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


Engaging employees in healthcare — even while traveling

What happens when an employee gets sick or injured while traveling? In 2018, Americans took 463.6 million trips for business, leaving employees unsure of what to do when they get sick or injured while away. Continue reading for how employers can engage employees who are traveling in healthcare.


Business travel is booming. Americans took 463.6 million trips for business last year. But what happens when a business traveler gets sick or injured while away from home and how can employers help their employees in this situation?

It starts with a simple solution: Make sure you’re providing employees with a health insurance plan that includes coverage outside the state or region where the business is located. While the majority of plans provide coverage for illnesses and injuries that meet the insurer’s definition of an emergency, some plans don’t cover care for common serious, but non-emergency health problems like strep throat, migraine headaches, a sprained ankle or back pain. Employers should ensure they offer at least one plan option that includes either an extended physician and hospital network or coverage for out-of-network care.

If employees need to travel out of the country for business, employers may want to consider offering travel medical insurance, which provides coverage during the period of time while the employee is outside the U.S. and medical evacuation if needed. To ensure employees have all the immunizations they need and are aware of any health risks at their destinations, employers can offer access to or reimbursement for pre-trip visits with a travel medicine specialist.

Even when employees have health insurance that gives them access to care while they’re away from home, connecting with experienced healthcare providers can still be difficult. Some insurers offer phone support for plan members seeking care providers, although often these providers are not heavily vetted for the experience or providing the highest quality care. Health advisory services can also help employees find and connect with healthcare providers in the U.S. and overseas.

When considering health advisory firms, employers should ask how the firm vets the healthcare providers it connects employees with and whether the firm uses a set network of providers or whether it connects employees with the most appropriate providers regardless of their health system affiliation.

Make sure employees know how to find the right type of care

When an employee falls ill or gets injured while traveling for business, her or his first instinct may be to seek care at a local emergency room, but that’s not always the best option. In addition to long wait times, the cost of care delivered in the emergency room is significantly higher than other care settings.

  • Employers can help employees make better choices by providing information about the options available and how to choose the right care setting:
  • The emergency room for serious, life-threatening illnesses and injuries such as chest pain, symptoms of a stroke, serious burns, head injury or loss of consciousness, eye injuries, severe allergic reactions, broken bones and heavy bleeding
  • An urgent care center for conditions you’d usually make a doctor’s appointment for such as vomiting or diarrhea, fever, sprains, moderate flu symptoms, small cuts, wheezing and dehydration
  • A walk-in or retail clinic for minor problems such as a rash with no fever, mild flu-like symptoms, sore throat, cough and congestion, ear pain and eye itchiness or redness
  • Telemedicine or virtual physician visits for minor illnesses and injuries and advice on whether additional care is needed

The key to helping employees know which care setting is the most appropriate is ongoing communication and education, which can take the form of in-person meetings with the benefits team, newsletter articles and email blasts, and video content shared through the company’s intranet channels.

Employees who are living with chronic health conditions should take special steps when traveling for business, including ensuring they have enough of any prescription medication they take and bringing an extra prescription with them for essential medications in case they’re lost in transit.

Ensure employees can quickly share their medical records with providers

Another important part of the healthcare equation for business travelers is ensuring that when they need care while they’re on the road, the healthcare providers who treat them can get quick, secure access to their medical records. Access to these records is important for several reasons:

  • It gives a provider who’s not familiar with the employee’s medical history a comprehensive look at past and current health problems and chronic conditions, medications, allergies or adverse reactions, and treatments and surgeries. Having this information can lower the risk of misdiagnosis, inappropriate care and duplicate care or testing, which not only adds unneeded costs but can also cause harm.
  • This information can be especially important when employees are seriously ill or injured and can’t speak for themselves to share medical history and their wishes about issues like the use of a ventilator or feeding tube.

There are several online services and apps that allow users to upload medical records so they can share them with healthcare providers. Another option is to work with a health adviser who can make sure employees’ records are carefully reviewed to ensure accuracy and stored in a secure universal medical record that can be accessed in minutes by treating physicians anywhere in the world.

Giving employees who travel for business the right resources and guidance can not only increase their peace of mind, it can help make sure they have access to the care they need wherever work takes them.

SOURCE: Varn, M. (18 June 2019) "Engaging employees in healthcare — even while traveling" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/engage-employees-in-healthcare-when-traveling


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


Mentorship Matters

Research shows that having a trusted mentoring relationship can help bolster emotional well-being for mentees. Continue reading this blog post from UBA for more on why mentorship programs matter.


Imagine highly tailored, expert advice for both professional and personal life goals and transitions being readily available. That’s what a skilled mentor can provide. Having an engaged, intentional, and present mentor helps support and build talent. Beyond talent and skill building, research points to a trusted mentoring relationship serving to bolster emotional wellbeing for mentees as well. No wonder people seek out mentors, and that people who seek out mentors are promoted more frequently.

There are benefits to the mentors, too. In some studies, mentors report feeling like their jobs are more meaningful. Mentors also report lower levels of anxiety as well, according to the HarvardBusiness Review. This relationship can be one that both parties learn from and creates a mentor pipeline with current mentees becoming future mentors.

Fortune 500 companies are keyed into the benefits of mentorship, with 70 percent of these large corporations having a program. Such programs can help boost a business' ability to attract and retain talent. This can be for all candidates but also for diversity and inclusion, since women and people of color report having a mentor as a valuable component of their success. This is particularly true for hiring Millennials, who want career direction and work that is meaningful and may benefit from strong mentoring programs.

With an ever-more-mobile workforce, mentorship can ensure your top performers share their knowledge in case they leave, per an article in Feedstuffs. Likewise, newer employees onboard more successfully when they have a strong mentor. Beyond sharing how processes and systems work at a particular company, mentors can also share culture tips that can help a newer employee integrate into an office community more seamlessly.

Whether a formal program or a more informal relationship, mentorship is something employees want but may not know how to get, says HR Dive. More than 75 percent say mentorship matters, but only 56 percent have ever had a mentor. Individuals currently being mentored falls to only 37 percent. HR departments of companies of all sizes should be prepared to answer questions about programs during interviews and hiring.

A few keys to building a successful mentorship program include:

Provide opportunities for feedback. For mentors looking to improve and open to constructive criticism, one of the best resources may just be anonymous feedback. It would only be truly anonymous, but also likely most valuable, after mentoring enough people to find trends or notice areas from improvement. Science reports that, while face-to-face conversations are important for mentoring relationships, anonymous feedback is equally important for individuals to improve.

Look beyond direct managers/supervisors for mentors. An article in Forbes points to a manager’s role as one of ensuring projects are successful and business goals met. That can get in the way of working on an individual’s development. Look outside of direct management for an employee’s mentor so the mentor can focus on the individual.

Invest in your mentoring program, and the mentors themselves. Creating a program is exciting and full of potential but taking time to train mentors is essential. Success happens after the launch of the program after all. Be sure you’re spending as much time developing your mentors, says the Association for Talent Development. If they feel like they are expected to just know what to do, they may struggle. Creating guides, training, and direction to mentors helps them feel successful from the start.

Make time for connection and conversation. Nearly half of mentees report that getting time with the mentors proves challenging. As an organization, consider how you can support a successful connection by carving out regular time for both individuals to be available. Trust building, boundary and expectation setting, and more all take time.

Read more:

Mentoring Can Supercharge Your Staff

Most Employees Say a Mentor Is Important, but Few Have One

Want to Become a Better Mentor? Ask for Anonymous Feedback

5 Reasons Mentors Need Help

Stressed at Work? Mentoring a Colleague Could Help

Why You Need A Mentor Who Isn't Your Boss

SOURCE: Olson, B. (18 June 2019) "Mentorship Matters" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/mentorship-matters


Tri-Agency Final Rules on Health Reimbursement Arrangements

Final rules regarding health reimbursement arrangements (HRAs) and other account-based group health plans were recently released by the Department of the Treasury (Treasury), Department of Labor (DOL), and Department of Health and Human Services (HHS). Read this compliance update to learn more.


The Department of the Treasury (Treasury), Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) released their final rules regarding health reimbursement arrangements (HRAs) and other account-based group health plans. The DOL also issued a news releasefrequently asked questionsmodel notice, and model attestations.

The final rules’ goal is to expand the flexibility and use of HRAs to provide individuals with additional options to obtain quality, affordable healthcare. According to the Departments, these changes will facilitate a more efficient healthcare system by increasing employees’ consumer choice and promoting healthcare market competition by adding employer options.

To do so, the final rules expand the use of HRAs by:

  • Removing the prohibition against integrating an HRA with individual health insurance coverage (individual coverage HRA)
  • Expanding the definition of limited excepted benefits to recognize certain HRAs as limited excepted benefits if certain conditions are met (excepted benefit HRA)
  • Providing premium tax credit (PTC) eligibility rules for people who are offered an HRA integrated with individual coverage
  • Assuring HRA and Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) plan sponsors that reimbursement of individual coverage by the HRA or QSEHRA does not become part of an ERISA plan when certain conditions are met
  • Changing individual market special enrollment periods for individuals who gain access to HRAs integrated with individual coverage or who are provided QSEHRAs

The final rules will be published in the Federal Register on June 20, 2019, be effective on August 19, 2019, and generally apply for plan years beginning on or after January 1, 2020.

However, the final rules under Section 36B (regarding PTCs) apply for taxable years beginning on or after January 1, 2020, and the final rules providing a new special enrollment period in the individual market apply January 1, 2020.

An HRA is a type of account-based group health plan funded solely by employer contributions that reimburses an employee for Section 213(d) medical care expenses incurred by the employee, or the employee’s spouse, dependents, and children who are not age 27 as of the end of the taxable year, up to a maximum fixed-dollar amount during a coverage period.

These reimbursements are excludable from the employee’s income and wages for federal income tax and employment tax purposes. An HRA can allow amounts that remain at the end of the year to be available to reimburse medical care expenses incurred in later years.


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


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


Is it Time for Unlimited Time off?

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


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

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

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

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

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

Read more:

The Benefit Workers Want Most is Less Work

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

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

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

Ask These Questions when Considering Unlimited PTO

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