The Open Enrollment Checklist: Are You Poised for a Successful Season

Did you know: Fifty-six percent of U.S. adults with employer-sponsored health benefits said health coverage satisfaction is a key factor in deciding whether they should leave their current job. Read the following blog post for an open enrollment checklist.


It’s here… the moment we’ve all been waiting for — or, in the case of HR, preparing for (at least we’d hope). That’s right, open enrollment season has arrived.

Open enrollment is a major opportunity for HR to contribute to their company’s performance — both in terms of healthcare savings and employee productivity. The better employees understand their benefits, the more likely they are to make cost-conscious decisions about their plan choices and their healthcare — saving themselves, and their employers, money. Not only that, but a recent survey found that 56% of U.S. adults with employer-sponsored health benefits said that whether or not they like their health coverage is a key factor in deciding to stay at their current job. And, interestingly, satisfaction with benefits and benefits communications have a tremendous impact on job satisfaction and engagement.

Not sure you’ve done everything you could to turn this annual necessity into a true financial, educational game-changer for your organizations? Ask yourself, did you:

Take stock of last year’s enrollment?Before diving into enrollment for 2020, employers should have taken stock of how the company fared last year. Post-mortem meetings with the enrollment team (along with key internal and external stakeholders) to assess what went well (or didn’t) can ensure the coming enrollment season runs smoothly.

In particular, identify the most time-consuming tasks and discuss how they could be streamlined in the future. Second, determine what questions employees asked the most about last year — and be prepared to answer them again this year. Third, consider whether the company achieved its overall open enrollment goals, and what contributed to those results. By addressing the peaks and pitfalls of last year’s season, HR should have a head start on planning for 2020.

Plan your communications strategy?With a defined approach to open enrollment in place, HR at this point should have developed an organized, well-communicated strategy to keep employees informed about their plan options at enrollment and throughout the year. Have you:

· Defined corporate objectives and how to measure success? · Assessed what messages to share with employees, especially anything that is changing — such as adding or eliminating plans or changing vendors? · Determined what information is best delivered in print (e.g. newsletters, posters, postcards, enrollment guides), online or in person through managers or one-on-one enrollment support? Adopting a multi-channel engagement strategy will ensure key messages reach the intended audience(s).

Make sure employees understand the deadline and process for enrolling — and the implications of missing the enrollment window. They must understand whether their existing coverage will roll over, if they’ll default to a specific plan and/or level of coverage (perhaps different from what they currently have), or end up with no coverage at all.

Take a pro-active approach to open enrollment?Ninety percent of employees report that they roll over their same health plan year over year — though this doesn’t indicate overwhelming plan satisfaction. More typically, it’s because they’re intimidated about what they don’t know, are confused about their choices or just don’t care. Employees don’t have the information they need, and aren’t likely to seek it out on their own.

Offering — or even requiring — one-on-one meetings with benefit experts during open enrollment provides a forum for employees to discuss their individual needs and ensure they are selecting the right coverage. These services — often available through brokers or outside engagement firms — provide employees with a safe space to ask specific questions about their health conditions, family history and potential life changes that could affect their insurance needs. This is the ideal time to remind employees that there is no one-size-fits-all plan, and that the least expensive plan on paper may not, ultimately, be the most cost-effective plan over time.

Revisit your SPD?The document we all love to hate, summary plan descriptions (SPDs) remain the best source for information about how each plan works, what it covers and the participant’s rights and responsibilities under that plan.

Having an SPD that is current, appealing (or at least not off-putting) and easy to access can answer many employee questions before they find their way to HR. Simple fixes like adding charts, callout boxes or icons can make your SPDs easier to navigate. Many employers are taking it a step further and offering interactive SPDs, which include robust search functionality and links to definitions, important forms, modeling tools and calculators, vendor sites and even short video clips. By making SPDs digital and interactive, employers can provide employees access to important information about their coverage 24/7 via any device. And, by adding a data analytics component, HR can track which sections employees visit most and pinpoint knowledge gaps about their benefit options to enhance understanding and drive increased benefits usage.

Account for all demographics?With all the focus on today’s multigenerational workforce, it’s important to remember that there’s more to “demographics” than age and gender. Worksite (office vs. shop floor vs. construction site vs. road warrior) can have a tremendous impact on the communications channels you use and when you use them.

And while some “generational generalizations” hold true — many older workers prefer paper, and most young people prefer mobile communication channels — it’s more important to look at employee cohorts from the perspective of differing priorities (planning for retirement vs. retiring student debt), different levels of education and healthcare literacy, and experience with choosing and using benefits. Employees just starting their careers are likely to need more support and different information than a more seasoned worker who’s had years of experience with the enrollment process. Consider the most effective ways to engage the different demographics of your population to gain their attention and interest in choosing the right plan for them.

Equip employees for smart healthcare choices year-round?For most employees, becoming an educated healthcare consumer is a work in progress — which is why many employers offer year-round resources to support smart healthcare choices. That said, these resources are often under-utilized because employees don’t know they exist.

Open enrollment is the perfect time to spread the word about these programs and address the key question for employees: “What’s in it for me?” For example, many employers offer transparency services, which enable employees to research the potential cost of care and compare prices across several providers in their area.

Other resources, such as benefits advocates, can answer questions from employees in real time — including where to get care, how to get a second opinion and what the doctor’s instructions really mean. When used in conjunction, transparency and advocacy services can lower out-of-pocket spending for the employee and reduce costs for the employer. Does your open enrollment communications strategy highlight that these resources exist, outline how they work and explain how they benefit the employee?

What if open enrollment is only a week away and you haven’t taken most, if any, of these steps? It’s not too early to start your to-do list for next year — perhaps by first tackling your SPD and drafting that communications plan. Most important, get that post-mortem meeting on the schedule now, while the lessons learned from this year’s open enrollment are still fresh.

SOURCE: Buckey, K. (3 October 2019) "The Open enrollment checklist: Are you Poised for a successful season" (Web Blog Post) https://www.benefitnews.com/list/the-employers-open-enrollment-checklist


Simple Open-Enrollment Tips That Can Make a Big Difference

Thirty-three percent of employees stated their primary emotions when thinking about open enrollment season as annoyance and dread. Read this blog post from SHRM for a few simple tips that can make a big difference this open enrollment season.


Trepidation is what comes to mind for many employees when asked their feelings about open enrollment, the annual period when they select employer-provided benefits for the coming year.

According to a nationally representative sample of 1,000 employees polled earlier this year, 33 percent cited "annoyance" or "dread" as their primary emotions when they thought about open enrollment and just 10 percent of workers said they were "confident" in the benefits choices they made when the enrollment process was over, according to VSP Vision Care's annual Open Talk about Open Enrollment survey.

In another survey, HR software company Namely found that 31 percent of employees give their employer a "C" or lower when it comes to open enrollment.

Here are some tips from benefits experts that will help you raise your grade this open-enrollment season.

What to Do, and Not to Do

Jennifer Benz, national practice leader at benefits communications firm Segal Benz, shared three bad HR practices that undermine open enrollment and three best practices for doing open enrollment the right way.

  • Don't hide vital information from employees. Benz recalls how one company sent out its benefits materials but didn't include monthly costs. "A group of enterprising employees crunched the numbers and came up with estimates and circulated a rogue spreadsheet. Dealing with this communications fiasco took more work" than being upfront about costs, she noted.

Best practice: Be transparent and share the reasons you are making benefits changes. Break down the details and do the work for the employees. Provide scenarios so employees can better understand their options and cost breakdowns for different life situations.

  • Don't cram in every benefit at once. Some companies hand out pages and pages of text, jamming a year's worth of communications into a few weeks, and figure they have done what they need to do. "What they have done is confused their employees," Benz said.

Best practices: Communicate the technical details of your various benefits over time. "Don't assume employees will weed through all your materials to make sense of the benefits offered to them," Benz said. Also make full use of visual aids. "Photos, icons, infographics, memes, charts, graphics and more—they all help to attract, and more importantly hold, people's attention," noted Amber Riley, a communications consultant to Segal Benz. "Whether you're driving an open-enrollment campaign, creating a new benefits guide or promoting a wellness program, when you increase the visual pleasure of what you are communicating, your people are more likely to engage, learn, understand and ultimately take action."

  • Don't give employees too little time to process their open-enrollment choices. While many people wait until the last day to fill out the health care selection forms, they may have been considering their options with family members for weeks, so giving them just a few days to make decisions is not going to be enough.

Best practice: Build in a time frame that gives HR staff and employees the time they need. Benz recommended three weeks.

"People are always talking about learning from the best practices and success stories, but you can also learn a lot from other companies' mistakes," she noted. "When you prepare for enrollment in advance and anticipate issues—including those you and others have experienced in the past—you are better-equipped to avoid missteps. Your employees will notice and appreciate the extra effort."

Help Employees Ace Open Enrollment

"Open enrollment is often time-consuming and confusing for employees, but these choices can make a huge financial impact," said Julie Stich, CEBS, vice president of content at the International Foundation of Employee Benefit Plans, an association of benefit plan sponsors. She suggested that HR share the following advice with employees to help prepare them for the upcoming enrollment season:

  • Take your time. Take time to really read through the enrollment materials you receive. If you are invited to a face-to-face meeting, make time to attend. It's possible you'll be offered different plan options and coverages this year. The better you understand the changes, the better decisions you'll make.
  • Look ahead. Consider what the next year will look like for you and your family. Are you planning to have a baby? Knee replacement surgery? A root canal? Does someone need braces? New glasses? Keep this in mind as you look at your coverage options.
  • Dive into the details. It's important to note whether the plans' provider networks have changed. Make sure your doctors are still in-network. Is your chiropractor also covered? Does the plan cover orthodontics? Is your spouse's daily prescription drug covered, and did the coverage change? Also consider areas of need like access to specialists, mental health care, therapies, complementary and alternative medicine, and chronic care. Look at the options offered in all plans, including health, dental, vision and disability.
  • Get out your calculator. Add up the amount you'll need to pay toward your health premium plus deductibles, co-payments (flat-dollar amounts) for prescriptions and doctor office visits, and co-insurance (a percentage of the cost you'll pay) for services. Understand what you'll be asked to pay if you seek care outside your network. This will give you a clearer picture of how much you're likely to spend. The plan that looks to be the cheapest option may not really be the cheapest for you.
  • Determine what's right for you. Consider your comfort level with risk. If you want your family to be covered for every eventuality, a more traditional plan, if one is offered, might be right for you. If you're comfortable taking on some upfront costs, a high-deductible plan with a lower premium ight be your plan of choice.
  • Take advantage of extras. Your employer may offer the option to reduce your health premiums in exchange for your participation in a wellness program or health-risk assessment. It may match some or all of the money you save in your 401(k) plan. It might let you set aside tax-deferred money into a health savings account or flexible spending account. Also, check with your employer to see if it offers voluntary insurance with a group discount and payroll deduction for premiums—like critical-illness, pet, auto and homeowners coverage. If these options work for your situation, sign up.
  • Ask questions. Don't be shy about asking your HR or benefits department to explain something if you're not sure. They're there to help and want you to make the best decisions for your situation.

"Taking the time upfront to carefully choose the best options will help employees better manage their finances throughout the year, alleviating stress and promoting productivity," Stich said.

SOURCE: Miller, S. (24 September 2019) "Simple Open-Enrollment Tips That Can Make a Big Difference" (Web Blog Post). Retrieved from https://www.shrm.org/ResourcesAndTools/hr-topics/benefits/Pages/simple-open-enrollment-tips-make-a-big-difference.aspx


Health insurance surpass $20,000 per year, hitting a record

An annual survey of employers recently revealed that the cost of family health coverage has now surpassed $20,000, a record high. The survey also revealed that while most employers pay most of the costs of coverage, workers' average contribution for a family plan is now $6,000. Read this blog post from Employee Benefit News to learn more.


The cost of family health coverage in the U.S. now tops $20,000, an annual survey of employers found, a record high that has pushed an increasing number of American workers into plans that cover less or cost more, or force them out of the insurance market entirely.

“It’s as much as buying a basic economy car,” said Drew Altman, chief executive officer of the Kaiser Family Foundation, “but buying it every year.” The nonprofit health research group conducts the yearly survey of coverage that people get through work, the main source of insurance in the U.S. for people under age 65.

While employers pay most of the costs of coverage, according to the survey, workers’ average contribution is now $6,000 for a family plan. That’s just their share of upfront premiums, and doesn’t include co-payments, deductibles and other forms of cost-sharing once they need care.

The seemingly inexorable rise of costs has led to deep frustration with U.S. healthcare, prompting questions about whether a system where coverage is tied to a job can survive. As premiums and deductibles have increased in the last two decades, the percentage of workers covered has slipped as employers dropped coverage and some workers chose not to enroll. Fewer Americans under 65 had employer coverage in 2017 than in 1999, according to a separate Kaiser Family Foundation analysis of federal data. That’s despite the fact that the U.S. economy employed 17 million more people in 2017 than in 1999.

“What we’ve been seeing is a slow, slow kind of drip-drip erosion in employer coverage,” Altman said.

Employees’ costs for healthcare are rising more quickly than wages or overall economy-wide prices, and the working poor have been particularly hard-hit. In firms where more than 35% of employees earn less than $25,000 a year, workers would have to contribute more than $7,000 for a family health plan. It’s an expense that Altman calls “just flat-out not affordable.” Only one-third of employees at such firms are on their employer’s health plans, compared with 63% at higher-wage firms, according to the Kaiser Family Foundation’s data.

The survey is based on responses from more than 2,000 randomly selected employers with at least three workers, including private firms and non-federal public employers.

Deductibles are rising even faster than premiums, meaning that patients are on the hook for more of their medical costs upfront. For a single person, the average deductible in 2019 was $1,396, up from $533 in 2009. A typical household with employer health coverage spends about $800 a year in out-of-pocket costs, not counting premiums, according to research from the Commonwealth Fund. At the high end of the range, those costs can top $5,000 a year.

While raising deductibles can moderate premiums, it also increases costs for people with an illness or who gets hurt. “Cost-sharing is a tax on the sick,” said Mark Fendrick, director of the Center for Value-Based Insurance Design at the University of Michigan.

Under the Affordable Care Act, insurance plans must cover certain preventive services such as immunizations and annual wellness visits without patient cost-sharing. But patients still have to pay out-of-pocket for other essential care, such as medication for chronic conditions like diabetes or high blood pressure, until they meet their deductibles.

Many Americans aren’t prepared for the risks that deductibles transfer to patients. Almost 40% of adults can’t pay an unexpected $400 expense without borrowing or selling an asset, according to a Federal Reserve survey from May.

That’s a problem, Fendrick said. “My patient should not have to have a bake sale to afford her insulin,” he said.

After years of pushing healthcare costs onto workers, some employers are pressing pause. Delta Air Lines Inc. recently froze employees’ contributions to premiums for two years, Chief Executive Officer Ed Bastian said in an interview at Bloomberg’s headquarters in New York last week.

“We said we’re not going to raise them. We're going to absorb the cost because we need to make certain people know that their benefits structure is real important,” Bastian said. He said the company’s healthcare costs are growing by double-digits. The Atlanta-based company has more than 80,000 employees around the globe.

Some large employers have reversed course on asking workers to take on more costs, according to a separate survey from the National Business Group on Health. In 2020, fewer companies will limit employees to so-called “consumer-directed health plans,” which pair high-deductible coverage with savings accounts for medical spending funded by workers and employers, according to the survey. That will be the only plan available at 25% of large employers in the survey, down from 39% in 2018.

Employers have to balance their desire to control costs with their need to attract and keep workers, said Kaiser’s Altman. That leaves them less inclined to make aggressive moves to tackle underlying medical costs, such as by cutting high-cost hospitals out of their networks. In recent years employers’ healthcare costs have remained steady as a share of their total compensation expenses.

“There’s a lot of gnashing of teeth,” Altman said, “but if you look at what they do, not what they say, it’s reasonably vanilla.”

SOURCE: Tozzi, J. (25 September 2019) "Health insurance surpass $20,000 per year, hitting a record" (Web Blog Post). Retrieved from https://www.benefitnews.com/articles/health-insurance-costs-surpass-20-000-per-year


IRS Releases Private Letter Ruling Regarding Section 213(d) Medical Care Expenses

A private letter ruling regarding DNA collection kits was recently released by the Internal Revenue Service (IRS). This letter addresses whether the price of these kits should qualify as Section 213(d) medical care expenses. Read this blog post from UBA to learn more.


The Internal Revenue Service (IRS) released a private letter ruling (Letter) regarding whether the price of a DNA collection kit – specifically services and reports related to a person’s health that are generated from analyzing the collected DNA – qualify as Section 213(d) medical care expenses.

Health services such as genotyping are medical care under Section 213(d) while reports that provide general information are not medical care. The IRS concluded that the DNA collection kit’s price must be allocated between health services that are medical care, such as genotyping, and the non-medical services, such as reports that provide general or ancestry information.

SOURCE: Hsu, K. (24 September 2019) "IRS Releases Private Letter Ruling Regarding Section 213(d) Medical Care Expenses" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/irs-releases-private-letter-ruling-regarding-section-213d-medical-care-expenses


Treasury, DOL, and HHS Issue FAQs on Enforcement of Final 2020 Benefit and Parameters Rule

The Treasury, Department of Labor (DOL) and Department of Health and Human Services (HHS) recently released FAQs regarding the enforcement of the final 2020 benefit and parameters rule. Read the following blog post from UBA for more information.


On August 26, 2019, the Treasury, Department of Labor (DOL), and the Department of Health and Human Services (HHS) (collectively, the Departments) issued FAQs About Affordable Care Act Implementation Part 40 (FAQs) regarding enforcement of the final rule.

Under the FAQs released after the final rule was published, the Departments will not initiate an enforcement action if an issuer or group health plan excludes the value of drug manufacturers’ coupons from the annual limitation on cost-sharing, until the final 2021 benefit payment and parameters rule is issued and effective.

SOURCE: Hsu, K. (6 September 2019) "Treasury, DOL, and HHS Issue FAQs on Enforcement of Final 2020 Benefit and Parameters Rule" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/treasury-dol-and-hhs-issue-faqs-on-enforcement-of-final-2020-benefit-and-parameters-rule


8 renewal considerations for 2020

Plan administrators have a lot to consider during open enrollment season. How are you preparing for 2020 open enrollment? Read the following blog post from Employee Benefit News for eight things to consider for renewals.


The triumphant return of the Affordable Care Act premium tax (the health insurer provider fee).

This tax of about 4% is under Congressional moratorium for 2019 and returns for 2020. Thus, fully insured January 2020 medical, dental and vision renewals will be about 4% higher than they would have been otherwise. Of note, this tax does not apply to most self-funded contracts, including so-called level-funded arrangements. Thus, if your plans are presently fully insured, now may be a good time to re-evaluate the pricing of self-funded plans.

Ensure your renewal timeline includes all vendor decision deadlines.

As the benefits landscape continues to shift and more companies are carving out certain plan components, including the pharmacy benefit manager, you may be surprised with how early these vendors need decisions in order to accommodate benefit changes and plan amendments. Check your contracts and ask your consultant. Further, it seems that our HRIS and benefit administration platforms are ironically asking for earlier and earlier decisions, even with the technology seemingly improving.

Amending your health plan for the new HSA-eligible expenses.

In July of this year, the U.S. Treasury loosened the definition of preventive care expenses for individuals with certain conditions.

While these regulations took effect immediately, they won’t impact your health plan until your health plan documents are amended. Has your insurer or third-party administrator automatically already made this amendment? Or, will it occur automatically with your renewal? Or is it optional? If your answer begins with “I would assume…,” double-check.

Amending your health plan for the new prescription drug coupon regulations.

As we discussed in July of this year, these regulations go into effect when plans renew in 2020. In short, plans can only prevent coupons from discounting plan accumulators (e.g., deductible, out-of-pocket maximum) if there is a “medically advisable” generic equivalent.

If your plan is fully insured, what action is your insurer taking? Does it seem compliant? If your plan is self-funded, what are your options? If you can keep the accumulator program and make it compliant, is there enough projected program savings to justify keeping this program?

Is your group life plan in compliance with the Section 79 nondiscrimination rules?

A benefit myth that floats around from time to time is that the first $50,000 in group term life insurance benefits is always non-taxable. But, that’s only true if the plan passes the Section 79 nondiscrimination rules. Generally, as long as there isn’t discrimination in eligibility terms and the benefit is either a flat benefit or a salary multiple (e.g., $100,000 flat, 1 x salary to $250,000), the plan passes testing. Ask your attorney, accountant, and benefits consultant about this testing. If you have two or more classes for life insurance, the benefit is probably discriminatory. If you fail the testing, it’s not the end of the world. It just means that you’ll likely need to tax your Section 79-defined “key employees” on the entire benefit, not just the amount in excess of $50,000.

Is your group life maximum benefit higher than the guaranteed issue amount?

Surprisingly, I still routinely see plans where the employer-paid benefit maximum exceeds the guaranteed issue amount. Thus, certain highly compensated employees must undergo and pass medical underwriting in order to secure the full employer-paid benefit. What often happens is that, as benefit managers turnover, this nuance is lost and new hires are not told they need to go through underwriting in order to secure the promised benefit. Thus, for example, an employee may think he or she has $650,000 in benefit, while he or she only contractually has $450,000. What this means is the employer is unknowingly self-funding the delta — in this example, $200,000. See the problem?

Please pick up your group life insurance certificate and confirm that the entire employer-paid benefit is guaranteed issue. If it is not, negotiate, change carriers, or lower the benefit.

Double-check that you haven’t unintentionally disqualified participant health savings accounts (HSAs).

As we discussed last December, unintentional disqualification is not difficult.

First, ensure that the deductibles are equal to or greater than the 2020 IRS HSA statutory minimums and the out-of-pocket maximums are equal to or less than the 2020 IRS HSA statutory maximums. Remember that the IRS HSA maximum out-of-pocket limits are not the same as the Affordable Care Act (ACA) out-of-pocket maximum limits. (Note to Congress – can we please align these limits?)

Also, remember that in order for a family deductible to have a compliantly embedded single deductible, the embedded single deductible must be equal to or greater than the statutory minimum family deductible.

Complicating matters, also ensure that no individual in the family plan can be subject to an out-of-pocket maximum greater than the ACA statutory individual out-of-pocket maximum.

Finally, did you generously introduce any new standalone benefits for 2020, like a telemedicine program, that Treasury would consider “other health coverage”? If yes, there’s still time to reverse course before 2020. Talk with your tax advisor, attorney, and benefits consultant.

Once all decisions are made, spend some time with your existing Wrap Document and Wrap Summary Plan Description.

For employers using these documents, it’s easy to forget to make annual amendments. And, it’s easy to forget, depending on the preparer, how much detail is often in these documents. For example, if your vision vendor changes or even if your vision vendor’s address changes, an amendment is likely in order. Ask your attorney, benefits consultant, and third party administrators for help.

SOURCE: Pace, Z. (Accessed 9 September 2019) "8 renewal considerations for 2020" (Web Blog Post). Retrieved from https://www.benefitnews.com/list/healthcare-renewal-considerations-for-2020


Cadillac tax may finally be running out of gas

The Cadillac tax, a part of the Affordable Care Act, may be in for a change. This tax was supposed to take effect in 2018 but has been delayed twice and recently, the House voted to repeal this tax entirely. Read this blog post to learn more about this potential change.


The politics of healthcare are changing. And one of the most controversial parts of the Affordable Care Act — the so-called Cadillac tax — may be about to change with it.

The Cadillac tax is a 40% tax on the most generous employer-provided health insurance plans — those that cost more than $11,200 for an individual policy or $30,150 for family coverage. It was supposed to take effect in 2018, but Congress has delayed it twice. And the House recently voted overwhelmingly — 419-6 — to repeal it entirely. A Senate companion bill has 61 co-sponsors — more than enough to ensure passage.

The tax was always an unpopular and controversial part of the 2010 health law because the expectation was that employers would cut benefits to avoid paying the tax. But ACA backers said it was necessary to help pay for the law’s nearly $1 trillion cost and help stem the use of what was seen as potentially unnecessary care. In the ensuing years, however, public opinion has shifted decisively, as premiums and out-of-pocket costs have soared. Now the biggest health issue is not how much the nation is spending on healthcare, but how much individuals are.

“Voters deeply care about healthcare still,” said Heather Meade, a spokeswoman for the Alliance to Fight the 40, a coalition of business, labor and patient advocacy groups urging repeal of the Cadillac tax. “But it is about their own personal cost and their ability to afford healthcare.”

Stan Dorn, a senior fellow at Families USA, recently wrote in the journal Health Affairs that the backers of the ACA thought the tax was necessary to sell the law to people concerned about its price tag and to cut back on overly generous benefits that could drive up health costs. But transitions in healthcare, such as the increasing use of high-deductible plans, make that argument less compelling, he said.

“Nowadays, few observers would argue that [employer-sponsored insurance] gives most workers and their families’ excessive coverage,” he wrote.

The possibility of the tax has been “casting a statutory shadow over 180 million Americans’ health plans, which we know, from HR administrators and employee reps in real life, has added pressure to shift coverage into higher-deductible plans, which falls on the backs of working Americans,” said Rep. Joe Courtney (D-Conn.).

Support or opposition to the Cadillac tax has never broken down cleanly along party lines. For example, economists from across the ideological spectrum supported its inclusion in the ACA, and many continue to endorse it.

“If people have insurance that pays for too much, they don’t have enough skin in the game. They may be too quick to seek professional medical care. They may too easily accede when physicians recommend superfluous tests and treatments,” wrote N. Gregory Mankiw, an economics adviser in the George W. Bush administration, and Lawrence Summers, an economic aide to President Barack Obama, in a 2015 column. “Such behavior can drive national health spending beyond what is necessary and desirable.”

At the same time, however, the tax has been bitterly opposed by organized labor, a key constituency for Democrats. “Many unions have been unable to bargain for higher wages, but they have been taking more generous health benefits instead for years,” said Robert Blendon, a professor at the Harvard T.H. Chan School of Public Health who studies health and public opinion.

Now, unions say, those benefits are disappearing, with premiums, deductibles and other cost sharing rising as employers scramble to stay under the threshold for the impending tax. “Employers are using the tax as justification to shift more costs to employees, raising costs for workers and their families,” said a letter to members of Congress from the Service Employees International Union.

Deductibles have been rising for a number of reasons, the possibility of the tax among them. According to a 2018 survey by the federal government’s National Center for Health Statistics, nearly half of Americans under age 65 (47%) had high-deductible health plans. Those are plans that have deductibles of at least $1,350 for individual coverage or $2,700 for family coverage.

It’s not yet clear if the Senate will take up the House-passed bill, or one like it.

The senators leading the charge in that chamber — Mike Rounds (R-S.D.) and Martin Heinrich (D-N.M.) — have already written to Senate Majority Leader Mitch McConnell to urge him to bring the bill to the floor following the House’s overwhelming vote.

“At a time when healthcare expenses continue to go up, and Congress remains divided on many issues, the repeal of the Cadillac tax is something that has true bipartisan support,” the letter said.

Still, there is opposition. A letter to the Senate on July 29 from economists and other health experts argued that the tax “will help curtail the growth of private health insurance premiums by encouraging employers to limit the costs of plans to the tax-free amount.” The letter also pointed out that repealing the tax “would add directly to the federal budget deficit, an estimated $197 billion over the next decade, according to the Joint Committee on Taxation.”

Still, if McConnell does bring the bill up, there is little doubt it would pass, despite support for the tax from economists and budget watchdogs.

“When employers and employees agree in lockstep that they hate it, there are not enough economists out there to outvote them,” said former Senate GOP aide Rodney Whitlock, now a healthcare consultant.

Harvard professor Blendon agrees. “Voters are saying, ‘We want you to lower our health costs,’” he said. The Cadillac tax, at least for those affected by it, would do the opposite.

SOURCE: Rovner, J. ( 19 August, 2019) "Cadillac tax may finally be running out of gas" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/articles/obamacare-excise-tax-may-be-at-an-end 


IRS Expands Benefits That Can Be Provided Before HDHP Annual Minimum Deductible Is Met

Recently, the Internal Revenue Service (IRS) released a notice that expanded the list of preventative care benefits that a high deductible health plan (HDHP) can provide without a deductible or with a deductible below the annual minimum. Read this post from UBA to learn more.


The Internal Revenue Service (IRS) released a notice, effective on July 17, 2019, that expanded the list of preventive care benefits that a high deductible health plan (HDHP) can provide without a deductible or with a deductible below the annual minimum deductible.

UBA-1000-HDHP_Chart2

The services and items listed above are treated as preventive care:

  • only when prescribed to treat a person diagnosed with the associated chronic condition listed in the table’s second column, and
  • only when prescribed for the purpose of preventing the chronic condition’s exacerbation or a secondary condition’s development.

SOURCE: Hsu, K. (20 August 2019) "IRS Expands Benefits That Can Be Provided Before HDHP Annual Minimum Deductible Is Met" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/irs-expands-benefits-that-can-be-provided-before-hdhp-annual-minimum-deductible-is-met


Compliance Recap - July 2019

July was a busy month in the employee benefits world.

The Internal Revenue Service (IRS) released a notice that expands the list of preventive care benefits a high deductible health plan can provide without a deductible or with a deductible below the annual minimum deductible. The IRS also released the indexed affordability percentage for plan years beginning in 2020.

The U.S. Preventive Services Task Force (USPSTF) published an “A” rating final recommendation. The Department of Health and Human Services (HHS) released an update to the notice requirements for plans using the HHS-administered federal external review process.

A U.S. District Court upheld the 2018 short-term, limited-duration insurance final rule. The Third Circuit Court of Appeals affirmed a federal district court’s preliminary injunction regarding contraceptive coverage exemptions.

The Department of Labor (DOL) released an advisory opinion regarding association health plans (AHPs) and multiple employer welfare arrangements (MEWAs). The Fifth Circuit Court of Appeals held oral arguments for the case challenging the ACA’s constitutionality.

HHS and the Food and Drug Administration (FDA) published a Safe Importation Action Plan regarding potential drug importation from other countries.

UBA Updates

UBA released one new advisor: New HDHP Preventive Care Benefits

UBA updated or revised existing guidance:

IRS Expands Benefits That Can Be Provided Before HDHP Annual Minimum Deductible Is Met

The Internal Revenue Service (IRS) released a notice, effective on July 17, 2019, that expanded the list of preventive care benefits that a high deductible health plan (HDHP) can provide without a deductible or with a deductible below the annual minimum deductible.

Preventive Care for Specified Conditions For Individuals Diagnosed with
Angiotensin Converting Enzyme (ACE) inhibitors Congestive heart failure, diabetes, and/or coronary artery disease
Anti-resorptive therapy Osteoporosis and/or osteopenia
Beta-blockers Congestive heart failure and/or coronary artery disease
Blood pressure monitor Hypertension
Inhaled corticosteroids Asthma
Insulin and other glucose lowering agents Diabetes
Retinopathy screening Diabetes
Peak flow meter Asthma
Glucometer Diabetes
Hemoglobin A1c testing Diabetes
International Normalized Ratio (INR) testing Liver disease and/or bleeding disorders
Low-density Lipoprotein (LDL) testing Heart disease
Selective Serotonin Reuptake Inhibitors (SSRIs) Depression
Statins Heart disease and/or diabetes

The services and items listed above are treated as preventive care:

  • only when prescribed to treat a person diagnosed with the associated chronic condition listed in the table’s second column, and
  • only when prescribed for the purpose of preventing the chronic condition’s exacerbation or a secondary condition’s development.

Read more about the expanded list of preventive care benefits.

IRS Releases the Indexed 2020 Affordability Percentage

The Internal Revenue Service (IRS) released the indexed affordability percentage of 9.78% for plan years beginning in 2020. An employer uses the affordability percentage to determine whether it has offered affordable coverage under the Patient Protection and Affordable Care Act’s employer shared responsibility provisions to avoid Penalty B.

Read more about the affordability percentage.

USPSTF Issues a Final Recommendation Giving PrEP an “A” Rating

The U.S. Preventive Services Task Force (USPSTF) published a final recommendation that gives an “A” rating to preexposure prophylaxis (PrEP) treatment. This means that the USPSTF recommends offering PrEP with effective antiretroviral therapy to people at high risk of HIV acquisition.

Group health plans and insurers subject to the preventive services coverage mandate must provide coverage for evidence-based items or services with an A or B rating recommended by the USPSTF without imposing copayments, coinsurance, deductibles, or other cost-sharing requirements when delivered by in-network providers. Group health plans and insurers subject to the preventive services coverage mandate generally must cover preventive services that are recommended by the USPSTF one year after the recommendation is issued.

HHS Releases Updated Notice Requirements for the HHS Federal External Review Process

On July 12, 2019, the Department of Health and Human Services (HHS) released updated requirements for notices that self-insured non-federal governmental health plans and health insurance issuers – using the HHS-administered federal external review process – must provide to their plan participants and beneficiaries.

District Court Upholds Short-Term Limited Duration Insurance Final Rule

As background, on August 1, 2018, the Internal Revenue Service (IRS), the Department of Health and Human Services (HHS), and the Department of Labor (DOL) (collectively, the Departments) released a final rule that amended the definition of short-term, limited-duration insurance (STLDI). HHS also released a fact sheet on the final rule. The final rule allows consumers to purchase STLDI policies that are less than 12 months in length and may be renewed for up to 36 months.

On July 18, 2019 the U.S. District Court for the District of Columbia (court) upheld the STLDI final rule. The court found that the final rule did not exceed the regulatory authority that Congress delegated to the Departments to define STDLI as a category of insurance that is exempt from individual insurance regulations. Employers should keep apprised of potential future developments as the case may be appealed.

Read more about the STDLI final rule.

Recent Litigation on the Contraceptive Coverage Exemption Rules

As background, the Department of the Treasury (Treasury), Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) published two final rules on November 15, 2018, regarding contraceptive coverage exemptions, to be effective on January 14, 2019. On January 14, 2019, the U.S. District Court for the Eastern District of Pennsylvania (Pennsylvania Court) granted a nationwide preliminary injunction that prohibits the implementation of the two final rules.

On July 12, 2019, the Third Circuit Court of Appeals (appeals court) affirmed the Pennsylvania Court’s preliminary injunction that prohibits the two final rules’ enforcement nationwide. The appeals court found that, until the final rules’ legality is decided, the injunction will allow states to avoid the imminent financial burden of subsidizing contraceptive services, providing funds for medical care associated with unintended pregnancies, and absorbing medical expenses that arise from decreased use of contraceptive medications for other health conditions.

The appeals court decision means that the Departments are prohibited from implementing and enforcing both final rules nationwide.

Read more about the status of the ACA contraceptive coverage mandate and exemption.

DOL Releases Advisory Opinion on AHPs and MEWAs

The Department of Labor (DOL) released an advisory opinion that analyzed a large retailer’s proposed group health plan to determine that the plan would be an association health plan (AHP) and a multiple employer welfare arrangement (MEWA) under ERISA. Although the advisory opinion can only be relied on by the retailer who requested it, the opinion gives employers an overview of the criteria that the DOL reviews when determining whether a plan fits the AHP definition that existed before the DOL’s 2018 AHP final rule. The opinion also provides a summary of the criteria that the DOL reviews when determining whether an arrangement is a MEWA.

Read more about AHPs.

Status of Court Case Challenging ACA Constitutionality

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

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

On July 3, 2019, the Department of Justice filed its supplemental brief to assert that the court decision striking down the ACA should not apply beyond the 18 plaintiff states. On July 9, 2019, the appeals court held oral arguments.

HHS and FDA Release Safe Importation Action Plan

The Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA) issued a Safe Importation Action Plan that overviews two pathways that could permit drug importation from foreign countries. HHS also issued a press release.

Under the first pathway, HHS would propose rules to allow states, wholesalers, and pharmacists to submit demonstration project plans designed to: import Canadian-approved drugs that are versions of FDA-approved drugs; meet certain conditions such as drug quality, record keeping, testing, and protections against counterfeiting; and significantly reduce consumer drug cost.

Under the second pathway, manufacturers of FDA-approved drugs could import versions of FDA-approved drugs that they sell in foreign countries, if they establish with the FDA that the foreign version is the same as the U.S. version.

Question of the Month

Q: What if a plan sponsor fails to file or pay the PCORI fee?

A: Although the PCORI statute and its regulations do not include a specific penalty for failure to report or pay the PCORI fee, the plan sponsor may be subject to penalties for failure to file a tax return because the PCORI fee is an excise tax.

A plan sponsor should consult with its attorney on how to proceed with a late filing or late payment of the PCORI fee. The PCORI regulations note that the penalties related to late filing of Form 720 or late payment of the fee may be waived or abated if the plan sponsor had reasonable cause and the failure was not due to willful neglect.

If a plan sponsor already filed Form 720 (for example, for a different excise tax), then the plan sponsor can make a correction to a previously filed Form 720 by using Form 720X.

8/1/2019


Mastering Healthcare Cost Transparency Within Your Self-Funded Benefits Plan

Finding high-value healthcare providers for your employees is a constant struggle. After interviewing our Executive Vice President, Scott Smeaton, he gave us insight on a strategy for conquering cost transparency while maintaining quality care.

Working with Hierl Insurance for over 24 years, Scott shared how his endeavors working with selffunded plans has led him to believe the best strategy is one that starts at the employee-level.

Filling the Transparency Gap

First, let’s define what a high-value healthcare provider is: A high-value provider is a physician and / or facility that consistently demonstrates better patient outcomes at a lower than average cost. This is accomplished by meeting the highest quality standards i.e. low infection and readmission rates, quicker recovery rates, and high patient satisfaction scores, among others, at a lower than average cost.

These high value providers perform more procedures (volume) in facilities where they have greater control of the outcome (low overhead, low infection rates), and often provide “bundled” pricing where the patient knows how much the procedure will cost before the work is ever done.

Have you, in the last year, bought a big-ticket item without knowing the cost? This is the question Scott starts with when speaking to a company’s employees. Often, no one can raise their hand. Why? Historically, the information hasn’t been available. As an industry, we still have a ways to go. We’re moving in the right direction, working with innovative partners focusing on what patients need to make better healthcare decisions.

As a society, it’s common sense – whether you’re buying a car, a TV, or a house – to do some research as to the quality and cost of a product or service. “That ability to access those numbers and identify cost and quality measures has not been available in healthcare,” Scott explained. This gap is beginning to be filled, though primarily in direct-to-provider contracting exclusive to certain specialties.

Because healthcare information can be overwhelming, businesses struggle to find the most appropriate venue for sourcing the lowest costs without relinquishing the highest quality of care.

“We’ve found that the lower cost providers actually have higher quality of care due to the volume of services they offer,” Scott explained. Hierl partners with third parties to identify these providers. “A great example is an orthopedic specialist we work with. They have finetuned their procedures and their processes so much that they receive the highest quality ratings, yet they are the lowest cost providers, in their area. They tell you what it’s going to cost with a bundled price, before the procedure is performed,” Scott mentioned.

Hierl partners directly with high value providers, designing employee benefits programs that offer incentives to employees who use those providers. When buying big-ticket items like a car, it’s often reasonable to assume the more the car costs, the higher quality and value you are going to get from it. In healthcare, it’s essentially the opposite. Take Lasik Surgery, for example. Fifteen years ago, Radial Keratotomy (RK), which was a precursor to LASIK, was performed with a scalpel by a surgeon and cost roughly $8,000. In 2017, the average cost of LASIK was $2,088. Now, the procedure is much more effective due to improved technology.

With high value providers, such as the orthopedic specialist mentioned previously, that “high value” comes from the fact they are typically operating in freestanding clinics and surgery centers. This means there is lower overhead compared to being in a hospital setting, and they are run by specialized teams that can give their patients more attention. “High volume of services, low overhead costs, and high-quality care – those are the key ingredients we look for in the providers we recommend to our clients,” explained Scott.

Flexibility in Cost Transparency Begins with Self-Funding

Perks such as gym memberships and free lunches have become common practice for companies looking to brand themselves as a great employer. However, it is important to understand these tactics aren’t the answer when it comes to employee experience but rather an engagement strategy. Modern employees want to work in a great environment and want to know their contributions are valued through benefit offerings like discounted healthcare.

For anyone looking to unlock the power of employee engagement through benefits, the time to act is now. With the number of companies catching on to the importance of customer experience, it will not only help you gain an edge on your competition but make your company a favorable place to work – the definition of a ‘win-win’ .

The plans that get the most value from this third-party vendor initiative are self-funded plans, due to their flexibility. “That’s not to say we can’t work with fully insured companies,” Scott insisted. “We have found being self-funded really allows the employer to access the ‘cream of the crop’ or the third-tier beyond typical in-network and out-network providers and facilities, which are those high value specialists.” Aiding employer and employee education through third-party care coordinators and plan incentives, Hierl’s benefits plans are next-level.

We give businesses focus and control over their healthcare expenditures. When it comes to shop-able services, or nonemergency services needed, our care coordinators will ensure you partner with the best high value, low cost provider possible. Scott emphasized, “We are a pilot of health plan partners – a conductor of sorts, pulling all the moving pieces and parts together for our clients to guarantee a more focused, transparent result of their healthcare spending.”

To speak with Scott, contact him today at (920) 921-5921 or by email at ssmeaton@hierl.com.