So, what can we expect from the employee benefits world in 2014? How about anything and everything! I wish I had 52 letters for this version of the benefits ABCs. 

Analyze your employee health data. Given privacy laws, it won’t be possible to learn what makes every employee tick, but analyzing metrics-based health reports will still provide valuable information to help control costs within your health insurance program (e.g., modify benefits plan design, introduce wellness initiatives, develop targeted education for employees, especially in high risk areas). Your health insurance carrier or broker should develop this report for you. Ask them for the concise 35-page version with proposed action items, not the 200-page data dump.      

Be prepared for the 2014 ACA requirements. Another year, another set of ACA provisions. Some of the key 2014 ACA requirements include a 90-day maximum waiting period for health insurance coverage, no annual dollar limits on “essential health benefits,” no pre-existing condition exclusions for any enrollees, and limits for annual out-of-pocket maximums. Work with your broker and carrier/s to ensure these are appropriately introduced into your plan and communicated to employees.

Cost-management. According to the 2013 International Foundation of Employee Benefit Plans Employer-Sponsored Health Care: ACA’s Impact Survey, organizations have/are implementing the following cost-management initiatives in the next 12 months: increasing participants’ share of premium costs (43%), increasing the employee portion of dependent coverage costs (34%), increasing in-network deductibles (33%), and increasing out-of-pocket limits (31%). Reviewing participant activity, benchmark data, and projected financial costs will allow you to determine the cost-management initiatives most appropriate for your organization.

Dispel the myths. Whether it’s the news, Internet, newspaper, friends, coworkers, or relatives, employees are hearing different things when it comes to employee benefits — some true, some untrue.  To make matters worse, information that could be true one day might not be true the next. The latest one I heard was that health insurance was going to be free for everyone. Bottom line: Encourage your employees to use you as the go-to resource for accurate, up-to-date employee benefits information.

Evolution of the traditional health care model. A greater partnership is developing between the traditional office-based health care model and virtual health care. Telehealth, telemedicine, and health-based mobile applications are becoming more prevalent as supplemental value-adds to the traditional office visit when it comes to the prevention and curative sides of health care. You may want to explore virtual opportunities with your health insurance carrier.

Financially model health care costs between now and 2018. For at least the next five years, medical insurance renewals will include significant costs associated with health care reform (on average, there has been a 2-3% increase in premium attributed to health care reform in the 2014 renewals).  That said, it is strongly recommended that you forecast the financial impact of such costs to your organization to allow for adequate budgets, minimize the financial surprise for senior management and develop strategies to mitigate future costs. Current and future costs impacts include the PCORI fee, transitional reinsurance fee, health insurer fee, automatic enrollment, shared responsibility requirement, and Cadillac tax.  

Grandfathered health plans continue to decline.  According to The Kaiser Family Foundation and Health Research & Educational Trust 2013 Employer Health Benefits Survey, the percentage of covered workers enrolled in grandfathered health plans declined to 36% of covered workers from 48% in 2012 and 56% in 2011. If your plans are losing grandfathered status in 2014, be sure to introduce all of the ACA provisions and notices associated with offering nongrandfathered plans. 

HIPAA compliance (Don’t forget!).  With everyone so focused on the ACA, it’s easy to lose sight that the compliance safe harbor period with the HIPAA/HITECH Omnibus Final Rule ended on September 23, 2013. Ensure you are complying with the HIPAA Privacy and Security requirements that apply to your organization which may include updating your HIPAA privacy and security policies and procedures and privacy notices, entering into new business associate agreements, and conducting appropriate employee training.

Increase awareness of state benefits requirements. Federal law seems to be king these days but that hasn’t stopped states from doing their own thing. It’s important to remain cognizant of state laws that affect your employee benefits program. Some 2014 state initiatives include California’s 60-day maximum waiting period for fully insured plans and each state’s definition of “essential health benefits.”

Just you. The benefits workload these days would be daunting to an entire department of people and there’s a good chance the “benefits department” is only you. If that’s the case, be sure to align yourself with good internal and external resources to help you get the job done and keep your sanity (e.g., health & welfare broker, legal counsel, IT, finance, payroll, communications). Plus, become active in your local HR/benefits organization. It will provide an opportunity to talk shop with your peers, including learning new ideas. 

Know and Learn what the new benefits strategy lingo means. Over the next year, you are going to hear more about private exchanges, “low-cost/skinny” plans, SHOP exchanges, and fixed indemnity plans.  One or more of these strategies may make sense for your organization so you should take the time to learn what they mean. 

Mt. Rushmore of benefits. Strategy, implementation, compliance, and communications — these are the four words that are going to keep you up at night in 2014. Start preparing yourself, your staff, and senior management for what these concepts mean to your company.

Stay tuned for Part 2.

Ed Bray, JD, MBA, is senior vice president, compliance for Ascension Benefits & Insurance. He can be reached at

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