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.
by US Rx Care | Apr 21, 2021 | Uncategorized
The Department of Health and Human Services has proposed cost-sharing limits that would apply to all Affordable Care Act-compliant health insurance policies for the 2022 policy year.
The ACA imposes annual out-of-pocket maximums on the amount that an enrollee in a non-grandfathered health plan, including self-insured and group health plans, must pay for essential health benefits through cost-sharing.
This means that health plans are not allowed to require their enrollees to pay more than the maximum in a given year for health services.
The proposed 2022 out-of-pocket maximums are $9,100 for self-only coverage and $18,200 for family coverage. This represents an approximate 6.4% increase over 2021 limits. For 2021, the out-of-pocket maximums are $8,550 and $17,100, respectively.
Penalties to rise
Applicable large employers (ALEs) — employers with 50 or more full-time or full-time-equivalent workers who are required to offer their employees health insurance under the ACA — can face large penalties known as “shared responsibility” assessments if they have at least one full-time employee who enrolls in public marketplace coverage and receives a premium tax credit. There are two types of infractions with different penalty amounts:
The “play or pay” penalty — This can be levied when an ALE fails to offer minimum essential coverage to at least 95% of its full-time employees and their dependent children during a month, and at least one of its full-time employees receives a premium tax credit through a public marketplace.
The per-employee penalty will rise to $2,880 in 2022 from the current $2,700.
The “play and pay” penalty — An ALE can be hit by this penalty if it offers minimum essential coverage to at least 95% of its full-time employees but a full-time employee receives a premium tax credit because: (1) the employer-offered coverage is unaffordable or fails to provide minimum value, or (2) the employee was not offered employer-sponsored coverage.
For 2022, the maximum annual assessment for each full-time employee receiving a premium tax credit will be an estimated $4,320, up from the current $4,060.
by US Rx Care | Apr 16, 2021 | Uncategorized
New guidance from the Internal Revenue Service allows employers to temporarily give their employees extra benefits leeway in making changes to their flexible spending accounts (FSAs) and health savings accounts (HSAs).
The guidance, in response to the COVID-19 pandemic, also allows employees to make changes to their health plans outside of the traditional open enrollment period.
The COVID relief bill signed into law at the end of 2020 changed the tax law. The law ordinarily requires employees to make irrevocable plan choices before the first day of the plan year; later changes are normally permitted only under certain circumstances, such as a change in employee status.
However, 2020 was an abnormal year. For example, stay-at-home orders left employees with unused money in their dependent care FSAs because they unexpectedly did not have to pay for child daycare.
The temporary changes
Recognizing the current extraordinary situation, the new guidance makes several temporary changes:
- Employers can permit employees to carry over unused funds from their 2020 FSAs to 2021, and from 2021 to 2022. Ordinarily, these accounts have a “use it or lose it” rule under which the employee forfeits unused funds at the end of the year.
If an employee contributed $5,000 to a dependent care FSA in 2020 but used only $3,000 because he or she worked from home, they can now carry the remaining $2,000 forward for use in 2021. - Alternatively, employers can extend the grace period for employees to spend unused FSA funds. Normally, employees have two and a half months from the end of the plan year to spend the money on qualifying expenses. The temporary rules permit employers to give them up to 12 months to do it.
- Employers can allow certain employees to use dependent care FSA funds for care of children up to age 14. The normal cut-off age is 13.
- Employers may allow employees to change their future contributions to 2021 FSAs mid-year, something that is ordinarily prohibited.
- Employers may also permit employees to make mid-year health plan changes. Employees who did not enroll in the employer’s health plan during open enrollment will be able to do so.
Employees can change available plans, or they can drop coverage entirely if they can show that they have replacement coverage such as through a spouse’s employer. - If an employee changes from a high-deductible health plan to one with copayments or lower deductibles (or vice versa), employers can also permit them to switch mid-year between contributing to an HSA or an FSA. By law, an HSA must be coupled with an HDHP.
- Lastly, they can allow employees who stop contributing to a health care FSA mid-year to receive reimbursements through the end of the plan year.
It is important to know that:
- The law does not require employers to make these changes.
- The changes expire for plan years starting in 2022 and later.
The pandemic has been difficult for employers and employees alike. These temporary changes will make it a little easier for both to cope.
by US Rx Care | Apr 8, 2021 | Uncategorized
One of the main recommendations for employees with 401(k) plans is that they should contribute at least enough to their plan every paycheck to ensure they receive the maximum they can in their employer’s matching contributions.
But a new study by Willis Towers Watson recommends that younger, healthier workers should divert savings to their health savings account from their 401(k) after capping out employer matching instead of continuing to put money into their retirement plan.
The report reasons that if they do this, they can get more bang for their buck when they use their HSAs to pay for future medical expenses.
That’s because HSAs can be kept for life and the money they’ve accumulated in them can be used to pay for medical expenses whenever they need them, including in retirement. And the moneys used in HSAs to pay for those expenses are not taxed when they are withdrawn, unlike 401(k)s, the funds of which are subject to federal income tax when withdrawn
The benefits of HSAs
With HSAs:
- Pretax contributions, gains from investment, and withdrawals used for qualified medical expenses are exempt from federal and most state taxes.
- Any unused balance is carried over to the next year.
- Funds never expire.
- Unused funds can be passed on to a beneficiary after death.
- After turning 65, account holders can withdraw money for any purpose. However, if those funds are not use for a bona fide medical expense, they are taxed as income.
No other retirement savings vehicle has the same tax advantages as an HSA, so a dollar saved in an HSA can be worth significantly more than an unmatched dollar saved in a 401(k), according to Willis Towers Watson. Some employers will match a portion of workers’ HSA contributions or seed their accounts with money to encourage participation.
That said, HSAs won’t outperform funds that are matched partly or fully by an employer, according to the report.
Willis Towers Watson said that those tax-free dollars and withdrawals can help pay for health care when we are likely to use it most: in retirement.
Men who retire at 65 with an average life expectancy of 85 would spend about $140,000 out of pocket for medical costs, and woman who retires at the same age and lives to 87 would spend an average of $159,000, according to the research.
The HSA pitch
HSAs can only be used in conjunction with a high-deductible health plan. When HSAs were first introduced, they did not have investment options for the money in the accounts, but as they have grown in popularity over the years, many HSAs now have evolved to essentially have the same investment choices as a 401(k).
HSAs have rules about how much of the balance can be invested. They will typically require that the first $1,000 in the account to be held in cash, and anything above that can be invested to help the funds grow over time.
In 2021, workers can contribute a maximum of $3,600 to their individual HSA account and $7,200 to a family coverage account.
If you are offering your workers high-deductible health plans with matching HSAs, and if you also provide a 401(k) and match part of the contributions, you may want to consider sharing this information with them to help them make informed choices on where to park their money for future use.
by US Rx Care | Mar 30, 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 from 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.
by US Rx Care | Mar 23, 2021 | Uncategorized
The Equal Employment Opportunity Commission has affirmed that employers can mandate COVID-19 vaccines for employees, subject to some limitations.
The EEOC’s updated guidance offers direction regarding employer-mandated vaccinations, accommodations for employees who cannot be vaccinated due to a disability or sincerely held religious belief, and certain implications of pre-vaccination medical screening questions under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act.
Asking a patient pre-screening questions is a routine part of a vaccination. These questions may constitute a “medical examination” as defined by the ADA. An employer must be able to show that the inquiries are “job related and consistent with business necessity” and that an unvaccinated employee could pose a direct threat to the health of others in the workplace.
The guidance does make clear that administration of a COVID-19 vaccination to an employee itself does not constitute a medical examination for the purposes of the ADA.
Urging employees to get the vaccine voluntarily or requiring them to submit proof that a non-contracted third party (physician, pharmacist or public health center) administered it may be a better alternative with fewer legal complications.
Reasonable accommodations
Some employees may be unable to get the vaccine for health or disability reasons. Other employees may have sincere religious objections to getting inoculated. In both cases, employers must make reasonable accommodations for the employees. The law permits them to exclude these employees from the workplace only if no reasonable accommodation is possible.
Employers and employees might not agree on what “reasonable accommodation” means. For this reason, employers should consult with human resources experts and carry employment practices liability insurance. Expert advice will help avoid these kinds of conflicts, and the insurance will pay for legal defense and settlement of resulting employee lawsuits.
Requiring employees to get vaccinated will also have implications for the employer’s obligations under state workers’ compensation laws. On the positive side, a vaccinated workforce should reduce the employer’s exposure to claims that an employee got the virus on the job.
On the negative side, some employees may experience adverse side effects. Since the vaccine would be a job requirement, the employee could make a claim for workers’ comp benefits due to the adverse reaction. In addition, the employer may have to pay the worker for the time spent getting vaccinated and for the cost of the injection.
What you can do
Employers can protect themselves by following these guidelines:
- Follow federal and local health guidelines for the vaccine.
- Vary the requirements depending on work conditions and locations, such as requiring vaccines for those who regularly interact with the public but making them optional for remote workers.
- Accommodate employees unable to get the vaccine or resistant to it, to the extent you reasonably can without endangering other employees or the public.
- Apply the requirements consistently to all employees.
No one wants to catch or spread this virus. Employers can help halt the spread by thoughtfully addressing the issue of vaccinating employees.
