A recent article in Human Resource Executive Online shared a startling statistic: It takes about 16 years to realize a positive return-on-investment on employer-sponsored wellness programs. That’s a long time, and more importantly makes you wonder why we implement wellness programs at all? According to this article, it’s not so much about the health care dollars you gain back for your business with wellness programs, but more about how these initiatives can transform your company culture for the better.
Here’s a quick article excerpt:
“Edington believes wellness programs can’t save enough in healthcare costs to make a difference – ‘maybe $200 to $300, at best’ – but he thinks a wellness program can create shareholder value.
How? By increasing job satisfaction, happiness factors and creating a great place to work. By association, according to Edington, wellness programs raise employee loyalty, decreases turnover and increases creativity and productivity. And that’s good for the business’ bottom line.
Edington summarizes it this way: ‘Happiness [is] the new, ultimate metric.’”
While some may want to argue the concept of wellness program ROI, you can’t debate the fact that more than 75 cents of every health care dollar spent in the United States goes toward treating chronic diseases such as arthritis, asthma, cancer, cardiovascular disease and diabetes, according to the Centers for Disease Control and Prevention.
Regardless of an employer’s main reason for implementing a wellness program, it’s important to know the latest strategies when it comes to ensuring that they’re effective and PPACA-compliant.
Unum and United Benefit Advisors (UBA) are hosting two free webinars: “Health and Wellness and Employee Motivation: Making the Connection” on Aug. 27, 2013 at 2 p.m. ET, and “Legal Considerations When Developing an Employer-Sponsored Wellness Program” on Aug. 29, 2013 at 2 p.m. ET, that aim to address effective wellness program strategies and health care reform considerations.
“Health and Wellness and Employee Motivation: Making the Connection” will prepare employee benefits and human resource managers to manage and consult upon the emerging issues related to the multigenerational workforce including productivity and motivation. The presentation examines the health care industry and its unique challenges in managing productivity due to the aging population, health reform, disengaged workers, and the need to mitigate the impact of the rising costs of healthcare among its own employees. To register for this webinar, visit http://tinyurl.com/n4olw4s. Receive a $149 discount for this webinar, enter code UNUMUBA27 when registering.
To ensure that your wellness programs are PPACA-compliant, the webinar, “Legal Considerations When Developing an Employer-Sponsored Wellness Program,” will review new rules for wellness programs under health care reform. To register, visit: http://tinyurl.com/n2yca7h. Receive a $149 discount for this webinar by entering the code UNUMUBA29 when registering.
By Linda Rowings
Chief Compliance Officer
United Benefit Advisors
Last week several media outlets picked up a FAQ that the Department of Labor issued in February of this year. (The FAQ may be accessed here: FAQs About Affordable Care Act Implementation Part XII.) Some of the reports have created confusion about the requirement, and the scope of what has been delayed; here is a summary of the rules:
Beginning in 2014, all non-grandfathered plans (whether fully insured or self-funded, and regardless of size) must have an out-of-pocket maximum that does not exceed $6,350 for single coverage and $12,700 for family coverage. The out-of-pocket maximum includes the deductible, coinsurance and copays. It may exclude out-of-network charges and excluded charges.
In response to industry comments that it would be difficult to integrate different vendors’ systems by 2014, the FAQ provides that if a plan uses different providers for medical and prescription drugs, it will not be required to integrate out-of-pocket maximums for 2014. Instead, simply ensuring that the medical benefit meets the out-of-pocket maximum will suffice. (Plans that have a common medical and Rx vendor are expected to apply both medical and Rx charges to a common out-of-pocket maximum.) Because of existing rules under the Mental Health Parity Act, plans that use a separate vendor for mental and nervous disorder coverage should already have an integrated out-of-pocket maximum for medical and mental and nervous coverage, and the transition rule does not apply to this situation.
With all of the Patient Protection and Affordable Care Act (PPACA) regulations, the last thing employers want to do is worry about requirements that don’t apply. One particular regulation that doesn’t necessarily concern employers is the individual responsibility requirement (also know as the individual mandate).
And although the employer shared responsibility requirements have been delayed to 2015, the individual responsibility requirement is still scheduled to take effect in 2014. Under the individual mandate, most people residing in the U.S. will be required to have minimum essential coverage, or they will have to pay a penalty. Many individuals will be eligible for financial assistance, through premium tax credits (also known as premium subsidies), to help them purchase coverage if they buy coverage through the health insurance marketplace (also known as the exchange).
Employers are not required to educate their employees about their individual responsibilities under PPACA, but providing information on this component of the law is just another way to help your employees understand all facets of health care reform.
United Benefit Advisors has developed a summary of individual mandate requirements that employers may find useful. The summary includes:
To view this summary, click here.
Holly Parsons
VP Marketing & Business Development
The Wilson Agency
We spend so much time worrying about how heath care reform will affect our business, which provisions apply and when, how much it will cost, and on and on, that I wanted to take a moment and write about what real health care reform is all about.
I recently attended a business luncheon where the keynote speaker was the CEO of a large regional hospital. At one point he asked the audience to hold up their hands if they could answer in the affirmative all of the following points:
Setting aside genetics, people who practice these behaviors will generally use less health care. Less health care usage will lead to lower health insurance premiums, among other positive benefits. Unfortunately, only about 30 percent of us could admit that we practice these elements of healthy behavior. As sad as this percentage is, the speaker informed us that it’s actually much better than the national average of only three percent.
But, consistently practicing healthy behaviors can be challenging, especially in our culture. Exercising takes time, sometimes money and knowledge of the best methods and techniques. Quitting smoking is one of the most difficult things a person can do, or so I’ve heard. Very few of us get enough fruits and vegetables. If you ever eat out, you can see this in our culture through abundant fast food options, limited offerings of vegetables, and plates filled primarily with white starch or cholesterol-laden meat. All of this leads to a BMI that is less than optimal.
If we want our health insurance costs to be lower, if we want to pay less at the doctor’s office, if we want to keep the government out of our business decisions, if we want to stop subsidizing other people’s health care, then we must begin the process ourselves. Address your own unhealthy habits. If you already have healthy habits, encourage others to do the same. Turn off the TV and take a walk after dinner. Learn a recipe that incorporates vegetables. Educate yourself about weight loss or exercise. Find restaurants that provide a good selection of healthy alternatives to high starch, high fat, and high sugared foods. Demand that healthier food be served at conferences and business meetings. By all means, stop smoking.
Change can be hard. For some people, it can be overwhelming to alter habits that have developed over a lifetime or longer and therefore they never try, or quit soon after they start. But, start we must. And continue to start, over and over until we experience the progress we need to see: lower blood pressure, normal BMIs, less medication, fewer doctor visits and sick days.
The real health care reform isn’t going to be found through Congress, your health plan or your doctor. Real health care reform begins and ends with you. What will you do today to start?
Encourage your best clients to enter The Principal 10 Best. This prestigious national program recognizes growing companies that excel in innovation, corporate culture and providing their employees financial security. Entries are due by Aug. 30, 2013.
As the complexities of the Patient Protection and Affordable Care Act (PPACA) continue to challenge business owners and HR professionals, UBA continues to lead the industry by sharing proprietary research and analysis, often utilized by journalists and media outlets looking to help employers and consumers navigate the increasingly complex world of insurance benefits.
UBA recently launched an online News Center, intended to provide a one-stop solution for media looking for resources on health insurance and employee benefits, health care reform and business compliance information. In the first part of 2013, we have already seen significant increases in media requests, having served as a source to leading publications such as The New York Times, Money Magazine, Business Insurance, Consumer Reports, HR Executive Magazine, Employee Benefit News, and dozens more.
The News Center includes press releases, expert bios, previous media coverage, a list of popular topics requested and various ways to connect to UBA, as well as links to valuable resources, such as whitepapers and UBA’s popular PPACA Resource Center.
As the News Center is updated, new features and information will be added to showcase UBA’s extensive research and analysis tools, highlighting expertise of staff as well as our network of 2,200 experienced benefits professionals representing more than 36,000 employers.
Journalists are encouraged to subscribe to News Center updates via RSS, and can request further information by contacting Bill Olson, Chief Marketing Officer, at bolson@ubabenefits.com.
Thomas Jefferson said it best: “Never put off tomorrow what you can do today.” And when it comes to the Patient Protection and Affordable Care Act, this lesson couldn’t ring more true. It’s easy to keep pushing compliance off to a more convenient time, but there are requirements that take effect later this year which demand preparation. The recent PPACA delays, while helpful in some ways, have erroneously caused many to think they can take a sigh of relief for a year.
But oftentimes the reasons for procrastination have to do with not knowing where to start. PPACA requirements are also affected by employer size, which adds further confusion.
The best approach for big projects, such as PPACA compliance, is to have a to-do checklist, especially in our environment where even something as seemingly simple as determining how many employees you have is almost incomprehensible! United Benefit Advisors has developed a PPACA Readiness Checklist that helps employers prepare for upcoming regulations. “Preparing for PPACA – A Readiness Checklist” outlines seven significant requirements, which include:
To view all the details in the guide, click here.
By Mick Constantinou, Advisor, Employee Benefits
Connelly, Carlisle, Fields, & Nichols, A UBA Partner Firm
Provisions under the Affordable Care Act allow health insurers to charge smokers 50 percent higher premiums than nonsmokers for new individual policies sold beginning in 2014. The question now is whether the final ruling on the tobacco surcharge will have the teeth necessary to promote healthier lifestyles.
In terms of the exchange application process, applicants will only need to attest whether they are or are not a smoker without further verification. Additionally, the final rules prevent insurers from rescinding a policy or denying coverage because someone was not “honest” about whether they are a smoker or not. Insurers can only charge “dishonest” policyholders for any surcharge amount that should have been paid that year.
Consumer advocates weighed in on the implementation of a tobacco surcharge and indicated that charging smokers more for health insurance was counterproductive for a variety of reasons:
In response to consumer advocates, final rules also give states the option to reduce or eliminate the variation in rates (i.e. the tobacco surcharge). Six states and the District of Columbia have opted not to charge smokers more, according to the Department of Health and Human Services. A few other states have limited the premium differential to less than 50 percent.
While the teeth around the tobacco surcharge may not be immediate, if the reporting verification process and systems catch up with the implementation of the exchanges, dishonestly with self reporting income and tobacco usage will have financial bites.
Brainshark, a UBA-Certified Solution, can help you take existing presentations and static documents, and create dynamic, media-rich, interactive presentations to effectively present employee benefit information.
By Mike Humphrey
Sr. Employee Benefits Advisor
The Wilson Agency, a UBA Partner Firm
I’ve been in human resources for a long time. One of the most frustrating parts of the job is managing Family Medical Leave Act (FMLA) compliance. This piece of legislation has been in place since 1993 and allows employees to be away from their job and still have it waiting for them when they return. It does have limitations on it, such as what events qualify and how long it can be used (12 weeks in a 12-month period or up to 26 weeks in a single 12-month period for military caregiver leave), and it’s a great assistance to employees who are going through an often traumatic period in their lives.
The biggest frustration about it comes from unplanned intermittent leave for chronic serious health conditions. Taking FMLA leave intermittently or on a reduced schedule doesn’t affect the total amount of leave available to an employee. Only the time actually taken is charged against the employee’s available leave, and generally an employer must account for the FMLA leave using an increment no greater than the shortest period of time that it uses to account for use of other forms of leave, provided that it is not greater than one hour. The result is an employee can stretch out their intermittent leave for a very long time.
The Department of Labor also recognized unplanned intermittent leave as a considerable issue for employers regulated by FMLA. As a result, the Department issued a Request for Information asking the public to assist the Department by furnishing information about their experiences. The response was significant—more than 15,000 comments were received. Although the Department noted the overwhelming majority of the comments were centered on the employer’s frustration about difficulties in maintaining necessary staffing levels and controlling attendance problems as a result of unscheduled intermittent leave, nothing was done to address this issue. So, employers are still left with managing this frustrating and time consuming provision of FMLA.
In my experience I find the best solution is to hire a professional organization to handle FMLA. These vendors can come in the form of your payroll, time & attendance, or disability insurance providers. Three primary reasons justify this added expense.
Neutrality: a third party manager takes the politics out and removes inequities that may exist between staff levels.
Systematic: a professional organization can find efficiencies in this laborious and technical compliance task.
Focus: the HR department can then focus on value added education to make sure employees & managers are fully trained on how this works, ultimately saving the company time and money.
UBA recently hosted a webinar on FMLA – Meeting the Challenge of Compliance and Cost. For a copy of the presentation, click here. If you are interested in a full audio/visual presentation on the recorded webinar, click here to request a copy from your nearest UBA Partner Firm.
