by US Rx Care | Sep 24, 2019 | Health care costs
As open enrollment is right around the
corner, now is the time to make a plan to maximize employee enrollment and help
your staff select the health plans that best suit them.
You’ll also need to make sure that you
comply with the Affordable Care Act if it applies to your organization, as well
as other laws and regulations.
Here are some pointers to make open
enrollment fruitful for both your staff and your organization.
Review what you did last year
Review the results of last year’s
enrollment efforts to make sure the process and the perks remain relevant and
useful to workers.
Were the various approaches and communication channels you used effective and did you receive any feedback about the process, either good or bad?
Start early with notifications
You should give your employees at least a
month’s notice before open enrollment, and provide them with the materials they
will need to make an informed decision.
This includes the various health plans that
you are offering your staff for next year.
Encourage them to read the information and
come to your human resources point person with questions.
Help in sorting through plans
You should be able to help them figure out
which plan features fit their needs, and how much the plans will cost them out
of their paycheck. Use technology to your advantage, particularly any
registration portal that your plan provider offers. Provide a single landing
page for all enrollment applications.
Also, hold meetings on the plans and put
notices in your staff’s paycheck envelopes.
Plan materials
Communicate to your staff any changes to a
health plan’s benefits for the next plan year through an updated summary plan
description or a summary of material modifications.
Confirm that their open enrollment
materials contain certain required participant notices, when applicable – such
as the summary of benefits and coverage.
Check grandfathered status
A grandfathered plan is one that was in
existence when the ACA was enacted on March 23, 2010, and is thus exempt from
some of the law’s requirements.
If you have a grandfathered plan, talk to
us to confirm whether it will maintain its grandfathered status for the next
plan year. If it is, you must notify your employees of the plan status. If it’s
not, you need to confirm with us that your plan comports with the ACA in terms
of benefits offered.
ACA affordability standard
Under the ACA’s employer shared
responsibility rules, applicable large employers must offer “affordable” plans,
based on a percentage of the employee’s household income. For plan years that
begin on or after Jan. 1 of next year, the affordability percentage is 9.86% of
household income. At least one of your plans must meet this threshold.
Get spouses involved
Benefits enrollment is a family affair, so
getting spouses involved is critical. You should encourage your employees to
share the health plan information with their spouses, so they can make informed
decisions on their health insurance together.
Also, encourage any spouses who have
questions to schedule an appointment to get questions answered.
by US Rx Care | Sep 17, 2019 | Health care costs
As the workforce ages and many
employers want to keep on baby-boomer staff who have the experience and
institutional knowledge that is irreplaceable, one issue that always comes up
is how to handle health insurance.
Once your older workers reach
the age of eligibility for Medicare, under current law you can help them pay
for Part B and D premiums with a Medicare Premium Reimbursement Arrangement.
These types of arrangements became legal after legislation was signed into law
in 2013 to help employers provide benefits to their Medicare-eligible staff.
But the issue surfaced again
recently when the Trump administration came out with new guidance for health
reimbursement arrangements that paves the way for employers to set up HRAs to
reimburse staff for health premiums in their personal (not company group)
health plans.
Anybody who is about to turn 65
has a six-month period to sign up for basic Medicare, but if they want
additional coverage they can pay for Medicare supplemental coverage such as
Parts B and D.
Part B covers two types of
services:
Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Part D, meanwhile, covers
prescription drug costs.
The dilemma for employers has
often been whether to keep the Medicare-eligible employee on the company health
plan or cut them free on Medicare.
Smaller employers – those with
20 full-time-equivalent employees – have the option to open a Medicare Premium
Reimbursement Arrangement for those employees if they are coming off a group health
plan and into Medicare.
For small employers, it’s legal
to set up an arrangement like that, as long as doing so is at the employee’s
discretion. Employers are not allowed to push an employee into a Medicare
Premium Reimbursement Arrangement in order to get them off the company’s health
plan.
The good news for employers is
that they often can reimburse their employees in full for Part B and D, as well
as Medicare Supplement, and still pay less than they would pay in group
employee premiums alone.
On top of that, the employee
gets a lower deductible and overall out-of-pocket experience with less, if any,
premium contribution.
What you need to know
Here’s what you should know if you’re considering one of these arrangements:
A
Medicare reimbursement arrangement is one where the employer reimburses some or
all of Medicare part B or D premiums for employees, as long as the employer’s
payment plan is integrated with the group’s health plan.
To
be integrated with the group health plan:
- The employer must offer a minimum-value group health plan,
- The employee must be enrolled in Medicare Parts A and B,
- The plan must only available to employees enrolled in Medicare
Parts A and B, or D, and
- The reimbursement is limited to Medicare Parts B or D, including
Medigap premiums.
Note: Certain employers are subject to Medicare
Secondary Payer rules that prohibit incentives to the Medicare-eligible
population.
by US Rx Care | Sep 4, 2019 | Health care costs
It’s looking more and more likely that a
federal appeals court will strike down the Affordable Care Act’s individual
mandate, which requires Americans to carry health insurance, either through
coverage they receive from their employer or buying it themselves.
The case challenging the landmark health
insurance law is currently before the 5th U.S. Circuit Court of
Appeals and is being heard by a three-judge panel.
Two of the judges, appointed by
Republicans, have signaled that they would strike down the individual mandate
but not the remainder of the law, including the employer mandate, because of
the lack of an individual penalty.
The Justice Department would normally be
defending the law of the land, but it has stepped away from the task and
signaled that it would prefer to see the law abolished. At issue is the repeal
by Congress in late 2017 of penalties for individuals that do not secure
coverage as required by the law.
Attorneys general from Republican states
banded together to challenge the entire law after the individual penalty was
abolished after Trump signed a tax bill that reduced the tax penalty to zero
dollars. They argued that if that penalty is no longer applicable, the rest of
the ACA is null and void.
According to trade press reports, the two
Republican-appointed judges probed the contention by Republican states’
attorneys general that the getting rid of the individual penalty nullifies the
entire law. The two judges’ line of questioning hinted at their skepticism of
that argument.
The background
The case is before the 5th
Circuit after a federal district court judge sided with the argument by Republican
state attorneys general that the individual mandate is unconstitutional and
could not be severed from the rest of the ACA, and hence the entire law must be
invalidated.
When the Justice Department declined to
defend the law, attorneys general from several Democratic states House
representatives appealed the ruling.
Lawyers for the Democratic states said that
the plaintiffs needed to prove that Congress intended for the entire ACA to be
struck down when it passed legislation to get rid of penalties.
The court has not made a decision on the
case yet, but whatever its ruling, it will be appealed to the U.S. Supreme
Court. Attempts to overturn the ACA at the Supreme Court have met stiff
resistance.
In 2012, a divided U.S. Supreme Court
upheld most of the law’s provisions, including the individual mandate, which
requires people to obtain insurance or pay a penalty.
The Supreme Court’s conservative majority
found Congress could not constitutionally order people to buy insurance. But
Chief Justice John Roberts joined the court’s four liberal members to hold that
the mandate was a valid exercise of Congress’s tax power.
by US Rx Care | Aug 27, 2019 | Health care costs
Diabetes is a devastating illness – and not just for those with the disease. Employers are also shouldering massive and increasing direct and indirect costs due to diabetes.
Diabetes afflicts more than 11% of the adult population, including about 6.3% of full-time workers and 9.1% of part-time workers.
Adults with diabetes incur more than $8,480 in direct treatment costs, on average. Those who are insured spend even more.
A 2016 report from the Health Care Cost Institute estimated that insured workers with diabetes spend more than $16,000 on health care costs per year. Those without diabetes, on average, generate about $4,396 in medical costs per annum.
Indirect costs
Employers aren’t just paying more in direct health care costs and insurance premiums. They also pay via lost productivity.
On average, those with diabetes miss an extra week of work – 5.5 days – compared to other workers, according to Gallup estimates. All told, that adds up to 45 million missed workdays and productivity costs to U.S. employers of $4 billion.
And for employers, these costs may represent just the tip of the iceberg. The Centers for Disease Control (CDC) estimates that more than 114 million adults in the U.S. – a third of the workforce – have undiagnosed diabetes or prediabetes.
What can employers do?
The CDC recommends that employers design wellness programs that specifically target improvements in the following areas:
- Exercise and activity levels
- Smoking
- Hypertension
- Blood cholesterol
- High blood glucose
- Weight/obesity
There also are a number of measures employers can take to help mitigate some of the costs to the organization.
- Offer ongoing counseling with professional dieticians. Employees that regularly meet with dieticians who can help them set small, manageable goals for themselves, make significant and measurable health improvements, according to a 2016 study. The research found that they lost 5.5% of their body weight and reduced blood glucose levels.
- Start a walking club. The American Diabetes Association’s Stop Diabetes @ Work program recommends that employers encourage company walking clubs to attend diabetes walk-a-thons like Step Out: Walk to Cure Diabetes, or host a Community Walk to Cure Diabetes.
You can find resources, including posters, newsletter articles, training plans, and walking guides, at diabetes.org. - Encourage self-assessment and screening. According to the CDC, 30% of people with diabetes aren’t even aware of it. Workplace screenings are easy and effective. Many employers provide incentives for workers to participate via reduced insurance copays or even cash payments. All screenings should be confidential and employers should not penalize employees who have diabetes, as this could violate the Americans with Disabilities Act.
- Encourage smokers to quit. Diabetics who smoke have far higher medical costs on average than non-smoking diabetics or non-diabetic smokers. Discouraging tobacco use can pay off in the long run.
With so much at stake, a robust workplace program to fight diabetes can generate a significant return on investment.
The American Diabetes Association estimates that preventing or delaying the onset of diabetes in just one prediabetic employee can generate more than $50,000 in direct and indirect cost savings over five years.
