on only one communication vehicle to reach millennials. Sixty percent of millennials say they would be willing to discuss their benefits options with someone face to face or over the phone.” Ken Meier, vice president, Aflac Northeast Territory

7. The power of praise

“The prevailing joke is that millennials are ‘the participation trophy generation,’ having always been praised just for showing up, not necessarily winning. Turn that negative perception into a positive by realizing that providing constructive, encouraging feedback when it's earned motivates this generation to strive for even more successes.” Kristen Beckman, senior editor, LifeHealthPro.com

8. Embrace diversity

“For the first time, employers are likely to have up to five generations working together — matures, baby boomers, Generation X, millennials (Generation Y) and now Generation Z. From their workstyles to their lifestyles, each generation is unique.” Bruce Hentschel, leads strategy development, specialty benefits division, Principal Financial Group

9. Non-traditional needs

“Millennials have moved the needle in terms of work-life balance. They don't expect to sit in their cubicles from 9-5. They want flexibility in their work location and hours. However, on the flip side of that, they are more connected to their work than generations before, often logging ‘non-traditional’ work hours that better fit into their lives.” Amy Christofis, client account executive at Connecture, Inc.

10. Listen in

“If there's one thing the Trump victory teaches us, it's to listen to the silence in others. Millennials may be giving the financial industry the silent treatment, but that doesn't mean they don't want to talk.” Christopher Carosa, CTFA, chief contributing editor,FiduciaryNews.com

See the original article Here.

Source:

Moriarty-Siler E. (2017 February 03). 10 tips for next generation benefits [Web blog post]. Retrieved from address http://www.benefitspro.com/2017/02/03/10-tips-for-next-generation-benefits?page_all=1


9 questions employees have about ACA – and how to answer them

Have your employees been asking more questions about the ACA? Check out this great article from HR Morning about some of the question your employees might ask and how to answer them by Christian Schappel.

Even under the Trump administration, the Affordable Care Act (ACA) is still a real, enforceable law. You already know this. But do all of your employees? 

Chances are, once employees start getting their ACA-mandated 1095 forms from you in the next few weeks, some of them are going to have questions — à la: What is this? I thought Trump did away with Obamacare.

Here are some of the questions employees are asking — and are bound to ask — along with how HR can answer them:

1. Didn’t Trump repeal Obamacare?

No. While he has promised to “repeal and replace” the ACA, all he has done so far is sign an executive order that directs federal agencies to grant certain exemptions from the law, as well as waive any requirements that they’re able to by law.

Surely, the executive order will eventually weaken some parts of the ACA — and maybe even lead to some repeals — but nothing concrete has happened yet. As a result, employers still have to comply with the “play or pay” mandates, and individuals still have to carry health insurance or risk penalties.

2. Didn’t Republicans in Congress start repealing the law?

No. Republicans in Congress don’t have the votes they need to repeal the ACA outright. They can’t avoid a Democratic filibuster.

As a result, what they have done is state their intention to attack the law through a process known as reconciliation. It’ll allow Republicans to vote on budgetary pieces of the law — like the individual mandate (which is imposed with a tax) and healthcare subsidies — without giving the Democrats a chance to filibuster.

The problem for Republicans, though, is that reconciliation limits how they can reshape (or repeal) Obamacare.

3. Then when will Obamacare be repealed?

All you can tell employees right now is that it hasn’t happened, and there is no clear answer on when (or even if) it will happen in its entirety.

However, Republicans recently made two things clear at its recent annual retreat in Philadelphia:

  • They plans to use the reconciliation process to “repeal and replace” parts of the law.
  • The GOP will bring a final reconciliation package to the floor of the House of Representatives by late February or early March.

Chances are, we’ll find out more once Trump’s cabinet picks — specifically his pick to lead the Department of Health and Human Services — have been confirmed.

4. If I have a pre-existing condition, will I have trouble finding a health plan?

President Trump, as well as Republicans in Congress, have stated their intentions to attempt to keep two popular requirements of the ACA in place:

  • The need for insurance companies to offer coverage to individuals with pre-existing conditions.
  • The ability for children to be able to stay on their parents’ health plans until age 26.

Form 1095 questions

5. What is this form?

Form 1095 is a little like Form W-2: The employer or insurer sends one copy to the Internal Revenue Service (IRS) and one copy to the employee. It describes whether the person obtained the minimum required level of health insurance under the ACA in 2016.

It also informs the IRS, and the employee, if the person was eligible for a premium tax credit in 2016.

6. If Obamacare is going to be repealed, do I still need this form?

Yes. The reason is because the ACA was in effect for all of 2016, and this form is for reporting information that reflects what happened in 2016.

7. What do I have to do with it?

In most cases, no action will be necessary. When filing taxes for 2016, individuals will be asked if they obtained minimum insurance coverage. This form will help individuals answer that question.

8. Do I have to wait to receive the form to file my taxes?

Again, in most cases, the answer is no. Only those who received insurance via an exchange or the “marketplace” will have to wait for their 1095 to file their taxes.

If a person received insurance through an employer, that person doesn’t have to wait for Form 1095 to file his or her taxes, assuming the person already knows whether or not they had minimum coverage throughout the year. In that case, the person can just keep the form for their records.

If a person’s unsure whether he or she had minimum coverage for the entire year, that person can wait for the form to file their taxes or ask their employer whether he or she had minimum coverage.

9. How will I receive the form(s)?

Individuals may receive their form(s) in one of three ways:

  • mail
  • hand delivery, or
  • electronically (if they have consented to receive it electronically).

See the original article Here.

Source:

Schappel C. (2017 February 1). 9 questions employees have about ACA- and how to answer them [Web blog post]. Retrieved from address http://www.hrmorning.com/employee-questions-aca-obamacare-repeal-answers/


Target employee financial needs by finding the right technology

Are you looking for new ways to help improve your employees' financial needs? Take a look at this interesting article from Employee Benefits Advisors about how the use of technology can improve your employees' financial needs by Mark Singer

We have seen how a large percentage of the American workforce has an inadequate degree of financial literacy, and how the lack of basic financial knowledge causes personal problems and workplace stress. We have also seen the importance of financial education and how raising employee literacy directly benefits the bottom lines of companies.

The financial health of employees can vary greatly between companies, as can employee numbers. Work schedules and available facilities are other issues of variance. There is also the interest factor to address. Employees must find programs interesting and beneficial, or they will not attend or glean maximum results. Financial wellness programs that may be beneficial and successful for one company may be burdensome and unsuccessful for another. To meet pressing personal financial problems effectively, cutting-edge technologies need to be applied that both address immediate employee issues and limit company expense.

There are numerous new technologies that can be utilized in a mix-and-match fashion that successfully target employee financial needs. This age of the World Wide Web brings a host of financial education tools directly to the audience. Informational videos, virtual learning programs, webinars, training portals and other virtual solutions are easily accessible over the Internet and most are quite user-friendly. This mode of education is significant. For example, 84% of respondents to a survey conducted by Hewlett-Packard and the National Association for Community College Entrepreneurship said that e-tools were valuable. The study went on to show that modalities containing some degree of online training were preferred by 56% of respondents.

Gaming and data
One form of online educational technology that is gaining momentum as well as results is known as game-based learning. This method of learning is particularly popular with the millennial generation that has grown up with an ever-increasing variety of online gaming. In 2008, roughly 170 million Americans engaged in video and computer games that compel players to acquire skills necessary to achieve specific tasks. It has been found that well-designed learning programs that utilize a gaming sequence improve target learning goals. Such games teach basic financial lessons in a fun and innovative way that requires sharpened financial skills to progress through the programs.

Technological tools not only benefit those that are utilizing them directly, but they also assist the entire community through the collection of key data. Many of the mentioned tools embed surveys within programs or collect other data such as age, income and location, which can be used to create even better educational materials or better target groups in need of specialized services.

Employers need to realize that they benefit when they utilize these new technologies in their financial wellness programs, since these tools assist workers in taking control of their financial lives. Thereby reducing their stress levels, which in turn leads to happier and more productive employees. Sometimes it is best to meet the employees where they are, with tools that are easy and fun to use.

See the original article Here.

Source:

Singer M. (2017 February 02). Target employee financial needs by finding the right technology [Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/opinion/target-employee-financial-needs-by-finding-the-right-technology


Who Are You Benchmarking Your Health Plan Against?

Great article about the importance of benchmarking your employer health plans from our partner, United Benefit Advisors (UBA) by RJ Nelson

Many employers benchmark their health plan against carrier provided national data. While that is a good place to start, regional cost averages vary, making it essential to benchmark both nationally and regionally—as well as state by state. For example, a significant difference exists between the cost to insure an employee in the Northeast versus the Central U.S.—plans in the Northeast continue to cost the most since they typically have lower deductibles, contain more state-mandated benefits, and feature higher in-network coinsurance, among other factors.

Drilling down even more, comparing yourself to your industry peers can tell a very different story.

Consider a manufacturing plant in Georgia that offers a PPO. Its premium cost for single coverage is $507 per month. Compare this with the benchmarks for all plans and you can see that it is $2 per month less than the national average. When compared with other PPOs in the Southeast region, this employer’s cost is actually $2 more than the average. This employer’s cost appears to be higher or lower compared with national and regional benchmarks, depending on which benchmark is used. Yet this employer’s cost is actually higher than its closest peers’ costs when using the state-specific benchmark, which in Georgia is $468. Bottom line, this employer’s monthly single premium is actually $39 more than its competitors in the state.

As our CEO, Les McPhearson, recently stated, “Benchmarking by state, region, industry, and group size is critical. We see it time and time again, especially with new clients. An employer benchmarks their rates nationally and they seem at or below average, but once we look at their rates by plan type across multiple carriers and among their neighboring competitors or like-size groups, we find many employers leave a lot on the bargaining table.”

See the original article Here.

Source:

Nelson R. (2017 January 27). Who are you benchmarking your health plan against? [Web blog post]. Retrieved from address http://blog.ubabenefits.com/who-are-you-benchmarking-your-health-plan-against


What Trump’s ACA executive order means for employers

Great article from our partner, United Benefit Advisors (UBA) by Nick Otto

President Donald Trump wasted no time in fulfilling one promise he made time and again on his campaign trail in undoing the Affordable Care Act on day one in office.

On Friday, Trump issued an executive order directing members of his administration to take steps that will facilitate the repeal and replacement of the ACA, but experts note employers should continue with business as usual until solid formalities come out.

From an employer’s perspective, “every regulation they need to comply with, they still need to until they hear differently,” says Steve Wojcik, vice president of public policy at the National Business Group on Health.

What Trump’s order did was send a signal to everyone that his administration is prioritizing to repeal major parts of the ACA and to replace it with something else.

“In terms of specifics, nothing changes now, and it makes it clear that some changes may take longer than others because of the regulatory process to revise existing regulations,” Wojcik notes.

This specific order reiterates that it is administration policy to seek the repeal and replacement of the ACA and directs relevant agencies like Health and Human Services, Treasury and Labor, to utilize their authorities under the act “to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market,” according to the order.

But the different agencies will have to follow the law that requires notice and commenting periods before any final regulation is put in place, adds Chatrane Birbal, a government relations senior advisor with the Society for Human Resource Management.

“Trump’s administration is drawing a line in the sand,” she says. “While Congress is working on making its changes on a legislative front, Trump wants to move forward with the regulatory side.”

The most immediate focus will be whether the IRS acts to delay the employer reporting requirements under the employer shared responsibility provisions of the law, points out Joy Napier-Joyce, principal and leader of the employee benefits group at labor & employment law firm Jackson Lewis P.C.

“Employer reporting is key to assessing employer penalties under the employer mandate, [but it] represents a significant burden to employers and the deadlines are fast approaching,” she says. Similarly, Napier-Joyce says, “we have not seen enforcement of employer penalties under the employer mandate to date.”

Especially given Trump’s announcement Monday of a hiring freeze for federal workers and the known shortage of resources at the IRS, employers will be eager to glean hints as to any non-enforcement stances, she says. Much of the requirements under the employer mandate have been formalized through statute and regulation, so in order to effectively and completely reverse course, formal processes will need to be followed, which will in turn take time.

“For now, employers should stay the course, but stay tuned as we await how and when the agencies, particularly the IRS, choose to exercise discretion,” Napier-Joyce adds.

One issue Birbal advises keeping an eye on is that the executive order calls for greater flexibility to states.

“This could be a concern for employers because it doesn’t recognize ERISA preemption,” she notes. “It has provided employers and employees with a workable regulatory framework for benefits, offering uniform set of benefits to employees throughout out the U.S.”

“We believe the flexibility and certainty of the ERISA framework already in place has been a success to the employers sponsored system and we hope that’ll be maintained,” she adds.

Another area to note, says NBGH’s Wojcik, is how providers could be impacted by the order.

“There are a lot of punitive delivery reform regulations that are in various stages of completion or haven’t been issued,” he says. “To the extent that that affects hospitals and physicians, it could be an area where you see a lot of impact besides issues like the individual mandates and excise tax.”

As for policies that were still in the works, “if something hasn’t come out yet, it’s likely that it won’t come out ever based on executive order,” Wojcik notes.

See the original article Here.

Source:

Otto N. (2017 January 23). What trump's ACA executive order means for employers [Web blog post]. Retrieved from address http://www.benefitnews.com/news/what-trumps-aca-executive-order-means-for-employers?feed=00000152-18a4-d58e-ad5a-99fc032b0000


Only 1 in 3 employees actually understands how their 401(k) works

Do all of your employees understand how their 401(k) works? If not check out this article from HR Morning on the statistics of about 1 in 3 employees that do not understand their 401 (k) by Jared Bilski,

When it comes to common financial vehicles like 401(k) plans, term life insurance, Roth IRAs and 529 college savings plans, most workers could use some education on the finer points.  

In fact, according to a recent study by The Guardian Life Insurance Company of American, one-third or  less of employees said they had a solid understanding of the most common financial products.

Problem areas

Here is the specific breakdown from the Guardian Life study on the percentage of worker that said they have a solid understanding of various financial products:

  • 401(k)s and other workplace retirement plans (just 32% of workers said they had a solid understanding)
  • IRAs apart from Roth IRAs (27%)
  • Individual stocks and bonds (26%)
  • Mutual funds (25%)
  • Pensions (25%)
  • Roth IRAs (24%)
  • Term life insurance (23%)
  • Separately managed accounts (23%)
  • Disability insurance (23%)
  • 529 college savings plans (23%)
  • Whole life insurance (22%)
  • Business insurance, such as key person insurance or buy/sell agreements (20%)
  • Annuities (19%)
  • Universal life insurance (19%), and
  • Variable universal life insurance (18%).

Education vs. no education

One of the best ways to help workers garner a better understanding of their finances — and the financial products available to them — is through one-on-one education.

Consider this example:

The Principal Group compared the saving habits and financial acumen of workers who attended a one-on-one session the organization offered one year to those who didn’t.

What it found: Contribution rates for those who attended the session were 9% higher than those who didn’t. Also, 19% of the workers who received education opted to automatically bump up their retirement plan increases with pay increases, compared to just 2% of other employees.

Also, 92% of the employees who were enrolled in Principal’s education program agreed to take a number of positive financial steps, and 80% of those workers followed through on those steps.

See the original article Here.

Source:

Bilski J. (2017 January 27). Only 1 in 3 employees actually understands how their 401(k) works [Web blog post]. Retrieved from address http://www.hrmorning.com/only-1-in-3-employees-actually-understands-how-their-401k-works/


Solving the Prescription Puzzle

Great article from our partner, United Benefit Advisors (UBA) by Mary Delaney

Determining how an employer develops the most effective formulary, while protecting the financial stability of the plan, is certainly the challenge of this decade. Prescription management used to mean monitoring that the right people are taking medications to control their disease while creating strategies to move them from brand name to generic medications. With the dawn of specialty medications, formulary management has become a game of maximizing the pass-through of rebates, creating the best prior authorization strategies and tiering of benefits to create some barrier to more expensive medications, all without becoming too disruptive. As benefits managers know, that is a difficult challenge. The latest UBA Health Plan Survey revealed that 53.6 percent of plans offer four tiers or more, a 21.5 percent increase from last year and nearly a 55.5 percent increase in just two years. Thus, making “tiering” a top strategy to control drug costs. There are many additional opportunities to improve and help control the pharmacy investment, but focusing on the key components of formulary management and working on solutions that decrease the demands for medications are critical to successful plan management.

When developing a formulary, Brenda Motheral, RPh, MBA, Ph.D., CEO of Archimedes, suggests that chasing rebates is not a strategy to optimize your investment. Some of the highest rebates may be from medications that add no better therapeutic value than an inexpensive medication that does not offer a rebate, but net cost is much lower than the brand or specialty medication being offered. Best formulary management will mean that specific medications that do not offer a significant therapeutic value are removed from the formulary, or are covered at a “referenced price” so the member pays the cost difference. Formulary management will need to focus on where the drug is filled and which medications are available.

When setting up parameters on where a drug is to be filled, the decision needs to be made if a plan will promote mail order. Mail order, if used and monitored appropriately, makes it more convenient for a patient to receive their regularly used medications and may provide savings. In fact, the UBA Health Plan Survey finds that more than one-third (36.3 percent) of prescription drug plans provide a 90-day supply at a cost of two times retail copays. But if mail order programs are not monitored, people can continue to receive medications that are no longer required and never used, adding to medical spend waste. Furthermore, in our analysis, we are finding that not all medications are less expensive through mail order, as shown in Figure 1 below. Therefore, examining the cost differential is critical in a decision to promote, or not promote, mail order.

To see the full original article and charts click Here.

Source:

Delany M. (2017 January 24). Solving the prescription puzzle [Web blog post]. Retrieved from address http://blog.ubabenefits.com/solving-the-prescription-puzzle


Best and Worst States for Group Health Care Costs

Great article from our partner, United Benefit Advisors (UBA) about which states are the best/worst for group health care by Matt Weimer.

Also make sure to register for our upcoming UBA webinar on Tuesday, February 21 at 2:00 p.m. ET. The topic will be a case study on why communication matters in employee benefits. To register for the webinar click Here.

Employer-sponsored health insurance is greatly affected by geographic region, industry, and employer size. While some cost trends have been fairly consistent since the Patient Protection and Affordable Care Act (ACA) was put in place, UBA finds several surprises in its latest Health Plan Survey. Based on responses from more than 11,000 employers, UBA recently announced the top five best and worst states for group health care monthly premiums.

The top five best (least expensive) states are:

1) Hawaii

2) Idaho

3) Utah

4) Arkansas

5) Mississippi

Hawaii, a perennial low-cost leader, actually experienced a nearly seven percent decrease in its single coverage in 2016. New Mexico, a state that was a low-cost winner in 2015, saw a 22 percent increase in monthly premiums for singles and nearly a 30 percent increase in monthly family premiums, dropping it from the “best” list.

The top five worst (most expensive) states are:

1) Alaska

2) Wyoming

3) New York

4) Vermont

5) New Jersey

The UBA Health Plan Survey also enables state ranking based on the average annual cost per employee. The average annual cost per employee looks at all tiers of a plan and places an average cost on that plan based on a weighted average metric. While the resulting rankings are slightly different, they also show some interesting findings.

The 2016 average annual health plan cost per employee for all plan types is $9,727, which is a slight decrease form the average cost of $9,736 in 2015. When you start to look at the average annual cost by region and by state, there is not much change among the top from last year. The Northeast region continues to have the highest average annual cost even with the continued shift to consumer-driven health plans (CDHP). In 2016, enrollment in CDHPs in the Northeast was 34.9 percent, surpassing those enrolled in preferred provider organization (PPO) plans at 33 percent. Even with the continued shift to CDHPs, the average annual costs were $12,202 for New York, which remained the second-highest cost state, followed by $12,064 for New Jersey, and rounding out the top five, Massachusetts and Vermont flip-flopped from 2015 with Massachusetts at $11,956 and Vermont at $11,762.

As was the case in 2015, Alaska continues to lead all states in average health plan costs, topping New York by more than $1,000 per employee, with an average cost of $13,251. While year-over-year the average cost for Alaska only increased 3.35 percent, the gap increased to 36.2 percent above the national average of $9,727.

Keeping close to the national average increase, the top five states all saw a year-over-year increase of less than 4.5 percent. Unfortunately, even at a modest increase, the one thing that the top five have in common is that they all are more than 20 percent above the national average for health plan costs per employee.

See the original article Here.

Source:

Weimer M. (2017 February 15). Best and worst states for group health care costs [Web blog post]. Retrieved from address http://blog.ubabenefits.com/best-and-worst-states-for-group-health-care-costs


10 tips for furthering benefits education

Are you looking for some new ways to educate yourself in the world of benefits? Here are some great tips from Benefits Pro you can use to help increase your knowledge about benefits by Erin Moriarty-Siler

In order to maintain relevant in today's ever-changing benefits market, it's important that brokers and benefits professionals keep learning.

Whether that be by networking with others in the industry, diving in with new technology efforts, or simply chatting about client needs, it's essential industry professionals keep learning.

As part of our our marketing and sales tips series, we asked our audience for their thoughts on how to continue their benefits education.

Here are the 10 tips we liked best.

1. Cost-effective education excites employees

Employees are eager to better themselves, especially if doing so can be cost effective through innovative benefits. Consider offering financial planning and educational services like career development courses or college prep classes, as these are becoming more and more popular.

2. Industry events

Disruption will continue in the insurance industry, but will you be able to keep up? Stay up-to-date by attending industry events, such as the BenefitsPRO Broker Expo in April.

3. Practice makes perfect

To retain knowledge and keep a competitive edge, it's important to practice and refresh skills year-round (think social media training, for instance).

4. It's not a "no," it's a growth opportunity

Treat rejection as a learning opportunity. Find ways to turn a no into a yes and remember that persistence prevails.

5. Trial and error is the best teacher

“Experiments are usually about learning. When you get a negative outcome, you’re still really learning something that you need to know.” Linda Hill, professor of business administration, Harvard Business School

6. Think outside your own experience

Look to your colleagues for exclusive insight you might not have. Ask a younger co-worker what they’d most like out of a benefits package, or what type of insurance is best for your officemate nearing retirement.

7. Learning and education are not created equal

“I’m a three-time college dropout, so learning over education is very near and dear to my heart, but to me, education is what people do to you, learning is what you do to yourself.” Joi Ito, director, MIT Media Lab

8. Become the expert

“You can distinguish yourself with top-notch technical or industry knowledge. It pays to be viewed as an expert, whether in risk management or the regulatory landscape. You’ll open up many opportunities by becoming an authority.” Renee Preslar, communications manager, Transamerica Employee Benefits

9. Money, money, money

“The No. 1 employee wellness trend in 2017 will be an increasing focus on helping employees better themselves financially by providing the tools, resources, education and environment to improve their finances.” Matt Cosgriff, retirement plan consultant, BerganKDV Wealth Management.

10. Too much is never enough

“You can never be overdressed or overeducated.” Oscar Wilde

See the original article Here.

Source:

Moriarty-Siler E. (2017 January 24). 10 tips for furthering benefits education[Web blog post]. Retrieved from address http://www.benefitspro.com/2017/01/24/10-tips-for-furthering-benefits-education?ref=hp-news&page_all=1


Large Employer Health Plans Could Also See Some Impacts From Obamacare Overhaul

Obamacare repeal could have a huge impact on employer healthcare plans. According to this article from Kaiser Health News large employers might feel some of the Obamacare overhauls ripple effect by Michelle Andrews

If you think that because you get health insurance through your job at a big company, you won’t be affected if Republicans overhaul Obamacare, think again.  Several of the law’s provisions apply to plans offered by large employers too (with some exceptions for plans that were in place before the law passed in March 2010).

It’s not yet clear how President-elect Donald Trump and the congressional Republicans plan to revamp the federal health law. They have not agreed on a plan, and they do not have enough votes in the Senate to fully repeal the current statute. So they are planning to use a budgeting rule to disassemble part of the law, and that will limit what they can change. But they also may seek revisions in important regulations and guidance that have determined how the law is implemented.

Nonetheless, as the tensions grow in Washington over the future of the health law, it is important to understand some of its effects on large-group plans.

No Copays For Preventive Services

The health insurance offered by big companies is typically pretty comprehensive, the better to attract and keep good employees. But Obamacare broadened some coverage requirements. Under the law, insurers and employers have to cover many preventive services without charging people anything for them. The services that are required with no out-of-pocket payments include dozens of screenings and tests, including mammograms and colonoscopies, that are recommended by the U.S. Preventive Services Task Force; routine immunizations endorsed by the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; and a range of services that are recommended specifically for children and for women by the federal Health Resources and Services Administration.

The change that affects the most people on an ongoing basis is likely the requirement that plans cover without cost sharing all methods of contraception approved by the Food and Drug Administration. (There are limited exceptions for religious employers.)

“In terms of sustained costs, birth control is probably the biggest,” said Caroline Pearson, a senior vice president at Avalere Health.

No Annual Or Lifetime Limits On Coverage

Even the most generous plans often had lifetime maximum coverage limits of a few million dollars before the health law passed, and some plans also imposed annual coverage limits. The health law eliminated those dollar coverage limits.

Annual Cap On Out-Of-Pocket Payments For Covered Services

The health law set limits on how much people can be required to pay in deductibles, copayments or coinsurance every year for covered care they receive from providers in their network. In 2017, the limit is $7,150 for individuals and $14,300 for families.

“Many employers often had an out-of-pocket limit anyway, but this guarantees protection for people with high needs,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms, who has written on this issue.

Adult Kids’ Coverage Expanded

The law allowed workers to keep their children on their plans until they reach age 26, even if they’re married, financially independent and live in another state. Republicans have said they may keep this popular provision in place if they dismantle the law.

Guaranteed External Appeal Rights

Consumers who disagree with a health plan’s decision to deny benefits or payment for services can appeal the decision to an independent review panel.

The provision applies to all new health plans, including those offered by self-funded companies that pay their workers’ claims directly and who were previously exempt from appeals requirements.

No Waiting Periods To Join A Plan 

Employers used to be able to make new employees wait indefinitely before they were eligible for coverage under the company plan. No more. Now the waiting time for coverage can be no more than 90 days.

No Waiting Periods For Coverage Of Pre-Existing Conditions 

Prior to the ACA, employers could delay covering workers’ chronic and other health conditions for up to a year after they became eligible for a plan. Under the ACA, that’s no longer allowed. As a practical matter, though, coverage of pre-existing conditions was rarely an issue in large-group plans, say some health insurance experts.

“It was difficult administratively, and the law of large numbers” meant that one individual’s health care costs didn’t generally have a noticeable impact on the group, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Repeal could reopen the door to that prohibited practice, however.

Standardized Plan Descriptions

The law requires all plans to provide a “summary of benefits and coverage” in a standard format that allows consumers to understand their coverage and make apples-to-apples plan comparisons. 

Basic Coverage Standards For Large-Group Plans

The health law isn’t as prescriptive with large-group plans about the specific benefits that have to be offered. They aren’t required to cover the 10 essential health benefits that individual and small-group plans have to include, for example. But the law does require that big companies offer plans that meet a “minimum-value” standard paying at least 60 percent of the cost of covered services, on average. Those that don’t could face a fine.

Initially, the online calculator that the federal Department of Health and Human Services provided to help large employers gauge compliance with the minimum value standard gave the green light to plans that didn’t cover hospitalization services or more than a few doctor visits a year. Now plans must provide at least that coverage to meet federal standards.

The result: Large employers generally no longer offer so-called “mini-med” policies with very skimpy benefits.

If the health law is repealed, that could change. In some industries with lower-wage workers and smaller profit margins, “they might begin to offer them again, and employees might demand it” to help make the premiums more affordable, said Steve Wojcik, vice president of public policy at the National Business Group on Health, a membership organization representing large employers.

Although the law strengthened coverage for people in large-group plans in several ways, consumer advocates have complained about shortcomings. It aimed to ensure that coverage is affordable by requiring that individuals be responsible for paying no more than 9.69 percent of their household income for individual employer coverage, for example.

If their insurance costs more than that, workers can shop for coverage on the marketplaces set up by the health law and be eligible for premium tax credits — if their income is less than 400 percent of the federal poverty level (about $47,000). But the standard does not take into consideration any additional costs for family coverage.

Consumer advocates also point to the wellness regulations as a problematic area of the law. The health law increased the financial incentives that employers can offer workers for participating in workplace wellness programs to 30 percent of the cost of individual coverage, up from 20 percent.

Such incentives can effectively coerce people into participating and sharing private medical information, critics charge, and unfairly penalize sick people.

“It potentially allows [plans] to discriminate against people with medical conditions, which the ACA is supposed to eliminate,” said Linda Blumberg, a senior fellow at the Urban Institute’s Health Policy Center.

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Source:

Andrews M. (2017 January 17). Large employer health plans could also see some impacts from obamacare overhaul [Web blog post]. Retrieved from address http://khn.org/news/large-employer-health-plans-could-also-see-some-impacts-from-obamacare-overhaul/