Here’s how to ensure employees know how to pick the right benefits

Open enrollment is often a stressful time for employees, as well as an important one. Recent research shows that the average employee spends less than 30 minutes selecting their benefits. Continue reading for more on communicating benefit options to employees.


Annual enrollment is an important time for employees — but it’s also a stressful one. The choices they make can affect their financial health, yet the average employee spends less than 30 minutes selecting their benefits, according to research from benefits provider Unum.

With annual enrollment planning underway, now is the time for employers to ask themselves, “How can we help employees make the right benefits decisions?” The answers may be more valuable than they think.

See Also: Avoiding Communication Overload During Open Enrollment

Today’s workforce is the most diverse in history, with four generations actively working, and a fifth connected through benefits and pensions. A robust benefits package is increasingly important for recruitment and retention, challenging employers to provide choices and options that support diverse needs.

About 80% of employees prefer a job with benefits over one with a higher salary but no benefits, according to the American Institute of CPAs. As such it’s vital that employers ensure their workforce is engaged with their benefits and taking full advantage of what is available. Here are five ways employers can make sure that happens.

See Also: Incorporating Incentives to Create Educated Benefit Consumers

1. Acknowledge that decision support addresses personalized needs. Tools that demystify the benefits selection process can help employees make choices that align with their risk tolerance, financial circumstances and unique needs. The best tools lead employees to a recommended suite of benefits options that fit their individual physical, emotional and financial health.

2. Know that year-round engagement improves benefits literacy. While employees appreciate benefits, they aren’t experts. Indeed, roughly one-third of employees are outright confused about their benefits, according to recent data from Businessolver. Keeping up a cadence of communication about benefits throughout the year can help address this challenge.

3. Recognize the power of a total rewards statement. It empowers employees to maximize the benefits available to them, and these tools can be accessed at any time, not just during enrollment. The most impactful solutions aggregate all employee benefits options in one integrated offering that demonstrates the full value of compensation and benefits investments made by them and their employer.

See Also: Communicating the Value of Employee Benefits

4. Think about different generations. Customizable benefits options are a crucial step in meeting the needs of today’s workforce. For example, our latest data shows that nearly two-thirds of millennials are concerned with managing their monthly budget, while over 50% of boomers are most worried about a large, unexpected cost. Having core medical plan offerings along with complementary voluntary options helps employees address varying financial needs. Likewise, paid parental leave and different health plan options assist families at any stage, and they make it likelier that your employees will engage with their benefits and remain with your organization.

5. Be sure employees know that savings vehicles contribute to financial well-being. Employees of all ages and income levels are facing financial stressors — but they may not be the same ones. Offering different financial benefits, such as student loan assistance and emergency savings accounts, in addition to retirement benefits, enables your employees to address both their immediate and long-term financial needs.

See Also: Ideas for Effectively Demonstrating Plan Choices

More than ever, employers have a responsibility to help employees make informed decisions when it comes to selecting the right benefits. Otherwise, they risk losing top talent to organizations that are better implementing benefits strategies and technologies.

By meeting the needs of a diverse workforce with an array of benefits options supported by appropriate decision support resources, employers can ensure they’re meeting their workforce’s needs and retaining valuable employees.

See Also: Ideas to Help Employees Find their "Best Fit" Plan

SOURCE: Shanahan, R. (26 June 2019) "Here’s how to ensure employees know how to pick the right benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/educating-employees-to-pick-the-right-benefits


The Occupational Phenomenon Called Employee Burnout

Workplace culture and work expectations at an organization often can foster employee burnout, defined as “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed,” by the World Health Organization. Continue reading to learn more.


Employee burnout is fast becoming prevalent in many workplaces and is also a recurring theme in my day-to-day conversations with people. Unfortunately, many workplaces dismiss the subject and make it more of the employee’s issue than a workplace issue.

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.”

— World Health Organization

An organization’s culture and the work expectations in those organizations can foster employee burnout. Below are examples of situations that make employees prone to burnout:

  • Digital Culture: A digital workplace, according to Deloitte, is one where many operational activities are performed over technology devices. These days, you can access your work emails, phone and video conferencing applications, instant messaging tools, and work documents through a single device. It is even more tempting to resist the notifications that continuously nudge you to respond to work-related matters. While I appreciate the digital workplace and understand that it is here to stay, it often implies that we need to be available around-the-clock, even during weekends. You have managers or coworkers sending work requests during early or late hours of the day, leading to a work-life imbalance for the employee. When work begins to encroach into an employee’s personal life, then they are at risk of burnout.
  • Excessive Meetings: Collaboration is a skill required in many workplaces, and there’s no doubt that it is essential. However, some organizations tend to go overboard with their expectations from employees. Study shows that the average employee spends approximately six hours in meetings per week, while senior managers spend about 23 hours in meetings per week, and this increases by the size of the organization. Meetings, whether in-person or virtual, provide excellent opportunities for collaboration. When meetings become excessive and leave employees with little to no time to decompress, this can cause stress for employees and eventually lead to burnout.
  • Dysfunctional Work Environments: In these work environments, employees face issues such as bullying, micromanagement, gossip, favoritism, or microaggression from coworkers or managers. A workplace that encourages such undermining behaviors can cause undue stress, which can eventually lead to burnout.
  • Overworking Top Performers: It is quite easy for managers to overwork the best-performing employees. While the managers have the assurance of quality work, such employees become the victims of burnout because it seems like the reward for top performance is more work. Worse still, burnout is likely to occur when these employees do not receive fair compensation for the work they do.

What are the Signs of Employee Burnout?

The following are some signs of burnout in your employees:

  • Reduced drive and work performance
  • Increased absences from work
  • Frequent tardiness
  • Mental health conditions like anxiety and depression
  • Poor concentration at work
  • Increased sick days
  • Visible frustration
  • Lack of trust in the company and its leaders

If you or your colleagues are exhibiting any of these signs, you might be burned out.

Some Data

  • A 2018 Gallup report states that “two-thirds of full-time workers experience burnout on the job.”
  • A Harvard Business School article reports that “the estimated cost of workplace stress is anywhere from $125 to $190 billion a year.”
  • An article by The World Economic Forum states that “the annual cost of burnout to the global economy has been estimated to be £255 billion.”
  • Research by Stanford Graduate School of Business states that “workplace stress—such as long hours, job insecurity and lack of work-life balance—contributes to at least 120,000 deaths each year and accounts for up to $190 billion in health care costs.”

The data shows that employee burnout is now a workplace epidemic. To prove the seriousness of this issue, the World Health Organization (WHO) recently classified burnout as an “occupational phenomenon” in its latest revision of the International Classification of Diseases (ICD-11).

Ways to Reduce Employee Burnout

  • Create and Maintain a Positive Work Environment: You can do this by being aware of your actions and how they impact those around you. Do not bully or micromanage your employees, or gossip about them to other employees you manage. When making decisions about your employees, be fair and consistent to avoid feelings of favoritism. Also, empower your employees to apply their skills by giving them autonomy. These help to increase satisfaction and create trust in the workplace.
  • Set Realistic Goals: Plan projects ahead of time with your employees, set realistic deadlines or meetings, and be mindful of their personal commitments when assigning projects with tight deadlines.
  • Show Support: Create communication channels for your employees to share their concerns or frustrations with you. Having an open-door policy or weekly check-in meetings where they can share their concerns with you can make your employees feel supported. Listen to them and help to address their issues.
  • Show Appreciation: Recognize your employees for their contributions to your team. Recognition makes your employees, especially your top performers, feel like their work is impactful. When employees feel appreciated, they are more likely and willing to do great work.
  • Promote Self-Care: Encourage your employees to practice self-care by permitting their requests for personal time off or vacation when they need it. You can also encourage them to fully unplug while they are out of the office by not sending urgent requests. Another way to promote self-care is to remove all expectations that employees need to be reachable around-the-clock. Also, do not encourage employees to stay long hours at work.

Originally published on Osasu Arigbe blog.

SOURCE: Arigbe, O. (13 June 2019) "The Occupational Phenomenon Called Employee Burnout" (Web Blog Post). Retrieved from https://blog.shrm.org/blog/the-occupational-phenomenon-called-employee-burnout


PCORI Fee Is Due by July 31 for Self-Insured Health Plans

Patient-Centered Outcomes Research Institute (PCORI) annual fees are due by July 31, 2019. Plans with terms ending after September 30, 2012, and before October 1, 2019, are required to pay an annual PCORI fee. Read this article from SHRM to learn more.


An earlier version of this article was posted on November 6, 2018

The next annual fee that sponsors of self-insured health plans must pay to fund the federal Patient-Centered Outcomes Research Institute (PCORI) is due July 31, 2019.

The Affordable Care Act mandated payment of an annual PCORI fee by plans with terms ending after Sept. 30, 2012, and before Oct. 1, 2019, to provide initial funding for the Washington, D.C.-based institute, which funds research on the comparative effectiveness of medical treatments. Self-insured plans pay the fee themselves, while insurance companies pay the fee for fully insured plans but may pass the cost along to employers through higher premiums.

The IRS treats the fee like an excise tax.

The PCORI fee is due by the July 31 following the last day of the plan year. The final PCORI payment for sponsors of 2018 calendar-year plans is due by July 31, 2019. The final PCORI fee for plan years ending from Jan. 1, 2019 to Sept. 30, 2019, will be due by July 31, 2020.

In Notice 2018-85, the IRS set the amount used to calculate the PCORI fee at $2.45 per person covered by plan years ending Oct. 1, 2018, through Sept. 30, 2019.

The chart below shows the fees to be paid in 2019, which are slightly higher than the fees owed in 2018. The per-enrollee amount depends on when the plan year ended, as in previous years.

Fee per Plan Enrollee for Payment Due
July 31, 2019
Plan years ending from Oct. 1, 2018, through Sept. 30, 2019. $2.45
Fee per Plan Enrollee for Payment Due
July 31, 2018
Plan years ending from Oct. 1, 2017, through Dec. 31, 2017, including calendar-year plans. $2.39
Plan years ending from Jan. 1, 2017, through Sept. 30, 2017 $2.26
Source: IRS.

Nearing the End

The PCORI fee will not be assessed for plan years ending after Sept. 30, 2019, "which means that for a calendar-year plan, the last year for assessment is the 2018 calendar year," wrote Richard Stover, a New York City-based principal at HR consultancy Buck Global, and Amy Dunn, a principal in Buck's Knowledge Resource Center.

For noncalendar-year plans that end between Jan. 1, 2019 and Sept. 30, 3019, however, there will be one last PCORI payment due by July 31, 2020.

"There will not be any PCORI fee for plan years that end on October 1, 2019 or later," according to 360 Corporate Benefit Advisors.

The PCORI fee was first assessed for plan years ending after Sept. 30, 2012. The fee for the first plan year was $1 per plan enrollee, which increased to $2 per enrollee in the second year and was then indexed in subsequent years based on the increase in national health expenditures.

FSAs and HRAs

In addition to self-insured medical plans, health flexible spending accounts (health FSAs) and health reimbursement arrangements (HRAs) that fail to qualify as “excepted benefits” would be required to pay the per-enrollee fee, wrote Gary Kushner, president and CEO of Kushner & Co., a benefits advisory firm based in Portage, Mich.

As set forth in the Department of Labor's Technical Release 2013-03:

  • health FSA is an excepted benefit if the employer does not contribute more than $500 a year to any employee accounts and also offers a group health plan with nonexcepted benefits.
  • An HRA is an excepted benefit if it only reimburses for limited-scope dental and vision expenses or long-term care coverage and is not integrated with a group health plan.

Kushner explained that:

  • If the employer sponsors a fully insured group health plan for which the insurance carrier is filing and paying the PCORI fee and the same employer sponsors an employer-funded health care FSA or an HRA not exempted from the fee, employers should only count the employees participating in the FSA or HRA, and not spouses or dependents, when paying the fee.
  • If the employer sponsors a self-funded group health plan, then the employer needs to file the form and pay the PCORI fee only on the number of individuals enrolled in the group health plan, and not in the employer-funded health care FSA or HRA.

An employer that sponsors a self-insured HRA along with a fully insured medical plan "must pay PCORI fees based on the number of employees (dependents are not included in this count) participating in the HRA, while the insurer pays the PCORI fee on the individuals (including dependents) covered under the insured plan," wrote Mark Holloway, senior vice president and director of compliance services at Lockton Companies, a benefits broker and services firm based in Kansas City, Mo. Where an employer maintains an HRA along with a self-funded medical plan and both have the same plan year, "the employer pays a single PCORI fee based on the number of covered lives in the self-funded medical plan (the HRA is disregarded)."

Paying PCORI Fees

Self-insured employers are responsible for submitting the fee and accompanying paperwork to the IRS, as "third-party reporting and payment of the fee is not permitted for self-funded plans," Holloway noted.

For the coming year, self-insured health plan sponsors should use Form 720 for the second calendar quarter to report and pay the PCORI fee by July 31, 2019.

"On p. 2 of Form 720, under Part II, the employer needs to designate the average number of covered lives under its applicable self-insured plan," Holloway explained. The number of covered lives will be multiplied by $2.45 for plan years ending on or after Oct. 1, 2018, to determine the total fee owed to the IRS next July.

To calculate "the average number of lives covered" or plan enrollees, employers should use one of three methods listed on pages 8 and 9 of the Instructions for Form 720. A white paper by Keller Benefit Services describes these methods in greater detail.

Although the fee is paid annually, employers should indicate on the Payment Voucher (720-V), located at the end of Form 720, that the tax period for the fee is the second quarter of the year. "Failure to properly designate 'second quarter' on the voucher will result in the IRS's software generating a tardy filing notice, with all the incumbent aggravation on the employer to correct the matter with the IRS," Holloway warned.

A few other points to keep in mind: "The U.S. Department of Labor believes the fee cannot be paid from plan assets," he said. In other words, for self-insured health plans, "the PCORI fee must be paid by the plan sponsor. It is not a permissible expense of a self-funded plan and cannot be paid in whole or part by participant contributions."

In addition, PCORI fees "should not be included in the plan's cost when computing the plan's COBRA premium," Holloway noted. But "the IRS has indicated the fee is, however, a tax-deductible business expense for employers with self-funded plans," he added, citing a May 2013 IRS memorandum.

SOURCE: Miller, S. (2 July 2019) "PCORI Fee Is Due by July 31 for Self-Insured Health Plans" (Web Blog Post). Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2019-pcori-fees.aspx


One overlooked way to promote well-being: Target oral health

How is your company promoting well-being? Research shows an association between gum disease and conditions like diabetes and coronary artery disease. Continue reading for how employers can promote well-being by targeting oral health.


With the cost of employer-sponsored healthcare benefits approaching $15,000 a year per employee, according to the National Business Group on Health, innovative companies are looking for new and creative ways to get maximum value from their benefits dollars.

By embracing benefits strategies focused on overall health, companies can help their current employees be healthier and more productive and attract and retain the workers they need to succeed in today’s competitive labor markets.

And although wellness programs or health apps might first spring to mind, there’s an overlooked way to promote employees’ health: oral care.

Guided by research that shows associations between gum disease and conditions like diabetes and coronary artery disease, forward-thinking dental insurers are developing products that emphasize the importance of regular oral care, particularly for workers with those conditions — and smart companies are jumping on board.

Products that emphasize the importance of maintaining oral health are an important step in integrating care. Over the next several years, leading-edge insurers will create new ways to engage patients in conversations about their dental and overall health, as they seek to encourage behavior changes and improve health outcomes. To help improve oral and overall well-being, insurers will need to share oral care information with their members through targeted emails, text messages and phone calls.

Additionally, because individuals dealing with a complex treatment plan may put off receiving oral care while they address their medical issues, they could benefit from plans featuring a case manager, or a “dental champion.” Working in conjunction with medical case managers, a dental champion can help employees understand how receiving regular oral care can influence their overall health. They also can ensure a company’s workforce is getting the oral care they need, helping them find providers and arrange appointments.

Savvy employers recognize that any realistic effort to limit the increase in healthcare costs begins by addressing chronic ailments. According to the Centers for Disease Control and Prevention, six in 10 Americans live with at least one chronic disease, like heart disease, cancer, stroke or diabetes.

By promoting overall health — including regular oral care — employers can encourage positive lifestyle changes that help their employees reduce the likelihood of many chronic problems. Those who brush and floss their teeth regularly, receive frequent cleanings and checkups and deal with oral issues at early stages are taking steps to improve their overall health.

Because everyone’s individual situation is different, insurers and employers will need to include a more personalized approach, engaging members in conversations about their dental health and how it contributes to attaining their overall health goals.

SOURCE: Palmer, T. (13 June 2019) "One overlooked way to promote well-being: Target oral health" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/promoting-wellbeing-through-dental-health


5 myths about returning to work after a disability

How is your return-to-work program? Many employers, human resources professionals and benefits experts have misperceptions about return-to-work and the accommodations that are used to make programs successful. Continue on for five myths about returning to work after a disability.


Carl was 58 when he found out he needed a hip replacement, and the environmental services worker was told he’d be out of work for three months to recover.

But less than eight weeks after his surgery, Carl was back on the job. It wasn’t because he couldn’t pay his bills without a paycheck — his short-term disability insurance through his employer helped with that. Instead, it was for two reasons: One, he was eager to get back to his normal life, and two, his employer was willing to support a plan for a gradual transition back to his usual duties. With his doctor’s approval, he worked half-days for two weeks as he built back his endurance and work stamina, and soon was working full-time again.

The result: Carl’s transition back to work over a 14-day period got him back on the job 40 days earlier than expected, based on initial estimated date. The transition plan also allowed him to return to work without needing to tap into his long-term coverage. At the same time, his employer was saved the cost of hiring and training replacement staff or paying overtime to other workers.

With a win-win like this — and it’s just one of thousands of examples I could share — you’d think all employers would be on board with return-to-work strategies. Instead we’ve found a surprising number of employers, human resources professionals and even benefits experts have misperceptions about return-to-work and the accommodations that can make it successful. And it’s hitting them and their employees hard on the bottom line.

Here are five of the most common myths about returning to work after a disability. See how many you mistakenly believe.

1. It’ll create a workers’ compensation claim. Some employers are afraid an employee who’s had a disabling injury will be a safety risk, getting reinjured on the job and creating a costly workers’ comp claim. The reality is a gradual transition back to full-time work makes employees safer as they regain strength and rebuild skills.

2. We don’t have to provide accommodations unless the injury happened at work.
This one’s not true, either, according to the Equal Employment Opportunity Council. Employers legally can’t differentiate between employees who suffer a disabling injury at work and those who’re injured at home or elsewhere. Smart employers focus on getting a valuable employee back to work, not the injury or illness and where it happened.

3. Employees must be 100% or they can’t perform productive work.Employers willing to be creative often find there are many tasks a skilled, knowledgeable employee can perform during a transition period. True, some jobs have more rigid requirements than others. For example, a nurse might not be physically able to go straight back to patient care. But if you’re like most of us, you have a stockpile of back-burner projects that would benefit your business. A transitioning employee could have the perfect skills to take those on. In other cases, simple, inexpensive accommodations can help an employee perform better: An assembly line worker who can’t stand for an eight-hour shift could use a leaning stool for support and be just as productive.

4. Customer care or service will be negatively impacted. This one might seem logically true, but it really isn’t when you crunch the numbers. Accommodating a returning employee with part-time hours or different duties for a period of time has less impact on service and productivity than hiring, training and ramping up replacement staff. Routinely cross-training employees in other jobs also gives employers the flexibility to move resources where they’re needed at any time.

5. Other employees will also want “light duty.” This may not exactly qualify as a myth, as some employees really might want what they perceive as easier work. The issue is the term light duty itself, which is both loaded and vague. Effective communication is essential here: Consistently refer to new, alternate or modified job tasks, be transparent, and make sure employees understand return-to-work options. Having a return-to-work program where employees feel valued impacts the morale of the whole team, boosting productivity.

How to make return-to-work work well

Helping your valued employees rejoin your team doesn’t have to be costly or difficult. Here are a few tips to make it successful.

Communicate early and often. Meet or talk with the employee before the leave and stay in touch while on leave. Talk before the return to work to set expectations.

Be flexible. Consider a graduated return-to-work plan to allow the employee to ramp up to full time. Allow work at home for part of the day or week, if possible. Make hours flexible to allow for medical appointments.

Be welcoming. Meet with the employee upon return, and ensure the manager conducts regular one-to-one meetings with the employee. Allow the employee time to reintegrate, perhaps with the aid of a mentor.

Focus on the job, not the illness or injury. Instead of asking the employee how he or she is feeling, ask how the company can better assist him or her in performing the essential functions of the job.

Be creative. Avoid making assumptions about what the returning employee can do. Flexible work arrangements, accessible technology or inexpensive adaptations can often help the employee do the job in alternate ways.

SOURCE: Ledford, M (5 June 2019) "5 myths about returning to work after a disability" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/myths-about-returning-to-work-after-a-disability


IRS increases 2020 HSA limits

The Internal Revenue Service (IRS) announced an increase in the annual limit on deductible contributions to HSAs. The annual limit will increase by $50 for individuals and $100 for families in 2020. Continue reading this blog post for more on this increase to HSA limits.


Employees will be able to sock away some extra money into their health savings accounts next year.

The annual limit on deductible contributions to an HSA will jump by $50 for individuals and $100 for families next year, the IRS announced Tuesday.

For 2019, the annual limit on deductible contributions will be $3,550 for individuals with self-only coverage, a $50 increase from 2019, and $7,100 for family coverage, a $100 increase from 2019.

The minimum deductible for a qualifying high-deductible health plan also will increase to $1,400 for self-only coverage and $2,800 for family coverage.

Annual out-of-pocket expenses will see an even bigger jump next year. Deductibles, copayments and other amounts that do not include premiums will have a maximum limit of $6,900 for individual coverage next year, up from $6,750 in 2019, and $13,800 for family coverage, up from $13,500 in 2019.

HSA enrollment continues to grow, especially as employees look at the accounts as a way to save for medical expenses in retirement. The number of HSAs grew 13% over the past year to top 25 million, according to research firm Devenir, while assets grew 19% to $53.8 billion. Devenir projects the number of HSAs to hit 30 million by 2020, with $75 billion in total assets and $16.7 billion in investment assets.

More employers are also offering employees contributions to their accounts. Indeed, the average HSA employer contribution rose to $839 last year, up 39% from $604 in 2017, according to Devenir. All told, employer contributions totaled almost $9 billion last year.

HSAs also saw a boon this year with Amazon’s decision to allow consumers to use the accounts to buy thousands of items on its site, a move that was ballyhooed as a positive for HSA customers, as well as Amazon. Items will be listed on Amazon as “FSA or HSA eligible” on the individual product pages; a full list of items can also be browsed on Amazon’s website.

“By accepting HSA dollars, Amazon is finally giving this untapped savings tool its moment to shine,” David Vivero, co-founder and CEO at Amino, an employee financial wellness platform, wrote recently in an Employee Benefit News blog. “Every payment method or currency — whether it’s dollars, airline miles, bitcoins or credit cards — depends on reliable large-scale merchant acceptance to become truly mainstream.”

Amazon’s chief competitor, Walmart, allows consumers to use HSA and FSA cards to purchase medical items, as well.

HSA contribution limits are updated annually to reflect cost-of-living adjustments. The increases are detailed in Revenue Procedure 2019-25 and take effect in January.

SOURCE: Mayer, K. (28 May 2019) "IRS increases 2020 HSA limits" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/irs-announces-2020-hsa-limits


CMS Releases 2020 Parameters for Medicare Part D Prescription Drug Benefit

The Centers for Medicare and Medicaid Services (CMS) recently released the 2020 parameters for the Medicare Part D prescription drug benefit. Continue reading this blog post from UBA to learn more.


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.

SOURCE: Hsu, K. (6 June 2019) "CMS Releases 2020 Parameters for Medicare Part D Prescription Drug Benefit" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/cms-releases-2020-parameters-for-medicare-part-d-prescription-drug-benefit


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


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


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