What do you get when you combinea three-year-old learning his ABCs, a six-year-old who wonders what daddy does for a living, and a nine-year-old who thinks its "cool" that daddy likes to write? You get the 2012 version of the employee benefits ABCs!
Analyze wellness programs.
A recent Fidelity/National Business Group on Health survey offers five suggestions to help employers maximize the effectiveness of their wellness programs: Secure commitment from senior management; align programs with the health risks and challenges of the workforce; set realistic goals and measure results; offer incentives that appeal to the workforce; and manage vendors by establishing performance requirements.
Be aware of state/federal guidance.
Whether it's waiting to learn the specifics of a respective health care reform provision whose original effective date has passed or to receive greater guidance on how to implement a respective Patient Protection and Affordable Care Act provision, you should remain cognizant of the "national and state benefits wires" on an almost daily basis.
CFOs at the HR table.
According to a Towers Watson/Forbes Insights survey, HR and finance executives see changes ahead in their own roles when it comes to reward programs, including greater partnering to manage costs associated with health care reform, and continuing to attract and retain talent.
Use HR/benefits as the prime resource for PPACA communication. Employees may hear differently from outsiders. For example, they may think the cost of benefits on their Form W-2 is taxable (it is not) or that the women's preventive care provision will take effect on Aug. 1 (it may not as it only applies to nongrandfathered plans and will take effect on the first of the plan year on or after Aug.1.)
Follow the Supreme Court.
The court will play a key role in determining the future of the PPACA. It is expected to release a ruling on PPACA this month.
Greater HIPAA policing.
The Health and Human Services' Office for Civil Rights has begun auditing covered entities under the Health Insurance Portability and Accountability Act, including employer-sponsored group health plans.
Help and Inform.
Inform and engage different functional areas within your organization when implementing the PPACA's provisions. One example for 2012 is the Form W-2 aggregate cost of benefits reporting requirement, where you will most likely be working with payroll to ensure compliance.
Jump in HSAs.
According to the 2011 Employee Benefit Research Institute/MGA Consumer Engagement in Health Care survey, there's been a significant increase in health savings accounts and health reimbursement arrangements between 2006 and 2011.
Keep employees engaged.
According to a WorldatWork survey, 45% of organizations say turning employees into educated consumers of benefits is a very high priority for their company.
Learn about ACOs.
An accountable care organization is a healthcare model that rewards providers for improving patient outcomes and slowing cost growth. ACOs consist of groups of doctors, hospitals and specialists who provide coordinated care. Insurance carriers are starting to develop ACOs for non-Medicare participants.
Manage carrier refunds.
In 2011, Blue Shield of California issued 2% pledge refunds to health plans in the form of invoice credits. As this practice may continue with BSCA and other carriers, it's critical that you manage the handling of any refunds appropriately as per ERISA guidelines. Refunds may be deemed ERISA plan assets so your participants may be due a portion.
Navigate new wellness approaches.
Wellness trends to watch for this year, according to OptumHealth, include: Outcome-based incentives; social media to reinforce healthy behaviors; health care advisory services; and maintaining or even increasing wellness spending.
Offer health insurance.
The majority (67%) of HR and finance executives expect to maintain health care benefits for their active employees, according to the Towers Watson/Forbes Insights survey.
Prepare for and Quantify play-or-pay costs.
The cost of not offering medical insurance generally looks like a better option than offering medical insurance. But when you consider the effect of corporate tax deductions and the employee salary gross ups, odds are you will see the results reversed. Construct a financial model illustrating the true cost of "playing" and "paying" for your organization.
Reasonable broker/consultant expectations.
HR staffing has been affected by the economy, so it's fair to expect more from your health and welfare broker/consultant. For more on this, read "Extras matter: Three things employers should expect from their brokers," in EBN February.
Standardize communications in a timely way.
PPACA requires health plans and health insurance issuers to provide a standardized Summary of Benefits and Coverage to applicants and enrollees. Starting September 23, 2013, health plans and health insurance issuers will have varying effective dates for complying with this provision.
Understand MLR rules.
Employers with fully insured group health plans may receive rebates beginning in August, pursuant to the medical loss ratio rules of PPACA. If you anticipate receiving a rebate, it's in your best interest to understand how to appropriately use a portion of it for your employees' benefit (if they contribute to the plan).
In 2011, some PPACA provisions were repealed, and both the early retiree reinsurance program and the annual limit waiver program were closed to new applicants. Keep an eye on additional provisions that are repealed or modified.
If required to comply with this provision of PPACA, make sure you effectively communicate the meaning of it to employees (what it is, what it represents, and reiterating that it is not taxable.)
Xchange development in your state.
State-run health insurance exchanges, due to open on Jan. 1, 2014. As of March, only 12 states and the District of Columbia have enacted state-based health insurance exchanges.
Zero in on benefit costs.
According to the 2012 Towers Watson/NBGH survey, 40% of employers say that developing a workforce culture where employees are accountable for their own health will be a top health care strategy focus in 2013.
Contributing Editor Ed Bray, JD, is director of compliance for Burnham Benefits Insurance Services. He helps corporate clients establish and maintain regulatory compliance for their benefits plans. He can be reached at firstname.lastname@example.org.
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