Healthcare Solutions: Recent Episodes
Cristy Gupton
Healthcare innovations that make a difference. On the show, Cristy Gupton, President of Custom Benefits Solutions, meets with other experts in the industry and talks over solutions to current obstacles. Today's problems with healthcare and how we change it for the better.
If you’re subscribed to my LinkedIn newsletter, “Transparency in Healthcare”, and if you read the last edition called, “We Brought this on Ourselves”, and if you watched the video I recorded with Madeline Clark, a pharmacist at Moose Pharmacy who runs the Project Impact: CGM Access program they were selected to try out with their patients (that’s a lot of “IFs” and I probably lost about 99% of you right there in the first run on sentence), then you heard me say that I usually fast through breakfast and lunch by drinking hot liquids like coffee and tea.
Because I like variety, I try out many different types of teas so I don’t get bored. I picked up this one yesterday while shopping at Aldi. I bought it originally because I know that the anti-inflammatory properties of ginger and turmeric are good for you, but I didn’t know I was in for a tasteful treat. At $1.89 per box with 20 tea bags inside that’s roughly 9.5 cents per bag. Not a bad deal and WAY better for you than an appetite suppressant in some capsule form and DEFINITELY better for you than any version of semaglutide, GLP-1, or whatever brand name label you want to use to describe the brutally expensive injectables that have taken America (and soon the world) by storm.
Benner Tea Company Ginger Turmeric Tea sold at Aldi for $1.89 per box. That’s 9.5 cents per tea bag.
When I first started doing intermittent fasting, I found that my morning coffee kept me satisfied until around 10:30am (especially if I poured it into a double-walled aluminum cup that keeps things hot for a pretty long time). By that time of the morning, I’m ready to get up from my desk and put a cup of water with a tea bag in the microwave for 4 minutes. This gives me time to rest my eyes from the computer screen anyway. When the microwave stops and the familiar sound beeps to tell me “hot tea is ready”, of course it needs a couple of extra minutes to cool to sipping temperature. Tiny sips of hot tea allows just enough liquid to hit my tummy and keep hunger away until noon. The properties in the ingredients are something I can get behind as well. Nothing bad for you here. And, this is just me, but when I put my lips on the cup and take a sip, the flavor bouquet reminds me of (don’t laugh)…Fruity Pebbles :) I’m just being honest. I said don’t laugh. Just go buy a box and try it for yourself.
It certainly doesn’t need warning labels, side-effect disclaimers, clinical studies showing the major health problems that await some who may experience gastroparesis, muscle wasting, and many of the other scary outcomes we’re starting to see from the franken-drugs that are bankrupting employer health plans across the country. The NC State Health Plan was right to exclude these drugs for the treatment of weight loss. Though big pharma paid writers in major publications to demonize them for it, I believe time will tell that they made the right decision on behalf of the State of North Carolina and the employees who depend on the NC State Health Plan. This change becomes effective tomorrow, April 1, 2024.
The other thing I like when I push through the breakfast and lunch hours with only hot liquid as my sustenance is that I know my cells are going through “autophagy”. What’s that? In my layman’s terms, it’s the internal garbage disposals in each cell, eating up bad stuff that causes cells to mutate, turn into cancer, and other prerequisites for disease. This would be highly preferrable to what semaglutide drugs do. Those drugs actually make the food in your stomach stay there for way longer than it should. Let’s face it, the American diet is mostly terrible. Why would you want to force it to stay in your stomach (where it can do damage) longer than necessary? It’s just not a good idea.
But make no mistake, the GLP-1s main function is to put you into a state of intermittent fasting. The same exact state you can achieve for a few cents per day if you’ll just try it. It took me about 2-3 weeks to see this become a reality for me. If you’re yelling at me through the computer screen right now, stop it! I know the struggle is real. I’ve lived it. But, this is my honest, personal experience and I’m just telling you what I’ve come to realize after decades of trying everything else.
Well, I guess that’s enough for now. I hope you’ll subscribe to my podcast, Healthcare Solutions on Apple Podcasts or Spotify, where I pick apart topics like this and others with the nation’s experts. If you’re an employer and you’re wondering how to get a handle on runaway healthcare costs…let’s talk!
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Spoiler alert. Intermittent fasting and consistent exercise will give you the same results but with better health as an ultimate outcome...not worse health because of a drug your body didn't really need. This week’s article in BenefitsPro about the 10K patients who are suing the makers of the GLP-1s like Ozempic and Wegovy was inevitable. These semaglutide drugs give patients a distorted weight loss experience. In my last blog, I said this..."Consider Ozempic and other semaglutide copycats that are flooding the market. Ozempic’s list price is approximately $1200 for a one-month supply. Patients taking this drug barely have to get out of bed to watch the pounds melt away. They get temporary weight loss that comes with a hefty price tag for your health plan. It also comes with significant side effects like loss of lean muscle mass, stomach troubles and more. And what happens to the coworkers who might be diagnosed with cancer or other difficult diagnoses while your health plan has been bled dry by this drug? Well, that’ll be between you and your plan administrator to figure out. It’s gonna have to come from somewhere, friend." If you didn't catch that blog you can still read it here -- https://www.custombenefits.work/news/2023/11/27/bcbsnc-tries-to-pull-one-over-on-us-but-we-arent-fooled.
Too many doctors don't get reimbursed much for the care encounters it takes to follow a patient through their weight loss journey; couple that with how Americans love quick fixes. Doctors are instead encouraged to prescribe expensive drugs to do the work for them. And why not! The health insurance companies are now fully integrated with pharmacy benefits managers. That's right, more spoilers…the healthcare system is now almost 100% controlled by big pharma. The fact that your doctor has less than 10 minutes with you during appointments is the perfect lay up for Blue Cross, UnitedHealthcare, Cigna and Aetna who are all about the hidden money they have embedded in the cost of these drugs. And let's face it, it's not just these drugs. It's ALL drugs. Is it any wonder that every other commercial on TV is a drug commercial and then the other commercials are from insurance companies selling Medicare Advantage plans? Even politicians are going to have to pay more to compete with healthcare for airtime in the upcoming election year. Couldn’t happen to a nicer group of folks considering they get more campaign money from healthcare than they do from anyone else.
Here's my unsolicited advice to anyone out there who is currently on Ozempic or other GLP-1 copycats. Get your doctor's help to wean off of them and start following some of the important experts in the intermittent fasting arena like David A. Sinclair A.O., Ph.D., Peter Attia, Andrew Huberman and others. Why? Because these drugs have chemically put you in a quasi-fasting state without you realizing it. Seriously, when you inject yourself once a week, there's at least a couple days where you're probably too sick to eat much. The nausea you experience makes you want to skip meals and push the plate away after just a few bites. So, embrace that! Go with it and I promise it won't take long (maybe 3 weeks) to realize that you made it through breakfast, lunch and clear into late afternoon before you ever thought about being truly hungry. My trick is to sip warm/hot liquid. Between coffee, hot tea and a hot brothy soup (like what you might get at a Hibachi restaurant), my tummy stays full on that liquid pretty much all day. Then I eat a sensible meal with my family after spin class (where I also gulp a bunch of water trying to keep up with the spin instructor). You can retrain your body to not get hungry until much later in the day. It’s the truth. I dare you to prove me wrong.
Dr. David Sinclair is a Harvard Researcher who studies longevity and reports on the science of intermittent fasting. He wrote a book called “Lifespan” and recorded a podcast by the same name.
The other trick that I think is instructive is using a Freestyle Libre 3 or Dexcom to watch your blood sugars fluctuate throughout the day. You’ll be amazed at how level they will stay even while fasting. Your body is a mostly well-functioning machine when you get out of the way and let it do its job. Even a lazy pancreas like mine regulates my blood sugars pretty well throughout the day when I’m not eating anything. While I usually just fast through breakfast and lunch, the longest continuous fast I’ve done so far is 3 days. My blood sugar never dipped below 75 the whole time. I like the Freestyle Libre 3 and I buy it at a local, independent, community pharmacy for around $70 per sensor. No insurance needed. Those sensors last 14 days. Even people who don’t struggle with their blood sugar control can buy one with a prescription just to see how their body processes certain foods. Like, for some reason, my body can deal with potatoes way better than rice, pasta or bread. Everyone’s body is different so each person should do some research and wear a sensor for 14 days to see what happens. It’ll be an interesting but needed experiment.
Freestyle Libre 3 checks your blood glucose once every minute and automatically plots that data to a graph on your smartphone.
OK, last but not least…and this is the most important trick of all. You need a direct primary care doctor to lean on during this process. Traditional insurance and their fee-for-service reimbursement methodology is not going to cut it when you need a doctor that sticks closer than a brother. As I went through my own epiphany around weight loss, Ozempic, fasting, etc. I would text my DPC doc fairly frequently and we’d have quick, spontaneous encounters that were either digital or live and in-person as needed. No insurance middleman to get between us. The national average for DPC memberships is around $80/month. Very affordable. Anyone who consumes care in the traditional sense, scheduling appointments way into the future, having to wait in waiting rooms and then wait in an exam room, getting maybe 10 minutes with the doctor, then paying a copay every time, then getting a surprise bill for something you didn’t expect to be billed for…all that can be alleviated in a direct primary care relationship. Well worth the cost! And employers can embed this tool into a well-designed health plan. If employers are curious about that, I know a gal!
You and your doctor deserve an appropriate amount of time together without any third party telling you what you can and cannot do. You can get the third parties out of the room when you use direct primary care.
When you realize that your “insurance” was part of the problem that was keeping you from a well-functioning primary care relationship, the most logical next question is “do I really need this type of insurance?”. Well, I can’t answer that for you, but I did answer that for myself and the answer for me? Again, spoiler…NO, NOPE, NOPITY NOPE, NOT EVEN A LITTLE BIT. If you’ll navigate over to my YouTube Channel, I’ve recorded several videos about different strategies that accomplish the goals most individuals and employer groups are aiming for. Well, like usual, I could keep going on and on, but I think that’s enough for today.
Stay well everyone! Hit me up if you wanna talk.
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My husband works for our local county government. This county uses one of the “bigs” in benefits consulting and, of course, they recommend Blue Cross & Blue Shield of North Carolina to administer the county’s health plan. Shocker, I know.
Today, my husband received an email from the Human Resources Department at his county. It explains that there are significant changes ahead for the way BCBSNC administers their prescription drug benefit. It never mentions the pharmacy benefit manager (PBM) that BCBSNC owns, Prime Therapeutics. I mean, why bother? It’s just too confusing. And therein lies many of healthcare’s problems, right?
When confusion reigns, many opt to skim over the details, opt not to read the fine print, or ask questions. This is actually a good strategy for BCBSNC and the employers who perpetrate their plans on unsuspecting employees. A confused employee is one who doesn’t challenge the status quo and spends more money because they don’t have the kind of healthcare savvy to avoid costly care.
All this is counterintuitively profitable for BCBSNC. You may be scratching your head on that one. Why would it be more profitable to BCBSNC if an un-savvy employee spends more money? Well, I said it was counterintuitive, didn’t I? The answer lies in an under-the-radar provision of the Affordable Care Act…the medical loss ratio. That part of the ACA was spun to sound as if it protected policyholders. On the contrary, it’s almost singlehandedly responsible for the year-over-year increases most health plans have seen under the BCBSNC umbrella. In fact, since the ACA was passed in 2010, the stock prices of BCBSNC, along with their other counterparts, have skyrocketed. Imagine if your retirement account showed this kind of growth? You’d be sitting pretty right now. Instead, your retirement is likely in jeopardy due in part to the amount of wealth the BUCAs* have extracted from you and others. Think on that for a minute.
(*BUCA stands for Blue Cross, UHC, Cigna, Aetna. I left Humana off because they exited the employee benefit space in 2023.)
BUCA Stock Price Increase Since Passing of ACA in 2010. “BUCA” stands for Blue Cross, UHC, Cigna, Aetna.
I don’t know who had the crystal ball. Someone must have known that the BUCAs were going to buy up the largest PBMs, and vertically integrate them into their opaque stack of solutions. These solutions trade your money between themselves in backroom deals where you can’t see what’s going on, and that’s exactly what happened. Blue Cross owns Prime Therapeutics, UHC has always owned Optum Rx, Cigna owns Express Scripts, and CVS/Caremark merged with Aetna to become CVS Health.
Let’s just put it like this, if any of these names are on your health plan ID card…good luck finding out where all the money is going. If you’re not sure what I mean by vertical integration, here’s a quick picture curated by Adam Fein of Drug Channels Institute to tell the story:
OK, back to what’s happening in my husband’s health plan. The email he received today said this, *“Blue Cross NC is taking several steps to help control the prices of prescription drugs for our customers. Many of the changes we are making will help us continue to offer sustainable health plans for our customers over the long term.*
- Ongoing programs such as utilization management and formulary management help us provide our members with access to drugs that are safe, effective, and as cost-efficient as possible.
- Blue Cross NC is committed to helping our members get the most appropriate medications. We regularly review medical research and costs of medications. A team of doctors and pharmacists use this information to make sure Blue Cross NC covers the most effective medicines while keeping costs more affordable for everyone.
- We encourage our members to talk to their doctors and pharmacists, to determine if lower cost medications may meet their needs.”
Interesting, right? Don’t stop reading. It gets better. All that gobbledegook above is BCBSNC code for “we’re not making enough money on your prescriptions so we’re going to pretend these new changes are good for you…but don’t worry, we’re going to be making even more money when all this is said and done.”
Here’s an excerpt from the email signaling the first Pinocchio they’ve earned.
“NEW REQUIREMENTS
Flovent Diskus, Flovent HFA
These medications will require step therapy on the Enhanced formulary, non-formulary review on the Essential formularies and value prior authorization on the Net Results formulary. Preferred products include Arnuity Ellipta, Asmanex HFA, Asmanex Twisthaler and Qvar Redihaler.
Ibrance
This medication will require step therapy on Enhanced and Net Results formularies and non-formulary review on the Essential formularies for new utilizers. Preferred products include Kisqali and Verzenio.
Tiotropium capsules (generic Spiriva Handihaler)
This medication will require prior authorization on the Enhanced formulary. Brand Spiriva Handihaler is preferred.”
Here, they’re telling employees that a generic drug is being replaced by a brand name drug on their formulary. I’m not quite sure why that’s a good thing, so I did some research. Now, quick disclaimer: I’m not a doctor or a pharmacist, so none of this should be considered medical advice. I’m just a lowly benefits advisor trying to figure out all this complexity coming out of BCBSNC.
Let’s just take the first one into consideration. Flovent which is a common treatment for asthma comes in a couple of variations. When the patient takes their prescription to the pharmacy, the pharmacist can ask the patient if they’d rather have the generic, especially if it’s a lower copay or preferably no copay. Regardless of how the patient responds, there are options. However, what BCBSNC is saying here is that if you still want this generic drug, you’re going to have to go through some unnecessary red tape.
What BCBSNC would prefer you to do is just fill the new brand name drug instead. I mean why wouldn’t you if BCBSNC is going to make it harder to get the generic you’re used to (with no rebate for BCBSNC to pocket) when a more expensive drug (with a nice rebate earmarked for BCBSNC) is what’s “preferred?” I have no idea why this type of gamesmanship is not labeled as money laundering, but there have been special rules for the healthcare industrial complex for decades now. The healthcare lobby (which spends more money than anyone else) isn’t going to stop playing these games anytime soon, so you’re going to have to take this matter into your own hands.
So, based on the email excerpt above, let’s just pick Arnuity Ellipta (this is a brand name drug only — no generic equivalent) and compare to generic Flovent, and see what happens to the cost of your health plan, which exists to help your employees and their families treat the conditions they might struggle with.
Even Jiminy Cricket knows Pinocchio shouldn’t be telling lies but he has no power to make him stop.
What about the most recent switcharooni that’s newsworthy? Consider Ozempic and other semaglutide copycats that are flooding the market. Ozempic’s list price is approximately $1200 for a one-month supply. Patients taking this drug barely have to get out of bed to watch the pounds melt away. They get temporary weight loss that comes with a hefty price tag for your health plan. It also comes with significant side effects like loss of lean muscle mass, stomach troubles and more. And what happens to the coworkers who might be diagnosed with cancer or other difficult diagnoses while your health plan has been bled dry by this drug? Well, that’ll be between you and your plan administrator to figure out. It’s gonna have to come from somewhere, friend.
One simple question to ask your PBM is, “What cost controls are in place to prevent unnecessary usage of GLP-1s like Ozempic?” Don’t expect to hear much that you couldn’t have thought of on your own. An even better questions is, “what about tackling the cost of the drug at its starting point”? The traditional PBMs aren’t really interested in messing up a good thing (for them). That’ll disturb the rebates they get where you can’t see what’s happening, and you’re never going to get between a traditional PBM and their rebates. Reach for their rebates and you might pull back a nub.
The best news of the day is that not all PBMs are created alike. A few are truly interested in serving your plan and what’s in it’s best interest. That’s what Vinay Patel of MakoRx has been working on. His company found an innovative way to procure Ozempic at a fraction of the normal list price on behalf of self-funded health plans, and pair it with frequent counseling with a pharmacist who has special training in the treatment and management of type II diabetes. “Rebates create perverse formulary incentives, drive up drug costs every year, and contribute to higher patient out of pocket expense at the pharmacy,” says Patel. MakoRx, a scrappy PBA (pharmacy benefits administrator) startup, serves employers nationwide and now also provides integrated health management which sets them apart from their competitors. You see, when no rebate is baked into the cost of your drug, you can have your cake and eat it too…well, maybe just one bite if managing diabetes and weight loss is your goal.
“Rebates create perverse formulary incentives, drive up drug costs every year, and contribute to higher patient out of pocket expense at the pharmacy”
— Vinay Patel, founder of MakoRx Vinay Patel, founder of Mako-Rx, a non-traditional PBM supporting health plan fiduciaries .
I interviewed Vinay for 2 episodes of Healthcare Solutions Podcast in Season 1. You can find those episodes here — Season 1 | Custom Benefits Solutions. Become a subscriber and new episodes will show up automatically on your device.
Subscribe to Healthcare Solutions on Apple Podcasts Subscribe to Healthcare Solutions on Spotify I encourage employers all over America to pull a switcharoony of their own. Change out your PBM. With the right third party administrator it’s easy peasy. You can hand pick the pharmacy benefits manager you really want to work with…one that is aligned with your best interests. If you follow Adam Fein of Drug Channels, you’ll see this post he made on LinkedIn a couple months ago about a few large employers who are doing just that. It’s pretty eye opening. More and more employers are watching closely. You should look into it too.
Here’s my punch list of prescription drug benefit features that can make the most difference for your health plan:
- The preferred network of pharmacies should be the local, independent, community pharmacies where $0 copays for generics are a huge advantage for your plan members and your plan’s assets. If you include big box retailers in your network those should cost more in copays. That’s the way we designed it at Moose Pharmacy, and it helped them win a Rosie Award at the August 2023 RosettaFest. You should think about joining us for the May 2024 RosettaFest. There’s nothing like it. If you’ve made it this far reading today’s blog, I think you’d be a good candidate to attend.
- No mail order. Opt instead for frequent delivery of prescriptions to employee home addresses or workplaces as needed. I know plenty of local, independent, community pharmacies that make multiple delivery trips every day. Mail order separates patients from their clinicians. No good can come from that. My colleague, Joe Moose, who co-owns Moose Pharmacy said in our presentation at RosettaFest 2023, that his delivery drivers notice important social determinants of health that his pharmacists need to know. For instance, one patient who was struggling with mobility issues had front steps leading out to where the car was parked that were totally unusable. How was that patient supposed to get out and go to the grocery store? The pharmacist helped make arrangements for food delivery and that one action made a huge difference.
- Sign employees with chronic disease up for one-on-one, virtual counseling with a clinical PharmD who has special knowledge and training on those disease states plaguing your plan spend. The only pharmacies that can handle this type of request are the local, independent, community pharmacies. Some pharmacies can extend volume pricing on disease management aids like continuous glucose monitors or tobacco cessation patches, etc. Seek out the independent pharmacy closest to your office. Make their owner your new BFF.
- Instead of using AWP as your starting point for drug pricing, ask your PBM about NADAC, or a cost-plus model (in other words a bottom up instead of a top-down pricing methodology). Make sure your benefits consultant can verify there’s no spread pricing or rebate gaming with any new PBM you engage with. Consider a direct contract with a local pharmacy if your workforce is centralized. A higher dispensing fee could be their main revenue source, and they could pass through their acquisition cost for the 100 most commonly used drugs. If your employees are on multiple drugs, consider a flat PMPM fee instead of a dispensing fee. It’s crucial to have a close business relationship with a local pharmacy, and have them at the table when these strategies are being discussed. In 2020, I co-wrote an article in the Journal of Managed Care and Specialty Pharmacy about a direct contract with a local pharmacy in Asheville, NC. It’s definitely unique, but it’s not a new concept.
Well, that’s certainly not all I could think of, but it’s a pretty good start. Here’s to a custom designed prescription drug benefit! If you sponsor a health plan for your employees, the ball is now in your court.
One last word on the magic behind the local, independent, community pharmacy idea. Did you know there are thousands of them all over the country? You should check out CPESN (stands for Community Pharmacy Enhanced Services Network). If your workforce is spread out in various geographies, you’ll find great resources there.
Thank you for reading my thoughts today! Please let me know if you’d like to discuss these ideas more as it relates to your health plan? Click here to email me.
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Dr. Marcelo Hochman, an accomplished Facial Plastic & Reconstructive surgeon, extends his expertise to a diverse patient base, encompassing both pediatric and adult individuals, irrespective of insurance status—be it insured, self-pay, or pro-bono.
Known for his advocacy in legislative initiatives, Dr. Hochman has spearheaded projects such as the repeal of the Certificate of Need, the prohibition of economic credentialing and non-compete clauses, and the promotion of tax incentives for doctors offering pro-bono medical care. He crafted the Action PPE project, which evolved into a nationwide movement that supplied 6 million units of PPE to independent practices during the pandemic. His humanitarian efforts have earned him accolades, including The Order of the Palmetto.
Healthcare professional and host, Cristy Gupton, interviews Dr. Hochman about IndeDocs’ upcoming event. The two discuss the benefits of pro-bono medical care, along with the benefits of owning a practice which isn’t tied to a larger figurehead.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Health Plan Fiduciary Compliance, LLC will save you time and money on CAA compliance.
Tony Sorrentino is the President of Health Plan Fiduciary Compliance, LLC. He has served within the business community providing professional services in accounting, law, and employee benefits consulting to hundreds of Nebraska based businesses for over 40 years. Sorrentino wants to save employers time and money through his business.
Healthcare professional and host, Cristy Gupton, interviews Tony Sorrentino about his company, Health Plan Fiduciary Compliance, LLC. They discuss the ERISA and CAA compliance, along with how to save employers money.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
American HealthScare is now available for purchase.
Dr. Richard Young is an author and researcher. He wrote the book: American HealthScare. It discusses the efficiency and capability of American businesses, and the disconnect employees feel within the companies. Within the book, he discusses the grim possibility of a bleak feature if we don’t work to fix things now. The book also features various solutions that American society could take to begin countering the 2060 dystopia.
Healthcare professional and host, Cristy Gupton, interviews Dr. Young about his latest book, along with discussions on the approaching 2060 American Healthcare dystopia. They attempt to find solutions, and discuss the effectiveness of these solutions in countering that possible future.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Are hospitals overcharging you? Do you feel stuck with your bad healthcare?
Christy Vago serves as Vice President of Business Development at Upland Advocacy. She is a dynamic, accomplished self-insurance leader with a successful track record of driving bottom line growth in new business revenue.
Healthcare professional and host, Cristy Gupton, interviews Christy Vago about the current healthcare crisis in the United States. They discuss common healthcare debts, along with ways to get funding and avoid health debt.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Healthcare has evolved to make a profit at the expense of reliable, accurate healthcare.
Chip Harvey serves as the Regional Vice president for Homestead Smart Health Plans. Harvey studied Economics at the University of South Carolina. He uses his financial knowledge to help with healthcare cost containment.
Healthcare professional and host, Cristy Gupton, interviews Chip Harvey about providing issues plaguing the current healthcare industry. They discuss the fiduciary responsibilities of companies and doctors. They discuss ways to contain costs and tear down the barriers in the healthcare industry.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Cristy Gupton will be speaking at the DisruptHR Charleston chapter on Thursday, May 18th. DisruptHR is a global organization promoting "the rebellious future of HR.” DisruptHR attracts the most innovative Human Resource professionals who are eager to embrace change especially when it's for the better.
Cristy's DisruptHR talk, patterned much like a "Ted Talk," is called "A Spontaneous Mentorship Moment.” DisruptHR talks have a unique format. Each speaker gets 5 minutes, and 20 slides that advance automatically every 15 seconds. This means you'd better have something important to say and be able to make it count.
DisruptHR events keep things interesting, fast-moving, fun, and entertaining. It's a nice change of pace for HR professionals to learn and network in an environment that's fast-paced, but impactful.
Cristy hosts the inaugural DisruptHR event in beautiful Asheville, NC, on Thursday, May 25th, at Hi-Wire Brewery from 5:30pm-8:30pm. Attendees can grab their tickets here.
The $39 ticket includes an hour of SHRM credit, burgers & brews, learning & laughter, new connections and inspirations. Vendors will showcase their new innovations and offer door prizes for lucky winners.
Should the law impact healthcare?
Healthcare professional and lawyer, Chris Deacon, is known for her work as a public sector leader who oversaw the New Jersey State Health Plan. In this position, Deacon created positive change for the state of New Jersey and saved 2 billion dollars for the plan’s members.
North Carolina Commissioner of Insurance Mike Causey a politician that has served in his position since 2017. His goal is to fight for more competition in the healthcare industry and combat insurance fraud. He proudly serves the people of North Carolina.
Healthcare professional and host, Cristy Gupton, interviews Chris Deacon and Mike Causey on the upcoming North Carolina bill, H346. They discuss the shady happenings behind the bill and their fears of how the bill will harm the people of North Carolina should it be passed.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Should the cost of scans stop you from taking care of yourself? No!
Dr. Cristin Dickerson is a founding partner of Green Imaging.
Healthcare professional and host, Cristy Gupton, interviews Christin Deacon on the Mass. Health and Welfare Fund v. Blue Cross Blue Shield of Mass. During the interview, the two discuss and clarify confusion related to ERISA Fiduciary Duties.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Can the law impact healthcare?
Healthcare professional and lawyer, Christin Deacon, is known for her work as a public sector leader who oversaw the New Jersey State Health Plan. In this position, Deacon created positive change for the state of New Jersey and saved 2 billion dollars for the plan’s members.
Healthcare professional and host, Cristy Gupton, interviews Christin Deacon on the Mass. Health and Welfare Fund v. Blue Cross Blue Shield of Mass. During the interview, the two discuss and clarify confusion related to ERISA Fiduciary Duties.
Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.
Moose Pharmacy is offering its employees mobile urgent care. Click here to watch the video
In part 2 with Doug Aldeen, we get into more commentary about hospitals and how being honest and fair with people has the makings of a very good payday if you approach it with integrity. But will they do that? We also drop a bombshell called for in Section 501R of the internal revenue code. Find out more on this episode of Healthcare Solutions!
Timestamps:
00:00 Intro
01:25 From last week’s episode…
04:00 No barriers to having “your personal physician on speed dial”
04:40 DPC—start with it first!
05:27 Hospital CFOs—listen up…you can make a good living just dealing fairly with people
06:00 Insurance companies + hospitals OR insurance companies vs. hospitals...which is it?
07:15 Who has offshore accounts? WTH!
07:52 EMTALA was passed in 1986, if you show up at an ER you must be treated
09:23 Can hospitals have non-profit status revoked?
10:00 Hospital market conduct will see more scrutiny from federal regulators
10:45 Suing someone based on a fake price? Scumbags!
11:00 501R…oh SNAP! Why isn’t anyone talking about this?
12:00 Not winning the mother of the year award, I procrastinated on getting my kid’s bloodwork
14:00 Mommy becomes a secret shopper, $951.00 for A1c, lipid panel, metabolic panel
14:52 25x on Rx and supplies at hospitals
15:55 Time for the smelling salts, transparency bill may be just what the doctor ordered
17:00 Give hospitals the opportunity to fulfill their charitable mission
18:00 Pre-qualify employees on your census for your local hospital’s financial assistance policy
18:50 1-2% is earmarked for charity care? That can’t be right.
20:00 Dr. Marty Makary at 2021 Health Rosetta Summit in Dallas, TX. This video is similar to the talk I heard in Dallas last year.
21:00 Financial harm is happening every day and doctors need to stand up and return to their roots
23:45 Article on rural hospitals closing—Schuessler LinkedIn post
25:00 Anything is possible, maybe those shuttered hospitals can someday reopen under new management
26:00 Thank you Doug! Employers + Doug + a good advisor = a winning combination! www.dougaldeen.com
27:00 #letsfixhealthcare www.custombenefits.work
Cristy Gupton and Doug Aldeen have a great discussion about fiduciary duty and how the new transparency law is going to make it easier for those charged with that task to honor their duty.
Timestamps:
00:00 Introduction
02:20 Doug Aldeen's background
03:28 So, what is the price?
04:30 If you're uninsured or underinsured you need to be asking for your hospital's Financial Assistance Policy
05:50 Quizzify's emergency consent is a gift to all people who might need emergent care...thank you, Al Lewis!
07:14 If you're being asked to sign something in the ER you must advocate for yourself or there's no turning back
08:00 No judge in the country would disagree with paying a fair price for ER services
09:11 Mark Watson of Union County, NC--a true fiduciary. Go back and listen to this episode https://www.custombenefits.work/news/2019/3/28-episode-6-t955b-362c7
10:18 Leon Wisniewski of Health Cost Labs, he's publishing hospital pricing online.
10:50 Information seeing the light of day means fiduciaries can't sit on their hands much longer
11:33 ERISA--the 2 faced law of convenience for health plan fiduciaries
13:00 Hey fiduciary! Start today!
13:46 "Turbocharging"...what's that?
14:55 Coming out of COVID, self-preservation efforts should lead CFOs to start looking at their health plans as ground zero
15:30 The transparency bill...should we get excited or roll our eyes?
16:10 The fine is no biggie, that's why eye-rolling might commence
16:40 But if hospitals really thumb their nose at it, will it jeopardize their Medicare status?
17:50 In light of value-based payments from Medicare, why do hospitals work so hard to get better payments from Medicare if it doesn't cover the costs?
18:43 So, does Medicare actually cover the costs or not? 7-9% margin in the aggregate.
19:30 Medicare Payment to Cost Report
21:21 Can't we all just get along? Willing buyers and willing sellers in mutually beneficial exchange. I could get behind that.
22:05 Employers come to the table...that's what starts the conversation.
22:30 Having some market intelligence when you come to the table at least gets the conversation started.
23:10 DPC rose from the underground during COVID, see also this video from Custom Benefits Solutions
23:55 First patients in the door are usually uninsured
24:23 Referrals are going to need to happen at some point
24:47 Never say "what do you charge"
25:08 Instead say "what would you accept if I pay cash"
25:55 A quasi-contract seed was planted right then
26:31 Employers can benefit from this arrangement without having to do all the work
26:52 The contracts are pretty straight forward especially when there are 2 willing partners
27:30 This is why being an independent doctor is so important
28:21 The ACA gave hospitals the license to steal
28:40 DPC is the smartest cost-containment strategy and if you start with it first it leads to many other innovations
29:00 Thank you! #letsfixhealthcare, www.custombenefits.work.
Tune in for the continuation of my conversation with Dr. Keith Smith, medical director of Surgery Center of Oklahoma and co-founder of the Free Market Medical Association.
Timestamps:
00:00 Intro
02:20 From last week's episode
04:55 This trend started by Surgery Center of OK is growing
06:09 What is it like to come to SCO?
06:18 Side note: the first patients who came to SCO were from Canada, Alaska, Wisconsin...areas that are ridden with no access to care
09:00 First you'd reach out online via SCO's website (surgerycenterOK.com) and click on "request a specialist"
09:29 Dr. Smith himself matches the patient with the right specialist, then the surgeon calls you directly
10:45 When you arrive in Oklahoma, you meet with the surgeon in their office to confirm that everything is a go, then go to SCO the next day for your procedure.
11:05 Depending on the need, you may have a home health nurse come visit you a couple times per day in your hotel room.
11:23 When you arrive home your surgeon stays in contact with you, your primary care doctor and your physical therapist...whatever is needed.
12:58 If patients can't travel or wouldn't make good medical tourism candidates, Dr. Smith can coach them on how to get a better deal locally using his prices in OK
13:08 And with Atlas Billing Company, Dr. Smith can act as the guarantor of his pricing in your local area
15:36 Sounds like concierge treatment at bargain basement prices
17:00 How do we influence tomorrow's doctors with this movement?
18:09 Start with supporting the Benjamin Rush Institute, donate here: https://benrush.wufoo.com/forms/r5pz5a306b4933/.
20:07 Remember, it's an ethical issue. If you work for a hospital, it's very unlikely you can always put the patient first
21:45 The "Do No Harm" oath is possibly a thing of the past
22:24 Read Dr. Marty Makary's book "Unaccountable" or watch the series "The Resident" inspired by that book to see validation that what Dr. Smith describes is true
24:00 If you really want to know where to get the best quality in a hospital setting you need to interview the staff who work there
24:30 Let's talk about the Free Market Medical Association--an organization composed of willing buyers and willing sellers
27:37 Who can argue with both cheaper AND better?
29:00 The true enemy of the free market is the government
30:44 See FMMA's upcoming Annual Meeting in August 2021 in Dallas, TX
31:17 Talk about cheaper and better! DPC + Sedera is cheaper and better than any insurance policy I've ever seen for individuals
35:21 You must leave behind the insurance status quo if you expect to be treated quickly and treated well in healthcare like if you were a celebrity
36:43 Insurance is not necessary for 85% of a person's healthcare needs
38:10 Watch "The Big Short". You'll find so many parallels to the healthcare industrial complex as were happening in the banking crisis of the late 2000s
39:33 What's a day in the life of Dr. Keith Smith
46:00 Thank you! #letsfixhealthcare, www.custombenefits.work.
Dr. Keith Smith literally changed my life. As a "broker" selling employee benefits I stumbled on another podcast (way back when) where Dr. Smith was the guest and transparency was the subject of the day. It shook me out of my comfort zone and led me to the advisor I am today.
Timestamps:
00:00 Intro
01:27 How I came to know Dr. Keith Smith
03:05 The Shiftshapers Podcast, Episode 164. That's where I heard the shot Dr. Smith fired around the world.
04:36 This story may surprise you
05:07 Pardon the misspeak there...I meant to say January of 2019. My bad!
07:00 Compare your surgery claims data to the fairly priced, free market, undiscounted, bundled and guaranteed cost on the Surgery Center of Oklahoma's website.
08:39 OMG! The insurance carrier fired the client! What?
10:05 Your insurance carrier has a lot to hide. Trust me.
10:40 What is employer-built healthcare? Find out here: mitigatepartners.com
11:09 Insurance companies hang their hat on their PPO network. But is that even a real benefit to you?
11:25 PPO networks are the ultimate participation trophy
12:25 Dr. Smith and I share the distinct honor of being fired by a carrier
14:23 Joining a PPO network was not only a mistake, it was like inviting a cancer into our organization.
15:10 Generally, prices at Surgery Center of OK (surgerycenterok.com) are about 1/5 of what insurance companies charge to the plan.
15:39 Most of the time the carriers don't want high quality and fair pricing because it's counterproductive to their revenue model
16:11 SCO will file claims as a courtesy but many times patients find that the entire fee they paid at SCO is lower than their deductible on their insurance plans
17:06 When the ACA was passed deductibles were allowed to skyrocket and those patients are "functionally uninsured"
17:22 Check out SHOPHEALTH at fmma.org
20:00 Watch this webinar
21:26 Don't believe the balance billing lie
22:15 Well, they were partially right
24:22 Now the client agrees their plan is actually a benefit, as opposed to before when their plan was only benefitting the insurance company
26:50 Waiting room story. BTW, I don't wait in waiting rooms any longer. I have Direct Primary Care.
30:00 State of Oklahoma could have saved $200M but they caved to special interests
32:15 A good lesson to learn is to just NOT work with entities who are dishonest (aka not transparent)
32:53 There's a gold nugget here! Instead of using "leverage" to get better prices (like your broker or insurance company is telling you), it's much smarter to engage in a mutually beneficial exchange
33:13 That's all for today! Join us again next time to #letsfixhealthcare, www.custombenefits.work.
Tune in for part 2 of the conversation with investigative healthcare journalist Marshall Allen and Cristy Gupton in the world of medical bills and Marshall’s path through the industry
Timestamps:
00:00 Intro
02:25 On last week's episode
03:00 Marshall's new book "Never Pay the First Bill: and other ways to fight the healthcare system and win" will be available June 22 (earlier than expected)! It's a step-by-step guide to coaching employees on how to save money in today's confusing and opaque healthcare system.
03:45 Introducing Professor Allen! Now conducting employee education meetings for your employees who have a vested interest in keeping your health plan sustainable for decades to come.
04:52 Remember, health plan dollars are ALL employee dollars! That's why there's a fiduciary duty in the first place. We need "woke" employers. If employers don't wake up, Marshall's book can at least help employees.
07:45 Since healthcare is considered employee money, employees will need to go through their own awakening. Employees will need to learn how paying reasonable charges for healthcare is helping them on all levels.
09:29 Dr. Eric Bricker, get to know his daily video teachings at AHealthcareZ, he describes our healthcare system as a national crisis and calls out price gouging.
10:44 The government is not going to help change the healthcare system. We're on our own and that's OK. Marshall's book helps us learn how to fix our own problems.
11:18 One in six Americans are dealing with medical debt collectors which is shameful since we spend twice as much as most other countries.
12:30 The supercharged, overly inflated starting prices only exist to game the system and let's not mince words...that's dishonest! and it's discriminatory!
14:00 Why do we accept the age discrimination of charging more to employees with health insurance more than what's charged to Medicare patients
14:15 Marilyn Bartlett's new work with NASHP is giving states a Medicare cost analysis so that they can see that a hospital's medicare revenue is adequately covering their costs (not that they want you to know that).
14:47 A local hospital's director of managed care even admitted to me that they rely on employer-sponsored plans to cover what they report as their loss on Medicare business. Truth is, they make plenty of money on Medicare and they way they gouge employers for the same services needs to be exposed.
15:30 Medicare rates are established in the first place by hospitals who self-report what it costs them to do a procedure. Using the NASHP hospital cost tool local communities can hold their hospital accountable for what they are charging.
17:43 The real payers--the employers in those communities can use that tool to establish prospective cost agreements with their local hospitals about what their employees will be charged if they seek care locally.
18:35 Does Marshall Allen ever lose? Does he have to give up without getting the story?
20:30 BUT! One story Marshall wrote about ended up influencing lawmakers and has fingerprints on the last major piece of legislation from the Trump Administration--The Consolidated Appropriations Act. Among other things, it requires insurance brokers to disclose their compensation to their clients.
24:30 Disclosing my revenue to my clients is not a new thing for me (I've been doing it since 2017), but now that it's required I'm thinking of it as a new opportunity to show my clients the expense side of my balance sheet; thereby showing them how I reinvest the revenue I earn into the services that help their health plan operate more efficiently than others.
27:27 What's a day in the life of Marshall Allen?
29:50 Go to www.marshallallen.com and place a bulk order for his employee education series that goes along with his new book.
31:14 Connect with Marshall on LinkedIn and follow him on Twitter
31:40 Thank you! #letsfixhealthcare, www.custombenefits.work
Tune in to investigative journalist Marshall Allen & Cristy Gupton as they delve into the world of Medical bills in the greater healthcare system.
Timestamps:
00:00 Intro
02:20 Side note: release date for Marshall's book "Never Pay the First Bill: and other ways to fight the healthcare system and win" got pushed up to June 22, 2021
03:10 I skipped Marshall's bio because you can read about it yourself on his own Wikipedia page...that's pretty awesome right there!
03:34 I first learned about Marshall Allen when he wrote a story about Marilyn Bartlett, the phenom who fixed the Montana State Health Plan
04:00 Marshall got the story from Carl Schuessler who's always on the front lines fighting the good fight.
04:38 ProPublica's mission to bring about change by telling stories but it takes a lot of dedication to make sure the facts check out
11:00 Another story about a mom who had a premature baby and was billed over $800K by her own employer
14:57 While my words "civil disobedience" are a bit strong, Marshall's description is more fitting..."people should not take advantage of other people" and his book gives every American the confidence to advocate for themselves
15:47 25% of healthcare spending is wasted, what if we could reduce our own healthcare costs by 25% if this waste didn't exist
16:27 Unfortunately, we're in a situation where there have to be winners and losers, right now the employers and employees are on the losing side
17:54 Marshall asks me if I'm seeing that same thing in my world, my answer? I see more individuals standing up and saying "I don't need this anymore"
20:22 Unnecessary care: here I go telling this DPC story again...but it's a good one
22:22 In "Never Pay the First Bill" there's a chapter on avoiding unnecessary care and asking questions like "what's the worst that could happen if I don't follow your recommendations"
25:56 Employees who have the blank check that is the insurance plan ID card in their wallet would do so much good for their fellow employees to ask the right questions
27:09 We finally say the name of the book. Order here: https://www.amazon.com/Never-Pay-First-Bill-Health/dp/0593190009/ref=sr_1_2?crid=223PO7G0SN3RA&dchild=1&keywords=marshall+allen+book&qid=1622391946&sprefix=marshall+allen%2Caps%2C191&sr=8-2
27:30 Thank you! #letsfixhealthcare www.custombenefits.work
Continue the conversation with Cristy, Scott Ray, and Heath Potter in understanding current healthcare transparency, hospital negotiations, and reference-based pricing.
Timestamps:
00:00 Intro
05:32 Many employees don't realize their employer is the health plan
06:18 Lots of employee education is needed
06:38 The irony of change can be comical
07:12 Change can also be cyclical. Cycling back to more local care teams rather than "corporate medicine" is happening.
10:10 Healthcare Buyers and Sellers don't have to be adversaries, there's an opportunity to work together.
14:28 When smart spending happens on the big things, smaller ticket items are easier to afford too.
15:12 Local governments should take note, they're hurting their communities by overspending on healthcare
17:26 The "outlier provision". Know what that is? You need to because it's eating your health plan alive.
19:06 Networks started out as a good idea, but the middlemen got greedy over the years.
20:20 Hey, Mr. Hospital. So, you got caught being greedy? Now's your chance to learn a lesson about free markets.
21:41 Employers have options now
21:45 Health Rosetta + 6 Degrees = High Performing Health Plans where best-in-class solutions can be built on a solid foundation
25:51 This is not a get rich quick scheme. We're all mission driven at this point.
26:16 Creating happier, healthier, more productive employees...isn't that the whole point of employee benefits?
27:30 A lot of us thought HDHPs were a good thing at first, until we didn't.
29:00 What does the future hold?
31:15 Signing off from beautiful Portland, OR
31:49 #letsfixhealthcare www.custombenefits.work
Join Cristy with Scott Ray and Heath Potter in understanding current healthcare transparency, hospital negotiations, and reference-based pricing.
Timestamps:
00:00 Intro
00:39 2020? See ya, wouldn't wanna be ya!
01:25 Intro to 6 Degrees, Scott Ray and Health Potter
02:37 Better for Less $$? Sign me up!
02:57 Medicare Rate Sausage? How is it made?
04:08 So, hospitals CAN cover their costs with Medicare reimbursement rates? Huh, that's not what they've been telling us.
05:18 And there's a wide variation in costs between hospitals nationwide.
06:14 So, if Medicare doesn't cover a hospital's reported costs you have to ask the obvious question...WHY?
07:50 The short answer is due to lack of transparency and lack of competition.
08:34 It's counterintuitive but higher quality costs less in healthcare.
09:20 It took RBP (reference-based pricing) to start the conversation around quality and fair pricing.
10:23 Back in the day, hospital's first knee-jerk reaction was to fight transparency. Wait, that's still happening today.
10:56 Now, if you don't present a PPO network card then you're considered cash pay. Which frankly helps employers pay a fair price.
11:22 Hey Mr. Hospital? Ever heard of the free market? It still exists.
12:22 Transparency alone is not the total solution.
13:26 FL Case Study.
18:24 In NC, people are getting "heated" over this discussion.
19:42 Balance billing isn't exclusive to RBP plans. What do you think a deductible and coinsurance is? Duh!
21:43 What happens when an employee has an accident? How does RBP work then?
21:58 First of all, don't forget about EMTALA. You can't be turned away at an ER.
22:39 If we have to, we'll show you the data to shame you into being fair.
23:17 But once in a blue moon you have to stand up to the bullies...with the help of 6 Degrees.
23:51 Even hospital VIPs admit their gross billed charges are meaningless numbers.
24:38 Smart plans are done with this.
25:00 2020 was supposed to be the year employers pushed back. I don't wanna talk about 2020.
26:32 Don't forget about quality. Is your broker using MediVi?
26:55 Proactive vs. Reactive.
27:26 Employees need to go on the same "learning journey" that the decision-makers went on.
28:29 Employers need to be transparent with their employees too. Just tell them the cold hard truth about the healthcare system.
29:48 See you next time! #letsfixhealthcare
www.custombenefits.work
On Sept. 29th, Cristy Gupton was a guest speaker on an episode of Healthcare Americana. The episode discussed small and large employers handling benefit plans for their employees in the midst of the COVID-19 pandemic and more
Custom Benefits Solutions hosts free webinar aimed at helping employers a they bring employees back to work after quarantine.
00:00 Intro
00:40 Vinay Patel of Self-Insured Pharmacy Networks
01:25 In last week's episode
02:38 A day in the life of a community pharmacist
03:32 Pharmacists in a big box format want to cater to patients just like community pharmacists do
03:53 We're replicating the same model on the pharmacy side as DPC has done on the medical side
04:41 Care coordination needs to happen all throughout the local care team (healthcare supply chain)
05:41 Community pharmacist is just that--part of the community
07:00 More tools, more attention to detail, more customization
07:38 Less overspending, overtreatment, example = mail order
07:58 Smaller is better, especially if you're trying hard not to overspend
12:00 Is mail order even all it's cracked up to be?
14:30 Those dealing with healthcare challenges could benefit by having another member of the local care team to help "tag team" with the physician
18:24 When you have a chronic disease you need high-touch support and accountability
19:00 Getting back to the basics might not be a bad thing
20:00 We drifted away from relationship-based primary care but we're coming back to it
20:32 www.sipharmacynetwork.com, Self-Insured Pharmacy Networks based in Raleigh, NC
21:00 vinay.patel@sipharmacynetwork.com
21:41 No one definition of "specialty drug". The definition your PBM gives it is in your contract
22:15 Get an actual list of what specialty drugs are on your formulary
22:26 Make sure you ask lots of questions
22:47 There shouldn't be any generic drugs in the specialty category
23:37 Allocate much more time to the PBM contract
25:00 Spend more time to the upfront education about the prescription drug benefit and what goes into that design
27:00 Crawl, walk, run strategy
28:30 Employers need a co-fiduciary to be their partner
30:00 Carriers glossed over Rx like there was "nothing to see here"
31:00 Rockford, IL story
32:00 You MUST read your PBM contract
33:43 This is people's lives we are dealing with
34:00 Municipality resources are deficient today because of the drainage into the healthcare system
35:00 Thank you, www.custombenefits.work, #letsfixhealthcare
00:00 Intro
00:40 In today's episode
00:58 Vinay Patel of Self Insured Pharmacy Networks
02:16 What is a PBM?
02:32 PBM = claim processor just like a TPA on the medical side
03:15 but also rebate management, clinical management, etc.
04:17 what about the cost?
04:42 episode 8, "transparency"
05:08 Tim Thomas, quote on transparency
05:50 There's money in here, if you can find it--it's yours
06:02 Do we just need transparency? Or do we need a fiduciary?
08:00 It all depends on what's in the contract
08:56 Fiduciary principles mean I'm acting in the best interests of my client
09:57 NADAC = National Average Drug Acquisition Cost
11:09 University of Lynchburg Master's Program in Health Benefits Design
12:06 All things being the same, the price fluctuates by hundreds of dollars
13:00 Supply & Demand still exists but Rx prices can still be normalized
13:13 Manufacturers adjust brand names twice per year
14:17 Average Wholesale Price (AWP) means wholesalers are setting the prices
14:55 A little disruption might be in order here
15:25 We should have a buyer's market, not a seller's market
15:50 Direct Primary Care doctors are also dispensing Rx onsite
16:40 Let's step back and highlight DPC
17:20 Patients want a relationship with their providers, Providers want that too
18:12 Now that DPC has primary care handled, let's give them better access to Rx
18:57 A subscription model for Rx also
20:00 How many pharmacies are locally owned?
20:39 Answer = one third, about 22,000 pharmacies
21:47 A superior customer experience with care catered to the patient
23:40 Pharmacists in big box stores want to cater to patients but can't because of the system
25:30 A "concierge" pharmacist? Yes, it's possible
26:39 Local care team like Carl Schuessler says in the "Marcus Welby days"
28:12 Quadruple Aim means the physician/provider experience is important too
29:01 Cliffhanger--What's a day in the life of a community pharmacists?
29:08 That's all for today
29:16 Thank you, visit us at www.custombenefits.work, #letsfixhealthcare
It’s you and your health insurance broker. You’re thinking, this year I’m really going to get tough with this insurance company and I’m gonna ‘em them who’s boss. I’m gonna be a tough negotiator and this is the year I’m gonna to get a better deal for my employees. Seriously, you might as well be Charlie Brown saying to himself, “This year I’m really gonna kick that football” and like every other time, Lucy swipes the football away from you at the last second—just like she always does. There you are, lying flat on your back wondering what just happened.
Don’t be that guy this year, when your BUCA (Blue Cross, United, Cigna, Aetna) plan sends you this year’s increase—you need to fight back. When you hear your broker tell you that healthcare costs “just go up”, or when they bring you this year’s gimmicky product that’s supposed to make everything better—you need to fight back. Find that broker who is more like Snoopy, the Flying Ace, shooting fake reasons for increasing costs out of the sky. You can find one at www.healthrosetta.org. Or just call me. I’ll fight for you.
Your employees are counting on you to look for a plan that provides transparency and lowers costs. They’re hoping you’re going to come up with a plan that reduces out-of-pocket and gives them better access to high-quality healthcare. I know what you’re thinking, “Better care, lower out-of-pocket? But I’m already paying more than I can afford. Better care is going to cost even more!” All I can tell you is that you’re wrong. You’re not listening to the right advice. Stop being a blockhead!
Let me give you an example of what happened at one of my clients this week. We uncovered that an employee is taking a high cost brand name drug. After some research, we determined that the brand name is just a quirky dosage of the generic ingredient. The drug was costing the employer $733.00 per month. I know that’s not much, but when we found out a local, independent compounding pharmacy could make the same dosage of the generic that the brand had for only $75.00 per month, we rejoiced like we’d won the lottery! Transparent Advisor = 1, Big Bad PBM = 0. And that was only one prescription! Imagine what we’ll find when we analyze every drug in their claims report.
Don’t let your employees be the one kid who looks in their treat bag and all they have is a rock. That’s no good for anyone. Be the employer everyone wants to work for because your health plan is the best around. It IS possible! You CAN do it! And it’s NOT scary! #letsfixhealthcare
Need help designing the best health plan in town? You can count on us. Message us at cristy@custombenefits.work. We can help.
00:00 Intro
01:00 Doctors entertain concepts of cash payments with patients
01:06 Dr. Jordan Johnson, DC—Morganton Chiropractic
01:30 In last week episode…
04:00 Let’s talk about diet
05:00 Food Guide Pyramid
05:30 What we define as “food” is key
05:37 Michael Pollan
06:25 What is “real food” anyway
06:46 Food, Inc., documentary-directed by Robert Kenner
07:25 Farmer’s Market First!
07:54 Plant-Based Diet
09:25 Don’t put Chiropractors in the “spine only” box
10:25 Most issues result from chronic, repetitive misalignment
12:00 Goal is to give the patient the skills to stay in alignment longer on their own
12:56 Who pays you?
13:00 David Contorno, “You work for whoever pays you”
13:25 Article, “My personal dilemma”
13:40 It’s very similar for physicians who are paid by insurance companies
14:14 Third party payment system in between the doctor-patient relationship
14:26 Doctors working at the discretion of an insurance company
14:51 If the patient is actually paying then the doctor works for them
15:05 The interaction between doctor and patient is a relationship
15:48 Patients stop receiving care once an insurance policy stops paying
16:12 The third party distorts the relationship and creates a barrier to care
17:08 Found myself out of town without medicine, just decided to go without
19:28 Third party payers lend patients to feel that care just isn’t worth the trouble
21:35 Average patient is 40 years old with low-back pain
21:45 First visit is about 1 hour long
21:57 Second visit is about 30 minutes long
25:00 Divert major surgery with better “joint care”
25:09 Or, have to treat because surgery was performed but results were not achieved
25:56 Once you have surgery, you can’t undo it
26:57 Employers could pay Chiropractors directly as a preventive measure
28:43 Health plan design should provide incentives for steerage
29:30 Don’t just give your employees a provider directory and no other direction than that
31:24 Ask the question, “do you accept cash”
32:27 drjohnsonmorgantonchiropractic@gmail.com
32:57 Thank you!
33:00 www.custombenefits.work
I finally got myself a Prius which I’ve been wanting for a long time. Watching the technology “do it’s thing” in the background while I drive really got my "wheels turning” (pardon the pun) about how health plans with great design and technology behind the scenes are similar.
For about a decade my Mom had a Toyota Prius. She absolutely loved it and I got to drive it from time to time. Sometimes I’d meet up with her midway between my NC home and her SC home and I’d swap my GMC Yukon loaded down with my kids and our clothes for the weekend. Then I’d get to drive the Prius around visiting a few clients on the way to reunite with them in SC. I loved scooting around in that little thing and set my sights on owning one someday.
Well, it finally happened. This week I became the proud owner of a cute pearl white Prius and I couldn’t be happier. There were 9 miles on it when I drove it off the lot and today (2 days later) there are 400 miles on it. Funny thing is, half of the “free” tank of gas the dealership put in still remains. I’m in love.
I’m sure I know what you’re thinking…”but you’re supposed to be a successful benefits broker. Can’t you afford anything better than a Prius?” Trust me, with the abuse I put my work car through, I can’t be trusted with a car worth any more than this. It’s just not a good idea. After all, I’m not Contorno with his big, fancy car and his personal driver.
Yesterday, as I was driving, I began to pay close attention to the monitors and displays that light up with every touch of the gas pedal. It shows me when the battery is providing all the power, when the power is coming from a mix of battery and gas and when the car is using 100% gas. This really got my “wheels turning” (pardon the pun).
I was reminded of how a transparent, high performing health plan works and how a successfully run plan only spends about half as much as a traditionally funded plan that has no view into the actual unit cost of healthcare. What I’ve told clients and prospects is that because of the technology operating behind a transparent, high-performing plan, it allows the plan to save money even when you’re using the high cost sources of funding like hospitals and facilities. On the other end of the spectrum, you completely level out your exposure to claims costs (why don’t we call this renewable energy) by embedding Direct Primary Care into your plan design. That’s just like when your Prius is only using the battery to get you from point A to point B. Everything in between is a mix of great technology and a smarter use of your plan’s resources. Just like the gas in your car.
Why is this so important? Well, we all know that the Kaiser Family Foundation just reported that American families and employers are spending around 67% more on healthcare than they were 10 years ago. Healthcare has exponentially outpaced inflation and it’s killing our economy, causing wage stagnation and keeping workers from being able to retire on time.
Why do we tolerate this? Because big insurers are marketing geniuses. And we bought it hook, line and sinker. Even though the net promoter score of the major insurers is in the single digits, many American employers are too afraid to design a plan that isn’t run by one of them. Until now.
At a very grassroots level, employers of all sizes and makeups are seeing the Direct Primary Care practices build a presence in their communities. Many seek out that care and then decide they want to try it out for themselves. They’re hooked instantly. They want to provide it as an option to the rest of their workforce. They ask their current broker to help them implement it and that’s where the difficulties start. They hear things like, “this is just an added expense” or “your employees already have all of the doctors in the network” or “this won’t work with your health savings account”.
As a Health Rosetta Advisor that’s music to my ears. My most recent client acquisition told me just before I was hired that it was refreshing to hear someone say “yes you can” when cost containment solutions like DPC, transparent pharmacy benefits and bundled surgical agreements were inserted into the conversation. They told me all they heard from their incumbent broker was how the status quo was the best they could do.
But not all employers are so bold. Many are too afraid that their employees are going to revolt at the mere mention of a different insurer. Well, I’ll just describe the open enrollment meeting at this new client. The changes were explained, the booklets were passed out, heads knodded, frowns turned to smiles and several employees were giving high fives to the CFO as they walked out of the conference room. I’d say those employees were pretty happy with those changes. Here’s the difference. Instead of employees being given bad news, they were told the following: “your primary care visits are free” and “your generic prescriptions can likely be dispensed right in your DPC provider’s office, no need for a separate trip to the pharmacy” and “if you follow the surgical advocate’s recommendation of the high-quality provider for your procedure, it’ll be no cost to you.” I’m no genius, but that sounds a whole lot better than “copays, deductibles, co-insurance and premiums are going up again.”
What’s my point? As an employer you have options. More importantly, so do your employees. Someday you may have to come to the sad reality that your outdated benefits package just cost you the great new hire you were recruiting. When that day comes you know where to reach me. I’ll show up in my cute, pearl white Toyota Prius that got me there at a rate of about 60 miles per gallon.
00:00 Intro
01:07 Dr. Jordan Johnson
01:28 Cash-based practice
02:14 My first interaction with Dr. Johnson at Morganton Chiropractic
04:14 One way doctors keep their own overhead down and spend more time with patients
06:38 Reverse-engineered pricing based on what was needed to have a healthy work-life balance
07:30 First appointment is one hour long, subsequent treatment visits
08:48 Why pay a higher price through an insurance company when the cash price is lower?
08:57 Are the premiums we pay for PPO “networks” really worth it?
09:12 Free MarketMedical Association, David Contorno, Shane Purcell
09:25 Dr. Keith Smith, Jay Kempton founded the FMMA
09:56 Faster access to care, more frequent care, less costly care lives in an environment where transparency and free market competition thrives
10:19 Dr. Johnson’s story brought him to NC
13:20 Insurance proved to be a costly model to administer which distracts doctors from patient care
14:22 It’s just too much to expect doctors to understand insurance policies in addition to the skilled knowledge they must have to treat patients
15:20 Direct Primary Care doctors felt similarly about overhead and time with patients
17:20 Doctors still want to be advocates and direct patients toward better health, not just more healthcare
17:40 Patients who pay high costs for ex. MRIs where the image isn’t even explained
18:07 My first patient encounter with Dr. Johnson
18:50 Pain! What a can of worms…
19:20 Pain is just your body’s response to something wrong, covering it up with medication is not going to solve it
20:17 You can’t beat gravity, you just have to counteract it
21:16 My own symptoms and how they were relieved over time and never returned
23:23 Patient education is key but having time to do that is MORE key
27:04 Physical activity takes a back seat when pain exists
On May 28, 2019, the Internal Revenue Service (IRS) released Revenue Procedure 2019-25 announcing the annual inflation-adjusted limits for health savings accounts (HSAs) for calendar year 2020. An HSA is a tax-exempt savings account that employees can use to pay for qualified health expenses.
To be eligible for an HSA, an employee:
- Must be covered by a qualified high deductible health plan (HDHP);
- Must not have any disqualifying health coverage (called “impermissible non-HDHP coverage”);
- Must not be enrolled in Medicare; and
- May not be claimed as a dependent on someone else’s tax return.
The limits vary based on whether an individual has self-only or family coverage under an HDHP. The limits are as follows:
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2020 HSA contribution limit:
- Single: $3,550 (an increase of $50 from 2019)
- Family: $7,100 (an increase of $100 from 2019)
- Catch-up contributions for those age 55 and older remains at $1,000
-
2020 HDHP minimum deductible (not applicable to preventive services):
-
Single: $1,400 (an increase of $50 from 2019)
- Family: $2,800 (an increase of $100 from 2019)
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2020 HDHP maximum out-of-pocket limit:
-
Single: $6,900 (an increase of $150 from 2019)
- Family: $13,800* (an increase of $300 from 2019)
*If the HDHP is a nongrandfathered plan, a per-person limit of $8,150 also will apply due to the Affordable Care Act’s cost-sharing provision for essential health benefits.
Originally posted on ThinkHR.com
High health care costs during working years and in retirement can easily derail a financial plan. Employees need a long-term strategy. Fortunately, more and more employers are bolstering their benefits programs to help their employees build a stable financial future.
Increasingly, employers are offering products such as voluntary insurance benefits and health savings accounts (HSAs) that employees can combine to create comprehensive plans that meet their unique needs and goals. With the right plan in place, employees are better able to save consistently, cover unexpected expenses, protect and grow their savings and prepare for health care costs later in life.
The trend toward prioritizing employee wellness is only expected to grow. In a 2018 report by Willis Towers Watson, 92 percent of employers said voluntary benefits and services “will be at the forefront of their strategic thinking and important to their employee value proposition over the next three to five years.” That’s up from just 59 percent in 2013.
Here are four strategies employers can consider as they help employees navigate the benefits and planning landscape for the long term:
- Encourage employees to look ahead, not just live in the momentMany people, particularly younger employees, tend to focus on the present. They may not understand that an accident or injury can bring unexpected out-of-pocket costs, from lost wages to high deductibles to paying for help with their daily tasks as they heal. Further, they probably don’t have all the facts about the health care costs they are likely to face in retirement. The percentage of household budgets spent on health expenses is nearly three times as high for retirees on Medicare as it is for working households, rising to 14 percent from 5 percent, according to a Kaiser Family Foundation study.
Even before they get to retirement, more than 25 percent of people have withdrawn money meant for retirement, according to PWC’s 2018 Employee Financial Wellness Survey. More than four out of 10 people believe they’ll need an early withdrawal at some point, with 31 percent of boomers and 30 percent of millennials saying they anticipate needing the money to pay medical bills. That percentage drops somewhat—to 21 percent—for Gen Xers.
The point to emphasize is that the most dependable short- and long-term strategy for employees is to have a plan that covers all the bases with voluntary benefits and a tax-advantaged HSA, as well as a retirement savings plan
- From saving to spending: The lifetime benefits of HSAsThe HSAs that go along with high-deductible health care plans were designed to offer maximum tax benefits. The money goes into employees’ accounts pre-tax, meaning there’s less of an impact on net pay and FICA withholding is lower. Once in the account, the money grows tax-free and can be withdrawn tax-free to cover qualified medical expenses, even for covering deductibles. Non-qualified expenses currently incur a 20 percent tax penalty.
After age 65 or when a person is Medicare-eligible, withdrawals for nonmedical expenses are no longer subject to the 20 percent penalty, although they are subject to income taxes.
What’s more, HSAs aren’t subject to “use-it-or-lose-it” like a flexible savings accounts where the employee has to spend their contributions by year-end. The money in your HSA can roll over year-to-year and continue to earn until you’re ready to use it.
- Explain how voluntary benefits fill the “coverage gap” at every life stageEmployers should make sure their health insurance plan descriptions make it loud and clear that they won’t cover every expense that results from an illness or injury. Many people are shocked to learn of out-of-pocket expenses they never considered. A range of products, such as accident, critical illness/specified disease and hospital confinement indemnity insurances, are designed to help fill the “gaps.”
Be sure employees understand these voluntary benefits are flexible and can be used for more than out-of-pocket medical expenses, like for mortgage or rent, utility payments, travel, meal prep, dog walking, child care and any other needs that arise. By covering some of the daily living expenses, these benefits also help mitigate stress so employees can focus on getting well and returning to work, a win-win for employees and their employers.
Employers should work with their providers to demonstrate the relevance of voluntary benefits. The idea is to help employees consider their individual needs and the needs of their family.
Segmenting employees by career or life stage can be useful. Here are a few examples.
Protecting “adulting” independence
A person who is “adulting”—getting settled in a career or an apartment—may have financial limitations, from an entry-level salary to student loans. If they are injured in an accident or develop a serious illness, they can quickly be overwhelmed financially. They may not have saved enough to meet a big deductible or continue paying rent if they miss work.
While any of the voluntary benefits would be helpful, young adults might want to consider accident insurance and look for coverage that pays an additional benefit if they’re injured playing in a friendly pick-up game or an organized sport, like sliding into home during the company softball league championship.
“Balancing” between two worlds
For those in the “balancing” stage of life, between “adulting” and “planning” for retirement, family may be their biggest priority. They need to protect themselves, their spouse and children, and maybe even an aging parent. Whether they are a “weekend warrior” family or one with a history of diseases with a genetic component, there’s a lot to protect against. Employees at this stage might want to consider accident, critical illness or specified disease benefits. Any serious injury or illness puts the whole family under significant financial strain.
“Planning” for what comes next
Employees in the “planning” stage are often more receptive to voluntary benefits than their younger colleagues. They have likely seen family and friends struggle with the costs of a serious illness. They are also acutely aware they have less time to save for retirement and less time to make up for unexpected costs or premature withdrawals from their retirement accounts. Appropriate benefits might include critical illness/specified disease, hospital confinement indemnity and accident insurances, and, depending on the plan, might even cover the entire family.
In all of these cases, having to interrupt saving or dip into a retirement savings account could undermine the ability to meet the high cost of health care in retirement. Balances will be smaller, there will be less of an opportunity for the money to grow, and one emergency could be followed by another, making it more difficult to catch up.
- The power is in the combinationEmployers are making it a top priority to help their employees be more financially resilient now and future ready. To help employees protect themselves and their families, employers need to stress that the best strategy is to not just rely on one savings or financial protection option, but to have a financial plan with the right combination of voluntary benefits in conjunction with an HSA.
With many of the tools employees need at their fingertips at work, it’s easier than ever to include the tools to enroll in and manage their HSA and benefits plans through the workplace. Employees can be confident their employer has the information to research and choose the best products at favorable rates. Employees benefit further from employer contributions to retirement plans, and investment options for HSAs.
An unexpected illness and injury can impact the present and the future, particularly when it comes to saving for retirement and amassing the resources to pay for high health care costs during working years and in retirement. Good employers help their employees stay financially fit while they’re working and give them the tools to prepare for retirement and its high health care costs.
by Rob Grubka
Originally posted on BenefitsPro.com
2019 has ushered in many new trends such as retro cartoon character timepieces, meatless hamburgers, and 5G networks to name a few. Not surprisingly, trend-watching doesn’t stop with pop culture, fashion, and technology. Your company’s human resources department should also take notice of the top changes in the marketplace, so they are poised to attract and retain the best talent. These top trends include a greater emphasis on soft skills, increased workforce flexibility, and salary transparency.
SOFT SKILLS
Gone are the days of hiring a candidate solely based on their hard skills—their education and technical background. While the proper education and training are important factors in getting the job completed, a well-rounded employee must have the soft skills needed to work with a team, problem solve, and communicate ideas and processes. According to Tim Sackett, SHRM-SCP and president of HRU Technical Resources in Michigan, “Employers should be looking for soft skills more and training for hard skills, but we struggle with that.” While hard skills can be measured, soft skills are harder to quantify. However, soft skills facilitate human connections and are the one thing that machines cannot replace. They are invaluable to the success of a company.
WORKFORCE FLEXIBILITY
As millennials begin to flood the workplace, the traditional view of the workweek has changed. Job seekers report they place a high importance on having the flexibility of when and where to work. The typical work day has evolved from a 9am – 5pm day to a flexible 24-hour work cycle that adjusts to the needs of the employee. Employers are able to offer greater flexibility about when the work is completed and where it takes place. This flexibility has so much importance that job seekers say remote work options and the freedom of an adaptable schedule have an higher priority to them over pay.
SALARY TRANSPARENCY
In the wake of the very public outing of the gender and race pay gaps, companies are opening up conversations about wages in the workplace. Once a hushed subject punishable by termination, salary information is now often being shared in the office. Employers have found that the more transparent and open that they are about the compensation levels in their organization, the more trustworthy they appear to their workforce. One way to stay educated on the welcome trend of pay equality is to visit the US Bureau of Labor Statistics’ website to review wage ranges across the nation. Another great resource is the Department of Labor’s free publication called “Employer’s Guide on Equal Pay.”
By watching the trends in the marketplace, employers can focus on what is important to their staff. Honest discussions about salary and compensation, when and where to work, and developing the employee as a whole, including soft skills, sets your company up for success. When you listen to what the market is saying, you show you are sensitive to what their priorities are—and this is always on trend.
When the Family and Medical Leave Act went into effect in 1993, advocates cheered. But they also lamented the fact that although eligible workers were now guaranteed leave from a job for having a child or other family events, that time would come without a paycheck.
Now, more than a quarter of a century later, the idea of paid parental or family leave in the U.S. appears to be gaining momentum. Both major political parties are stumping for proposals that would provide paid leave — though how the benefit would get paid for differs substantially—and several states and municipalities have already passed laws mandating it.
Paid leave benefits for new parents and other caregivers have also ticked up among the largest 20 U.S. companies in recent years, though benefits vary widely—granted sometimes just to birth mothers. Still, paid family leave of all types increased significantly between 2016 and 2018, according to a Society for Human Resource Management survey of 3,500 HR professionals.
That the U.S. would be last among developed countries to enshrine in law paid parental leave, and that it would happen now under a presidential administration seen by many as unfriendly to workers, strikes many as unlikely.
But several political, societal and business factors now coming together explain the new energy.
“I think what’s in the air is a larger conversation about gender inequality,” says Wharton management professor Stephanie Creary. “People are starting to see the issue of parental leave and gender bias as one and the same.”
In the last five years or so, the conversation about gender bias in the tech sector has ramped up, she notes, and in order to get more buy-in many companies have linked it to a conversation about parents. “That parent also is someone who is male,” Creary says. “It’s something that resonates with many people. By making gender inequality also about parents, it has allowed more people, including men, to champion this issue. You are seeing more men talking about parental leave, and that’s a new phenomenon.”
Three trends in particular are contributing to heightened attention around paid parental leave, says Wharton management professor Matthew Bidwell. “The first, of course, is that the nature of work has changed with the demise of the single-breadwinner model, and people are much more conscious of the disconnect between employment policies and the realities of daily life,” he says. “On top of that there has been this big shift toward parents spending more time with their children despite the fact that both parents are now more likely to be working.
“Also, there has been this enormous wave of anger around multiple aspects of the ways that women have been treated that is roiling the political system. Women currently bear the brunt of the tensions between bringing up a family and being at work,” says Bidwell. “So any politician who is paying attention is trying to figure out how to appeal to women voters. Parental leave is a really obvious issue.”
In the current crop of declared and near-declared candidates in the 2020 presidential race, “everybody has got to have an opinion about this,” says Stew Friedman, director of the Wharton Work/Life Integration Project and author of the book Total Leadership. Five years ago, paid parental leave was not a mainstream issue, and now it is, he says.
That the U.S. still does not have paid parental leave is a vestige of a former societal order, says Friedman. “We’re in transition as a society, and I think the traditional ideology remains. It’s weakening, but still too pervasive—this idea of the single-earner household where the primary income generator is the man who is always available for work and the woman is the caretaker of the home. We need more progressive social policy, favored by most Americans, that fits with the pressing realities of today’s working families and that truly invests in meeting their needs.”
Reaching Across the AisleIt is perhaps adding momentum that one prominent figure advocating for federally mandated paid family leave is Ivanka Trump. “It’s encouraging to see members on both sides of the aisle putting forward paid family leave proposals,” said President Trump’s daughter in a statement provided to The Washington Post.
But the details on proposals from Democrats and Republicans differ greatly. Sen. Marco Rubio, R-Fla., announced a proposal in 2018 in which new parents could draw down on their Social Security benefits earlier in life, providing income for parental leave but forcing those workers to extend working years or face reduced retirement benefits later.
“It strikes me as a bad idea,” says Olivia S. Mitchell, Wharton professor of business economics and public policy and executive director of the Pension Research Council. For one thing, Social Security is already facing “enormous financial insolvency problems, and so anything that would stress the ability of the system to pay benefits troubles me a great deal.”
Current projections are that by 2034, in order to meet its obligations, Social Security will have to cut benefits by about 30% or raise taxes by 60%, she notes. “We need to face as a nation what Social Security needs in order to pay its benefits, but picking away at the edges by having it offer other benefits for other purposes doesn’t seem viable.”
The other math problem that would come with the proposal, she said, is that proponents of the idea assume that people will eventually pay more into the system by virtue of the fact that they will work longer to make up for the money they took out as young parents. “But it’s a very big assumption we’re making here,” Mitchell said.
“Why would you require people to hurt their long-term financial security to take care of their kids when there are other alternatives? And this would hurt people at the bottom end of the economy more than at the top end,” says Friedman. “A healthy society is one that cares for its young without forsaking the needs of elderly people, and this tradeoff that’s being imposed in the Rubio plan I think is misguided.”
Democrats are floating their own proposals. In February, presidential candidate Sen. Kirsten Gillibrand, D-N.Y., and Rep. Rosa DeLauro, D-Conn., reintroduced the Family Act, which would give eligible workers up to 12 weeks of pay at two-thirds of their monthly wages—for new parents as well as caregivers dealing with serious health issues of a parent, spouse or domestic partner or child. It would be funded jointly by employer and employee payroll deductions of two cents per $10 in wages.
In perhaps the most promising sign of progress, a bi-partisan proposal from the Senate is emerging. Republican Sen. Bill Cassidy (La.) and Democratic Sen. Kyrsten Sinema (Ariz.) are crafting a paid family leave proposal, though the details on how it would be funded and what it would provide are unclear. As discussed right now, its benefit term would be, in the eyes of many, inadequate. “Six to eight weeks is maybe not as long as some would like, but is something we could afford,” Cassidy recently told Bloomberg.
But what is clear is the disconnect between the 17% of American workers who get paid parental leave and the 84% who say they would like to see paid family leave for all workers, according to a 2018 survey published by the National Partnership for Women & Families.
It’s easy to see why the idea has become popular. The financial burdens created by taking unpaid leave are substantial, according to a Pew survey published in 2017. That snapshot found that 78% of respondents who received no pay or only part of their regular pay when they took leave from work had to cut back on spending to make up for the lost income. About half said they ate into savings, 40% said they cut their leave time, nearly 40% took out debt, a third said they delayed paying bills, about a quarter reported borrowing money from friends or family, and 17% went on public assistance.
The numbers cut even deeper for households making $30,000 or less, with half of those on family leave without full pay tapping public assistance.
Various Models for Benefits and Funding Whatever federal proposal for paid family leave ends up prevailing, current programs at other levels of government and in other countries offer some guidance.
“I don’t think we have a good handle on the ‘optimal’ system yet, but there are some good arguments for expanding parental leave in the U.S., which is currently an outlier relative to other developed countries,” says Benjamin B. Lockwood, Wharton professor of business economics and public policy. “We already have many public policies devoted to investing in children and providing support for working parents—from the Earned Income Tax Credit to the Child Tax Credit to our public education system. Given that commitment, it makes sense to me that we would want to provide support during the crucial formative first months of a child’s life.”
The system in Iceland is worth considering, he says. “It has a relatively generous parental leave policy, but it is a bit distinctive in that it has substantial non-transferable (‘use it or lose it’) paid leave for fathers as well as mothers. That helps even out childcare roles between parents.” Moreover, one concern about generous leave policies is they could have the unintended consequence of employers passing over qualified female job applicants in favor of men who are less likely to take parental leave. “A policy like Iceland’s reduces the asymmetry between men and women in that respect, and so may create more equal hiring treatment,” Lockwood adds.
One concern is on the part of small businesses, says Andrea Zuniga, vice president of legislative affairs for Paid Leave for the United States, a three-year-old advocacy and lobbying group. “On the ground when we are talking to small business owners, they say, ‘I’d love to pay this benefit but I don’t have the means to do it.’”
But Zuniga points to systems being used in states that use an insurance model to fund paid-leave programs. In Rhode Island, for instance, workers pay a 1.2% tax on the first $68,100 in earnings, she said. Benefits come to about 60% of an employee’s weekly wage, up to a maximum weekly benefit of $817.
Another concern is how businesses deal with covering the work of parents or caregivers on leave. Larger firms can redistribute the work, and the change creates minimal ripples. But what about in smaller workplaces or on teams? If a worker disappears for six weeks or six months, temps must be brought in.
“It is quite common for a temp to be hired for several months to cover somebody on parental leave,” says Bidwell, adding that it’s “obviously not a painless process.”
Still, short-term pain might be a good investment in the long-term gain. Friedman says some of the best evidence for why paid parental leave is a good idea comes from California and other states that have already enacted forms of Family Temporary Disability Insurance programs.
“The California model has employers and employees pitching in a tiny amount, two-tenths of a percent of payroll contributions, that funds a program that has resulted in better retention of women in companies and without the anticipated, but not observed, fears of loss of productivity. That model seems to be working,” says Friedman. “You get to hold onto talented and experienced people and reduce the likelihood of all of the indirect costs of employees having to find support to take care of their children and the elderly, especially when unexpected problems come up. It’s a win for everybody.”
But legal provisions for paid parental leave are one thing; how it plays out in reality another. Given how competitive the workplace has become, some workers may hesitate to take time off, especially where there is a certain kind of corporate culture.
Unfortunately, there is still career stigma attached to taking leave, says Creary. “In order for the fear of missing out at work to lessen, the culture of workplaces would need to change more broadly to value taking time off. So the stigma is that someone is taking time off at all—not that they’re just taking time off for parental leave.”
Taking time off means working extra hard when you get back, says Bidwell, “reactivating your social network, catching up on what you’ve missed, that sort of thing. Obviously if you are just coming back from parental leave you are already massively stretched. Ultimately, there is a basic tension between extremely competitive careers that reward those who work hardest, and having a rich, fulfilling family life, and those can be difficult of tensions to reconcile.”
It is possible that the more common parental leave becomes, the less serious of a concern this will be. “It’s a bit of a chicken and egg problem,” Bidwell says.
In fact, many feel it may not be a problem much longer. Says Friedman: “Change is finally here.”
Originally posted on Human Resource Executive
00:00 Intro
00:45 Mark Watson and Kent Thomas
01:47 In last week’s episode
04:48 Now for more with our guests
05:00 Plan design is SO important! Learn how to design your plan from the bottom up
06:16 In what other part of our economy would we conduct our affairs this way…NOWHERE!
08:06 You’re not in control until you know where the dollars are going
09:00 Lots of plans are including DPC as an option but they’re paying double
09:08 Primary care physicians can perform 85% of what patients need
10:30 In DPC, a fixed, capitated cost is mutually agreed upon
11:50 Do I have $10 today?
12:39 That medical home becomes the “healthcare hub”
13:00 Professional oversight is weaved in
13:43 Can DPC show a natural reduction in the prescribing of opioids?
16:00 Primary care oversight helps protect employees
18:32 Local governments filing class action lawsuits
19:42 If you don’t know where your dollars are going you can’t manage it
21:15 I want to know why the costs are coming in the way they are
12:32 Transparent pricing model, with audit rights, etc.
23:05 We have an embedded pharmacist in our plan to provide consulting on costs
24:28 DPC is incentivized to provide healthcare on behalf of the employer, who pays them
28:45 “keys to the kingdom” you have to understand where the money is going and you have to get consistency in consumer behavior
30:09 What is next?
31:08 RBP, when implemented and managed correctly, puts employers in the driver’s seat
31:36 Hospitals have purchased entry practices to “feed” the rest of the system
32:36 So many hospitals were founded as non-profit, public entities…but today what have they become?
33:56 RBP gives you license to start asking “do I really need a PPO network”?
35:26 PPO networks…do we need them anymore?
36:30 RBP loves rural hospitals so long as they have high quality
37:46 Medicare is the “reasonable profit” benchmark
38:56 Local Governments should hear this message
39:17 Thank you!! #letsfixhealthcare www.custombenefits.work
00:00 Intro
00:40 In today’s episode
00:53 Mark Watson
01:14 Kent Thomas
01:34 What is a fiduciary?
02:55 Our story started in 2002
03:33 County Commissioners knew status quo didn’t work any longer
04:23 Consumer-driven healthcare was new at the time
04:54 Transparency was a new question? How do you know you are getting the real answers?
05:23 When your advisor is only giving you part of the picture, that is a problem.
06:08 Dissecting the financial picture of the plan became a problem because of missing info
06:44 2003, we implemented a CDHP, did away with copays, moderate deductibles, etc.
07:29 We actually looked at the impact on the employee’s bottom line
08:27 We made generic prescriptions available at no cost to employees
09:31 Generic penetration jumped immediately and paid for itself
10:24 Employee meetings brought success stories to the table
13:00 Cute story about retiree realizing $200 per month savings
14:00 2003, the first year of new strategies, yielded $1M in cost offsets to the plan
15:20 Understanding the financials is important but you have to work at getting the data
16:05 We’ve maintained a stable health plan since 2003
16:28 We stay within 1% of our annual projections
17:21 As long as you can “see” the math that goes into it
17:56 You’re always looking to “sharpen the pencil”
19:05 Shiny new objects…don’t be fooled by them, especially wellness plans
21:35 We kicked the tires on DPC for about a year and a half
22:38 Maybe we wouldn’t even have ever needed wellness programs if we hadn’t undervalued the primary care relationship in the first place
25:25 Eliminating barriers always leads to savings when the patient gains unlimited access to their doctor
26:33 Data is great but what are the “action steps”
28:12 Medical home model
29:49 This case study should become a model to the rest of the public entities that need to adhere to a fiduciary standard
30:44 Non=integrated silos are costing so much excess money
32:01 The data exchange, so long as it’s good data, is key
33:47 Join us next time! #letsfixhealthcare www.custombenefits.work
One in five adults (43.8 million people) will experience a mental illness in any given year. The consequences of living with a mental illness or substance use disorder affect all areas of a person’s life, including work. And that affects every employer’s bottom line: Serious mental illness costs America $193.2 billion in lost earnings per year.
However, more than half of people who need mental health treatment do not receive it. In addition to stigma, a major deterrent to treatment is a lack of understanding and support from employers. For example, a survey by Mental Health America found that more than three-quarters of respondents are afraid of getting punished for taking a day off to attend to their mental health.
Investing in a mentally healthy workforce is good for business, says the Center for Workplace Mental Health. It estimates that 80 percent of employees treated for mental illness report improved productivity and satisfaction. Lower healthcare costs, decreased absenteeism, and reduced disability costs also result when employees feel it’s safe to seek the mental health care they need thanks to awareness and a supportive culture.
Take the First StepCreating a mental-health friendly workplace starts with understanding the issue.
Check out these resources to learn more about how you can foster a mental-health friendly workplace:
- The Center for Workplace Mental Health’s Making the Business Case for Mental Health
- The U.S. Department of Labor’s Mental Health Toolkit
- The National Alliance on Mental Illness’ Why Care Campaign
By Rachel Sobel
Originally posted on ThinkHR.com
Spring is here! That means it's time to ditch those winter layers, and even that excess winter weight. No matter what your current fitness level, spring is a great time to refocus your habits and spruce up your routine.
Get a Check Up or a PhysicalBefore starting any new fitness regimen, it's a good idea to check with your doctor. Your medical professional will be able to assess any potential risks associated with starting a new fitness routine and may advise you on the types of activities you should try or avoid. For example, if you suffer from low back pain, your doctor can suggest the types of activities that will strengthen your muscles without extra risk of injury, and they may even suggest avoiding certain types of workouts.
Hit the TrailsIf you enjoy walking, jogging, or biking, it’s time to take your workouts into the great outdoors. Indoor workouts are convenient, not to mention climate controlled, but it’s time to take advantage of the spring weather and enjoy those activities out of doors for a nice change of pace. While you're at it, change your pace! Try increasing your speed or adding in some hills and add the extra challenge your current fitness level.
Sign Up for a RaceSpring is a great time to walk, jog, or run in a charity race. Whether it's a cause close to your heart, or an event close to home, there are lots of 5K's and fun-runs to choose from. Try searching on Facebook events for upcoming races. Sometimes the simple act of paying a registration can be all the motivation needed to get your running or walking back on track--figuratively and literally.
Join a Local TeamAll work and no play can make for a very boring fitness routine. Try joining a local recreational sports league. Check with your local parks and recreation office for adult leagues. It can be a great way to get fit while making new friends. Soccer, softball, volleyball and even dodgeball are common. If you can find coworkers to join you, consider starting an office team of your own. Bragging rights can be very effective motivational tools!
Start a Fitness Challenge at WorkStart a sports team isn't the only way to get the office involved. Consider starting an office fitness challenge. It could be something as simple as a "30-Day Water Challenge" or a "Biggest Loser" weight loss contest. The most important part of a fitness challenge at work is the opportunity to motivate one another, to challenge one another, and even to hold each other accountable.
Start by assessing your current fitness level, consult a medical professional as needed, and set realistic goals for improvement. From there, the possibilities are endless.
Summer internships offer students opportunities to gain real-world experience and hands-on career development. Conversely, internship programs give employers access to highly motivated and educated young workers and give junior managers more experience training and supervising. There are benefits for everyone involved.
However, there are some people risks that many employers overlook. One of the largest issues is determining what interns should be paid – or not paid.
The Department of Labor issued new guidance on January 5, 2018, that gives employers more flexibility in deciding whether to pay interns. A seven-criteria test is now used to determine if an internship may be unpaid, but the biggest change is that not all factors need to be met – no single factor is decisive, and the determination is made on the unique circumstances of each case.
If the job training program primarily provides professional experience that furthers a student’s educational goals, a student may not be considered an employee entitled to compensation. However, if students are doing work usually done by employees and are not receiving training and close mentoring, they should be paid wages. If there is any doubt, the best approach is to pay the student.
4 Reasons to Pay InternsHowever, while it’s now legally permissible to classify more interns as unpaid, there are still compelling reasons to pay interns even when the internship does meet the criteria for unpaid status.
Unpaid internships tend to exclude students from lower- and middle-income backgrounds, who cannot afford not to work at paid jobs during the summer. In addition, they may need to pay up to several thousand dollars for course credit, in addition to coming up with funds for housing, clothing, and transportation related to the internship. This can put internships out of reach for some of the students who can benefit from them the most.
Unpaid internships may devalue the work paid employees are doing. After all, interns are working alongside regular employees — often doing some of the same tasks — and not being compensated for that work. This may send the message to employees that their work, or time, is not valued.
Unpaid internships can create a negative impression of your company. Customers or the community may see you as taking advantage of these students, which is not the message you want to portray. It’s a good community relations move to offer youth paid opportunities.
The work the unpaid intern is doing may actually be work that should be compensable. Improperly classifying an internship and not paying the student could result in wage claims that include back pay, penalties, and fines. To mitigate those risks, once again, the best approach is to pay the student.
Hiring summer students is a great way to help youth learn what it takes to be successful in business while helping employers get special projects completed. Plan ahead and structure your program so that your summer internship program is a great experience for everyone.
by Rachel Sobel
Originally posted on ThinkHR.com
"Work is where I go to de-stress," said no one ever. Whether you're passionate about your job or spend all of your free time polishing your resume in hopes of greener pastures, there's no two ways about it: Work can be stressful. And office spaces? Even with a well-stocked snack supply, they don't exactly exude a sense of serenity.
Most people know that stress, regardless of its origin — can be the catalyst for a variety of emotional and biological issues, including increased anxiety and depression and even heart disease. But how many are actively taking steps to reduce work stress on a daily basis? Not nearly enough. From the perfect lunch to mindfulness techniques, here's how to hack your workplace for a stress-free day.
- Get Enough SleepA good day usually starts with a good night's sleep. So if you're skimping on sleep in order to hang out with friends or catch up on your latest Netflix obsession, there's a good chance you're going to wake up groggy and less inclined to take the proverbial bull by the horns at work.
Without enough rest, your performance at work suffers. You're more prone to burn out, poor decision-making, mistakes and the inability to recover from distractions in the workplace, according to the National Sleep Foundation. If you've heard it once, you've heard it a thousand times — aim to go to bed and wake up around the same time each day, logging seven to nine hours.
- Choose a Better BreakfastIn a cruel twist of irony, the most often-skipped meal of the day is also the most important. Not only does sitting down to the right breakfast each morning help you make better food choices throughout the day, it makes thinking clearly and combating work stress easier.
"The reason breakfast helps with brain function is simple — your brain runs on glucose, or sugar," says Patricia Bannan, RDN, author of Eat Right When Time Is Tight. "When you awaken, your blood sugar levels are low because you haven't eaten for eight to 12 hours. Properly fueling up each morning will positively affect tasks that require retaining new information and help you feel better emotionally and physically."
For a healthy, filling breakfast, Bannan suggests her blueberry power muffins, oatmeal with almond butter or plain Greek yogurt with blueberries.
- Get Preemptively ZenTaking five to 10 minutes to practice Mindfulness-Based Stress Reduction (MSBR) — either on your commute or before you leave the house — can go a long way to easing stress throughout your day, says Nancy Douglass, a therapist and executive coach at the Stress Management Counseling Center in Clinton, NJ.
"MBSR helps because it trains your brain to be more present," she says. "When you're more present, you tend not to get overwhelmed and look ahead at all the many tasks yet to do — instead, you mindfully concentrate on the ones at hand, effectively reducing your stress."
If you're pressed for time, Douglass recommends doing a mini-MBSR exercise to reel yourself back in if you catch yourself stressing. Ask yourself if what you're stressing over is in or out of your control, and then let go of anything that's outside of your control, such as a difficult person at work or a deadline you can't change, she says. "Also, reminding yourself frequently that you can 'only do the best that you can do' will go a long way in keeping work stress in check."
- Get a PlantNot only are plants a fun, affordable accessory for any cubicle, they'll make you more productive and will help you deal with work stress, too. A 2011 study published in the Journal of Environmental Psychology showed that the mere presence of plants in an office can positively affect one's attention span.
How? Plants help activate your undirected attention systems — the part of your brain that's effortlessly drawn to the attractive or interesting aspects of our surroundings — and this, in turn, gives our directed attention systems — the part that's capable of staring at a spreadsheet for extended periods of time — time to rest and rejuvenate itself.
- Walk It OffWhen stress creeps up at work, take a walk! A 2015 study published in the Scandinavian Journal of Medicine and Science in Sports found that participants reported feeling less tense, less stressed and more productive after walking. Cecilie Thogersen-Ntoumani, the study's lead author, wrote that, "Lunchtime walks improved enthusiasm, relaxation, and nervousness at work."
Bonus points if said walk can be done in nature, which also has been shown to be effective in reducing stress, according to a 2011 study in Public Health Reports.
- Choose Lunch WiselyJust as choosing the right breakfast is important for combating work stress, so is your lunch selection. Ideally, you want to avoid meals that are too heavy and make you feel sluggish, instead opting for foods that will energize you and that have staying power (think lean proteins and fiber).
"A salad or Buddha bowl made with a large base of greens and other veggies, a lean protein, such as wild salmon, chicken breast or beans, a small scoop of quinoa and a drizzle of tahini sauce is a great workplace lunch," says NYC- and Los Angeles-based dietician Cynthia Sass. "Other options are a taco salad (skip the fried shell!) with greens, grilled veggies, pico de gallo, a scoop of black beans and either half of an avocado or a quarter cup of guacamole; or a veggie broth-based soup with beans, like white bean and kale."
- Breathe DeeplyKeeping a small essential oil diffuser on your desk can be helpful once that dreaded 4 p.m. slump rolls around. "For an afternoon energy boost, try using a combination of peppermint and lemon in a diffuser, or apply to your temples, wrists and between the collar bones after diluting with a carrier oil," says Kac Young, Ph.D., author of The Healing Art of Essential Oils.
Young, who's also a certified meditation teacher, also recommends breathing deeply when work stress starts rearing its ugly head. "Take a long, slow breath in through your nose, first filling your lower lungs, then your upper lungs," she says. "Hold your breath to the count of three, then exhale slowly through pursed lips, while you relax the muscles in your face, jaw, shoulders, and stomach."
- Know How to Shake It OffIt's inevitable that at some point or another in your career, a coworker or superior is going to make a rude comment or offer unproductive criticism — be prepared. "In The Four Agreements by Miguel Ruiz, he says, 'Don't take anything personally. Nothing others do is because of you. What others say and do is a projection of their own reality…' This couldn't be more true," Douglass says.
"If someone deals out harsh criticism or rude comments at work, keep in mind that it's more about their need to offload the negativity and possibly their bad day than it is about you. When people are secure in themselves, they take the time to be respectful of others, not hypercritical and demeaning. If you can keep this truth in mind, you will be able to quickly shake off the salty comments and get back to the tasks at hand."
by Nicole Fabian-Weber
Originally posted on LiveStrong.com
00:00 intro
00:42 welcome Carl Schuessler
01:18 in last week's episode
02:16 absolving employee's of out-of-pocket cost burden
02:54 low income + maximum OOP = recipe for bankruptcy
03:30 employee's who go to their hospital employer have no OOP
03:49 "friends of family" network
04:22 removed all barriers to care
04:35 what was the magic sauce?
05:39 340B eligibility makes them unique
05:58 Marshall Allen--ProPublica article
06:48 keep more dollars in the community
07:30 critical access hospital has <25 beds, or DSH hospital
08:04 keep as much revenue coming to the hospital as possible
08:47 add more direct contracts for services at the hospital
09:25 medical tourism without having to leave your hometown
10:29 $65,000 vs. $25,000...um, I think I'll take the latter
11:16 new revenues bring new investments in more advanced care
11:50 big thanks to the CEO, CFO, HR team
12:33 Marcus Welby, where healthcare gets local and personal again
13:27 quadruple aim includes provider satisfaction
14:18 love square
15:00 what's your message for the C-suite?
15:52 EBITDA--earnings before interest, taxes, depreciation and amortization
17:00 6 opportunities in healthcare
17:54 Marilyn Bartlett
18:00 are we setting ourselves up for single payer with the BUCAs?
19:18 Millennials advocating for Medicare for All don't realize that it will be run by insurance companies
20:42 managed care social experiment over the last 50 years
21:21 just because employers change insurers doesn't mean employee healthcare has to change
21:52 let's plan for the "I told you so" episode
22:32 Barry Murphy, another Mitigate Partner
22:47 Frank Micdroppa, the Walk On Clinic
23:23 don't steal my phrase!
24:14 Rosen Hotels, free college education for employees and their children
25:04 dis-intermediate the system and break down the counterproductive barriers
27:08 don't get an advisor who just pushes a rope
27:22 Dave Chase, healthcare is already fixed...we just need to replicate those fixes
27:47 Health Rosetta
28:03 Episode 3 with David Contorno
28:46 let's put this to the test, find out the "chase" gets reduced when neighborhood healthcare takes effect
29:36 cry me a river about Reference-Based Pricing
30:06 pigs get fed, hogs get slaughtered
30:35 let's look forward to talking outcomes
31:31 communities just need a hand up
31:45 thank you and #letsfixhealthcare www.custombenefits.work
00:00 intro
00:42 who is Carl Schuessler
00:50 rural health is in jeopardy
01:08 community healthcare gets a boost with Carl's new client
01:33 hospital systems are employers too...and they need help
02:24 started in 2017
02:36 Lee Gross, DPC guru and visionary
03:05 rural hospitals all over the country are struggling
03:28 demographics and local economy are huge factors
04:25 even sending their own employees were having to go elsewhere for certain procedures
05:05 some hospitals haven't learned how to think outside their own box
05:32 hospitals need to get their own house in order
06:28 current systems were not minding the store
06:48 Carl identified a variety of risks that were not being attended to
07:19 remove ALL barriers to employees who need to do better
07:40 be like George Costanza and do the opposite!
08:03 made the hospital their own PBM
08:20 pharmacy spend should see dramatic reduction
09:00 pharma savings should outpace Reference-Based Pricing savings by a lot in this case
09:23 avoidance of care because of disconnected care is a problem
09:47 bringing Direct Primary Care right into the hospital setting for hospital employees was important
11:00 integrating DPC right into the plan design
11:43 partnering with a DPC provider is key
11:56 80% of employees enrolled in the DPC option
12:27 identified specific employee needs that were resolved immediately
14:21 preconceived notions don't apply here
15:07 Carl talks about his early steps with new client
16:09 Fair Co$t Health Plan effective 1/1/2019 for new client
16:31 hospital should see increased revenue just because of this change
16:45 community outreach planned
16:58 community built healthcare vs. insurance company built healthcare
17:17 partnering with local, independent pharmacy
17:43 plan design steerage
17:53 assemble the local care team
18:16 dis-intermediate the players and create the love triangle
18:42 employers paying extra for so many layers of extraneous intermediaries
19:17 it only took a 157-employee group to get it done
19:40 local employers within vicinity will benefit
20:20 pregnancy claims mitigated with cash based negotiating
22:20 social determinants of health? quit talking and start doing!
22:43 wrap up
22:51 thank you and #letsfixhealthcare visit us at www.custombenefits.work
00:00 introduction
00:42 welcome Mark Pew
01:27 recap
02:13 employer wake-up call
03:34 whole person well-being programs
03:52 absenteeism vs. presenteeism
04:21 progress we've seen just in the last 5 years, like standing desks
05:04 workplace culture change even affects what is in vending machines
06:23 resilient thinking is a positive byproduct that results from positive workplace "whole person" well-being program fostered at work
06:37 call it yoga? call it stretching? hey..whatever helps dude!
07:09 the big lie of the 1990's--that we shouldn't feel pain
07:45 pain is just part of the human condition
08:08 we process pain in the brain
08:46 attitude change, instant gratification has no place here
10:30 employers are part of the messaging on the "whole person" healthy image
11:43 employee wellness programs vs. employee total well-being culture
13:15 local governments jumping on the class action lawsuit bandwagon
14:15 public employers need to get their own houses in order
15:27 we all had a role and we all need to help #cleanupthemess
17:07 opioid prescribing decline began in 2012, now we are dealing with fentanyl crisis
18:05 the lost generation
18:25 functional restoration programs being paid for by Worker's Comp
19:12 #preventthemess
20:00 PBMs need to track the pharmacy trend and act on the "polypharmacy" issue when they see it happen
20:42 withdrawal from benzos is worse than opioids
22:13 anxiety associated with opioid use even after 3 days
22:39 DisposeRx
22:58 "Opioid Crisis Wake-Up Call" by Dave Chase
23:31 speaking of hastags? #letsfixhealthcare
23:45 where in the world is Mark Pew?
24:46 blogger on LinkedIn, 2-3 articles per day
25:08 @rxprofessor
25:19 SIIA (Self Insurance Association of America) platform for advisors who serve self-funded health plans
25:57 Announcing, Mark's new YouTube channel!
27:02 he's the son of a preacherman
28:19 wrap up
28:30 thank you and #letsfixhealthcare www.custombenefits.work
00:00 Intro
00:42 Mark Pew introduced
01:26 Welcome
02:00 How it started in 2003
02:40 "Poly pharmacy" problem
03:40 Trends in data presented illogical conclusions
04:21 First presentation to audience in 2013
05:12 Mark Pew on LinkedIn
05:50 Most connections are not related to Worker's Comp
07:18 Worker's Comp beat the healthcare insurers to the punch
08:00 Own the care for life
08:35 No "long view" on the healthcare side
09:15 Medicare set asides
10:40 Math is easy but not realistic
11:47 Superbowl commercials
14:33 Get a moral compass
15:27 Social determinants play a huge role
16:00 BioPsychoSocialSpiritual -- whole person model of care
16:41 We've changed the dialogue in Worker's Comp
17:40 Long journey which started as a financial issue
18:30 Makes sense to eat an anti-inflammatory diet, functional medicine
20:00 Vitamin D deficiency
20:43 Press Ganey satisfaction surveys
21:08 Get back to basics
21:55 What we didn't know in the 90's
22:30 Employee education is so necessary
23:30 What's it gonna take?
24:07 Infographic in the disability check
24:41 Increased focus on well-being
26:00 Employees need to "own" their healthcare journey
26:42 Thank you, please subscribe at www.custombenefits.work #letsfixhealthcare
Maybe it’s something in the gazpacho or paella, as Spain just surpassed Italy to become the world’s healthiest country.
That’s according to the 2019 edition of the Bloomberg Healthiest Country Index, which ranks 169 economies according to factors that contribute to overall health. Spain placed sixth in the previous gauge, published in 2017.
Four additional European nations were among the top 10 in 2019: Iceland (third place), Switzerland (fifth), Sweden (sixth) and Norway (ninth). Japan was the healthiest Asian nation, jumping three places from the 2017 survey into fourth and replacing Singapore, which dropped to eighth. Australia and Israel rounded out the top 10 at seventh and 10th place.
For the Bloomberg 2019 Healthiest Country Index full data set, click HERE
The index grades nations based on variables including life expectancy while imposing penalties on risks such as tobacco use and obesity. It also takes into consideration environmental factors including access to clean water and sanitation.
Spain has the highest life expectancy at birth among European Union nations, and trails only Japan and Switzerland globally, United Nations data show. Spain by 2040 is forecast to have the highest lifespan, at almost 86 years, followed by Japan, Singapore and Switzerland, according to the University of Washington’s Institute for Health Metrics and Evaluation.
“Primary care is essentially provided by public providers, specialized family doctors and staff nurses, who provide preventive services to children, women and elderly patients, and acute and chronic care,” according to the European Observatory on Health Systems and Policies 2018 review of Spain, noting a decline the past decade in cardiovascular diseases and deaths from cancer.
Eating habitsResearchers say eating habits may provide clues to health levels enjoyed by Spain and Italy, as a “Mediterranean diet, supplemented with extra-virgin olive oil or nuts, had a lower rate of major cardiovascular events than those assigned to a reduced-fat diet,” according to a study led by the University of Navarra Medical School.
Meanwhile in North America, Canada’s 16th-place ranking far surpassed the U.S. and Mexico, both of which dropped slightly to 35th and 53rd. Life expectancy in the U.S. has been trending lower due to deaths from drug overdoses and suicides.
Cuba placed five spots above the U.S., making it the only nation not classified as “high income” by the World Bank to be ranked that high. One reason for the island nation’s success may be its emphasis on preventative care over the U.S. focus on diagnosing and treating illness, the American Bar Association Health Law Section said in a report last year after vising Cuba.
South Korea improved seven spots to 17th while China, home to 1.4 billion people, rose three places to 52nd. Life expectancy in China is on track to surpass the U.S. by 2040, according to the Institute for Health Metrics and Evaluation.
Sub-Saharan economies accounted for 27 of the 30 unhealthiest nations in the ranking. Haiti, Afghanistan and Yemen were the others. Mauritius was the healthiest in Sub-Sahara, placing 74th globally as it had the lowest death rate by communicable diseases in a region still marred by infectious mortality.
This post originally appeared on BenefitsPro.com.
The FDA has come under bipartisan fire in recent years for its oversight of opioids. Treatment advocates and lawmakers have blamed the agency for turning a blind eye to the widespread abuse of prescription medication, both by approving powerful new opioids for medical use and for failing to put in place effective rules to prevent inappropriate prescriptions.
The agency has proposed new rules that will require drugmakers to conduct studies examining the effectiveness of their medications when used for chronic conditions.
The rules aim to address the fact that doctors are often prescribing highly addictive drugs to treat chronic pain. Many experts have argued that powerful opioids should only be used occasionally to treat acute pain.
Notably, the FDA approved the use of OxyContin for chronic pain with no evidence that it can effectively reduce pain in the long-term.
“There are certain important questions that we could answer by properly studying the chronic administration, looking at the efficacy over time,” explained FDA Commissioner Scott Gottlieb in recent testimony to a Congressional committee.
Experts have highlighted a number of medical practices that have facilitated widespread opioid addiction. Not only have those dealing with chronic conditions become addicted to painkillers due to what were likely inappropriate prescriptions, but prescriptions often include far more pills than necessary to deal with the pain that is being targeted, such as recovering from wisdom tooth removal.
Painkiller addiction has played a major role in fueling an explosion in heroin use, as opioid addicts who have exhausted their prescriptions turn to a cheaper fix on the street. Since 2017 nearly 50,000 Americans have died of opioid overdoses.
This post originally appeared on BenefitsPro.com.
Guest Post by Tom Emerick
When I travel around the U.S. giving speeches I often ask for a show of hands of people who have had relatives harmed by a major misdiagnosis, bad surgery, botched treatment plan, etc. Nearly every hand in the room always goes up and everyone is always incredibly surprised to see this. I then share that if they know ten people who have died of cancer, likely three of those ten were misdiagnosed and given a useless or harmful treatment plan. Jaws drop, but it’s true.
I follow this with “how are we spending $3 trillion on a healthcare system that is harming so many people?”How is this happening? We’ve all seen bad medical events with our own families and friends, but we don’t realize how common and costly it is.
This is also the core insight behind what’s wrong with the U.S. health care system.
I’ve had the unique experience of being behind the scenes for more than 30 years. This has let me identify seven high-level systemic problems with the US health care system. All are the result of various flawed incentives Dave covers in the following pages. These problems enormously damage our country, both individually and collectively. This book addresses these issues and practical solutions in a systemic way I’ve not found elsewhere.
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Lack of accountabilityHealth care providers aren’t accountable to anyone for the quality of care provided in the U.S. A clinician can misdiagnose 20-40 percent of patients, which many do, yet nobody prevents it or stops them. The biggest care quality failure is misdiagnosis. Anything that follows harms you and your wallet. Data shows that misdiagnosis rates in some categories of major care are 20-40 percent! We have an epidemic of misdiagnosis.
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Status quo lobbying powerHealth care institutions in America are very powerful. Few, if any, sectors of our economy have more powerful lobbies at both the national and local levels than health care providers and health insurers. They have $3 trillion reasons to protect the status quo and spend more than anyone to protect it.
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The American health care exceptionalism fallacyThere is a fallacy in the U.S. that we have the best health care. This is simply not true. We may have the easiest access to care or the most providers in certain categories. However, the cost and quality of this doesn’t really stack up to our peer countries in any critical systemic metric. Our health care is twice as expensive with significantly worse results.
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Limited individual purchaser influenceThe individuals and corporations that pay for over half of health care lack the individual power or influence to offset that of our collective health care institutions. Our government pays the other half, yet even Medicare and Medicaid do a poor job of managing many issues, including the widespread misdiagnosis and over-treatment of patients discussed in Dave Chase's book CEO's Guide to Restoring the American Dream.
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Widespread conflicts of interestThe world of health care insurers, providers, vendors, buyers, brokers, and advisors is a bizarre world rife with conflicts of interest we just wouldn’t accept elsewhere in society. For example, benefit managers generally hire benefit consultants paid by health insurers and providers. This is a textbook conflict of interest. If Fred hires Bob to sue Joe, Joe would be off his rocker to hire Bob to defend him. Yet this kind of nuttiness is the default approach throughout the purchasing, administration, and delivery of health care in America. Enough is enough.
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Poor internal financial oversightHealth care plans are one of the biggest areas of spending and financial risks facing public and private employers, yet they’ve been placed in the hands of human resources managers. Taking care of employees is in HR’s DNA and many are very good at it. Unfortunately, this same trait makes many of them poor benefits managers, risk assessors, and financial analysts. Many just have not made the necessary decisions to maximize the quality and minimize the cost of health benefits.
This isn’t from a lack of solutions. They exist. They give employees better quality care, save employees out of pocket spending, and save employers money. Many HR managers are just not willing to shake up the status quo. Alas, the status quo needs to be shaken up badly.
- Reimbursement is more a wealth transfer than an economic transactionExpense reimbursement models in health care are not really economic transactions. If a consumer goes to a doctor who treats the consumer, but is paid by a third-party—an employer, insurer, or government entity—this is more a wealth transfer than a classic economic transaction. Market economics do not apply when third parties pay consumers’ bills. Yet this is how health insurance works.
I highly recommend Chase’s book as it explains these problems and the root causes behind them in detail, then offers common sense ways to take control of health care costs and improve the quality of care your employees receive.
It is do or die time. If you think it wise to save our country and health care system, things need to change and change now.
About the Guest Contributor:
Addressing misdiagnosis and overtreatment in cancer, musculoskeletal procedures, organ transplants, and other high-cost areas has a greater impact on patients than any blockbuster drug. Tom Emerick has more experience with these types of claims than most, if not all, benefits leaders. He was Walmart’s Global VP of benefits and ran benefits at Burger King, British Petroleum, and American Fidelity. He’s the author of Cracking Health Costs and created one of the first centers of excellence programs for large employers, subsequently making it accessible for any self-insured employer. He’s been walking the path this book lays out for decades.
The opioid crisis is real, and its effects can be seen from suburban homes to high-rise offices. Watch our latest video to learn more about its causes as well as helpful resources to address opioid addiction in the workplace.
Cristy talks with David Contorno, Founder of E-Powered Benefits, about how he is helping an upstate SC County with about 1,000 employees break free from status quo healthcare and try something new. They discuss the many moving parts of affecting change in a positive way even if everyone is not on board at first. Learn from their experience and get excited about what you can achieve in your own community.
Do you offer health coverage to your employees? Does your group health plan cover outpatient prescription drugs? If so, federal law requires you to complete an online disclosure form every year with information about your plan’s drug coverage. You have 60 days from the start of your health plan year to complete the form. For instance, for a calendar-year health plan, this year’s deadline is March 1, 2019.
BackgroundThe Centers for Medicare and Medicaid Services (CMS) is a federal agency that collects data and administers various federal programs. The agency utilizes the CMS online tool to collect information from employers about whether their group health plan’s prescription drug coverage is creditable or noncreditable. Creditable coverage means the group health plan’s prescription drug coverage is actuarially equivalent to Medicare’s Part D drug plans. In other words, the group plan is considered creditable if its drug benefits are as good as or better than Medicare’s benefits.
To confirm whether your plan provides creditable or noncreditable coverage, check with the plan’s carrier or HMO (if insured) or the plan’s actuary (if self-funded). CMS provides guidance to help plan sponsors, carriers, and actuaries determine the plan’s status.
Deadline for DisclosureAll group health plans that include any outpatient prescription drug benefits, regardless of whether the plan is insured, self-funded, grandfathered, or nongrandfathered, must complete the CMS disclosure requirement. There is no exception for small employers.
Complete the CMS online disclosure form every year within 60 days of the start of the plan year. For instance, for calendar-year plans, this year’s deadline is March 1, 2019.
Additionally, if your plan terminates or its status changes between creditable and noncreditable coverage, you must disclose the updated information to CMS within 30 days of the change.
Completing the Disclosure FormThe CMS online tool is the only method allowed for completing the required disclosure. From this link, follow the prompts to respond to a series of questions regarding the plan. The link is the same regardless of whether the employer’s plan provides creditable or noncreditable coverage.
The entire process usually takes only 5 or 10 minutes to complete. To save time, have the following information handy before you start filling in the form:
- Information about the plan sponsor (employer): Name, address, phone number, and federal Employer Identification Number (EIN).
- Number of prescription drug options offered (e.g., if employer offers two plan options with different benefit levels, the number is “2”).
- Creditable/Noncreditable Offer: Indicate whether all options are creditable or noncreditable or whether some are creditable and others are noncreditable.
- Plan year beginning and ending dates.
- Estimated number of plan participants eligible for Medicare (and how many are participants in the employer’s retiree health plan, if any).
- Date that the plan’s Notice of Creditable (or Noncreditable) Coverage was provided to participants.
- Name, title, and email address of the employer’s authorized individual completing the disclosure.
We suggest you print a copy of the completed disclosure to keep for your records.
Note: Employers that receive the Retiree Drug Subsidy (RDS), or sponsor health plans that contract directly with one or more Medicare Part D plans, should seek the advice of legal counsel regarding the applicable disclosure requirements.
Additional Disclosure RequirementSeparate from the CMS online disclosure requirement, employers also must distribute a disclosure notice to Medicare-eligible group health plan participants. The deadline for distributing the participant notice is October 14 of the preceding year. It often is difficult for employers to identify which employees and spouses may be Medicare-eligible, so most employers simply distribute the notice to all participants regardless of age or status.
Click here to download more information.
This post originally appreared on ThinkHR.com.
Cristy Gupton, President of a leading North Carolina employee benefits consulting firm, Custom Benefits Solutions, was featured as one of America’s Top 20 Women in Benefits Advising in the October 2018 Issue of the national trade publication Employee Benefits Advisor.
A Morganton, NC resident, Gupton was selected based on her nationally-recognized seminars, publications and work to help employers combat the opioid crisis through employee education and smart design of employee health plans. A cornerstone of her presentations is her vision to simultaneously reduce both supply and demand for opioids by using the employee health plan to improve healthcare while reducing costs.
“While it’s humbling to be recognized on a national level, it also adds fuel to my fire and propels me to keep working until the problem is solved”, said Gupton, who is a member of the peer group The Health Rosetta lead by author and healthcare visionary, Dave Chase.
"The status quo health plans that most employers offer drive employees to volume-centric primary care centers designed to refer you to expensive (and often unnecessary) services that produce poor patient outcomes," says Dave Chase, author of The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here's How We Take It Back. ”Employers are paying far too much for low-quality care – a side effect of which is the opioid crisis – and transparent benefits advisors like Cristy are helping lead a health care revolution and find actionable solutions."
These and other events inspired Gupton to begin a national conversation about finding solutions to the problems plaguing our current healthcare system, she said.
“That’s when the idea of hosting a podcast came to mind,” Gupton said. “I learn a lot from podcasts and I’m always eager to hear the next one in the lineup. I don’t even need a radio in my car anymore.”
The launch of her podcast, Healthcare Solutions, will address topics like Direct Primary Care, Reference-Based Pricing, Pharmacy Benefits Management, and many other issues detailing how employers who provide healthcare to over 170 million Americans can improve care while lowering costs.
“I’m excited to bring the problem solvers to the table to talk about real solutions that make a difference,” Gupton said. “In the third episode, the case-study of an upstate SC local government who decided to abandon the status quo and try something new is captured for listeners to learn from. Hopefully, what resonates with listeners is that the solutions are here. It’s just up to us to put them in place.”
Finding the podcast and subscribing won’t be difficult. It’s easily found on Apple podcasts, Google Play, and www.custombenefits.work. Searching the hashtag “#letsfixhealthcare” should lead you right to it.
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If you would like more information about this topic, please contact Cristy Guptonat828.413.3581or email cristy@custombenefits.work.
ABOUT CUSTOM BENEFITS SOLUTIONS: Custom Benefits Solutions has assisted employer organizations in crafting the best benefit packages for employees using three core beliefs: Trust, Transparency and Technology. Cristy Gupton, a third-generation insurance expert, founded Custom Benefits Solutions in 2006. She is a co-creator of the Substance Use & The Workplace Community Forum and lead of the Health Rosetta’s Opioid Component Committee.
Download the press release.
Eighteen states rang in 2019 with new, higher minimum wage rates. These states (AK, AZ, CA, CO, DC, FL, ME, MN, MO, MT, NV, NJ, NV, NY, OH, OR, SD, and WA) have scheduled annual adjustments for their minimum wages based on approved legislation, via ballot initiative, or varying formulas.
Thirty states have a minimum wage higher than the federal rate, sixteen states’ minimum wages are equal to the federal rate, and five states have no minimum wage requirement at all. The higher rate (state or federal) always prevails when the laws differ.
Get the DetailsThe 2019 State and Federal Minimum Wage Chart is available for free download on the ThinkHR website. They track all state minimum wage rates throughout the year and provide information on changes.
This post originally appeared on ThinkHR.com.
Ever wonder why the resolutions you make in January don’t stick around after March? You aren’t alone! Studies show that only 8% of peoplekeep their New Year’s resolutions. Only 8%! Why? And how do people achieve their goals set at New Year’s? We’ve broken it down for you so you can identify your goal-breaker as well as give you some tips on how to make those resolutions stick.
There are three main reasons that New Year’s resolutions fail. The first goal-breaker is taking on too much (too big of a goal) and expecting it to happen too fast. Researchers have found that it takes 66 days to break a habit. That’s much higher than the previously published 21 days. It conversely means that it also takes 66 days to form a new habit. So, battle your goal-breaker by setting smaller goals and not expecting to master those resolutions by the end of the month.
The second reason you fail to keep your resolution is you don’t have anyone supporting you. This could be because you simply didn’t tell anyone that you have new life goals. It could also be due to fear of accountability. You need some life-cheerleaders that root you on to victory. These cheerleaders also call you out when you are riding off the tracks. Their support isn’t tied to your achievement of your goals but instead their support is firmly tied to you and they want to see you succeed.
The last goal-breaker is that you don’t believe in yourself! When you make New Year’s resolutions that are super unattainable, and then you fail, you doubt yourself. When this cycle persists, time and again, you fill your head up with negative thoughts and begin believing you aren’t capable of accomplishing anything. Self-doubt is powerful.
Now, let’s steer this ship back on course with some tips on KEEPING your New Year’s resolutions.
Remember that bigger isn’t always better. Set your resolutions as small, attainable, goals. With those small goals, set realistic timelines to achieve them. Avoid “I want to run the Ironman by November” if you’ve never run more than 2 times a month. Set your goal as “I want to run a 5K by Christmas” and work towards increasing your endurance each week.
Reward yourself along the way.If exercising is your goal, reward yourself with a trip to the movies if you go to the gym 3 times a week. When you look forward to rewards, and you feel like they are attainable, you are more likely to work hard to get them!
Tell others about your resolutions. Finding an accountability partner helps keep your ship on course as they can encourage you for achievements as well as guide you back to the course when you start to stray.
Write your goals down on paper. Mark Murphy says “Writing things down doesn’t just help you remember, it makes your mind more efficient by helping you focus on the truly important stuff. And your goals absolutely should qualify as truly important stuff.”
Identify your purpose. Knowing your “WHAT” (goal) is important, but knowing “WHY” can be just as important when it comes to following through on your intentions. Whydo you want to lose weight in 2019? When you put the why to the what, you are truly focused on what matters. “I want to lose weight so that I can play with my children without getting tired and show them that hard work is worth it.” Now, THAT’S a great goal.
Identifying goal-breakers and goal-makers are equally important pieces to achieving what you set out to accomplish, especially with regards to New Year’s resolutions. Make this the year your goals become reality by focusing on these five simple tips.
00:10 intro
00:44 welcome and what's up?
01:10 primary care revolution
02:16 what does direct primary care cost?
02:40 Free Market Medical Association--Carolinas Chapter
03:17 it's just like paying for a gym member
03:50 what if employers knew what they were missing?
05:00 PCPs are overworked and underpaid by insurance companies
06:40 direct pimary care includes a lot more than the office visit
08:18 DPC docs don't need no stinkin' insurance
09:25 the reveal--my own personal story
11:16 "I need to see you back in 90 days"
11:55 I had a bad attitude but I needed support
13:25 sugar dependency--the struggle is real
14:30 I was trying too hard and failing miserably
15:29 maybe I could have triumphed but we will never know
16:15 healthcare freedom
16:53 thank you! #letsfixhealthcare www.custombenefits.work
00:10 intro
00:44 welcome and what's up?
01:14 cost containment? Is that a thing?
02:10 do healthcare costs just "go up"?
02:45 there is a new normal out there waiting for you
03:07 pay healthcare just like any other bill
03:59 "fair trade healthcare"
05:52 no need to be dependent on insurance companies
06:21 disassemble then reassemble
07:21 consumer driven healthcare---LOL :)
08:00 we got infrastructure but no transparency
08:30 self-funded health plans bring transparency
09:28 CFO conundrum
09:53 you're a fiduciary for a reason
11:19 nurse advocate services
11:38 upfront, bundled surgical agreements
12:11 money talks
13:30 savings per employee
13:51 thank you! #letsfixhealthcare www.custombenefits.work
Managing the Intersection of Workers’ Compensation with Other Leave Regulations
You’re ready when the call comes in. Your client’s employee was seriously injured on the job. You reassure the client that your team has them covered, and you outline their workers’ compensation policy provisions, administrative claim filing process, and accident site investigation protocols.
You check in later in the week. As a result of the accident site investigation, the employer’s worksite processes are updated, equipment is modified, and employees are being trained to prevent future accidents like this one. Employee training records are updated, the OSHA injury/illness logs are completed, and the safety team is monitoring the new processes and systems.
The employee is not back to work, but is progressing well with medical treatment and is receiving wage replacement provided by the policy. Everything is well documented so that the client is ready in the event of an OSHA or state safety audit/inspection.
The client appreciates the extra service and professional advice you’ve given to make the best of the unfortunate accident. You’re satisfied that this situation is under control and make a note to follow up with them in the next few weeks. Your job on this claim is done … or is it?
Important Leave Details Cannot be OverlookedYour goal is to advise your clients of all risks affecting their business, and it’s likely you haven’t spent much time thinking about the impact of uninsurable HR-related business risks or opportunities to mitigate them. In this situation with an injured worker, there are other employment laws and benefits considerations besides state workers’ compensation rules that your client should factor in when managing time off and return to work.
Although workers’ compensation eligibility, coverage, and benefits rules vary from state to state, most employees are covered when the occurrence is job-related. Depending upon the employer size and type of injury or illness suffered by the employee, the employee also may be entitled to medical and/or disability-related protections under two federal laws: the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). To make things even more complicated, some states have enacted their own disability and family and medical leave laws, some of which provide greater amounts of leave and benefits than the federal rules. Failure to look at the entire situation and take these laws into consideration can prove costly to your client.
Counsel your client to consider the following:
- If the employee has a serious health situation requiring time off the job, then FMLA may apply.
- If the employee is disabled, the ADA may apply.
The bottom line is that when employees need time off because of a medical or disability-related issue, it is important to remember that they may have rights under all of these laws at the same (or different) times for the same illness or injury. Each situation needs to be reviewed very carefully, so that the right amounts of time off to manage the condition are provided, and that benefits, compensation, notifications, and other protections are managed.
Avoidable Mistake #1The most common mistake that employers make with work-related employee injuries/illnesses: Not considering and/or designating FMLA leave concurrently with a workers’ compensation claim. This can result in legal claims for failure to provide benefits, as well as additional costs to the business.
For the claim you just handled, let’s say that the injured employee is off work on temporary total disability for 16 weeks. His doctor then releases him to return to light-duty work, and your client offers him a light-duty job. If they had not properly designated that employee’s time off as FMLA leave, the employee may be able to reject the offer of light-duty work and then be entitled to up to 12 additional weeks of unpaid FMLA leave. Additionally, your client would also be required to keep the employee on their health insurance through those 12 additional weeks of unpaid leave and return him to his former job when he finally returns to full-duty work.
If the client had designated the leave concurrently at the time of the injury, the FMLA job and benefits protections would terminate after the first 12 weeks, while the employee was still on temporary total disability. The employee would then have four more weeks of workers compensation temporary disability, without FMLA protections for additional time off or benefits continuation beyond the wage replacement and benefits provided under workers compensation.
Here’s why: FMLA is a federal law that provides employees up to 12 weeks of unpaid leave per year for specific reasons, including a serious health condition due to a work-related injury or illness. FMLA applies to:
- Private employers with 50 or more employees working within 75 miles of the employee’s worksite; and
- All public agencies and private and public elementary and secondary schools, regardless of the number of employees.
Employees are eligible to take FMLA leave if they have:
- Worked for their employer for at least 12 months;
- Worked for at least 1,250 hours over the 12 months immediately prior to the leave; and
- There are at least 50 employees working within 75 miles of the employee’s worksite.
Note: The 12 months of employment do not need to be consecutive, which means that any time previously worked for the same employer can be used to meet the requirement unless the break in service lasted seven years or more. Some exceptions apply.
Within the context of a work-related injury or illness, the most common serious health conditions that qualify for FMLA leave are:
- Conditions requiring an overnight stay in a hospital or other medical care facility; and
- Conditions that incapacitate the employee for more than three consecutive days and have ongoing medical treatment (either multiple appointments with a healthcare provider, or a single appointment and follow-up care such as prescription medication).
Generally, basic first aid and routine medical care are not included unless hospitalization or other complications arise.
Employers must also consider compliance with state “mini-FMLA” laws that cover an employee’s serious health condition. California, Connecticut, Maine, Oregon, Rhode Island, Vermont, Washington, Wisconsin, and the District of Columbia have enacted medical leave laws impacting private employers. Massachusetts medical leave law provides for leave benefits beginning January 2021, with proposed regulations to be published in March 2019. Other states are considering similar laws.
Avoidable Mistake #2The second common mistake that employers make with work-related employee injuries/illnesses: Not considering the ADA requirements for entering into an interactive process for reasonably accommodating an employee’s return to work.
The ADA is a federal law that prohibits covered employers from discriminating against people with disabilities in the full range of employment-related activities. Title I of the ADA applies to employers (including state or local governments) with 15 or more employees and to employment agencies, labor organizations, and joint labor-management committees with any number of employees.
The ADA protects individuals with a disability who are qualified for the job, meaning they have the skills and qualifications to carry out the essential functions of the job, with or without accommodations. An individual with a disability is defined as a person who:
- Has a physical or mental impairment that substantially limits one or more major life activities;
- Has a record of such an impairment; or
- Is regarded as having such an impairment.
The ADA does not set out an exhaustive list of conditions covered by the law, making it more difficult for employers to determine with certainty what conditions actually are considered a disability. These conditions require medical interpretation of the severity of the condition by the employee’s healthcare provider, and it is always a best practice to work with medical and legal experts when in doubt. A good rule of thumb to use in reviewing ADA issues is to look at the medical condition in its entirety. Generally, conditions that last for only a few days or weeks and are not substantially limiting with no long-term effect on an individual’s health — such as basic first aid, broken bones, and sprains — are not considered disabilities under the Act.
The ADA does not specifically require employers to provide medical or disability-related leave. However, it does require employers to make reasonable accommodations for qualified employees with disabilities if necessary to perform essential job functions or to benefit from the same opportunities and rights afforded employees without disabilities. Accommodations can include modifications to work schedules, such as leave. There is no set leave period mandated because accommodations depend on individual circumstances and should generally be granted unless doing so would result in “undue hardship” to the employer.
One of the most common questions — and one of the most difficult to answer — is the definition of what is considered a reasonable accommodation.
In the real world, the definition of what is a reasonable accommodation varies and is based on several factors. Examples include: making existing facilities accessible; job restructuring; part-time or modified work schedules; acquiring or modifying equipment; changing tests, training materials, or policies; providing qualified readers or interpreters; or reassignment to a vacant position. Determining what is reasonable and does not cause undue hardship to the business can be difficult, so be sure to consult with experts and provide documentation regarding why an accommodation would be unreasonable for the business.
The Department of Labor (DOL) suggests that every request for reasonable accommodation under the ADA should be evaluated separately to determine if it would impose an undue hardship, taking into account:
- The nature and cost of the accommodation needed;
- The overall financial resources of the company, the number of employees, and the effect on expenses and resources of the business; and
- The overall impact of the accommodation on the business.
There are two issues that arise with returns to work that are risky for employers: (1) 100 percent healed policies and (2) light-duty rules.
Regarding 100 percent healed policies, employers cannot require an employee to be completely healed before returning to work because those rules violate the ADA’s requirements to allow workers to use their right to an accommodation. Even if the employee is not 100 percent healed, he or she could possibly still work effectively with an accommodation.
Employers may create light-duty positions as a reasonable accommodation under the ADA or as part of the return-to-work plan from workers compensation. The goal is to get employees back to work at 100 percent of the productivity that they had before the injury, and there are times when a light-duty position might be the next step, with lighter physical requirements and reduced productivity expectations.
Caution your clients to design the light-duty position to meet the physical requirements of the partially healed worker, so that there will be no physical reason for the employee to refuse the light-duty position.
Under most workers compensation plans, an employee’s refusal to return to work in a light-duty position that meets his or her medical restrictions can result in termination of workers compensation benefits. Additionally, the ADA does not allow an employee to refuse work that meets the physical requirements of the accommodation.
Without that careful look at the duties of the position as they pertain to the employee’s medical needs, however, the employee can refuse the position and continue to collect benefits until he or she is able to perform the requirements of the position.
Steps for SuccessWhile these laws have different goals, medical circumstances create overlaps between them. It is important to understand the rules and benefits in order to manage them correctly and avoid the risk of legal challenges and more expensive or longer leaves.
Advise your clients to:
- Designate FMLA leave for eligible employees concurrently with the workers compensation claim.
- Keep in touch with injured or ill employees throughout their leave.
- Manage pay and benefits according to each situation.
- Carefully evaluate requests for intermittent time off, light duty, or other modified work.
- Consult with your legal advisors and insurance carriers regarding special situations.
- Handle returns to work and reinstatement of benefits in accordance with the laws.
This article originally appeared on ThinkHR.com.
Many human resources and business leaders think about compliance in black-and-white terms. We simply check the boxes and evaluate compliance efforts using one measure: “Are we doing it right or not?”
It’s easy to fall into the trap of failing to see the broader implications of our compliance efforts. We need to go beyond, “What’s the law and what should I do about it?” We need to ask questions like, “How does this law intersect with our culture?” or “What best practices will support this requirement?” We need to understand that risk crosses our desks every day.
That’s where people risk management comes in.
People Risk Management: What It IsPeople risk management is simply the strategic and wholistic view of compliance. It’s really all about the end-to-end story; it’s how we deal with all the things that happen in the employee lifecycle in a way that minimizes risk while maximizing employee engagement.
It’s all about how we anticipate risk, reduce the likelihood of risk events, and deal with them when they do happen. The best companies proactively respond to risk in an ethical way that not just protects us from liability, but also builds trust and respect among the workforce.
People Risk Management: An ExampleLet’s say a new sexual harassment law goes into effect in your state. This triggering event (the new law) is just part of the issue. You need to take a big-picture view of the entire situation. You’ll need to know what you should anticipate, what you need to do, and how to evaluate your efforts to make sure you’ve addressed every risk.
Because this law is related to how people behave, in addition to administrative requirements, it can be difficult to understand how to simultaneously address both the risk of harassment and the risk of failing to comply with each aspect of the law. You also need to incorporate your response to this issue into your company culture to demonstrate that you care about protecting not just the company, but also your employees.
When engagement and compliance issues intersect, and you do both well, you create a culture that says you deal with stuff in a clear way, but also you protect yourself from legal risks. It’s a double benefit.
This article originally appeared on ThinkHR.com.
As we begin our new year of 2019, we have also closed 2018 with lots of celebrations, gift-giving, and family time. Showing appreciation for others during this generous season comes second nature for some but for others, it doesn’t. You may be looking for ideas on how to express your gratitude effectively to those around you and so we’ve compiled a list of five unique ways to say “thank you” to someone.
WRITE IT OUTReceiving a handwritten note is a rare occurrence in this day. Speaking or emailing a thank you is more common and does effectively communicate the gratitude of the sender. However, the spirit of gratefulness that is communicated by sitting down and taking pen to paper to express your thankfulness for the act or gift received, is a bonus to the note receiver. Take the extra time to write out that thank you.
PHONE A FRIENDIn a day and age of emails and texts and social media, we rarely get phone calls from people who aren’t asking for something—billing issues, appointment reminders, robo-calls. Even if the person on the other end of the call doesn’t pick up, leave that voicemail telling them thank you for their thoughtfulness for the gift you received. Be specific and mention the gift by name and what it meant to receive it. That phone call may be the brightest part of their day!
SAY IT ON SOCIAL MEDIAWe spend more time scrolling through social media than we do having face-to-face contact with people. Instead of getting caught up in a heated debate on NextDoor, take a few minutes to write on a friend’s wall to tell them thank you. It’s refreshing to see gratitude on display instead of incivility. And it’s always nice to see your friends get noticed for kindness!
FLASH A SMILEThe look of surprise on someone’s face is sometimes the greatest thank you that you can receive! The age old saying of “your face says it all” is true. When you open that gift and you can tell that the giver spent time thinking of the perfect thing to give you, look up and give them the thank you of a smile!
PAY IT FORWARDWere you bowled over by the thoughtfulness of a gift or act? A beautiful way to show your gratefulness is to pay it forward. Buy the coffee of the person behind you in line. Say three nice things to strangers on the way in to your office. Tell your child a character quality you see in them that is fabulous. While this act of gratitude may mean that the original giver never knows about the ripple effect of their gift, you will, and hopefully that ripple is carried on and on and on.
These acts of gratitude are simple, effective, and most of all, meaningful. We should all be more mindful of taking the time to say thank you!
On December 22, 2018 the U.S. Citizenship and Immigration Services (USCIS) and Department of Homeland Security (DHS) posted notice that due to the lapse in federal funding the E-Verify website will not be actively managed and will not be updated until funding resumes. Although some online resources will remain available for employers or employees to review, webinars, myE-Verify accounts, Form I-9 and E-Verify telephone support will not be available.
Understandably, employers may be concerned about how to proceed with hiring or maintaining their E-Verify account. Employers are encouraged to review the guidance on the E-Verify website outlining how to proceed with employment verification during the outage.
Several E-Verify policies have been implemented to assist employers during this time to minimize employer burden:
- The “three-day rule” for creating E-Verify cases is suspended for cases affected by the unavailability of E-Verify.
- The time period during which employees may resolve “tentative nonconfirmations” (TNCs) will be extended. The number of days E-Verify is not available will not count toward the days the employee has to begin the process of resolving their TNCs.
- USCIS and DHS will provide additional guidance regarding “three-day rule” and time period to resolve TNCs deadlines once operations resume.
- Employers may not take adverse action against an employee because the E-Verify case is in an interim case status, including while the employee’s case is in an extended interim case status due to the unavailability of E-Verify.
- Federal contractors with the Federal Acquisition Regulation (FAR) E-Verify clause should contact their contracting officer to inquire about extending federal contractor deadlines.
Although the use of E-Verify and live support are not available, employers that are actively hiring should proceed with the use of I-9’s and verify employment eligibility as required. The E-Verify website states:
“The lapse in government appropriations does not affect Form I-9, Employment Eligibility Verification requirements. Employers must still complete Form I-9 no later than the third business day after an employee starts work for pay, and comply with all other Form I-9 requirements outlined in the Handbook for Employers (M-274) and on I-9 Central.”
This originally appeared on ThinkHR.com.
How long has it been since your organization updated its employee handbook? It’s time to brush off any layers of dust that have accumulated over the years and make it a priority to conduct a review prior to the year’s end. This article highlights five evolving areas employers can focus on now to start the quickly-approaching new year off on the right foot.
1. #MeToo
The #MeToo movement has shone a spotlight on equal employment opportunity, sexual harassment, gender discrimination, and retaliation in the workplace. Employers may want to carefully review their policies on these subjects, including their complaint and investigation procedures. Harassment policies can include prohibitions against harassment based on any legally protected category in addition to addressing sexual harassment. As a best practice many employers include in their policies clear, complaint procedures that allow for multiple reporting avenues and are available during all shifts. In fact, employers may have an affirmative defense to a harassment claim if an aggrieved employee unreasonably fails to take advantage of an employer’s complaint procedures and other corrective measures. Appropriate training and consistent disciplinary enforcement are also key.
2. The NLRB’s New Guidance on Handbook Rules
In the recent past, much has been made regarding the National Labor Relations Board (NLRB) exercising authority over employers’ social media policies and other handbook policies. Yet, things appear to be shifting to a more employer-friendly direction. On June 6, 2018, on the heels of the Boeing decision, the Board’s general counsel (GC) issued an advice memorandum on the new standard for analyzing whether a work rule violates employees’ rights.
The GC’s memorandum analyzes common employer rules and provides guidance as to whether a complaint should be issued in terms of three categories of work rules: (1) those that are generally lawful, (2) those that require case-by-case evaluation, and (3) those that are unlawful. The memorandum emphasizes that the agency’s focus is now on whether a rule in question would actually be interpreted to cover protected concerted activity under Section 7 of the National Labor Relations Act. Specifically, the memorandum states that “ambiguities in rules are no longer interpreted against the drafter, and generalized provisions should not be interpreted as banning all activity that could conceivably be included.” Thus, the time is ripe for employers to reconsider their policies regarding civility, photography/recording, insubordination, disruptive behavior, confidentiality, disparagement, and conflicts of interest, among others.
3. Data Privacy
On March 28, 2018, Alabama followed the lead of 49 other states in requiring protection of sensitive consumer information and notice of data breaches, as well as imposing consequences for failing to comply with the law. Due to the prevalence of federal and state data privacy laws impacting the workplace, along with the implementation of the European Union’s new privacy law, the General Data Protection Regulation (GDPR), employers may want to scrutinize their existing privacy rules to ensure compliance.
4. Superfluous Language
Most employers have learned that including an at-will policy in an employee handbook reinforces the principle that employment may be terminated at any time for any lawful reason. Likewise, at-will policies can explicitly clarify that a handbook is not a contract and that employers may revise policies without prior notice.
Employers may also want to take caution to avoid potential promises made by superfluous language. Unnecessary purpose statements, rigid progressive discipline steps, and unrealistic commitments to provide training or a mutually enjoyable work environment can expose employers to liability. To prevent estoppel arguments, employers may want to ensure that they do not label personal or extended leave as falling under Family and Medical Leave Act (FMLA) when it does not.
5. Employee Acknowledgments and Training
Employee acknowledgements demonstrate evidence that employees have received a handbook. Employers can obtain these acknowledgments each time they update their handbooks. Employers can utilize acknowledgements to reiterate an at-will policy and to direct employees to raise any complaints or questions about the handbook or other personnel policies. An acknowledgment can also note that violations of any policy, whether or not identified in a handbook, can lead to discipline. When employers significantly update their handbooks, they also might want to take the opportunity to train their managers and employees.
Employers will find that dedicating the time and resources to reviewing employment policies on an annual basis may be well worth the investment.
This post originally appeared on Ogletree.com.
Question: Is the common flu considered a serious health condition under the Family and Medical Leave Act (FMLA)?
Answer: Most cases of the common flu do not meet the definition of “serious health condition” and would not be eligible for Family and Medical Leave Act (FMLA) leave.
Some cases of the flu, however, are severe or result in complications, and these have the potential to meet the FMLA definition of “serious health condition.” This is defined as an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a healthcare provider. Continuing treatment means:
- The employee has been incapacitated for a period of more than three full days; and
- Consults with a doctor two or more times within 30 days, or
- Has one consult with a doctor and a regimen of continuing treatment.
If an employee is out sick with the flu for more than three days, consider whether the need for FMLA leave may exist. This doesn’t mean that you need to go through the whole FMLA process to determine eligibility for each flu absence; just that you shouldn’t automatically reject FMLA requests for the flu either.
Review each case based on the facts, keep the “serious health condition” definition in mind, and if the illness is severe, ask the employee to submit certification from a health care provider to support the their need for leave protection under the FMLA.
This post originally appeared on ThinkHR.com.
Picture this: You’re sitting at your desk at 3 pm and realize you haven’t gotten up from your chair for hours. You realize you’ve been snacking instead of eating a lunch. You have read the same sentence four times and still can’t figure out what it means. Your back hurts, your eyes feel dry, and you feel totally blah. You, my friend, are a victim of a sedentary lifestyle. How can we combat this lack of energy and inattentiveness in our workplace? By adopting healthy workplace initiatives, you will reap the benefits of a more engaged workforce and a healthier environment.
What’s the problem?* The average worker sits 7.5 hours at a desk every day * Add in couch time, sitting to eat meals, commute, and sleeping, and it could mean that the average adult is only active for 3 hours in a 24-hour period * Prolonged sitting is directly related to higher risk of heart disease, weight gain, and diabetes * Poor posture can lead to chronic health issues such as arthritis and bursitis * Staring at computer screens for long amounts of time lead to higher instances of headaches and migraines
What’s the solution?* Healthy snack options in vending machines—SnackNation and Nature Box have healthy snack delivery services for offices of all kinds and sizes. * Fitness challenges—Encourage different office-wide challenges to promote a more active lifestyle.
+ Incentives for most consecutive gym check-ins
+ Step contests using fitness trackers such as FitBit, Pebble, and AppleWatch
+ Bike or Walk to Work Days
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Standing desks—Companies such as Varidesk make standing desks or sit/stand desks that lower and raise so that you vary your position during the day
- Reduces back pain
- Burns more calories during the day
- Increases energy
- Some insurance companies will cover all or portion of the cost if they deem it “medically necessary.”
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Practice gratitude—keep a daily log of things to be thankful for that day
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Shown to ease depression, curb appetite, and enhance sleep
- Spirit of gratefulness leads to more sustainable happiness because it’s not based on immediate gratification, it’s more of a state of mind
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Get moving during the day—if your office doesn’t have sit/stand desks, schedule time to move each day.
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Stretch time/desk yoga
- Computer programs to remind you to move such as “Move” for iOS and “Big Stretch Reminder” for Windows
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Extra happiness in the office—
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Add a plant
- Aromatherapy
- Host a cooking class to encourage healthy meal plans
- Pet-friendly office days
By showing your employees that you care about their physical and mental health you are showing that you care about them as people and not just employees. This results in higher motivated staff who are healthier. The Harvard Business Review even says that “employers who invested in health and wellness initiatives saw $6 in healthcare savings for every $1 invested.” You cannot always measure ROI on personnel investment, but it looks like for workplace wellness, you can! Now get moving and get your office moving!
As the holiday season approaches, the economy is humming along, unemployment is low, and companies are enjoying the fruits of corporate tax breaks. Time to celebrate? Not so fast, according to the 2018 Holiday Party Survey by Challenger, Gray & Christmas. The survey found that just 65 percent of companies are holding holiday festivities this year, the lowest rate since the 2009 recession.
While in 2009, holiday parties were skipped for financial reasons, the 2018 causes are more complex. Andrew Challenger, VP of Challenger, Gray & Christmas, speculates that the two biggest factors are #MeToo and an increase in the number of remote employees.
If your company is among those celebrating the holiday season this year, what can you do to avoid liability from sexual harassment, alcohol consumption, and other categories of risk?
Risk: Harassment Allegations Communicate behavior expectations to employees ahead of time. Consider using this language to set standards of conduct. You may even choose to redistribute your sexual harassment policy. Be sure to emphasize that all employee policies apply at the party, even if it is off-site or after work hours. Racial or sexual jokes, inappropriate gag gifts, gossiping about office relationships, and unwelcome touching will not be permitted during the holiday party, just as they are not allowed in the office. * Do not allow employees to get away with bad behavior. Remind your supervisors to set a good example and keep an eye out for employee behavior that needs managing at the event. * Follow up immediately on allegations of inappropriate behavior and conduct a thorough investigation of the facts, even if the alleged victim does not file a complaint and you only hear about the behavior through the grapevine. If corrective action is warranted, apply it promptly. * Invite significant others or families. Employee behavior tends to improve at company events when spouses or partners and children are present. If your budget allows, include the entire family in the celebration. Be sure to review your liability coverage with your broker first. * Avoid incidents related to relaxed inhibitions* by following the tips for reducing alcohol-related risks (see below).
Risk: Alcohol-Related Incidents Take steps to limit alcohol consumption. If alcohol will be served, provide plenty of food rich in carbohydrates and protein to slow the absorption of alcohol into the bloodstream. You can also have a cash bar, limit the number of drink tickets, or close the bar early to deter over-consumption. Also have a good selection of nonalcoholic beverages or a tasty signature “mocktail” available. Make sure water glasses are refilled frequently. * Get bartenders on board. If you have underage workers or invite children of employees, be sure that servers ask for ID from anyone who looks under age 30. Ask servers to cut off anyone who appears to be intoxicated. * Make sure employees get home safely. Offer incentives to employees who volunteer to be designated drivers, offer to pay for ride shares or taxis, or arrange group transportation or accommodations. Planning for safe transportation can potentially minimize your liability if an employee causes an accident while driving under the influence. * Do not serve alcohol if your party is at the office and your policies do not permit drinking* on company premises or during work hours. Deter employees from an informal after-party at a bar or restaurant where the alcohol could flow.
Risk: Workers’ Compensation Claims Keep the party voluntary and social. Typically, workers’ compensation does not apply if the injury is “incurred in the pursuit of an activity, the major purpose of which is social or recreational.” If the carrier determines that the company party was truly voluntary and not related to work, you may not be liable for injuries sustained at the party. * Go offsite. Hosting your holiday party at an offsite location is a smart idea. Your employees will be thankful for the change in setting, and this could reduce insurance liabilities for your company, especially when it comes to third-party alcohol and injury policies. * Check with your broker before the party.* Review your insurance policies and party plans to make sure you do everything you can to avoid risk and know how to handle any incidents that result from the party.
Risk: Perceptions of Unfairness Determine how to handle pay issues in advance of the party. You’re not required to pay employees who voluntarily attend a party after hours. However, nonexempt employees need to be compensated if they are working the party or if attendance is mandatory. If the party is held during regular work hours, then all employees must be paid for attending the party. * Decide in advance whether and how to include remote employees, independent contractors, temporary employees, or agency workers.* Be consistent in sending invitations, and if a category of workers will not be invited to the party, consider other ways to reward them for their hard work throughout the year, such as gifts. * Do not penalize employees who choose not to attend.** The message may be misinterpreted and could create employee relations concerns. Be considerate of those who do not attend the event due to religious beliefs, sobriety, mental health issues, family obligations, child care conflicts, or any other reasons. Avoid religious symbols or themes as they could offend individuals of different faiths.
If your company received a rebate check from your health insurance carrier, there are restrictions on how you can use the rebate money. Read this short article to learn more.
Study after study has shown that no one is immune from the motivating effects of acknowledgement and thanks. If you’re not quite sure how to communicate your appreciation, read this article to learn more.
Cybercriminals are becoming more focused on users of company networks as a weak link in the security infrastructure chain. Secure web gateways, anti-virus tools, malware scanners, spam quarantines, and other technologies help filter out malicious content and defend against a growing variety of threats, but technology alone cannot stop humans from clicking on the wrong links.
Gone are the days when cybersecurity was the sole responsibility of the corporate IT department. Cyber safety programs are a best human resources practice and should be included in new employee onboarding and ongoing training awareness programs. HR might even consider incentive plans for helping keep networks safe.
Why? Employees are vulnerable to malware through their use of company email, the web, social media, instant messaging, and other communication and network software. Employees must be able to spot the types of attacks that may compromise company networks and be ready to use best practices against data breaches and malware infiltration as part of the organization’s overall risk prevention program.
How Pervasive is the Threat?According to Michael Osterman of Osterman Research, Inc., there is more than a one-in-four chance that a user will mistakenly click on a phishing email and infect a corporate network. Costs to affected companies are steep. A recent example is the city of Atlanta, where a single ransomware infection cost the city more than $2.6 million. Trend Micro predicts worldwide losses from business email compromise (BEC) attacks at more than $9 billion in 2018.
Osterman Research conducted a study of organizations that had been victims of security incidents between March 2017 and March 2018 and found:
- 9% were victims of phishing attacks that successfully infected systems with malware.
- 25% had targeted email attacks launched from a compromised account that infected a network endpoint with malware.
- 25% had sensitive/confidential information accidentally leaked through email.
- 1% suffered targeted email attacks launched from a compromised account that successfully stole a user’s account credentials.
- 1% had files encrypted because of a successful ransomware attack.
- 2% saw malware infiltrate internal systems without being able to pinpoint the source of attack.
- 2% had one or more systems successfully infiltrated through a “drive-by” malware attack from employee web surfing.
- 3% had a CEO fraud/BEC email attack that successfully tricked one or more employees in the organization.
- 7% had sensitive/confidential information accidentally or maliciously leaked through a cloud-based file sharing tool like Dropbox.
- 8% were victims of sensitive/confidential information accidentally or maliciously leaked through a social media or cloud application.
One reason we are seeing increased vulnerability to cyberattacks stems from a growing attack “surface,” or possible entry points for malware and other malicious attacks. Most employees use multiple company-provided hardware and software products that widen that attack surface. These represent ingress points for various types of threats and often are a more serious problem because their use is not as well controlled by IT, if they’re controlled at all.
Cyberthreats Aimed at EmployeesWhat types of threats should your employees be trained to spot so that they think before they click? Here are the most common ones:
Phishing emails. These are relatively unfocused email messages designed to collect sensitive information, such as login credentials, credit card information, Social Security numbers, and other valuable data. Phishing emails pretend to come from trustworthy sources like banks, credit card companies, shippers, and other sources with which potential victims have established relationships. More sophisticated phishing attempts use corporate logos and other identifiers to fool potential victims into believing the emails are genuine.
Spearphishing emails. These are targeted phishing attacks typically focused on one company or affinity group (such as an industry organization), reflecting the fact that a cybercriminal has studied the target and crafted a message designed to have a high degree of believability and a potentially high open rate.
Consumer file sync and share tools. Productivity tools like Dropbox, Microsoft OneDrive, and Google Drive, which let users make files available on all desktop, laptop, and mobile platforms, generally are safe but can be targeted by sophisticated criminals as an entry point. For example, when an employee accesses corporate files on a home computer that doesn’t have current anti-virus software, the employee can inadvertently infect these files with malware. When files are synced back to the employee’s work computer, malware can infect the network because it may have bypassed corporate email, web gateway, and other defenses.
Watering holes. In these social engineering attacks, cybercriminals identify websites they would like to infiltrate and that employees might visit on a regular basis. They infect these sites with malware.
Malicious Internet advertising (malvertising). This is designed to distribute malware through advertising impressions on websites.
User errors. Users sometimes inadvertently install malware or compromised code on their computers. This can occur if they install ActiveX controls, download a codec, install various applications intended to address some perceived need (such as a capability that IT does not support), or respond to scareware attempts that prey on users who are trying to protect their platforms from viruses and other malware.
Mobile malware. The growing use of smartphones and tablets is increasingly being exploited by cybercriminals. Most infections impact Android devices.
Compromised search engine queries. Valid queries can be hijacked by cybercriminals to distribute malware when employees perform web searches. This type of attack relies on poisoning results, leading to the display of malware-laden sites during these searches. This is particularly effective for popular search terms, such as information on celebrities, airline crashes, natural disasters, and other “newsy” items.
Mobile copycat apps. Some mobile applications are distributed through vendor-based and third-party stores that offer varying levels of security. If the store lacks stringent standards, serious security risks like distribution of copycat apps and malware that can cause infections when downloaded can occur.
Botnets. These are the source of many successful hacking and phishing attacks against high-profile targets. A CenturyLink Threat Research Labs study for a 2018 threat report tracked an average of 195,000 threats per day from botnets impacting an average of 104 million unique targets, from large servers to handheld devices, that steal sensitive data and launch network attacks impacting businesses worldwide.
Ransomware. In this particularly malicious form of attack, a cybercriminal can encrypt all files on a hard disk and then demand ransom for access to a decryption key. Victims who choose not to pay the ransom quickly will have their files remain encrypted permanently. Cryptolocker, a common variant of ransomware, typically extorts a few hundred dollars per incident and normally is delivered through email with a PDF or .zip file disguised as a shipping invoice or some other business document.
Hacking. With this form of cyberattack, cybercriminals use many techniques to breach corporate defenses.
Think Before You ClickTrain employees to become the first line of defense in the network security risk prevention infrastructure. First, remind them to physically protect devices by not leaving them unattended or in unsecure areas, including locked cars. Focus training on identifying the types of malware they may encounter and how to escalate attempts to the IT professionals for resolution. Use a catchy slogan, like “think before you click,” to create engagement and promote awareness.
Here are some simple training tips:
- Be skeptical of any email, web page, or social media post that appears to be even remotely suspicious, makes an offer that is too good to be true, or contains strange information.
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Ask questions. Michael Osterman recommends asking these questions when viewing emails:
- Do you recognize the sender’s email address?
- Do you recognize anyone else copied on the email?
- Are others in the email seemingly from a random group of people or do their last names all begin with the same letter?
- Is the domain in the email address spelled correctly or is it simply close to the actual URL (e.g., bankofamerica.com vs. bankofarnerica.com).
- Would you normally receive an email from this individual or organization?
- Does the subject line make sense?
- Is the email a “response” to an email you never sent (e.g., does it begin with “re:”)?
- Does the email contain an attachment that does not make sense in the context of the email or sender?
- Does the attachment end in “.exe,” “.zip,” or some other possibly dangerous attachment type?
- Did you receive an email at an unusual time, such as 3 a.m. on a Sunday?
- Is the sender asking you to keep the contents of this email or requests within it a secret?
- Does the email contain spelling or grammatical errors?
- Is there even a hint of extortion in the email, such as a request to look at compromising or embarrassing photos of you or someone else?
- Review quarantined messages carefully before bringing them out of quarantine. Most anti-spam solutions capture phishing emails correctly.
- Don’t click on a link in an email or open an attachment until you are certain it is valid.
- Never use USB flash drives from unknown sources.
- Set strong passwords. Change passwords regularly.
- Use password protection on every electronic and mobile device.
- Intentionally use wrong information for security questions.
- Keep security software up to date on personal devices.
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For mobile devices:
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Disable auto usernames and passwords. This reduces the risk of having personal data accessed if the device is lost or stolen.
- Know how to wipe your data if your device is lost or stolen.
- Be careful when using public Wi-Fi networks, especially with insecure networks that do not require a password.
- Use safe stores for downloading mobile applications.
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For social media:
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Don’t overshare personal information on social media.
- Turn off location services.
- Be careful clicking on links, liking, and sharing them.
Cyber Risk Prevention is Everyone’s JobDon’t put it off — take the time to implement or enhance security awareness training for employees, contractors, and others who interact with corporate systems and data sources. Create a stronger line of defense against increasingly sophisticated cyber threats now. Preventing even one employee from making an honest mistake and clicking on the wrong link could save the business from reputational and financial losses. Clients will appreciate having the information to protect their home computers and personal devices, too!
This article was originally posted on ThinkHR.com.
On November 1, 2018, the Internal Revenue Service (IRS) released Notice 2018-83announcing cost-of-living adjustments affecting dollar limits for pension plans and other retirement-related items for tax year 2019. Many pension plan limits will change next year because the increase in the cost-of-living index has met the statutory thresholds that trigger their adjustment. Other items, however, will remain the same. The following is a summary of the limits for 2019.
For 401(k), 403(b), and most 457 plans and the federal government’s Thrift Savings Plans:
- The elective deferral (contribution) limit increases from $18,500 to $19,000 for 2019.
- The catch-up contribution limit for employees aged 50 and over who participate in these plans remains at $6,000.
For individual retirement arrangements (IRAs):
- The limit on annual contributions has not changed for many years. For 2019, however, it increases from $5,500 to $6,000.
- The additional catch-up contribution limit for individuals aged 50 and over is not subject to an annual cost-of-living adjustment so it remains $1,000 for 2019.
For simplified employee pension (SEP) IRAs and individual/solo 401(k) plans:
- Elective deferrals increase to $56,000 for 2019, based on an annual compensation limit of $280,000 (up from the 2018 amounts of $55,000 and $275,000).
- The minimum compensation that may be required for participation in a SEP remains unchanged at $600 for 2019.
For savings incentive match plan for employees (SIMPLE) IRAs:
- The contribution limit on SIMPLE IRA retirement accounts increases to $13,000 for 2019 (from $12,500 for 2018).
- The SIMPLE catch-up limit remains unchanged at $3,000 for 2019.
For defined benefit plans:
- The basic limitation on the annual benefits under a defined benefit plan is increased to $225,000 for 2019 (from $220,000 for 2018).
Other changes:
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Highly-compensated and key employee thresholds:
- The threshold for determining “highly compensated employees” increases to $125,000 for 2019 (from $120,000 for 2018).
- The threshold for officers who are “key employees” in a top-heavy plan increases to $180,000 for 2019 (from $175,000 for 2018).
- Social Security cost of living adjustment: In a separate announcement, the Social Security Administration stated that the taxable wage base will increase to $132,900 for 2019, an increase of $4,500 from the 2018 taxable wage base of $128,400. Thus, the maximum Social Security tax liability will increase for both employees and employers.
This article originally appeared on ThinkHR.com.
Election Day is next Tuesday, November 6. Do you know what provisions, if any, you must make to accommodate your employees’ rights to vote? Time off for voting is not a federal requirement; however, 30 states have voting leave laws impacting the workplace.
These state laws vary significantly. Not all leave is required to be paid, and the amount of time varies. For some states it’s described as “reasonable time” necessary to vote, and in other states the law specifically states two, three, or even four hours to vote. Furthermore, some states, such as California and New York, require you to post notices of employees’ rights for time off to get to the polls.
Twelve of the 30 states also impose penalties for employers who prohibit employees from voting. For example, Colorado and New York employers could lose their corporate charter and Arizona, Missouri, and Kansas supervisors could face fines up to $2,500. While 20 states and the District of Columbia do not have voting leave laws in place, there are other provisions you should be aware of when it comes to your employees exercising their voting rights.
Even if your state doesn’t have a law in place requiring you to provide voting leave, that does not preclude you from having a company policy in place that provides voting leave. In addition to offering employees time on election day to vote, you could also remind employees about absentee or early voting options in your community.
Be ready for the midterm elections this November by knowing your time off rules and encourage your employees to exercise their civic duty to vote!
We all get cold feet when it comes to addressing difficult issues with colleagues in the workplace. It’s stressful, and you just can’t help but think of all of the ways that a well-meaning conversation could go sideways. You worry about the longer-lasting effects of a damaged work relationship but know that you must correct problematic work performance or behaviors before they get out of control.
Uncomfortable conversations about personal behaviors and poor performance are tough, and putting them off just allows the problems to worsen. Use your knowledge of the situation and put together the right combination of management skills to tackle the talk now.
Imagine these all-too-familiar employee situations that you know you need to address but don’t think you have the wisdom (or can’t muster up the courage) to handle:
- The “No Good Deed Goes Unpunished” situation. For the past several months, one of your team members has been underperforming, and it has dragged down your business unit’s productivity. The underperforming employee has shared that she has a number of family and financial issues and is trying her hardest to stay ocused on work because she needs this job and loves the company. She lives your company values and is well-liked by her co-workers. Everyone feels bad for her situation and has been picking up the slack, but they are growing resentful of the extra work with no end in sight. You’ve been trying to be kind by avoiding the issues as her performance has slid from bad to worse. It is now impacting your company’s overall performance and degrading the employee relations climate.
- The “Bad Behavior, Great Performer” situation. One of your employees consistently exceeds his production goals at the expense of the company culture. He is highly critical of others, issues demands from other work teams without regard for their other priorities, and employees grudgingly drop everything to deliver on impossible deadlines because they believe that they cannot push back. It’s all about him and his performance. He is regularly recognized by the company leadership for being the top producer, and employee complaints to management about his behavior have not been addressed. While production goals are good, your company culture is sinking and you’re starting to see increased absenteeism and turnover among your staff.
Don’t Overlook the SignalsIn addition to employee resentment and lost productivity, there’s a bottom-line impact for not tackling these tough talks at the right time and in the right manner. The key is to pay attention to the signals and not feed the problem with neglect.
In the first scenario, trying to be a kind and sensitive boss worked in the beginning but is now backfiring. At first the team worked together to help their struggling colleague, but without a plan to fix the problem in the longer term, it created three serious issues for you to fix: employee morale, lack of confidence in your leadership for missing the signals of “team fatigue,” and not having a plan to keep the team on track — all resulting in lost productivity.
The best thing you can do in situations like these is to work with the struggling employee to develop a plan that puts her back on track or helps her consider alternatives if necessary. This type of conversation requires sensitivity along with some firmness because you need to steer the conversation from the personal issues back to actionable work deliverables.
In my experience dealing with circumstances like the second scenario, typically management allows the top performer’s behavior to go unchecked for fear that if the employee is corrected his performance will suffer or he will quit the company. While there may be an element of truth to those concerns if the individual is unwilling to accept constructive feedback, the bigger fear should be for the company’s culture, employee erosion of trust and confidence in the leadership team, and the motivation, performance, and retention of the other company employees if the behavior is not changed.
Often the top performer continues to use the same work patterns that have been successful and isn’t even aware of the impact on others. Addressing the issues sensitively so that he can make personal changes has the potential to create even higher levels of team unity and performance.
What Signals are You Looking For?For starters, watch your team’s interactions with each other, be sure that each team member understands their key performance objectives, and take the time to “check in” regularly and solicit feedback about the job, work team, and overall company with each employee.
Having direct conversations on a regular basis helps you nip problems in the bud and shows your employees that you care about their concerns. You also learn each other’s communication patterns so that when it comes time to have that awkward or difficult conversation, you both are less uncomfortable.
Groups where team members work remotely increase the chances that signals can be missed. When telecommuting is coupled with the use of instant messaging and other forms of communications in place of direct face-to-face or voice communications, the sender’s well-intentioned messages may get lost in translation. Be sure to follow up any electronic communications with a direct phone call or meeting.
Eight Tips for Tackling These ConversationsStrategies to manage conflicts with subordinates are not fully taught in business classes. More common are courses addressing project conflicts, where the focus is on fixing the “what” of the problem, such as resetting priorities, changing business plans, or repairing broken systems or processes. There are fewer tools focusing on how teams communicate and repairing broken business relationships. Preparation and planning are critical to get what you need from these hard conversations while keeping your relationship with the employee intact.
- Focus your own viewpoint first. If you start out thinking the conversation will be really hard, you’re going to be more anxious. Chances are the conversation will be harder. Instead, position this discussion as a means to enhance your relationship while helping your employee develop better skills, understand company priorities better, or work more positively on the team. Think about how you can deliver the difficult talking points with honesty, courage and fairness.
- Recognize the emotions you will be feeling. Are you disappointed in this employee? Angry about the problems they’ve caused? Scared that your conversation will damage your work relationship? Put your negative feelings aside and consider how you will frame the problem you need to discuss and how your employee may feel. Try to come at the discussion with consideration and compassion for their feelings and frame the conversation with a desire for the employee’s success. “John, we need to have a hard conversation today, and I’m feeling anxious because I want you to win. Please know that I am invested in your success and will work with you to make that happen.”
- Be intentional in planning the conversation, but don’t script it out so that your delivery sounds mechanical. Some business consultants suggest drafting a script and considering alternatives based on the employee’s reactions. In my experience, these conversations never go completely according to plan, and scripted conversations feel artificial. Instead, write down key points and plan as if you are just having a simple conversation with a colleague. Be prepared to provide specifics and pace your conversation so that you take time to gauge your employee’s reactions to your comments. Your employee may react defensively if you provide vague statements. Instead of saying, “Sue, people in the company are telling me that you are difficult to work with and have a bad attitude,” frame the issue with examples, such as, “Sue, I am concerned because I’ve noticed in the last four team meetings you arrived late and weren’t prepared with project updates. As a result, both Joe and Sam missed their deliverables, and you didn’t let any of us know in advance that the timeline was slipping.”
- Recognize that you own part of the problem, too. Your goal is to have a conversation between adults where each owns some responsibility for the issue and solving the problem. This takes the conversation from finding fault to finding solutions. “Rob, I realize now that you have too many priorities and I didn’t provide you with the resources to deliver on the project. I also realize that I avoided addressing the problem at the beginning of the project and let it go too long without discussing it with you.”
- Outline what you want changed. Don’t just discuss the problem; describe the end result you envision. Discuss realistic and achievable outcomes and be willing to offer resources and assistance as appropriate.
- Ask the employee for his or her viewpoints. The last thing you want is a one-sided conversation. Slow the pace of the conversation, observe the employee’s reactions to your comments, and ask for feedback and suggestions for solving the problem. You may learn new information about what may have caused the problem, and the employee could offer even better solutions than you thought possible. Throughout the conversation, look for areas of consensus and acknowledge the employee’s feelings and concerns. That shows respect.
- End the conversation on a positive note with an action plan. Thank the employee for working with you through the difficult discussion. Acknowledge that it was a tough conversation and express appreciation for the employee’s professionalism as you both work towards a better outcome. Develop a going-forward action plan to solve the problem. “Tom, this was a hard talk, and I know it wasn’t easy for you. You provided some good ideas for fixing the issue, and I appreciate your professionalism. You can do this, and I am here to help you win.”
- Close the loop and follow up. Give the employee a little time to reflect on the discussion, but no more than a day or two. Follow up and ask the employee if they would like to have another discussion to cover any additional information or clarification. Put the agreed-upon action plan in writing, schedule regular status meetings, and recognize progress and improved performance. Taking these steps demonstrates your respect for the employee and desire for them to succeed.
Keep the Conversation GoingGreat managers keep the conversation going to ensure team members are aligned and supporting each other to create a healthy corporate culture and successful company. When problems arise, they have the tough conversations to get things back on track. Handling these discussions well takes courage as well as empathetic listening and communications skills. Pay attention to the signals, develop your communications plan, and you’ll be more confident in tackling your next tough employee communications challenge.
Originally published by www.thinkhr.com
While there is no law that prohibits employers from mandating flu shots, you should carefully determine if the benefits to your business outweigh the risks. Read the article to determine the best course of action, from incentives to suggestions about policy wording.
We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.
Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.
Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.
Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offer
Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”
As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.
Gupton’s work on the opioid crisis continues to get attention. October 9th, Employee Benefit Advisor Magazine published an article on Gupton’s motivators, statistics, current pushes, and ideas on how an employee benefit consultant can impact the opioid crisis.
Question: Our company is getting ready for open enrollment. Can we distribute ERISA notices electronically instead of printing and delivering hard copies?
Answer: Yes, electronic delivery complies with ERISA’s disclosure rules – but certain conditions must be met.
First, whether delivered in hard copy or electronic media, ERISA requires preparing and furnishing materials “in a manner consistent with applicable style, format, and content requirements.” It is a good idea to test electronic documents to make sure the formatting and style are correct.
Secondly, materials must be furnished using “measures reasonably calculated to ensure actual receipt.” For instance, if using a traditional delivery method, such as first-class mail, be sure to follow up on any undelivered/returned mail.
For electronic delivery, the compliance rules work differently depending on whether the recipients have regular access to the employer’s electronic information system:
- Regular access means the recipients use the system, such as the employer’s email system or intranet, as an integral part of their regular job duties. This may include employees who work from home or who are traveling. However, simply having access to a kiosk in a workplace common area does not qualify as having regular access.
- Without regular access means all other recipients. This may include employees on leave as well as non-employees such as COBRA participants, retirees, and alternate payees. For this group, electronic delivery does not comply with ERISA unless the recipient first affirmatively consents to receive the material electronically, provides an electronic address, and reasonably demonstrates their ability to access the material in electronic form. Since the process to secure consent is fairly cumbersome, most employers choose to distribute materials to this group using traditional hard-copy methods instead of electronic delivery.
Both groups of recipients must be notified of their rights to receive paper copies of the documents (at no charge), and reasonable and appropriate steps must be taken to safeguard confidentiality of personal information related to benefits. A best practice is for employers to ensure return-receipt or notice of undelivered mail features are enabled. Employers may conduct periodic reviews or surveys to confirm receipt as well.
Just emailing documents or posting them on the company’s intranet or benefit administration portal is not enough. Each time an electronic document is furnished, a notice (electronic or paper) must be provided to each recipient describing the significance of the document.
Originally published by www.thinkhr.com
Are you an employer that offers or provides group health coverage to your workers? Does your health plan cover outpatient prescription drugs — either as a medical claim or through a card system? If so, be sure to distribute your plan’s Medicare Part D notice before October 15.
PurposeMedicare began offering “Part D” plans — optional prescription drug benefit plans sold by private insurance companies and HMOs — to Medicare beneficiaries many years ago. People may enroll in a Part D plan when they first become eligible for Medicare.
If they wait too long, a late enrollment penalty amount is permanently added to the Part D plan premium cost when they do enroll. There is an exception, though, for individuals who are covered under an employer’s group health plan that provides creditable coverage. (“Creditable” means that the group plan’s drug benefits are actuarially equivalent or better than the benefits required in a Part D plan.) In that case, the individual can delay enrolling for a Part D plan while he or she remains covered under the employer’s creditable plan. Medicare will waive the late enrollment premium penalty for individuals who enroll in a Part D plan after their initial eligibility date if they were covered by an employer’s creditable plan. To avoid the late enrollment penalty, there cannot be a gap longer than 62 days between the creditable group plan and the Part D plan.
To help Medicare-eligible plan participants make informed decisions about whether and when to enroll in a Part D drug plan, they need to know if their employer’s group health plan provides creditable or noncreditable prescription drug coverage. That is the purpose of the federal requirement for employers to provide an annual notice (Employer’s Medicare Part D Notice) to all Medicare-eligible employees and spouses.
Employer Requirements
Federal law requires all employers that offer group health coverage including any outpatient prescription drug benefits to provide an annual notice to plan participants.
The notice requirement applies regardless of the employer’s size or whether the group plan is insured or self-funded:
- Determine whether your group health plan’s prescription drug coverage is creditable or noncreditable for the upcoming year (2019). If your plan is insured, the carrier/HMO will confirm creditable or noncreditable status. Keep a copy of the written confirmation for your records. For self-funded plans, the plan actuary will determine the plan’s status using guidance provided by the Centers for Medicare and Medicaid Services (CMS).
- Distribute a Notice of Creditable Coverage or a Notice of Noncreditable Coverage, as applicable, to all group health plan participants who are or may become eligible for Medicare in the next year. “Participants” include covered employees and retirees (and spouses) and COBRA enrollees. Employers often do not know whether a particular participant may be eligible for Medicare due to age or disability. For convenience, many employers decide to distribute their notice to all participants regardless of Medicare status.
- Notices must be distributed at least annually before October 15. Medicare holds its Part D enrollment period each year from October 15 to December 7, which is why it is important for group health plan participants to receive their employer’s notice before October 15.
- Notices also may be required after October 15 for new enrollees and/or if the plan’s creditable versus noncreditable status changes.
Preparing the Notice(s)Model notices are available on the CMS website. Start with the model notice and then fill in the blanks and variable items as needed for each group health plan. There are two versions: Notice of Creditable Coverage or Notice of Noncreditable Coverage and each is available in English and Spanish:
- Model Notice for Group Plan that is Creditable Coverage (English)
- Model Notice for Group Plan that is Noncreditable Coverage (English)
- Model Notice for Group Plan that is Creditable Coverage (Spanish)
- Model Notice for Group Plan that is Noncreditable Coverage (Spanish)
Employers who offer multiple group health plan options, such as PPOs, HDHPs, and HMOs, may use one notice if all options are creditable (or all are noncreditable). In this case, it is advisable to list the names of the various plan options so it is clear for the reader. Conversely, employers that offer a creditable plan and a noncreditable plan, such as a creditable HMO and a noncreditable HDHP, will need to prepare separate notices for the different plan participants.
Distributing the Notice(s)You may distribute the notice by first-class mail to the employee’s home or work address. A separate notice for the employee’s spouse or family members is not required unless the employer has information that they live at different addresses.
The notice is intended to be a stand-alone document. It may be distributed at the same time as other plan materials, but it should be a separate document. If the notice is incorporated with other material (such as stapled items or in a booklet format), the notice must appear in 14-point font, be bolded, offset, or boxed, and placed on the first page. Alternatively, in this case, you can put a reference (in 14-point font, either bolded, offset, or boxed) on the first page telling the reader where to find the notice within the material. Here is suggested text from the CMS for the first page:
“If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage. Please see page XX for more details.”
Email distribution is allowed but only for employees who have regular access to email as an integral part of their job duties. Employees also must have access to a printer, be notified that a hard copy of the notice is available at no cost upon request, and be informed that they are responsible for sharing the notice with any Medicare-eligible family members who are enrolled in the employer’s group plan.
CMS Disclosure RequirementSeparate from the participant notice requirement, employers also must disclose to the CMS whether their group health plan provides creditable or noncreditable coverage. The plan sponsor (employer) must submit its annual disclosure to CMS within 60 days of the start of the plan year. For instance, for calendar-year group health plans, the employer must comply with this disclosure requirement by March 1.
Disclosure to CMS also is required within 30 days of termination of the prescription drug coverage or within 30 days of a change in the plan’s status as creditable coverage or noncreditable coverage.
The CMS online tool is the only method allowed for completing the required disclosure. From this link, follow the prompts to respond to a series of questions regarding the plan. The link is the same regardless of whether the employer’s plan provides creditable or noncreditable coverage. The entire process usually takes only 5 or 10 minutes to complete.
Originally published by www.thinkhr.com
Question: Our company offers flexible spending accounts (FSAs) for health care and dependent daycare. Our plan limits are the maximum amounts allowed by federal law. Will the IRS increase the limits for 2019? We hold open enrollment in November for employees to make their FSA elections for the following year.
Answer: The maximum annual limits for Dependent Care FSAs and Health Care FSAs are set forth under § 129 and § 125, respectively, of the Internal Revenue Code.
The § 129 (Dependent Care) limits do not change from year to year. They are currently $5,000, or $2,500 if married and filing separately, and they apply on a calendar-year basis. To change them would require a change in law, which is unlikely in the current Congress.
On the other hand, the maximum limit for elective contributions to a Health Care FSA (HFSA) may change from year to year depending on inflation. The limit applies on a plan-year basis and the HFSA limit for a 12-month plan year beginning in 2018 is $2,650. The limit is one of over 50 different tax provisions that is subject to annual cost-of-living or inflation adjustments. Each fall, the IRS announces any changes for the following year. The announcement usually is released in mid-October, which should give employers time to prepare 2019 enrollment materials.
Based on estimated inflation, it appears the HFSA limit will increase from $2,650 for plan years beginning in 2018 to $2,700 for plan years beginning in 2019. The increase will not be official, however, until the IRS announcement is released.
Originally published by www.thinkhr.com
We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.
Check out these four things to look at as you go into Open Enrollment season!
The Affordable Care Act’s employer shared responsibility provision — often called the employer mandate or “play or pay” — requires large employers to offer health coverage to their full-time employees or face a potential penalty. (Employers with fewer than 50 full-time and full-time-equivalent employees are exempt.) Large employers can avoid the risk of any play or pay penalties by offering all full-time employees at least one group health plan option that meets two standards: It provides minimum value and it is affordable.
Minimum value means the plan’s share of total allowed costs is at least 60 percent and the plan provides substantial coverage of physician services and inpatient hospital services.
Affordable means the employee’s required contribution (payroll deduction) for self-only coverage, if elected, does not exceed a certain percentage of the employee’s household income. The affordability percentage changes slightly each year based on the law’s indexing rule. For 2018, the percentage is 9.56 percent. For 2019, however, the percentage increases to 9.86 percent.
Although the change is minor, it means that employers may increase their plan’s employee-only contribution rate and still meet the affordability standard next year.
Determining AffordabilityThe first step in determining whether a group health plan option is affordable is to define the employee’s “income.” Employers do not know their workers’ total household income, so the play or pay rules offer employers three optional safe harbor methods to define income using information known to the employer. Employers may use any of the safe harbor methods. They also may use different methods for different classes (such as one method for hourly employees and another method for salaried employees), provided that the chosen method is applied uniformly to all employees in the class.
The three IRS safe harbor methods are:
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Federal Poverty Line (FPL)The FPL method is the easiest of the three methods. Multiply the mainland FPL amount for a single-member household by the affordability percentage, then divide by 12. As long as the self-only contribution rate does not exceed the resulting amount, the plan’s coverage is deemed affordable. For instance:
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2018: ($12,060 x 9.56%)/12 = $96.08 per month
- 2019: ($12,140 x 9.86%)/12 = $99.75 per month
The FPL chart is updated every year in late January. For 2019 calendar-year health plans, the employer needs to refer to the current FPL amount ($12,140) since the new FPL amount will not be available until after the plan year starts. If the health plan year starts February 1, 2018 or later, however, the employer may refer to the new FPL amount which likely will be a little higher.
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Rate of PayThis is the most convenient method to define income when applied to hourly employees. Multiply the employee’s hourly rate of pay times 130 hours per month (regardless of how many hours he or she actually works), then multiply by the affordability percentage. As long as the self-only contribution rate does not exceed the resulting amount, the plan’s coverage is deemed affordable. For instance:
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2018: ($11* x 130) x 9.56% = $136.70 per month
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2019: ($11* x 130) x 9.86% = $140.99 per month
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Replace $11 with the hourly employee’s rate of pay.
For salaried employees, the rate of pay method is somewhat complicated so employers generally avoid using this method for non-hourly employees.
- W-2The W-2 method requires using current W-2 wages instead of looking back at the prior year. W-2 wages means the amount that will be reported in Box 1 of Form W-2. Pretax contributions, such as § 125 plan contributions and 401(k) or 403(b) plan deferrals, are not included in Box 1, so using the W-2 safe harbor method may understate the employee’s actual income. Coverage will be deemed affordable if, for each month of the plan year, the self-only contribution does not exceed the Box 1 amount multiplied by the affordability percentage.
SummaryLarge employers can avoid the risk of potential penalties under the ACA’s play or pay rules by ensuring that they offer full-time employees at least one minimum value plan option that also is affordable. Affordable means the employee’s contribution to elect self-only coverage would not exceed a certain percentage of the employee’s income.
The percentage used to determine affordability changes from year to year is based on the law’s indexing formula. For 2018 plan years, the affordability percentage is 9.56 percent, but it increases to 9.86 percent for 2019 plan years. Employers and their advisors will want to keep this information in mind as they finalize their group health plan offerings and employee contribution rates for 2019.
Originally published www.thinkhr.com
The coals from the Labor Day barbecues have cooled, the beach chairs have been returned to their sheds, the ice cream shops have scaled back their hours, and the white shoes have been set aside for the next nine months. Whatever the end of summer means to you, for millions of families, it signals the return to school for children in preschool through college.
This means your employees will likely need to take a few hours out of their workday occasionally to participate in their children’s education. Parents’ fall calendars are often packed with school events, parent-teacher conferences, and/or parent meetings – some of which will inevitably occur during their usual working hours – and any flexibility you give them to attend these events, or even volunteer in the classroom or chaperone a field trip, will be greatly appreciated.
Where it’s the lawNine states and the District of Columbia have passed laws protecting parents’ rights to take small increments of time away from work to attend to school matters. They vary widely in their specifics regarding eligibility for leave, whether the time is paid or unpaid, and the amount of time available for use. (ThinkHR customers can get details about each state’s provisions by clicking the act titles listed below after logging into to your ThinkHR account.)
- California Family-School Partnership Act: Up to 40 hours each year, up to eight hours per month
- District of Columbia Parental Leave Act: Up to 24 hours of leave during a 12-month period
- Illinois School Visitation Rights Act: Up to eight hours during any school year, but not more than four hours in one day
- Louisiana School and Day Care Conference and Activities Leave Act: Up to 16 hours per year
- Massachusetts Small Necessities Leave Act: Up to 24 hours every 12 months
- Minnesota School Conference and Activities Leave: Up to 16 hours every 12 months
- Nevada Leave for School-Related Activities: Up to four hours per school year
- North Carolina Parental Leave: Up to four hours per year
- Rhode Island School Involvement Leave: Up to 10 hours during any 12-month period
- Vermont Short Term Family Leave: Up to 24 hours in 12 months, but not more than four hours in any 30-day period
Even if it’s not the lawIt’s a best practice to offer flexibility to all employees so that they can meet the obligations of daily life while still performing at their peak at work. It goes a long way toward making an employee feel good about where they work when they can see their child perform in a school play, take their dog to the vet, or accept an appliance delivery without worrying about missing a couple hours of work or needing to take a full day off.
The beginning of fall is a great time to review your established time off policies to see how you can accommodate parents and guardians who need to meet school obligations as well as giving all employees the flexibility to attend to the other small necessities of life.
In many cases, your established policies may not need to change. Depending on the needs of your workplace, your state laws, and the employee’s position, this could mean allowing employees to make up a few hours of work, take an extended lunch period, shift their schedule to start earlier or later to still get a full day in, or use personal, vacation, or PTO time in small increments.
Originally published by www.thinkhr.com
On August 24, 2018, the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) announced the following three directives:
- Guidance for Contractor Compensation Practices: Directive 2018-05 clarifies the OFCCP’s approach to conducting compensation evaluations, supports compliance and compensation self-analyses by contractors, and improves compensation analysis consistency and efficiency during compliance evaluations.
- Contractor Recognition Programs: Directive 2018-06 establishes a contractor recognition program with awards that highlight best practices, a contractor mentoring program, and other initiatives that provide opportunities for contractors to collaborate or provide feedback to OFCCP.
- Affirmative Action Program Verification Initiative: Federal contractors are legally required to take steps to ensure equal opportunity in their employment processes, including developing a written affirmative action program within 120 days of when the contract begins. Directive 2018-07 establishes a program for verifying compliance with these and other affirmative action obligations.
The OFCCP enforces federal laws that prohibit federal contractors and subcontractors from discriminating on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. In addition, contractors and subcontractors are prohibited from discriminating against applicants or employees because they inquire about, discuss, or disclose their compensation or that of others, subject to certain limitations.
Originally published www.thinkhr.com
Cristy Gupton, founder and president of Custom Benefits Solutions in Morganton, NC, was recently recognized as a top social media adviser in the latest edition of Employee Benefit Adviser (EBA) magazine.
On August 3, 2018, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (the Departments) published a Final Rule to expand the availability of short-term medical policies. Called short-term, limited-duration insurance (STLDI), the policies are marketed to individuals as an alternative to ACA-compliant plans. Currently a short-term policy is limited to less than three months, but the new rule will allow carriers to issue the policies for longer periods.
What is short-term limited-duration insurance (STLDI)?
Short-term, limited-duration insurance is a specific type of health coverage that is exempt from the ACA’s market reform rules. STLDI policies may exclude entire categories of benefits, such as prescription drugs, maternity, or mental health care, may impose coverage caps, and may reject applicants with pre-existing conditions. STLDI policies offer lower premiums than ACA-compliant plans because they provide less coverage and typically only accept healthy applicants.
Note that STLDI is not minimum essential coverage and does not satisfy the ACA’s individual mandate. The individual mandate (i.e., the requirement for individuals to have some form of minimum essential coverage) expires at the end of 2018, after which persons without adequate health coverage will no longer be exposed to potential IRS tax penalties.
What is the purpose of the new federal rule?
The existing rule defines “short term” as less than three months and limits the policy’s duration by prohibiting renewals that would go beyond the three-month period. The new rule, on the other hand, will allow carriers to issue STLDI policies for an initial term of up to 364 days, and allows extensions or renewals for up a total of 36 months. This is a significant change that is intended to expand access to low-cost limited-coverage options for individuals.
The new federal rule takes effect for STLDI policies issued October 2, 2018, or later. There is a catch, however. Insurance is subject to state insurance laws, and many states appear reluctant to adopt the new rule for policies issued in their state. Some states even prohibit short-term policies under the current federal rule. At last weekend’s National Association of Insurance Commissioners (NAIC) meeting, several state regulators expressed concerns about “junk insurance” or deceptive marketing practices that may lure consumers into purchasing substandard coverage.
Are employers affected by STLDI policies or the new rule?
No.
Employers are not directly affected by STLDI policies. The policies are marketed to individuals, where permitted by state insurance law; they are not group plans.
Some workers may consider STLDI options, or ACA-compliant individual insurance options, as an alternative to their employer’s group plan. In most cases, though, persons who buy individual insurance do so because they do not have access to an employer’s plan. Workers whose employment ends may also consider individual options as an alternative to COBRA.
What’s Next?Over the coming weeks and months, state insurance regulators and state legislatures are expected to review their existing laws and regulations on short-term, limited-duration insurance and consider whether to adopt changes. Some states likely will choose to implement rules to support the new federal rule, while other states certainly will impose restrictions or continue to prohibit the sale of insurance products they consider to be substandard.
Originally published by www.thinkhr.com
The U.S. Department of Labor (DOL) has updated the model notice for employers to use to inform employees about the Children’s Health Insurance Program (CHIP). All employers with group health plans are required to distribute a CHIP notice at least once a year to employees living in certain states. There is no need to send another notice to workers who received the prior version in the past year, but employers should use the updated notice going forward. This also is a good time for employers to review their procedures for distributing CHIP notices.
The following are the most frequently asked questions we receive from employers about CHIP notices.
Frequently Asked QuestionsWhat is the purpose of the CHIP notice?
The CHIP notice informs benefits-eligible employees that their state’s CHIP or Medicaid program may offer premium assistance to help them pay for group health coverage at work. Many states offer some form of premium assistance to residents based on their family income. The updated notice includes contact information for each participating state (currently 37 states) and explains that persons approved for premium assistance have a special 60-day enrollment period to join their employer’s group plan without having to wait for the employer’s next annual enrollment period.
Does the CHIP notice requirement affect all employers?
All employers that offer a group health plan providing medical benefits, whether insured or self-funded, must consider the CHIP notice requirement. Each employer then will determine if it must distribute the notice depending on whether any of its employees live in one of the states listed in the notice.
Further, all group health (medical) plans must offer a special 60-day enrollment period when an employee becomes eligible for premium assistance (for the employee or a family member) from a state’s CHIP or Medicaid program.
Is the notice required for all employees or just for those enrolled in our group health plan?
The notice must be given to all employees living in any one of the listed states and eligible for the employer’s group health plan, whether or not currently enrolled. That is the minimum requirement. Many employers, however, choose to distribute the notice to all employees, regardless of benefits eligibility or location, to avoid the need for separate distributions when an employee’s status or location changes.
How do we prepare and distribute the notice? How often?
The DOL provides a model notice that employers can copy and distribute. Although employers have the option of creating their own notice to list only the states where their employees are located, most employers simply use the DOL model notice as it is. The model notice also is available in Spanish.
The notice must be distributed when employees initially become eligible for the employer’s health plan and then at least once a year thereafter. For convenience, most employers provide the notice at the same time as they distribute new hire materials and annual enrollment materials.
When combined with other materials, the CHIP notice must appear “separately and in a manner which ensures that an employee who may be eligible for premium assistance could reasonably be expected to appreciate its significance.” For instance, the notice may be a loose item in the same envelope with other material. If the notice is stapled inside other material, however, there should be a note on the top page or cover alerting the reader to the placement of the CHIP notice and its importance.
Do we have to mail out paper copies or can we distribute the notice electronically?
The notice may be sent by first-class mail. Alternatively, it can be distributed electronically if the employer follows the DOL’s guidelines for electronic delivery of group health plan materials. That means that the employer first must determine whether the intended recipient has regular access to the electronic media system (e.g., email) as an integral part of his or her job. If so, the notice can be sent electronically provided the employer takes steps to ensure actual receipt, along with notifying the employee of the material’s significance and that a paper copy is available at no cost.
For persons who do not have regular access to the electronic media system, the notice cannot be sent electronically unless the intended recipient provides affirmative consent in advance. The guidelines for obtaining advance consent are fairly cumbersome, so employers are advised to distribute paper copies in these cases.
SummaryEmployers offering group health plans are encouraged to review their procedures for distributing CHIP notices. At a minimum, the notice must be given annually to all employees eligible for the employer’s health plan who live in any of the states listed in the notice. Many employers choose to distribute the notice to all workers in an abundance of caution. The DOL provides model notices in English and Spanish that do not need any customization, so employers can simply copy and distribute one or both versions as needed.
Incidences of workplace violence are becoming more common and are all over the news. It’s not just high-profile headline cases that are a concern—it’s happening on a smaller scale in all kinds of businesses. Threats to workplaces can take many forms, from cyberbullying and workplace harassment to physical altercations and targeted violence.
The Occupational Safety and Health Administration (OSHA) estimates that every year nearly 2 million U.S. workers are victims of workplace violence, with a total economic cost of more than $55 billion. According to the most recent National Census of Fatal Occupational Injuries, violence in the workplace increased 23 percent between 2015 and 2016 to become the second-most common category of workplace fatalities, behind transportation incidents.
Assessing elements of risk that may trigger violence, along with developing a prevention plan, is critical.
While a bill has been recently introduced in Congress relating to workplace violence in the healthcare industry, and some states address workplace violence in their safety regulations, there are no specific OSHA standards for workplace violence at the federal level outside of the OSHA General Duty Clause. This clause requires employers to provide their employees with a place of employment that is “free from recognized hazards that are causing or are likely to cause death or serious harm.”
If your clients experience acts of workplace violence or become aware of threats, intimidation, or other indicators suggesting that the potential for violence in the workplace exists, OSHA and state programs would expect them to implement a workplace violence prevention program combined with controls and training.
The good news is, you can help arm your clients with strategies for reducing the risk of workplace violence this summer.
Prevention is keyAssessing elements of risk that may trigger violence, along with developing a prevention plan, is critical. This starts with a complete evaluation of the organization’s strengths, weaknesses, opportunities, and threats as they relate to the types of risks the organization might face. A review of the company’s strategic objectives and deliverables, the resources available to employees to accomplish these deliverables, and the physical layout of the facility are important elements to include in this evaluation.
Workplace violence preparation and prevention strategiesHire right. Your clients’ businesses may be at risk due to the actions of their employees. Advise them to make good hiring decisions by clearly defining job requirements and thoroughly evaluating applicants. They should look carefully at resumes and job applications, probe gaps in applicants’ work histories, and verify education and work experience. Encourage them to conduct reference and background checks and be consistent with all applicants throughout the hiring process. That way, they can potentially avoid bad hires or negligent hiring claims.
Set clear expectations. When employees know what is expected of them, including behaviors important to the organization and performance standards, and those expectations are consistently enforced, they may experience less work-related stress and anxiety that can lead to hostility and violent outbursts.
Nurture an inclusive company culture. Studies show that in companies where employees feel like they are a part of the business and understand how their work contributes to the organization’s success, employees are more engaged and have more trust in their leaders and co-workers. Encourage your clients to focus on an inclusive culture built on strong values and it might result in fewer accidents, less absenteeism, and reduced risk for EPLI claims or workplace violence incidents.
Establish emergency preparedness plans. Advise your clients to develop emergency plans covering human-caused emergencies such as crime and violence, as well as hazards caused by natural disasters, outbreaks of disease, and accidents.
Establish safe reporting systems.Recommend that clients establish more than one method for employees to report any type of threat or issue that makes them feel unsafe in the workplace. These systems should include clear communication to employees that everyone is responsible for workplace safety, and there will be no retaliation for reporting safety concerns.
Provide workplace wellness programs. Some safety experts suggest that companies that demonstrate their commitment to their employees’ wellbeing through comprehensive wellness programs may reduce the risk of workplace violence. The rationale is that these programs help to defuse employee stress, anxiety, and unhealthy personal behaviors that can lead to violence.
Train, train, train. Every member of the team should be trained to know what to do in each type of emergency. In the case of workplace violence prevention, encourage your clients to train employees who have contact with the public about how to defuse potentially violent situations and protect themselves. Designate management team members to receive additional training to recognize the signs of employee distress — such as physical exhaustion, missing work commitments, more time out of the office, violent outbursts, isolating themselves from co-workers, or talking about hurting themselves or others — with the proper procedures for handling those situations. Well-trained team members who react quickly can save lives.
With the proper planning, systems, communications, and training, your clients can be better prepared to prevent or lessen the threats of workplace violence.
Originally published by www.thinkhr.com
Don’t lie--we ALL love gadgets. From the obscure (but hilariously reviewed on Amazon) Hutzler 571 Banana Slicer to the latest iteration of the Apple empire. Gadgets and technology can make our lives easier, make processes faster, and even help us get healthier. Businesses are now using the popularity of wearable technology to encourage employee wellness and increase productivity and morale.
According to a survey cited on Huffington Post, “82% of wearable technology users in American said it enhanced their lives in one way or another.” How so? Well, in the instance of health and wellness, tech wearers are much more aware of how much, or how little, they are moving throughout the day. We know that our sedentary lifestyles aren’t healthy and can lead to bigger health risks long term. Obesity, heart disease, high blood pressure, and Type 2 Diabetes are all side effects of this non-active lifestyle. But, these are all side effects that can be reversed with physically getting moving. Being aware of the cause of these problems helps us get motivated to work towards a solution.
Fitbit, Apple Watch, Pebble, and Jawbone UP all have activity tracking devices. Many companies are offering incentives for employees who work on staying fit and healthy by using this wearable technology. For example, BP Oil gave employees a free Fitbit in exchange for them tracking their annual steps. Those BP employees who logged 1 million steps in a year were given lower insurance premiums. These benefits for the employee are monetary but there are other pros to consider as well. The data collected with wearable technology is very accurate and can help the user when she goes to her physician for an ailment. The doctor can look at this data and it can help connect the dots with symptoms and then assist the provider with a diagnosis.
So, what are the advantages to the company who creates wellness programs utilizing wearable technology?
· Job seekers have said that employee wellness programs like this are very attractive to them when looking for a job.
· Millennials are already wearing these devices and say that employers who invest in their well-being increases employee morale.
· Employee healthcare costs are reduced.
· Improved productivity including fewer disruptions from sick days.
The overall health and fitness of the company can be the driving force behind introducing wearable technology in a business but the benefits are so much more than that. Morale and productivity are intangible benefits but very important ones to consider. All in all, wearable technology is a great incentive for adopting healthy lifestyles and that benefits everyone—employee AND employer.
Just Don’t AskJob candidates are covered by the Civil Rights Act prohibiting discrimination, and most interviewers know what kinds of direct questions to avoid. But what seems like a friendly conversation-starter could be an unwitting violation of the act. Read five questions you should never ask.
Read more on Namely.
Trust in DesignOffice design is known to have an impact on employee productivity and satisfaction. At the heart of this is trust – trust that staff will choose to use the facility in the most effective way rather than be chained to their desks. And when trust rises, engagement follows.
Read more on Entrepreneur.
Pride Without PanderingJune was Pride Month, and corporations everywhere joined in the celebration. Some, although well-meaning, missed the mark. Seven LGBTQ executives explain how employers can embrace inclusion and celebrate diversity without coming across as pandering.
Read more on Fast Company.
Dad DaysReddit cofounder Alexis Ohanian was a proponent of paternity leave and planned to lead by example by using his company’s benefit. However, he didn’t fully appreciate its importance until his daughter was born and he used the time off to slow down and take stock of his priorities.
Read more on CNN.
Culture Still Eats StrategyStrategy is essential, but if a company doesn’t have a good culture, it won’t matter. Once you understand what culture is and isn’t, you can work toward developing a strong one, starting with defining the qualities you value in your employees.
Read more on Forbes.
Buy in BulkA rule released by the U.S. Department of Labor on June 19 loosens restrictions on association health plans, paving the way for more small businesses to band together to buy health coverage. That is, if it stands up to legal challenges, state laws, and the realities of the insurance marketplace.
Read more on Kaiser Health News.
The Family Friendly WorkplaceWork-life balance can be especially challenging for parents. Both mothers and fathers lament not having enough time for their children. Get 10 creative ways you can make your workplace better for working parents.
Read more on Employee Benefit News.
Remote ControlThe remote workforce continues to grow, but 57 percent of companies still lack a remote work policy. These companies may be missing out on attracting and retaining top talent. There’s no one-size-fits-all solution, with numerous factors to consider in crafting one.
Read more on HR Dive.
What Makes a Great WorkplaceInc. magazine surveyed thousands of employees to measure what employer qualities lead to high levels of employee engagement and sentiment, taking into account elements of corporate culture. See which of 45 perks and benefits employees value most.
Read more on Inc.
Run, Hide, FightLaw enforcement officials stress the need for employers to conduct active shooter training to protect their employees and customers in the event of a violent incident. In addition to training, find out other ways to mitigate the risk a shooter or potential shooter holds.
Read more on Business Insurance.
Originally published by www.thinkhr.com
On June 19, 2018, the U.S. Department of Labor released its Final Rule regarding Association Health Plans (AHPs). AHPs are not new, but they have not been widely available in the past and, in some cases, they have not been successful. The Final Rule is designed to make AHPs available to a greater number of small businesses as an alternative to standard ACA-compliant small group insurance policies.
This article answers common questions about AHPs under the current rules (which groups can continue to use) and the new rules.
Is group medical insurance the same for small and large employers?Yes and no. Federal law imposes certain basic requirements on all group medical plans, regardless of the employer’s size. For instance, plans cannot exclude pre-existing conditions nor impose annual or lifetime dollar limits on basic benefits. If the plan is insured, it also is subject to the insurance laws of the state in which the policy is issued.
Small group policies, which are sold to employers with up to 50 or 100 employees, depending on the state, are subject to additional requirements. These policies must cover 10 categories of essential health benefits (EHBs), including hospitalization, maternity care, mental health and substance abuse treatment, and prescription drugs. (Some states allow certain grandfathered or grandmothered policy exceptions.) For most small employers, their options for group medical insurance are limited to small group policies that comply with the full scope of ACA requirements. On the other hand, the policies are subject to guaranteed issue and adjusted community rating rules, so carriers cannot refuse to insure a small employer nor use any past claims experience in setting rates.
Large group policies, which can only be sold to groups with at least 50 or 100 employees, depending on the state, are not required to cover all EHBs. Carriers have more flexibility in designing coverage options and developing premium rates in the large group market. This means larger employers have more options to choose from and may be able to purchase coverage at a lower cost than would apply to a small group policy. Note, however, that there is no guaranteed issue protection, so carriers can accept or reject each employer’s application or use the employer’s past claims experience in setting rates.
Lastly, self-funded plans are subject to the ACA and other federal laws, but generally are exempt from state laws. They typically are not feasible for small employers, however, due to the financial risk of uninsured programs.
What is an Association Health Plan (AHP)?Group insurance covers the employees of an employer (or an employee organization such as a labor union). An AHP, as the name implies, covers the members of an association. Unrelated employers can obtain coverage for their employees through an AHP provided the employers form a bona fide association. Traditionally, this has meant that the employers had to have a “commonality of interest” and their primary interest had to be something other than an interest in providing benefits. For this reason, AHPs generally have been limited to associations formed by employers in the same trade, industry, or profession.
The Final Rule makes AHPs available to a wider range of businesses by expanding the meaning of “commonality of interest.” Once the Final Rule takes effect, an association may be formed by employers that are:
- In the same trade, industry, or profession, regardless of location; or
- In the same principal place of business; i.e., in the same state or in the same multi-state metropolitan area.
Under the new rules, the employer’s primary interest in associating may be benefits coverage, although they still will need to have at least one other substantial business purpose other than benefits. This is a key difference from the current rules.
When does the new Final Rule take effect?The Final Rule expanding the definition of an association for purposes of an AHP will take effect on staggered dates:
- For fully insured AHPs: September 1, 2018
- For self-funded AHPs:
- If in existence on or before June 19, 2018: January 1, 2019
- If created after June 19, 2018: April 1, 2019
As noted, the new rules do not replace existing rules. Employers and associations may continue to follow the existing rules (which generally limit AHPs to employers in the same trade, industry, or profession). The new rules merely expand the opportunities for AHPs, such as making them available to employers in the same state or metropolitan area even if they are in different industries.
Are AHPs limited to employers with employees? What about sole proprietors?Currently, sole proprietors, such as mom-and-pop shops without any W-2 employees, purchase medical insurance in the individual market. Individual policies often cost more than group policies or AHPs. The new rules will expand the availability of AHPs to include sole proprietors who work a minimum number of hours (so-called working owners).
What about state laws? Will AHPs be available nationwide?Insurance products, including AHPs, are regulated by state law. Under both the existing and new rules, AHPs are multiple employer welfare arrangements (MEWAs). State laws on MEWAs are quite complicated. In some states, MEWAs are prohibited. In others, insured MEWAs are allowed but self-funded plans are prohibited. The laws vary from state to state, so different carriers will make different decisions about whether they want to design and market AHPs in various jurisdictions around the country.
A number of states are very concerned about AHPs and may prohibit them in their states or impose strict requirements to ensure they will provide reliable and effective coverage. Other states will view AHPs as cost-effective alternatives to ACA-compliant policies for small employers and look to encourage their expansion.
What’s next?There is no clear answer to what’s next. Over the coming months, carriers across the country likely will review the reasons they have or have not offered AHPs in the past, and whether they want to consider new approaches in the future. Along with economic and market issues to consider, carriers also must consider the state insurance laws in different jurisdictions. At the same time, many state legislatures and insurance commissioners will be reviewing their existing rules and whether they want to promote or expand the availability of AHPs in their area.
Oh … and the lawsuits. Yes, that also is what’s next. As of this writing, attorneys general in different states are planning to join together in challenging the federal government’s Final Rule on AHPs. Their stated concern is that effective regulation is required to ensure that plans provide adequate coverage.
School’s out! Summer is here, and it’s the time of year when working parents have questions about using their Dependent Care Spending Accounts (DCSAs). Are summer camp expenses eligible? What about day versus overnight camps? Employers and benefit advisors want to be ready with answers about this valuable benefit program.
The following are the top summertime questions about DCSAs and reimbursable expenses:
1. What are the basic rules for reimbursable expenses?
Dependent care expenses, such as babysitting and daycare center costs, must be work-related to qualify for reimbursement. Work-related means the expenses are for the care of the employee’s child under age 13 to allow the employee to work. If the employee is married and filing jointly, the employee’s spouse also must be gainfully employed or looking for work (unless disabled or a full-time student).
In some cases, expenses to care for a disabled dependent, regardless of age, may be reimbursable. This article focuses on expenses for children under 13 since those are by far the most common type of DCSA reimbursement.
2. One of our employees and his family are taking a two-week vacation this summer, but his children’s daycare center will charge its regular fee. Are the expenses reimbursable even if the employee and spouse are off work?
Yes. In most cases, expenses are not eligible unless the dependent care services are necessary for the parents to work, but some exceptions apply. The IRS rules for DCSAs provide that expenses during short, temporary absences are eligible if the employee has to pay the child’s care provider. Absences of up to two weeks are automatically considered short, temporary absences. Depending on the circumstances, longer absences also may qualify.
3. During the school year, our employee uses her DCSA for her 10-year old’s after-school daycare center expenses. This summer, the child’s daycare will be provided by her 20-year old sister. If the older daughter bills for her services, are the costs eligible for reimbursement?
The answer depends on whether the employee or spouse can claim the older daughter as a tax dependent. If the older daughter can be claimed as a dependent, whether or not the employee actually claims her, she is not a qualifying dependent care provider under the DCSA rules.
If the older daughter cannot be claimed as a tax dependent, her charges for providing care are eligible expenses. The specific rule is that a child of the employee, whom the employee cannot claim as a dependent, may be a qualifying provider if the child is age 19 or older by the end of the year.
Note that the employee’s spouse or the child’s parent is never a qualifying provider.
4. One of our employees has to pay an application fee and deposit before her child starts attending a daycare center this summer. Are those expenses eligible for reimbursement?
Prepaid expenses are eligible for DCSA reimbursement, provided the costs are required in order for the child to receive care. In this case, after the daycare center begins providing care, the employee can be reimbursed for the application fee and deposit she paid. On the other hand, if the employee cancels and her child does not attend, then the application fee and deposit are not eligible expenses.
5. An employee will pay day camp expenses for his 8-year-old son and overnight camp expenses for his 12-year-old daughter this summer. Are both types of expenses eligible for reimbursement?
The day camp expenses generally are reimbursable. Expenses for overnight camp, however, are not eligible since overnight care is not work-related.
Under the IRS rules for DCSAs, expenses for food, lodging, clothing, education, and entertainment are not reimbursable. If, however, such expenses are small, incidental expenses that cannot be separated from the cost of caring for the child, they may be included for reimbursement. For instance, the day camp may include lunch, snacks, and some sports activities in its basic fee, which would be eligible for reimbursement.
6. An employee’s children go to private year-round schools. He pays tuition for one child’s grade school and fees for the other child’s nursery school. Are both types of expenses eligible for reimbursement?
Educational expenses are not reimbursable, unless the educational services are merely incidental as part of a child care service. Expenses to attend kindergarten or a higher grade are educational, so the older child’s school fees are not eligible for DCSA reimbursement. (Expenses for before- or after-school care, however, may qualify as reimbursable expenses.)
On the other hand, expenses for a child in nursery school, preschool, or a similar program for children below the level of kindergarten are expenses for care. Such expenses are not considered educational even though the nursery school may include some educational activities.
Originally published by www.thinkhr.com
As the costs of health care soar, many consumers are looking for ways to control their medical spending. Also, with the rise of enrollment in high deductible health plans, consumers are paying for more health care out-of-pocket. From medical savings accounts to discount plans for prescriptions, patients are growing increasingly conscious of prices for their healthcare needs. Price shopping procedures and providers allows you to compare prices so that you are getting the best value for your care.
Check out this short video to learn more!
Lately, there’s been a big focus on America’s opioid addiction in the news. Whether it’s news on the abuse of the drug or it’s information sharing on how the drug works, Americans are talking about this subject regularly. We want to help educate you on this hot topic.
Opioids are made from the opium poppy plant. Opium has been around since 3,400 BC and it was first referenced as being cultivated in Southwest Asia. The drug traveled the Silk Road from the Mediterranean to Asia to China. Since then, the drug has gained popularity for pain relief but it also has gained notoriety as an abused drug. Morphine, Codeine, and Heroin are all derived from the opium poppy and are all highly addictive drugs that are abused all around the world. As the demand for these drugs has increased, so has the production. From 2016 to 2017, the area under opium poppy cultivation in Afghanistan increased by 63 percent. In 2016, it killed some 64,000 Americans, more than double the number in 2005.
We can see that the danger from this drug is growing rapidly. What can we do to recognize potential abuse problems and to get help? Here are some facts about opioid addiction:
· How do they work? Opioids attach to pain receptors in your brain, spinal cord, and other areas that recognize pain signals. As they attach to the receptors, it reduces the sending of pain messages to the brain and therefore reduces the feelings of pain in your body.
· Short-acting opiates are typically prescribed for injuries and only for a few days. They take 15-30 minutes for pain relief to begin and this relief lasts for 3-4 hours. Long-acting opiates are prescribed for moderate to severe pain and are used over a long period of time. Relief typically lasts for 8-12 hours and can be used alongside a short-acting drug for breakthrough pain.
· Dependence is common with long-term use of an opiate. This means that the patient needs to take more of and higher doses of the medicine to get the same pain relieving effect. This does not necessarily mean the patient is addicted. Addiction is the abuse of the drug by taking it in an unprescribed way—like crushing tablets or using intravenously.
· Americans account for less than 5% of the world’s population, but take 80% of the world’s opioid medications. About 5% of the people who take opiates become addicted to the drug.
· Help is available through many channels from private recovery centers to insurance providers. The Substance Abuse and Mental Health Services Administration helpline is 1-800-662-HELP. This line is confidential, free, and available 24-hours a day and 7 days a week. Family and friends may also call this number for resources for help. Additional resources can be found at www.drugabuse.com.
Make sure you are educated about the dangers of opioid abuse. But, don’t be discouraged and think that the abuse is incurable! There are many resources that can be used to break the addiction cycle and can make real change in the lives of its victims. Ask for help and offer help.
On May 10, 2018, the Internal Revenue Service (IRS) released Revenue Procedure 2018-30 announcing the annual inflation-adjusted limits for health savings accounts (HSAs) for calendar year 2019. An HSA is a tax-exempt savings account employees can use to pay for qualified health expenses.
To be eligible for an HSA, an employee:
- Must be covered by a qualified high deductible health plan (HDHP);
- Must not have any disqualifying health coverage (called “impermissible non-HDHP coverage”);
- Must not be enrolled in Medicare; and
- May not be claimed as a dependent on someone else’s tax return.
The limits vary based on whether an individual has self-only or family coverage under an HDHP. The limits are as follows:
- 2019 HSA contribution limit:
- Single: $3,500 (an increase of $50 from 2018)
- Family: $7,000 (an increase of $100 from 2018)
- Catch-up contributions for those age 55 and older remains at $1,000
- 2019 HDHP minimum deductible (not applicable to preventive services):
- Single: $1,350 (no change from 2018)
- Family: $2,700 (no change from 2018)
- 2019 HDHP maximum out-of-pocket limit:
- Single: $6,750 (an increase of $100 from 2018)
- Family: $13,500* (an increase of $200 from 2018)
If the HDHP is a nongrandfathered plan, a per-person limit of $7,900 also will apply due to the Affordable Care Act’s cost-sharing provision for essential health benefits.
Originally published by www.thinkhr.com
The world is connected nowadays through our screens. Whether it be email, texting, websites, Facetime, or social media; we all use technology to connect us to others. According to Hubspot, an online marketing and sales software provider, consumers are on social networks more than ever before. They wrote:
“In our survey of 1,091 global internet users, we’ve found people have dramatically increased content consumption on the three most popular social networks in the last two years: Facebook (+57% increase), Twitter (25% increase), and LinkedIn (21% increase). These networks have notably doubled down on content in the past few years to capture and retain the attention of their users -- and it appears the playbook is working.” The Future of Content Marketing: How People Are Changing the Way They Read, Interact, and Engage With ContentSo, how do you harness this tech to strengthen your connectivity to your audience? Here’s the top 5 tips for using social media that every agency can benefit from using.
1. Consistent Content Posting
Your followers want to know when they can expect new info to be posted on your website and social media. If you post once a week for 3 weeks and then not post again for another month, your audience will quit paying attention. Consistency is the key! Mke a point to post at the same general time on the same days and you will see more interaction from your followers.
2. Images & Videos
62% of users thoroughly consume the social media post if it includes video as compared to only 25% consumption of traditional long content posts. That’s a HUGE difference! Grab your audience’s attention when they are scrolling through their social media by posting pictures and videos. They are telling us that they will stop and watch or read more than skimming because of the images they see.
3. Keep Up with Social Media Trends
Pay attention to what you are most engaged with on social media. Do you like to watch Facebook Live videos? Do you stop and scroll through pictures from companies when they post what they are doing in the community? Do you prefer to chat with a customer service representative online versus an email? If you are seeing your preferences change, there is a good chance your audience’s preferences are changing. Post pictures of your teams serving their community. Use videos to educate your clients on relevant issues in your field. Social media is constantly evolving so stay up on trends and use them on your pages!
4. Facebook is Still King
Consumers are using Facebook for more than just connecting to their high school friends—they are using it to read content from their favorite businesses and groups. This means you MUST keep your Facebook page updated and have new content posted regularly. According to a new Hubspot survey, 48% of consumers use their Facebook feed to catch up on news, business, and lifestyle stories. This ties back to Tip #1 and reiterates that consistent posting is the sweet spot for engaging customers.
5. Engage Your Audience
How are you talking to the people who use your business? Are you responding to inquiries on Facebook? When you post pictures on LinkedIn are you responding to the people who are looking and commenting on them? When you engage with your followers, they are more likely to have a stronger relationship with you. Entrepreneur Magazine says, “They are more likely to have a better evaluation of the brands, stay loyal to the brands and recommend the brands to others.”
By following these tips, your social media pages can grow into healthy sites and you can be more effective as you engage with your audience. Start using them today!
Becoming a well-informed patient who follows through on going to their annual exam, as well as follows the advice given to them from their physician after asking good questions, will not only save your budget, but it can save your life!
Check out this short video so you too, can be a well informed patient!
Did you know that you can save time and money on your prescription drugs by simply signing up for a discount card online? With savings as much as 80% off, these discount cards keep your health care costs down even when the prices of prescriptions are sharply rising. At no cost to the patient, discount drug programs negotiate the price of medicines with pharmacies and then pass the savings on to the consumer. These programs give subscribers a personalized discount card to be used at any pharmacy. While the discount card cannot be used in conjunction with health insurance, the consumer may see that the cost of their medicine is actually LESS with the card than it is with their insurance.
Another benefit to the consumer is that these programs will publish at which pharmacy you can find your medicine. This is especially helpful to the person who has specialty drug prescriptions. For example, Rebekah is prescribed a specialty drug for pain and neuropathy due to Multiple Sclerosis. This drug is not commonly stocked in pharmacies and so many times, she has had to wait for them to order it. By using the discount drug program, Rebekah is able to see which pharmacies have her medicine in stock and the estimated price.
So where do you start? Here are a few discount drug programs to investigate costs and providers for your prescriptions:
- StateRXPlans.us
· Provides free drug cards to reduce the out-of-pocket cost of prescription drugs.
· Click on your state and the site will redirect you to your corresponding prescription assistance program.
- GoodRX.com
· Compares prices and discounts at thousands of pharmacies.
· Receive coupons via phone, email, or text to print or present for discounts.
- RefillWise.com
· Free drug card to present at pharmacy for cost savings on prescriptions.
· Earn rewards each time you use their card—similar to credit card rewards. Each fill is 500 points and when you reach 5,000 points, you earn a gift card to various retailers.
Being a savvy consumer can save you money! Shop around to find the best cost for your prescription drugs and save time by locating the pharmacy that has your meds in stock. Discount drug programs are a great resource so do your research and find one that fits your needs.
Health care consumers can find ways to save money even as the cost of medical care increases.
Check out this short video to learn more!
There’s a good chance you use a wrap document to help satisfy your Employee Retirement Income Security Act (ERISA) summary plan description (SPD) obligations. Yet if you look for a definition of wrap document in ERISA statutes or regulations, you will not find one. The wrap is not a defined term or required document; it is simply a format. So why do you need a wrap document? Here are three (of many) reasons why a wrap document is a solid choice.
Reason 1Your insurance carrier materials are not enough in most cases.
A common misconception is that carrier materials or benefit description booklets meet all ERISA SPD requirements. They rarely do; in fact, they usually fall short.
For example, the SPD must define or explain eligibility for benefits. A carrier’s materials may indicate that a benefit is available for all full-time employees, but not define what constitutes “full-time.” An SPD that does not completely communicate eligibility is deficient, may confuse employees, and could result in costly litigation for your company.
Therefore, to address gaps like these, it’s advisable to use a wrap document to “wrap around’ the existing carrier documents and fill in any required ERISA provisions the carrier documents are missing.
Reason 2You are an applicable large employer (ALE) and use the lookback measurement method.
ALEs who use the lookback measurement method to determine eligibility for medical benefits must meet a complex set of rules for determining whether and how certain employees are eligible for healthcare coverage under the Affordable Care Act (ACA). The rules are complex and daunting for employers. Even more daunting, however, is explaining these eligibility rules to employees.
Carriers are not required to communicate this information, and very likely will not. Therefore, it is up to you to ensure the information is communicated. While your specific lookback measurement method is not required to be explained in an SPD – and some employers choose to put it in an employment policy or handbook — the SPD is a logical place to include this information because it also communicates your other benefits eligibility requirements.
Reason 3A wrap reduces your reporting obligations.
You may use a wrap document to combine multiple insurance policies into a single document, which results in one ERISA plan for all combined benefits. This simplifies and reduces reporting requirements for employers who are subject to Form 5500 filing requirements.
Most employers with 100 or more health and welfare benefit plan participants as of the first day of the plan year, as well as certain employers with fewer than 100 participants, are required to file a Form 5500 annually. (Participants include covered employees and former employees who elect COBRA, but spouses and dependents are not counted.) Some plans, such as governmental plans or certain church plans, are exempt from filing a Form 5500.
The wrap document may be a time saver if you have multiple health and welfare benefit plans subject to Form 5500 filing requirements. For example, if you have a vision, dental, and medical plan that each meet the “100 or more participant” threshold, then you would be required to file a Form 5500 for each plan. However, if the plans are all wrapped together into a single document, then they are considered one ERISA plan and you would only have to file one Form 5500.
Do it RightWhile there are many other reasons an employer should consider investing in a wrap document, not all wrap documents are made equal. Work with a reputable vendor and/or competent counsel to ensure your wrap document meets all compliance requirements.
Originally published by www.thinkhr.com
“Your most valued asset isn’t your house, car, or retirement account. It’s the ability to make a living.”
No one foresees needing disability benefits. But, should a problem arise, the educated and informed employee can plan for the future by purchasing disability insurance to help cover expenses when needed.
When you ask people what is the number one reason disability insurance is needed, most will answer that it is for workplace related injuries. However, the leading causes of long-term absences are back injuries, cancer, and heart disease and most of them are NOT work related. In addition, the average duration of absences due to disability is 34 months. So how do you prepare for an unplanned absence from work as a result of an injury or illness? Disability insurance is a great option.
Disability insurance is categorized into two main types.
Short Term Disability covers 40-60% of the employee’s base salary and can last for a few weeks to a few months to a year. There is typically a short waiting period before benefits begin after the report of disability. This plan is generally sponsored by the employer.
Long Term Disability covers 50-70% of the employee’s base salary and the benefits end when the disability ends or after a pre-set length of time depending on the policy. The wait period for benefits is longer—typically 90 days from onset of disability. This plan kicks in after the short-term coverage is exhausted. The individual purchases this plan to prevent a loss of coverage after short-term disability benefits are exhausted.
While the benefits of these disability plans are not a total replacement of salary, they are designed for the employee to maintain their current standard of living while recovering from the injury or illness. This also allows the individual to pay regular expenses during this time.
There are many ways to enroll in a disability insurance plan. Often times your employer will offer long-term and short-term coverage as part of a benefits package. Supplemental coverage can also be purchased. Talk with your company’s HR department for more information on how to enroll in these plans. Individuals who are interested in purchasing supplemental coverage can also contact outside insurance brokers or even check with any professional organizations to which they belong (such as the American Medical Association for medical professionals) as many times they offer insurance coverage to members.
As you begin planning for your future, make sure you research the types of coverage available and different avenues through which to purchase this coverage. For more information on disability and the workplace, check out:
· Americans with Disabilities Act
· The National Organization on Disability
· Council for Disability Awareness
· Social Security Administration
The topic of Self-Funding is huge, so let's break it down into smaller bites to digest. Check out this great video on it!
Summary plan descriptions (SPDs) are required for all retirement, health, and welfare plans subject to the Employee Retirement Income Security Act of 1974 (ERISA). However, misconceptions about this requirement are widespread. ERISA attorney Stacy H. Barrow, partner with Marathas Barrow Weatherhead Lent LLP, had a chat with ThinkHR about the importance of having proper ERISA documentation and the consequences of failing to do so.
THR: What types of employers need to have an SPD?
SHB: We tell all employers — of any size — who offer plans subject to ERISA that they need to have an SPD. This is the first item in every Department of Labor (DOL) audit. If you don’t have one and you get audited or a participant asks for plan documents, you will be scrambling to put documents together and you can’t do them fast enough to avoid an issue. In addition, cafeteria plans can only be adopted prospectively, so if you don’t have a written cafeteria plan in place, you may be jeopardizing the tax qualified status of your plan.
THR: Won’t my broker or carrier take care of these documents?
SHB: Employers may think that brokers or carriers take care of all required benefits documentation, but at the end of the day, it’s the employer who is responsible for complying with ERISA’s SPD requirement. Your broker may help you, but they might not be aware of every benefit you offer or your eligibility guidelines. The carrier’s documentation often is missing some of the required language, which is why you use a wrap. You don’t specifically have to use a wrap to develop your SPD, but the carrier document won’t get you there and an wrap is often the best way to comply. If the plan documents aren’t compliant, that’s not the carrier’s or broker’s responsibility, it’s the employer’s.
THR: Do I really need to be concerned about a DOL audit?
SHB: Employers can get complacent about documentation, thinking that only large employers get audited, or it won’t happen to them. It’s not only the large corporations that get audited. It can happen to employers of any size or type. It’s important to make sure you have good benefits documentation, because if you don’t, and you do get audited, it might cause the DOL to dig deeper and look for other problems, such as looking into your 401(k) plan.
Plan documentation is a huge part of every DOL audit. I can’t stress strongly enough that they will want to see the summary plan description and plan documents. If you can get good, compliant documents to the DOL, it increases the chances of a speedy resolution. If you can provide them quickly, it sends a message that you are ready and in compliance.
THR: What are the consequences of being out of compliance?
SHB: Not having the proper documents may be an issue if you get audited or there is litigation over a denied claim. You need to be prepared for this possibility. If the DOL audits and imposes penalties, it may not be because the employer didn’t have a wrap document, but rather because the document wasn’t updated, wasn’t compliant, or wasn’t distributed to employees. And the DOL may impose penalties of up to $152 per day for failure to provide an SPD upon request. Also, failure to inform participants of plan changes may invalidate those changes.
Originally published by www.thinkhr.com
Taking control of health care expenses is on the top of most people's to-do list for 2018. The average premium increase for 2018 is 18% for Affordable Care Act (ACA) plans. So, how do you save money on health care when the costs seems to keep increasing faster than wage increases? One way is through health savings accounts.
Health savings accounts are used in conjunction with High Deductible Health Plans (HDHP) and allow savers to use their pre-tax dollars to pay for qualified health care expenses. There are three major types of medical savings accounts as defined by the IRS. The Health Savings Account (HSA) is funded through an employer and is usually part of a salary reduction agreement. The employer establishes this account and contributes toward it through payroll deductions. The employee uses the balance to pay for qualified health care costs. Money in HSA is not forfeited at the end of the year if the employee does not use it. The Health Flexible Savings Account (FSA) can be funded by the employer, employee, or any other contributor. These pre-tax dollars are not part of a salary reduction plan and can be used for approved health care expenses. Money in this account can be rolled over by one of two ways: 1) balance used in first 2.5 months of new year or 2) up to $500 rolled over to new year. The third type of savings account is the Health Reimbursement Arrangement (HRA). This account may only be contributed to by the employer and is not included in the employee's income. The employee then uses these contributions to pay for qualified medical expenses and the unused funds can be rolled over year to year.
There are many benefits to participating in a medical savings account. One major benefit is the control it gives to an employee when paying for health care. As we move to a more consumer driven health plan arrangement, the individual can make informed choices on their medical expenses. They can "shop around" to get better pricing on everything from MRIs to prescription drugs. By placing the control of the funds back in the employee's hands, the employer also sees a cost savings. Reduction in premiums as well as administrative costs are attractive to employers as they look to set up these accounts for their workforce. The ability to set aside funds pre-tax is advantageous to the savings savvy individual. The interest earned on these accounts is also tax-free.
The federal government made adjustments to contribution limits for health savings accounts for 2018. For an individual purchasing single medical coverage, the yearly limit increased $50 from 2017 to a new total $3450. Family contribution limits also increased to $6850 for this year. Those over the age of 55 with single medical plans are now allowed to contribute $4450 and for families with the insurance provider over 55 the new limit is $7900.
Health care consumers can find ways to save money even as the cost of medical care increases. Contributing to health savings accounts benefits both the employee as well as the employer with cost savings on premiums and better informed choices on where to spend those medical dollars. The savings gained on these accounts even end up rewarding the consumer for making healthier lifestyle choices with lower out-of-pocket expenses for medical care. That's a win-win for the healthy consumer!
On March 5, 2018, the Internal Revenue Service (IRS) announced a reduction in the maximum annual contribution allowed for Health Savings Accounts (HSAs) in 2018. The change does not affect people whose HSA contributions are based on self-only health coverage, but it does affect those with family coverage under a qualifying High Deductible Health Plan (HDHP). Previously, the 2018 HSA contribution limit for persons with family HDHP coverage was $6,900. That limit is now reduced retroactively to $6,850.
In Revenue Bulletin 2018-10, the IRS explains that the recently-enacted tax reform law requires recalculating inflation-adjusted amounts under various tax code provisions. One of the affected provisions is § 223 pertaining to HSAs. Using the new required method of applying annual inflation adjustments, the 2018 HSA contribution limit for those with family HDHP coverage is $6,850, which is a $50 reduction from the amount previously announced.
HSA SummaryAn HSA is a tax-exempt savings account employees can use to pay for qualified health expenses. To be eligible to contribute to an HSA, an employee:
- Must be covered by a qualified high deductible health plan (HDHP);
- Must not have any disqualifying health coverage (called “impermissible non-HDHP coverage”);
- Must not be enrolled in Medicare; and
- May not be claimed as a dependent on someone else’s tax return.
HSA 2018 LimitsLimits apply to HSAs based on whether an individual has self-only or family coverage under the qualifying HDHP.
2018 HSA contribution limit:
- Single: $3,450
- Family: $6,850
- Catch-up contributions for those age 55 and older remains at $1,000
2018 HDHP minimum deductible (not applicable to preventive services):
- Single: $1,350
- Family: $2,700
2018 HDHP maximum out-of-pocket limit:
- Single: $6,650
- Family: $13,300*
*If the HDHP is a nongrandfathered plan, a per-person limit of $7,350 also will apply due to the ACA’s cost-sharing provision for essential health benefits.
Originally published by www.thinkhr.com
This year’s flu season is a rough one. Although the predominant strains of this year’s influenza viruses were represented in the vaccine, they mutated, which decreased the effectiveness of the immunization. The flu then spread widely and quickly, and in addition, the symptoms were severe and deadly. The U.S. Centers for Disease Control and Prevention (CDC) reported that the 2017 – 2018 flu season established new records for the percentage of outpatient visits related to flu symptoms and number of flu hospitalizations.
Younger, healthy adults were hit harder than is typical, which had impacts on the workplace. In fact, Challenger, Gray & Christmas, Inc. recently revised its estimates on the impact of this flu season on employers, raising the cost of lost productivity to over $21 billion, with roughly 25 million workers falling ill.
Fortunately, the CDC is reporting that it looks like this season is starting to peak, and while rates of infection are still high in most of the country, they are no longer rising and should start to drop. What can you do as an employer to keep your business running smoothly for the rest of this flu season and throughout the next one?
- Help sick employees stay home. Consider that sick employees worried about their pay, unfinished projects and deadlines, or compliance with the company attendance policy may feel they need to come to work even if they are sick. Do what you can to be compassionate and encourage them to stay home so they can get better as well as protect their co-workers from infection. In addition, make sure your sick leave policies are compliant with all local and state laws, and communicate them to your employees. Be clear with the expectation that sick employees not to report to work. For employees who feel well enough to work but may still be contagious, encourage them to work remotely if their job duties will allow. Be consistent in your application of your attendance and remote work rules.
- Know the law. Although the flu is generally not serious enough to require leaves of absence beyond what sick leave or PTO allow for, in a severe season, employees may need additional time off. Consider how the federal Family and Medical Leave Act (FMLA), state leave laws, and the Americans with Disabilities Act (ADA) may come into play for employees who have severe cases of the flu, complications, or family members who need care.
- Be flexible. During acute flu outbreaks, schools or daycare facilities may close, leaving parents without childcare. Employees may also need to be away from the workplace to provide care to sick children, partners, or parents. Examine your policies to see where you can provide flexibility. Look for opportunities to cross-train employees on each other’s essential duties so their work can continue while they are out.
- Keep it clean. Direct cleaning crews to thoroughly disinfect high-touch areas such as doorknobs, kitchen areas, and bathrooms nightly. Provide hand sanitizer in common areas and encourage frequent handwashing. Keep disinfecting wipes handy for staff to clean their personal work areas with.
- Limit exposure. Avoid non-essential in-person meetings and travel that can expose employees to the flu virus. Rely on technology such as video conferencing, Slack, Skype, or other platforms to bring people together virtually. Consider staggering work shifts if possible to limit the number of people in the workplace at one time.
- Focus on wellness. Offer free or low-cost flu shots in the workplace. If your company provides snacks or meals for employees, offer healthier options packed with nutrients.
Originally published by www.thinkhr.com
Have you ever heard the proverb "Knowledge is power?" It means that knowledge is more powerful than just physical strength and with knowledge people can produce powerful results. This applies to your annual medical physical as well!
The #1 goal of your annual exam is to GAIN KNOWLEDGE. Annual exams offer you and your doctor a baseline for your health as well as being key to detecting early signs of diseases and conditions.
The #1 goal of your annual exam is to
GAIN KNOWLEDGE
According to Malcom Thalor, MD, "A good general exam should include a comprehensive medical history, family history, lifestyle review, problem-focused physical exam, appropriate screening and diagnostic tests and vaccinations, with time for discussion, assessment and education. And a good health care provider will always focus first and foremost on your health goals."
Early detection of chronic diseases can save both your personal pocketbook as well as your life! By scheduling AND attending your annual physical, you are able to cut down on medical costs of undiagnosed conditions. Catching a disease early means you are able to attack it early. If you wait until you are exhibiting symptoms or have been symptomatic for a long while, then the disease may be to a stage that is costly to treat. Early detection gives you a jump start on treatments and can reduce your out of pocket expenses.
When you are prepared to speak with your Primary Care Physician (PCP), you can set the agenda for your appointment so that you get all your questions answered as well as your PCP's questions. Here are some tips for a successful annual physical exam:
· Bring a list of medications you are currently taking—You may even take pictures of the bottles so they can see the strength and how many.
· Have a list of any symptoms you are having ready to discuss.
· Bring the results of any relevant surgeries, tests, and medical procedures
· Share a list of the names and numbers of your other doctors that you see on a regular basis.
· If you have an implanted device (insulin pump, spinal cord stimulator, etc) bring the device card with you.
· Bring a list of questions! Doctors want well informed patients leaving their office. Here are some sample questions you may want to ask:
o What vaccines do I need?
o What health screenings do I need?
o What lifestyle changes do I need to make?
o Am I on the right medications?
Becoming a well-informed patient who follows through on going to their annual exam as well as follows the advice given to them from their physician after asking good questions, will not only save your budget, but it can save your life!
As the first month of 2018 wraps up, companies have already begun the arduous task of submitting budgets and finding ways to cut costs for the new year. One of the most effective ways to combat increasing health care costs for companies is to move to a Self-Funded insurance plan. By paying for claims out-of-pocket instead of paying a premium to an insurance carrier, companies can save around 20% in administration costs and state taxes. That's quite a cost savings!
The topic of Self-Funding is huge and so we want to break it down into smaller bites for you to digest. This month we want to tackle a basic introduction to Self-Funding and in the coming months, we will cover the benefits, risks, and the stop-loss associated with this type of plan.
THE BASICS
· When the employer assumes the financial risk for providing health care benefits to its employees, this is called Self-Funding.
· Self-Funded plans allow the employer to tailor the benefits plan design to best suit their employees. Employers can look at the demographics of their workforce and decide which benefits would be most utilized as well as cut benefits that are forecasted to be underutilized.
· While previously most used by large companies, small and mid-sized companies, even with as few as 25 employees, are seeing cost benefits to moving to Self-Funded insurance plans.
· Companies pay no state premium taxes on self-funded expenditures. This savings is around 1.5% - 3/5% depending on in which state the company operates.
· Since employers are paying for claims, they have access to claims data. While keeping within HIPAA privacy guidelines, the employer can identify and reach out to employees with certain at-risk conditions (diabetes, heart disease, stroke) and offer assistance with combating these health concerns. This also allows greater population-wide health intervention like weight loss programs and smoking cessation assistance.
· Companies typically hire third-party administrators (TPA) to help design and administer the insurance plans. This allows greater control of the plan benefits and claims payments for the company.
As you can see, Self-Funding has many facets. It's important to gather as much information as you can and weigh the benefits and risks of moving from a Fully-Funded plan for your company to a Self-Funded one. Doing your research and making the move to a Self-Funded plan could help you gain greater control over your healthcare costs and allow you to design an original plan that best fits your employees.
WHD Revises Test for Unpaid InternshipsOn January 5, 2018, the U.S. Department of Labor’s Wage and Hour Division (WHD) released a Field Assistance Bulletin (FAB No. 2018-2) establishing that the primary beneficiary test, rather than the six-point test, will determine whether interns at for-profit employers are employees under the federal Fair Labor Standards Act (FLSA).
The primary beneficiary test requires an examination of the economic reality of the intern-employer relationship to determine which party is the primary beneficiary of the relationship. The following seven factors are part of this test:
- The extent to which the intern and the employer clearly understand that there is no expectation of compensation. Any promise of compensation, express or implied, suggests that the intern is an employee — and vice versa.
- The extent to which the internship provides training that would be similar to that which would be given in an educational environment, including the clinical and other hands-on training provided by educational institutions.
- The extent to which the internship is tied to the intern’s formal education program by integrated coursework or the receipt of academic credit.
- The extent to which the internship accommodates the intern’s academic commitments by corresponding to the academic calendar.
- The extent to which the internship’s duration is limited to the period in which the internship provides the intern with beneficial learning.
- The extent to which the intern’s work complements, rather than displaces, the work of paid employees while providing significant educational benefits to the intern.
- The extent to which the intern and the employer understand that the internship is conducted without entitlement to a paid job after the internship.
According to the WHD, under the primary beneficiary test, no one factor is dispositive and every factor is not required to be fulfilled to conclude that the intern is not an employee entitled to the minimum wage. The primary beneficiary test is a distinct shift in analysis because per the six-part test every intern and trainee would be an employee under the FLSA unless his or her job satisfied each of six independent criteria. Courts have held that the primary beneficiary test is an inherently “flexible” test and whether an intern or trainee is an employee under the FLSA necessarily depends on the unique circumstances of each case.
The WHD announced it will conform to the federal court of appeals’ determinations and use the same court-adopted test to determine whether interns or students are employees under the FLSA.
Read the field bulletin
Increased Penalties for Federal ViolationsOn January 2, 2018, the U.S. Department of Labor (DOL) announced in the Federal Register that penalties for violations of the following federal laws have increased for 2018:
- Black Lung Benefits Act.
- Contract Work Hours and Safety Standards Act.
- Employee Polygraph Protection Act.
- Employee Retirement Income Security Act.
- Fair Labor Standards Act (child labor and home worker).
- Family and Medical Leave Act.
- Immigration and Nationality Act.
- Longshore and Harbor Workers’ Compensation Act.
- Migrant and Seasonal Agricultural Worker Protection Act.
- Occupational Safety and Health Act.
- Walsh-Healey Public Contracts Act.
These increases are due to the requirements of the Inflation Adjustment Act, which requires the DOL to annually adjust its civil money penalty levels for inflation by no later than January 15.
These increased rates are effective January 2, 2018.
Read the Federal Register
OSHA Penalties IncreasedOn January 2, 2018, the U.S. Department of Labor announced in the Federal Register that Occupational Safety and Health Administration (OSHA) penalties will increase for 2018 as follows:
- Other-than-Serious: $12,934
- Serious: $12,934
- Repeat: $129,336
- Willful: $129,336
- Posting Requirement Violation: $12,934
- Failure to Abate: $12,934
These increases apply to states with federal OSHA programs; rates for states with OSHA-approved State Plans will increase to these amounts as well; State Plans are required to increase their penalties in alignment with OSHA’s to maintain at least as effective penalty levels.
These new penalty increases are effective as of January 2, 2018 and apply to any citations issued on that day and thereafter.
Read the Federal Register
Agencies Release Advance Copies of Form 5500 for Filing in 2018The Employee Benefits Security Administration (EBSA) the Internal Revenue Service (IRS), and the Pension Benefit Guaranty Corporation (PBGC) released the advance informational copies of the 2017 Form 5500 and related instructions. For small employee benefit plan reports, advance short form copies of 2017 Form 5500-Short Form (SF) and 2017 Instructions for Form 5500-SF were also released with supplemental materials including schedules and attachments.
Read about and download the Form 5500 Series
Originally published by www.thinkhr.com
Have you heard the saying “the eyes are the window to your soul”? Well, did you know that your mouth is the window into what is going on with the rest of your body? Poor dental health contributes to major systemic health problems. Conversely, good dental hygiene can help improve your overall health. As a bonus, maintaining good oral health can even REDUCE your healthcare costs!
Researchers have shown us that there is a close-knit relationship between oral health and overall wellness. With over 500 types of bacteria in your mouth, it’s no surprise that when even one of those types of bacteria enter your bloodstream that a problem can arise in your body. Oral bacteria can contribute to:
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Endocarditis---This infection of the inner lining of the heart can be caused by bacteria that started in your mouth.
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Cardiovascular Disease---Heart disease as well as clogged arteries and even stroke can be traced back to oral bacteria.
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Low birth weight---Poor oral health has been linked to premature birth and low birth weight of newborns.
The healthcare costs for the diseases and conditions, like the ones listed above, can be in the tens of thousands of dollars. Untreated oral diseases can result in the need for costly emergency room visits, hospital stays, and medications, not to mention loss of work time. The pain and discomfort from infected teeth and gums can lead to poor productivity in the workplace, and even loss of income. Children with poor oral health miss school, are more prone to illness, and may require a parent to stay home from work to care for them and take them to costly dental appointments.
So, how do you prevent this nightmare of pain, disease, and increased healthcare costs? It’s simple! By following through with your routine yearly dental check ups and daily preventative care you will give your body a big boost in its general health. Check out these tips for a healthy mouth:
· Maintain a regular brushing/flossing routine---Brush and floss teeth twice daily to remove food and plaque from your teeth, and in between your teeth where bacteria thrive.
· Use the right toothbrush---When your bristles are mashed and bent, you aren’t using the best instrument for cleaning your teeth. Make sure to buy a new toothbrush every three months. If you have braces, get a toothbrush that can easily clean around the brackets on your teeth.
· Visit your dentist---Depending on your healthcare plan, visit your dentist for a check-up at least once a year. He/she will be able to look into that window to your body and keep your mouth clear of bacteria. Your dentist will also be able to alert you to problems they see as a possible warning sign to other health issues, like diabetes, that have a major impact on your overall health and healthcare costs.
· Eat a healthy diet---Staying away from sugary foods and drinks will prevent cavities and tooth decay from the acids produced when bacteria in your mouth comes in contact with sugar. Starches have a similar effect. Eating healthy will reduce your out of pocket costs of fillings, having decayed teeth pulled, and will keep you from the increased health costs of diabetes, obesity-related diseases, and other chronic conditions.
There’s truth in the saying “take care of your teeth and they will take care of you”. By instilling some of the these tips for a healthier mouth, not only will your gums and teeth be thanking you, but you may just be adding years to your life.
December 18th, 2017
Late Friday, the public got its first look at the Tax Cuts and Jobs Act. The 500-plus page bill is the product of separate House and Senate bills that were reconciled in conference. Congressional Republicans appear to have sufficient votes to pass the reconciled bill in both chambers and deliver it to President Trump’s desk this week.
If signed into law, the bill will make significant changes in the Internal Revenue Code with respect to corporations, businesses, and individuals. There also are a small number of provisions that will affect employee benefit plans. This article outlines the items of particular interest to employers that sponsor health and welfare benefits or retirement and savings plans.
Health and Welfare Benefits
Group health benefits, often considered the primary and most valuable benefit provided by employers, are not affected by the bill. Requirements that were added several years ago by the Affordable Care Act (ACA), including the so-called employer mandate and employer reporting requirements, will continue to apply. There also are no changes with respect to health flexible spending accounts (HFSAs), health reimbursement arrangements (HRAs), or health savings accounts (HSAs).
Current tax laws for group life and accident insurance and short- and long-term disability benefits also continue unchanged.
The original House bill would have affected the preferred tax treatment of adoption assistance benefits and educational assistance plans. The final bill, however, preserves the current treatment.
Dependent care assistance plans, including dependent FSAs, also escaped changes in the final bill. For individual income tax purposes, the federal child care tax credit will be expanded somewhat, so some employees will want to take another look at whether their employer’s FSA, or the federal credit, will offer the greater benefit.
Qualified transportation benefits, often referred to as commuter benefits, are affected by the new bill. For tax years 2018 through 2025, the bill repeals current law that allows employees to exclude bicycle commuting expenses from their gross income. Employees will continue to be able to exclude qualified parking and transit benefits from their income, but employers will lose the ability to deduct their costs for these benefits.
Retirement and Savings Programs
While early House proposals targeted retirement plan contribution limits, employer-sponsored retirement plans were generally unscathed in conference. Therefore, in 2018 employee contributions to 401(k), 403(b), most 457 plans, and the federal government’s Thrift Savings Plan remain capped at $18,500 ($24,500 for those age 50 or older). Roth and Traditional IRA limits in 2018 are capped at $5,500 ($6,500 for those age 50 or older).
The most notable change for tax favored employer-sponsored retirement plans relates to loan offsets. Under current law, if an employee receives a loan from the retirement plan and either the plan terminates or the employee terminates employment, then the employee’s obligation to repay the loan is accelerated and the employee must either repay the outstanding balance on the loan or roll the outstanding balance into another eligible retirement plan within 60 days to avoid tax liability for loan offset.
Under the bill, if the plan terminates or an employee fails to meet the repayment terms of the loan because they sever employment, then time period within which a loan offset can be rolled over tax-free to another eligible retirement plan is extended from 60 days to the employee’s due date (including extensions) for filing federal income taxes for the tax year in which the plan loan offset occurs. This provision takes effect for plan loan offset amounts treated as distributed in taxable years beginning after December 31, 2017.
Additionally, the tax plan provides more relief for employees impacted by natural disasters occurring in the 2016 or 2017 tax years. The natural disaster had to occur in an area declared as a disaster area by the president and the casualty damage (exceeding $500) must have resulted from that disaster. In such cases, employees who received a distribution from their eligible retirement plan (including a 401(k) plan, 457(b) plan or an IRA) may recontribute the funds to an eligible retirement plan to which a rollover can be made within three years after the date on which the distribution was received to avoid the money being included as income.
For this to apply to employees, employers will need to make retroactive plan amendments on or before the last day of the first plan year beginning after December 31, 2018 (December 31, 2020 for governmental plans) or a later date prescribed by the Secretary of the Treasury. The amendment is retroactively effective if it applies retroactively for the applicable period and the plan is operated in accordance with the amendment during that period. Therefore, amendments should reflect their operations during that time period. Employers are encouraged to work with employee benefits counsel to address any retroactive plan amendments.
Summary
Although early versions of tax reform bills would have affected several types of employee benefits, the final bill makes very few changes and those changes are fairly modest. Employers and their advisors will want to pay particular attention to issues affecting commuter benefits, loan provisions under 401(k) and similar plans, and tax relief for retirement/savings plan participants who were impacted by natural disasters in the past two years.
Originally published by www.thinkhr.com
‘Tis the Season’. Like most, you‘re probably in the midst of the “hustle and bustle” of this holiday season with dinners, parties, and activities; Christmas shopping; and spending those remaining FSA dollars you have allocated this year.
Wait, what? Yes, you read right. Chances are, if you’ve opted to utilize an employer-sponsored FSA account in 2017, you may have remaining funds you’ll need to spend. This is especially true if your employer opted for the $500 carryover rule in lieu of a grace period. Regardless of what flexible spending account you have, here are some strategies to get the most out of this benefit before year end.
Medical Care
Medical FSAs are the most common supplemental flexible coverage offered under employer benefit plans. If you’ve elected this coverage for 2017, here are a few things to consider when spending these funds.
Routine and Elective Medical Procedures
Whether routine or not, now’s the time to get appointments booked. If your employer offers a grace period for turning in receipts, you can book appointments into the first couple of months of the New Year and get reimbursed from this year’s funds without affecting 2018’s contributions. This has a two-fold advantage, as you can also spread next year’s deductible over the coming year.
Several routine and elective procedures that are FSA-eligible include:
· Lasik
· Sleep Apnea/Snoring
· Hernia surgery
· Colonoscopy
· Smoking/Weight Loss Cessation Programs
Alternative Therapies
Under IRS law, certain alternative therapies are eligible for reimbursement. Acupuncture and chiropractic care, alternative medicinal treatments, and herbal supplements and remedies are a great way to use up your funds for the year and get a little cash back when you most need it.
Dental
Dental benefits often work differently than medical coverage. According to the American Dental Association, this benefit is often capped annually – generally between $1,000 and $3,000. If you have unused funds remaining in your FSA, now may be the time to schedule a last-minute appointment with your dentist, especially if you might need serious work down the road. This way, you can use up the funds remaining in your account by year-end, and reduce your out-of-pocket expense next year by sharing the cost of additional dental services over a longer period of time.
Prescription Refills
Refilling your prescription medications at year end are a great way to use up your funds in your medical FSA. Take inventory of your prescription drugs, toss out expired ones, and make that call for a refill to your doctor or pharmacy.
Over the Counter Drugs, Medical Equipment and Supplies
Many OTC medications, medical equipment and supplies are eligible for reimbursement under a medical FSA. First-aid kits, blood-pressure monitors, thermometers, and joint braces are just a few. Please note that some will require a note or prescription from your doctor.
Mileage and Other Healthcare-Related Extras
Traveling to and from any medical facility for appointments or treatment are eligible for reimbursement under your FSA. This not only includes traveling by your own vehicle, but also by bus, train, plane, ambulance service; and does include parking fees and tolls.
In addition, you can get reimbursed for other health-related expenses. These include:
· Lodging and meals during a medical event.
· Medical conferences concerning an illness of you or one of your dependents.
· Advance Payments on a retirement home or long-term care.
Dependent Care
If you have opted to contribute to a DCFSA, you can get reimbursed for day care, preschool, summer camps and non-employer sponsored before and after school programs. In addition, funds contributed to this type of FSA can be used for elderly daycare if you’re covering more than 50% your parent’s maintenance costs.
Adoption Assistance
If you are contributing to an Adoption Assistance FSA offered by your employer, you can get reimbursed for any expenses incurred in the process of legally adopting an eligible child. Eligible expenses include adoption fees, attorney fees and court costs, medical expenses for a child prior to being placed for adoption, and related travel costs in association with the adoption process.
Make the most out of your FSA contributions by using the above strategies to your advantage as we close out 2017. As you move into 2018, review the maximum contribution guidelines for the coming year as set by the IRS, and establish a game plan on expenditures next year. Seek your HR department’s expertise for guidelines and tips they can give you to maximize this valuable benefit package.
Corporate fitness programs not only build camaraderie and morale, they can improve company bottom lines considerably. Improved worker health results in lower absenteeism, improved productivity, decreased health care costs and fewer lawsuits, according to the Wellness Council of America. Incentives and contests can help your company increase employee participation in wellness programs.
BenefitsA corporate fitness program improves employee health in several ways. Workers lose weight, reduce stress, lower blood pressure and sleep better. All of these can reduce sick days, doctor visit and workplace injuries. For example, lower-back injuries cause employees to miss 100 million work days annually, according to the Wellness Council of America. The DuPont corporation decreased disability days at its Tennessee plant by 14 percent after instituting a wellness program, saving almost $120,000 annually.
MotivationWhile employee education is an important part of any corporate wellness program, a fitness incentive program motivates employees to participate. Holding a team competition or offering cash or other prizes can create a buzz throughout your workplace and get more employees participating.
Team CompetitionsOne way to increase fitness program participation is to create a team contest. You can draw names at random to create teams, pit management against staff, place workers from different departments on teams to create more interaction or have different offices face off against each other.
Weight-loss ChallengeWeight loss is one aspect of fitness that concerns or interests many people. Create a weight-loss challenge as either an individual contest or team competition. You can award a prize or prizes based on total number of pounds lost or percentage of individual or team weight lost.
Fitness ChallengeIf you don't want to focus on weight loss only, have a broader fitness competition. Track total number of verifiable hours participants exercised during the competition period, how much each person or team lowered their cholesterol or a fitness challenge, with participants or teams competing in tests such as number of sit-ups and push-ups, minutes on a treadmill or jumping rope, timed laps swum or other measurements. Work with a fitness professional and your insurance company to create a test that is safe for all participants.
IncentivesYou can use a variety of incentives to motivate employees to participate in a fitness program. You can award cash prizes, trips, gift certificates, extra vacation days or other tangible rewards. You can add prestige with winners names on plaques displayed at headquarters, a mention in the company newsletter and press releases sent to local papers. With team events, the winning team might get to name the charity that receives a donation from the company. Whenever you award prizes, make sure the rules are clear, the judging criteria are objective and that all employees are eligible -- if you set up a contest for one department or employees with more than one year's service, you may create ill will among other employees.
Originally published by www.livestrong.com
The end of the year is upon us and a majority of companies celebrate with an end-of-year/holiday party. Although the trend of holiday parties has diminished in recent years, it’s still a good idea to commemorate the year with an office perk like a fun, festive party.
BENEFITS OF A YEAR-END CELEBRATION
- Holiday staff parties are a perfect way to thank your employees for a great year. All employees want to feel appreciated and valued. What better way to serve this purpose, than with an end of the year office celebration. Hosting a night out to honor your employees during a festive time of year boosts morale. And if done right, your party can jump start the new year with refreshed, productive employees.
- End-of-year celebrations allow employees to come together outside of their own team. The average American will spend 90,000 hours (45 years) of their life at work. Unless you have a very small office, most employees only engage in relationships within their department. When employees have a chance to mingle outside of their regular 9 to 5 day, they’ll build and cultivate relationships across different teams within the organization; creating a more loyal, cohesive and motivated culture.
- Seasonal parties can provide employers insight on those who work for them. Spending the evening with your employees in a more casual and relaxed atmosphere may reveal talents and ideas you may not have otherwise seen during traditional work hours.
CREATING THE RIGHT FIT
Regardless of office size, if planned right, employers can make a holiday party pop, no matter your budget. Whether this is your first go at an end-of-year celebration for your employees, or you host one every year, keep a few things in mind:
- Plan early. Establish a steering committee to generate ideas for your holiday party. Allow the committee to involve all employees early on in the process. Utilize voting tools like Survey Monkey or Outlook to compile employee votes. This engages not only your entire workforce, but serves you as well when tailoring your party to fit your culture.
- Create set activities. Engaging employees in some type of organized activity not only eases any social anxiety for them and their guests, it cultivates memories and allows colleagues to get to know each other. Consider a “Casino Night”, a photo booth (or two if your company can justify to size), an escape room outing—anything that will kick the night off with ease.
- Incorporate entertainment during the dinner. Have team leads or management members come up with fun awards that emphasize character traits, strengths, and talents others may not know of. This is a great way to create cohesiveness, build relationships, and have your employees enjoy a good laugh at dinner.
- Offer fun door prizes every 15 minutes or so. Prizes don’t have to be expensive to have an impact on employees, just relevant to them. However, with the right planning you may be able to throw in a raffle of larger gift items as well. Just keep in the specific tax rules when it relates to gift-giving. Gift cards associated with a specific dollar amount available to use at any establishment, and larger ticket items, can be subject to your employees having to claim income on them and pay the tax.
- Make the dress code inclusive of everyone. Employees should not feel a financial pinch to attend a holiday office party. Establish a dress code that fits your culture, not the other way around.
TAKE AWAY TIPS FOR A SUCCESSFUL HOLIDAY PARTY
According to the Society of Human Resource Management, statistics show in recent years only 65% of employers have offered holiday parties—down from 72% five years ago. Consider the following tips when hosting your next year-end celebration.
- Keep it light. Eliminate itineraries and board-room like structure. Choose to separate productivity/award celebrations and upcoming year projections from your holiday party.
- Invite spouses and significant others to attend the party. Employees spend a majority of their week with their colleagues. Giving employees this option is a great way to show you value who they spend their time with outside of work.
- Allow employees to leave early on a work day to give them time to get ready and pick up who is attending the party with them.
- Mingle. Show how you value your employees by chatting with them and meeting their guests.
- Provide comfortable seating areas where employees can rest, eat and talk. Position these in main action areas so no one feels anti-social for taking a seat somewhere.
- Consider tying in employees that work in different locations. Have a slideshow running throughout the night on what events other office locations have done throughout the year.
- Create low-key conversation starters and get people to chat it up. This is valuable especially for those that are new to the company and guests of your employees. Incorporate trivia questions into the décor and table settings. Get them to engage by tying in a prize.
- Keep the tastes and comfort level of your employees in mind. Include a variety of menu items that fit dietary restrictions. Not all employees drink alcohol and not all employees eat meat.
- Limit alcohol to a 2 ticket system per guest. Opt for a cash bar after that to reduce liability.
- Provide access to accommodations or coordinate transportation like Uber or Lyft to get your employees somewhere safely after the party if they choose to drink.
Ultimately, holiday parties can still be a value-add for your employees if done the right way. Feel free to change it up from year to year so these parties don’t get stale and continue to fit to your company’s culture. Contemplate new venues, ideas and activities and change up your steering committee to keep these parties fresh. Employees are more likely to enjoy themselves at an event that fits with their lifestyle, so don’t be afraid to get creative!
We’ve all been there – once or twice (or more)—when a child, spouse or family member has had to gain access to healthcare quickly. Whether a fall that requires stitches; a sprained or broken bone; or something more serious, it can be difficult to identify which avenue to take when it comes to walk-in care. With the recent boom in stand-alone ERs (Emergency Care Clinics or ECCs), as well as, Urgent Care Clinics (UCCs) it’s easy to see why almost 50% of diagnoses could have been treated for less money and time with the latter.
It’s key to educate yourself and your employees on the difference between the two so as not to get pummeled by high medical costs.
- Most Emergency Care facilities are open 24 hours a day; whereas Urgent Care may be open a maximum of 12 hours, extending into late evening. Both are staffed with a physician, nurse practitioners, and physician assistants, however, stand alone ECCs specialize in life-threatening conditions and injuries that require more advanced technology and highly trained medical personnel to diagnose and treat than a traditional Urgent Care clinic.
- Most individual ERs charge a higher price for the visit – generally 3-5 times higher than a normal Urgent Care visit would cost. The American Board of Emergency Medicine (ABEM) physicians’ bill at a higher rate than typical Family-Medicine trained Urgent Care physicians do (American Board of Family Medicine (ABFM). These bill rates are based on insurance CPT codes. For example, a trip to the neighborhood ER for strep throat may cost you more than a visit to a UC facility. Your co-insurance fee for a sprain or strain at the same location may cost you $150 in lieu of $40 at a traditional Urgent Care facility.
- Stand alone ER facilities may often be covered under your plan, but some of the “ancillary” services (just like visit rates) may be billed higher than Urgent Care facilities. At times, this has caused many “financial sticker shock” when they first see those medical bills. The New England Journal of Medicine indicates 1 of every 5 patients experience this sticker shock. In fact, 22% of the patients who went to an ECC covered by their insurance plan later found certain ancillary services were not covered, or covered for less. These services were out-of-network, therefore charged a higher fee for the same services offered in both facilities.
So, what can you and your employees do to make sure you don’t get duped into additional costs?
- Identify the difference between when you need urgent or emergency care.
- Know your insurance policy. Review the definition of terms and what portion your policy covers with regard to deductibles and co-pays for each of these facilities.
- Pay attention to detail. Understand key terms that define the difference between these two walk-in clinics. Most Emergency Care facilities operate as stand-alone ERs, which can further confuse patients when they need immediate care. If these centers, or their paperwork, has the word “emergency”, “emergency” or anything related to it, they’ll operate and bill like an ER with their services. Watch for clinics that offer both services in one place. Often, it’s very easy to disguise their practices as an Urgent Care facility, but again due to CPT codes and the medical boards they have the right to charge more. Read the fine print.
It’s beneficial as an employer to educate your employees on this difference, as the more they know – the lower the cost will be for the employer and employee come renewal time.
As 2017 comes to a close, it’s time to act on the money sitting in your Flexible Spending/Savings Account (FSA). Unlike a Health Savings Account or HSA, pre-taxed funds contributed to an FSA are lost at the end of the year if an employee doesn’t use them, and an employer doesn’t adopt a carryover policy. It’s to your advantage to review the various ways you can make the most out of your FSA by year-end.
Book Those Appointments
One of the first things you should do is get those remaining appointments booked for the year. Most medical/dental/vision facilities book out a couple of months in advance, so it’s key to get in now to use up those funds.
Look for FSA-Approved Everyday Health Care Products
Many drugstores will often advertise FSA-approved products in their pharmacy area, within a flyer, or on their website. These products are usually tagged as “FSA approved”. Many of these products include items that monitor health and wellness – like blood pressure and diabetic monitors – to everyday healthcare products like children’s OTC meds, bandages, contact solution, and certain personal care items. If you need to use the funds up before the end of the year, it’s time to take a trip to your local drugstore and stock up on these items.
Know What’s Considered FSA-Eligible
Over the last several years, the IRS has loosened the guidelines on what is considered eligible under a FSA as more people became concerned about losing the money they put into these plans. There are many items that are considered FSA-eligible as long as a prescription or a doctor’s note is provided or kept on file. Here are a few to consider:
1. Acupuncture. Those who suffer from chronic neck or back pain, infertility, depression/anxiety, migraines or any other chronic illness or condition, Eastern medicine may be the way to go. Not only are treatments relatively inexpensive, but this 3,000 year old practice is recognized by the U.S. National Institute of Health and is an eligible FSA expense.
2. Dental/Vision Procedures. Dental treatment can be expensive—think orthodontia and implants. While many employers may offer some coverage, it’s a given there will be out-of-pocket costs you’ll incur. And, eye care plans won’t cover the cost of LASIK, but your FSA will. So, if you’ve been wanting to correct your vision without the aid of glasses or contacts, or your needing to get that child braces, using those FSA funds is the way to go.
- Health-boosting Supplements. While you cannot just walk into any health shop and pick up performance-enhancing powder or supplements and pay with your FSA card, your doctor may approve certain supplements and alternative options if they deem it to benefit your health and well-being. A signed doctor’s note will make these an FSA-eligible expense.
4. Smoking-cessation and Weight-Loss Programs. If your doctor approves you for one of these programs with a doctor’s note deeming it’s medically necessary to maintain your health, certain program costs can be reimbursed under an FSA.
Talk to Your HR Department
When the IRS loosened guidelines a few years ago, they also made it possible for participants to carry over $500 to the next year. Ask Human Resources if your employer offers this, or if they provide a grace period (March 15 of the following year) to turn in receipts and use up funds. Employers can only adopt one of these two policies though.
Plan for the Coming Year
Analyze the out-of-pocket expenses you incurred this year and make the necessary adjustments to allocate what you believe you’ll need for the coming year. Take advantage of the slightly higher contribution limit for 2018. If your company offers a FSA that covers dependent care, familiarize yourself with those eligible expenses and research whether it would be to your advantage to contribute to as well.
Flexible Spending/Saving Accounts can be a great employee benefit offering tax advantages for employees that have a high-deductible plan or use a lot of medical. As a participant, using the strategies listed above will help you make the most out of your FSA.
Can you still provide benefits without a group health plan? Yes, you can! Small employers who need to entice the best, most qualified employees can still have an attractive benefits package without having the stress of a high-cost health plan. Even better news? The way to do it is tax deductible. Learn more about the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) from our compliance bulletin. Follow us to stay up-to-date on the rules, regulations and laws that affect small employers by connecting with us on social media and signing up for our monthly newsletter.
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Open Enrollment season can be a stressful time but hopefully these tips will help for a smoother transition into the next year for your business.