by US Rx Care | Jun 2, 2021 | Uncategorized
Research has found that employers who offered their workers stand-alone vision benefits experienced $5.8 billion in cost savings in the aggregate over four years due to reduced health care costs, avoided productivity losses, and lower turnover rates.
That’s because individuals who receive an annual comprehensive eye exam are more likely to enter the health care system earlier for treatment of serious health conditions, thereby significantly reducing their long-term cost of care.
Additionally, people are more likely to get an annual comprehensive eye test than a routine physical, according to the study by HCMS Group, a human capital risk management firm that analyzes data to help employers reduce waste in health benefits.
While not mandatory under the Affordable Care Act for adults, you may consider vision coverage for your employees as it may help decrease your overall health insurance outlays in the future.
The ACA requires that pediatric vision care coverage be embedded in medical benefits for children up to age 19 in group health plans purchased by employers with 100 or fewer employees.
The ACA’s vision care requirement for kids has exposed a gap in coverage for adults that is prompting an uptick in interest in voluntary vision benefits.
According to the “2020-2021 WorkForces Report” by the life insurer Aflac, 67% of U.S. employers surveyed offered voluntary vision benefits in 2020.
And nearly eight out of 10 employees said they would enroll in vision benefits if they were offered by their employer.
Early detection
The main reason vision benefits can help with early detection of illnesses is that comprehensive eye exams provide the only possible non-invasive view of blood vessels and the optic nerve.
As a result, eye doctors can detect early signs of chronic diseases before any other health care provider.
Eye doctors were the first to identify in patients signs of:
- Diabetes (34% of the time) — The HCMS study estimates savings of $3,120 per employee due to early identification of diabetes.
- High blood pressure (39% of the time) — The study estimates savings of $2,223 per employee due to early identification of high blood pressure.
- High cholesterol (62% of the time) — The study estimates savings of $1,360 per employee due to early identification of high cholesterol.
The case for vision insurance
Vision insurance policies typically cover routine eye tests and other procedures, and provide specified dollar amounts or discounts for the purchase of eyeglasses and contact lenses. Some vision insurance policies also offer discounts on refractive surgery, such as LASIK and PRK.
Vision insurance only supplements regular health insurance. Regular health insurance plans pay for eye injuries or ocular disease.
Vision insurance, on the other hand, is a wellness benefit designed to reduce your costs for routine, preventative eye care such as eye exams, eyewear and other services.
With the prospect of reduced health care costs among your employees, which in turn would reflect well in your health insurance premiums, if you have not considered vision benefits before, it may be time to take a second look.
Contact us for more information on how a vision plan can be incorporated into your employee benefits offerings.
by US Rx Care | May 25, 2021 | Uncategorized
As the light at the end of the pandemic tunnel gets brighter, more health insurers are ceasing to offer cost-sharing waivers for COVID-19 treatment.
After legislation was enacted in 2020 that required health insurance companies to cover COVID-19 tests and vaccines, many insurers voluntarily waived all deductibles, copayments and other costs for insured patients who fell ill with COVID-19 and needed hospital care, doctor visits, medications or other treatment.
Not all health insurers extended these waivers to their enrollees, but many did.
Insurers are still required to provide free COVID-19 testing and vaccinations to their enrollees. That’s because federal guidance requires them to waive such costs.
Also, guidance issued in February after President Joe Biden assumed office, reinforced the Trump administration rule about waiving cost-sharing for testing. Biden’s guidance took an extra step, saying that it applies even in situations in which an asymptomatic person wants a test before traveling or seeing a relative.
Almost 90% of individual and group health plans enrollees were in plans that waived cost-sharing for COVID-19 treatment, according to the Peterson-KFF Health System Tracker.
What insurers are now doing
However, starting in late 2020, more and more insurers have quietly been dropping those waivers. For example:
- UnitedHealthcare started curtailing its waivers in November.
- Anthem stopped its cost-sharing waivers on Jan. 31.
- Cigna stopped offering cost-sharing waivers for COVID-19 treatment on Feb. 15.
- Aetna ceased offering deductible-free inpatient COVID-19 treatment waivers on Feb. 28.
Not all insurers are doing this though. Blue Cross and Blue Shield of Minnesota extended eligibility for telehealth benefits and COVID-19 treatment waivers through the end of 2021. Humana, meanwhile, has left the cost-sharing waiver in place for Medicare Advantage members, but dropped it on Jan. 1 for those in job-based group plans.
A study by the Peterson Center on Healthcare and the Kaiser Family Foundation released in November 2020, found that 88% of Americans who have health coverage — including employer-sponsored heath plans and individual plans purchased on exchanges — had polices that waived cost-sharing for COVID-19 treatment.
Despite the fact that vaccines are rolling out quickly across the country and in light of a significant percentage of people who are hesitant to get vaccinated for COVID-19, the coronavirus is expected to be a presence in society for some time to come. And that means people will contract it and get sick.
There are also concerns about mutant strains that have developed in South Africa and Brazil, and possibly in India during the massive outbreak in April.
The takeaway
You may want to check with your group health plans to see if they have waived any cost-sharing for COVID treatment, and have since dropped or are planning to drop it.
You should meet with your employees or send them a memo explaining any impending changes for them if they have a health plan that is ending or has ended waivers.
by US Rx Care | May 18, 2021 | Uncategorized
As the country and our businesses continue trudging along and hope that vaccines will pave the way out of the COVID-19 crisis, employers are increasingly seeing the effects of pandemic fatigue among their workers.
The same issues people are grappling within their personal lives — exhaustion with social distancing and masking, a sense of loss of community and camaraderie, sadness over lost loved ones — are also spilling over into workplaces and affecting job performance.
Pandemic fatigue can manifest itself in noticeable changes in employees’ mood or demeanor and result in an inability to concentrate due to anxiety and sleeplessness.
And now that vaccines are being administered at a quickening pace and word is that we may be able to soon resume normal activities, people have a sense of unbridled excitement. It’s like how kids feel when they’ve had a year of school and summer vacation is right around the corner.
It’s important for all employers to stay the course on their safety protocols, while at the same time acknowledging what their employees are going through. Keep requiring mask-wearing and social distancing.
The effects
Pandemic fatigue is real and can result in:
Employee disengagement — This can lead to poor productivity and mistakes in their work.
Employee conflicts — Many people are stressed and exhausted, which can lead to arguments and irritation with co-workers. It can also happen if one employee doesn’t take COVID-19 precautions seriously, wearing a mask below their nose or chin (or not at all), and angering a co-worker who is serious about safety.
Failing to observe social distancing rules of being 6 feet apart can also result in arguments between co-workers.
Lost concentration — Pandemic fatigue can also lead to employees not focusing well on their jobs and safety regimens. This can result in workplace accidents.
What you can do
There are steps you can take to combat pandemic fatigue in the workplace, but the first and foremost thing you should do is consistently enforce safety rules and make sure that COVID-19 protocols should be part and parcel of the rest of your safety procedures.
You should do this by incentivizing good safety behavior, and rewarding that good behavior.
But you must also be cognizant of the emotional toll the pandemic has had on your workers. You can do this by boosting morale through:
Giving compliments — Provide positive feedback when merited, even for smaller achievements. Compliments go a long way these days due to the stress people have been through.
Showing compassion — Be consistent in your treatment of staff and consider checking in with employees to ensure that they are doing well. Ask how they’ve been faring and show empathy and sympathy for the issues they may be wrestling with.
Remember, some of your employees may have family that has succumbed to the virus or may currently be battling it.
Being calm and patient — It’s important that management shows calm and measured leadership, which can reassure the ranks that things aren’t so bad. Also, if management and supervisors can be patient when workers are dealing with stress, it can, in turn, tamp down any stress building among staff.
Exuding confidence — Part of being a steady and calming force includes expressing confidence that better times are ahead. This too can help your employees feel more relaxed about the future. Supervisors and managers should also express confidence in and appreciation for the employee’s individual commitment to stay the course.
The final word
These are tough times for most everyone, and for many people, their work and personal lives have been upended and replaced with little to no social activity and feelings of isolation and frustration.
By providing steady leadership, continuing to enforce safety protocols, and paying attention to the struggles your staff are facing, you can help any workers dealing with pandemic fatigue to better weather the storm that we may soon be exiting.
by US Rx Care | May 11, 2021 | Uncategorized
A new study has found that high-deductible health plans have only a limited effect on the growth of health care spending for people who sign on for these plans.
The National Bureau of Economic Research researched HDHPs over a period of four years and found they failed to control health spending any more than traditional preferred provider organization plans (PPOs) and health maintenance organizations (HMOs). The only statistically significant impact on lower growth by HDHPs was on more expensive pharmaceuticals.
The news comes as HDHPs continue growing in use and popularity among employers and some of their workers. They are often paired with a health savings account that allows participants to set aside a portion of their wages before taxes in special accounts used to pay for health-related expenses, including deductibles.
When HDHPs first came on the scene they were touted as a potential cost-saver. The logic went that when the worker has more skin in the game and has to pay more for their medical care and medications, they will shop around for the lowest-cost service or drug.
Here are the main findings of the report:
- Covered workers who switched from low-deductible plans to high-deductible plans saw lower growth rates of spending, but for no more than a year.
- HDHPs seem to discourage the use of less cost-effective drugs. The report surmised that’s because people with these plans will be more motivated to shop around for better prices, like from an online pharmacy.
Considerations
PPOs continue to be the most popular choice among employees and HDHPs continue growing as employers look to cut their and their employees’ premium expenditures, according to a recent report by Benefitfocus, a benefits technology company. HDHPs currently account for about 30% of group health plans in play.
Also, some employees prefer having an HDHP as they can save money up front on the premium.
Over the past few years, employers have noticed that younger and healthier workers will gravitate towards HDHPs when offered them, as they will usually not need much health care and they are willing to trade a lower up-front premium for the small likelihood that they will need a significant amount of medical care, which they would have to pay for out of pocket.
However, workers in their 40s and older are more apt to stick to their PPO or HMO plans, which have higher premiums but lower out-of-pocket maximums.
But the authors of the National Bureau of Economic Research report said that for some people with health problems, HDHPs “may have high adverse health consequences when patients delay, reduce, or forgo care to curb costs, even when costs are moderate compared to health benefits.”
The takeaway
There is no doubt that HDHPs will continue growing in use, but they are not for everyone. Employers that give their workers an option of choosing an HDHP or a traditional PPO plan will be able to better cater to the different needs of their workers.
This is important as the U.S. workforce becomes more diversified, and for employers with multi-generational employee pools.
by US Rx Care | May 4, 2021 | Uncategorized
The recently enacted American Rescue Plan Act of 2021 includes a 100% COBRA subsidy for up to six months for employees laid off during the COVID-19 pandemic. The subsidy is in effect through September 30.
Due to the short ramping up period, it’s imperative that employers who have laid off workers, or who plan to do so, start preparing to notify them.
The Consolidated Omnibus Budget Reconciliation Act requires group health plans sponsored by employers with 20 or more employees to offer staff and their families the opportunity for a temporary extension of health coverage (called continuation coverage) after they have quit or been laid off for 18 months. The employees will usually be responsible for the entire premium.
Who is eligible?
Eligible individuals include:
- Workers who were previously laid off or lost their benefits and became eligible for COBRA continuation coverage but chose not to purchase it, as long as they would still be eligible now. Example: A worker who was laid off in November 2020 but rejected the offer of COBRA coverage then.
- Individuals who previously elected COBRA continuation coverage, but later dropped it, as long as they would still be eligible now. Example: A worker was laid off in August 2020, elected and purchased COBRA coverage, but dropped the coverage in January.
- Individuals who were involuntarily terminated or experienced a reduction in hours, and who timely elect COBRA continuation coverage after April 1.
Individuals are not eligible for a subsidy:
- If they voluntarily resigned from their job.
- They become eligible for other employer coverage or Medicare.
- They are beyond their maximum COBRA coverage period (which under federal law is 18 months, and under California law may be up to 36 months).
What’s covered
The subsidy applies to all health coverage that COBRA usually covers: health insurance, and dental and vision coverage too. Generally, the coverage that employers offer Assistance Eligible Individuals (AEIs) should be the same coverage in effect prior to their COBRA-qualifying events.
Individuals who qualify for the COBRA subsidy are not required to pay a premium.
The group health plan will cover the cost of the coverage, which will be reimbursed (including any administrative fee) by the U.S. government via a payroll tax credit.
Notice requirements
When notifying newly eligible individuals, the information can be included with the COBRA election notice or a separate notice that would come along with the election packet.
The notices must include:
- Notification of the availability of subsidies.
- A prominently displayed description of the AEI’s right to the subsidy and conditions.
- The forms necessary to establish eligibility.
- A description of the special election period.
- A description of the qualified beneficiary’s obligation to notify the plan when they are no longer eligible for coverage.
- Contact information of the plan administrator and any other person maintaining relevant information in connection with the subsidy.
Important: The Department of Labor is expected to provide model language for these notices by April 10.
What you should do
There are a number of steps employers need to take as the ramping up period is quite short:
- Coordinate with your COBRA administrator to ensure that you agree about who should identify eligible individuals and who will be sending out notifications.
- If that is you, identify those individuals who may be eligible for the COBRA subsidy and who may be eligible to make a new election.
- Prepare notification documents.
- Notify all eligible individuals.
by US Rx Care | Apr 27, 2021 | Uncategorized
A new study has identified the top five health conditions that are driving the overall cost of group health plan outlays, and without which spending would actually be falling.
The report is enlightening, and employers can use the findings to offer programs aimed at education and prevention to help control their employees’ health care costs and cut into health insurance premiums paid by both employers and workers.
Inspecting its study data for trends, the Health Action Council (HAC) determined that 63% of its covered lives had at least one of five conditions that were driving health care costs. Most of these top five conditions are preventable or treatable with lifestyle modifications that employers can encourage.
Here’s a look at the five conditions and the burden they put on your employees and your company:
Asthma
Average costs paid per member of the HAC for asthma treatment are increasing on average 6.4% a year. This is one of the most prevalent health conditions in the country. Three important stats:
- The incidence of asthma was 31% higher among women than men.
- The incidence of asthma among African American covered lives was 20% more prevalent than among other races.
- The average age of HAC members with asthma was 31.9, two years younger than the overall membership average age of 33.9.
Diabetes
Average costs paid per member of the HAC for diabetic treatment are also increasing 6.4% a year. Three important stats:
- Diabetes was 20% more common in men than women among the HAC’s enrollees.
- The average age of HAC plan enrollees with diabetes was 52.
- Although Asian covered lives amounted to only 3% of the HAC enrollees, they had the highest incidence of diabetes of all racial groups.
Hypertension
Average costs paid per member of the HAC for hypertension treatment are increasing 6.3% a year. Three important stats:
- Hypertension was 23% more common in men than women.
- The average age among HAC enrollees with hypertension was 53.1.
- The risk of African Americans developing hypertension was 63% more than for other races.
Back disorders
Average costs paid per member of the HAC for back treatment are increasing 3.4% a year. Three important stats:
- Back disorders were 27% more common in women than men.
- The average age among HAC enrollees with back disorders was 43.3.
- Caucasian HAC members had 14% higher back disorder prevalence than other races.
Mental health, substance abuse
Average costs paid per member of the HAC for mental health and substance abuse treatment are increasing 2.7% a year. Three important stats:
- Mental health and substance abuse problems were 39% more common in women than men.
- The average age among HAC enrollees with mental health and substance abuse issues was 32.8.
- Caucasian HAC members had 20% higher mental health and substance abuse issues than other races.
The takeaway
To help workers with these conditions, the report recommends:
- Creating and implementing simple education and targeted wellness programs to address common conditions among your employees.
- Instituting an exercise, stretch or meditation program at the beginning of a work shift to improve safety and decrease injuries. These types of practices are preventative and may decrease the severity of an injury if one occurs.
- Evaluating benefit plan design for opportunities to implement continuum-of-care protocols. For example, employers can make chiropractic care or physical therapy mandatory for back disorders before moving to more aggressive treatments.
- Covering medications for specific common chronic conditions as preventative care. Another option is to promote the use of patient assistance programs for medicines that may be excluded in your plan’s drug formulary.
- Promoting virtual care for specific conditions; for example, mental health support if you have staff in rural areas.
- Working with your health insurer or medical expert(s) to identify opportunities for provider outreach and education to your workers.
