In conversations with HR professionals and benefit brokers, we find that the topic of long-term care insurance (LTCi) is often covered in less than two minutes during renewal meetings. When I ask why the topic of conversation is so short, they tell me, “Employees just aren’t asking about it, so they must not be interested.”

If employees aren’t asking about LTCi, does it mean they aren’t interested? They just may be unaware of the value of LTCi and that it can be offered by their employer with concessions not available in the open market. Here are the top seven reasons why LTCi should be a bigger part of the employee benefits conversation.

  1. Do you know LTCi can be offered as an employee benefit?
    There are multiple employer-sponsored products, including those with pricing discounts, guarantee issue, and payroll deduction.
  2. Do you believe Medicaid and Medicare will provide long-term care for employees?
    This is a popular misconception. Medicare and Medicaid will restrict your employees’ choices of where and how they receive care. These options will either not offer custodial or home care, or they’ll force employees to spend down their assets for care.
  3. Do you think LTCi is too expensive, or that your employee population is too young to need it?
    Many plans can be customized to meet personal budgets and potential care needs. It’s also important to know that rates are based on employees’ ages. The younger the employees are, the lower their rates will be.
  4. Are you aware of the variety of LTCi plans?
    Many policies offer flexible coverage options. Depending on the policy an employer selects, LTCi can cover a wide range of care—in some cases even adult day care and home safety modifications.
  5. Do you believe the market is unstable?
    Today’s products are priced based on conservative assumptions, and employers are enrolling very stable LTCi plans for their employees. Each month, we see new plan options and products being introduced along with new carriers entering the market.
  6. Do you already offer an LTCi plan but it’s closed to new hires?
    Being able to offer a similar LTCi benefit to all employees is crucial for most employers. Find a partner that can assist with the current LTCi plan and can assist with bringing in a new LTCi offering for new hires.

 

By Christine McCullugh
Originally Published By United Benefit Advisors

Insurance has become the method by which most Americans have their health-care costs paid. By paying a regular monthly bill for health insurance, the cost of expected health care events is spread out into even payments and the cost of major unexpected medical incidents is absorbed by insurance. Lack of health insurance can have a profound negative effect on personal finances.

Bankruptcy

Lack of health insurance can come about due to lack of income to pay for it, or when a breadwinner is between jobs that would otherwise provide health insurance as an employment benefit. If a major illness or accident occurs during the time a person is uninsured, it can lead swiftly to bankruptcy, reports the Oregon Public Broadcasting News. Under-insurance, that is, health insurance which is not sufficient to cover the costs of a major health incident, can also lead to bankruptcy. A study published by the American Journal of Medicine in August 2009, reported that well over 60 percent of U.S. bankruptcies filed. in 2007 were due to inability to pay medical costs. Most of these debtors had medical debts over $5,000, which represented a significant portion of their household annual income; three-quarters had health insurance insufficient to cover their bills, and one-quarter had no insurance.

Reduction in Income

Lack of health insurance can lead to a breadwinner's death, further causing the most severe reduction on household income. According to a Harvard Medical School study reported by Reuters news, about 45,000 people in the United States die each year due to lack of health insurance. Thus, people who could otherwise serve as breadwinners or care-givers are removed from being able to do so. The Urban Institute points out that people lacking health insurance create the significant economic impact of reduced personal earnings, because poorer health means less productive work years and more time off work due to illness or injuries during those working years.

Penalties

Beginning January 1, 2014, most people will be required to maintain health insurance, and individuals who do not obtain health insurance will have to pay a penalty under the federal Patient Protection and Affordable Care Act of 2010. The insurance requirement penalty provision exempts people with income below the poverty level, as well as those in jail, members of registered Indian tribes, those whose religious tenets preclude health insurance, and individuals for whom essential health insurance coverage cost for one month would exceed 8 percent of their household gross income for the year. People who do not meet one of these exemptions, but who decline to purchase health insurance, may be penalized up to $95 in 2014, $350 in 2015, $750 in 2016, and $750 plus a cost of living increase for subsequent years. According to SmartMoney, the penalty provision is likely to have the strongest impact on the personal finances of younger, unmarried consumers. Although the statute exempts the poorest people from its provisions, the penalty for failure to have health insurance will negatively impact the personal finances of those to whom it applies.

By Cindy Hill
Originally Published By LiveStrong.com

Online enrollment platforms are great, but communication and understanding are terribly important for the end-user.

I always say, “technology is great, when it works.” Online enrollment platforms have been around for years, and the technology that powers them has grown and advanced at an exponential rate. Who would have guessed that we would be enrolling in our employee benefits directly from our own phones and tablets, without being given the huge enrollment packets from HR?

In this virtual communication age, you can’t take the “human” out of Human Resources, and you can’t take the confusion out of insurance benefits just because you wrap it in a nice, pretty website with fancy graphics and videos.

An employee’s health concerns and needs are as diverse and different as hair colors are at Comic Con, so while a brief overview of plan details is fine for one person, someone else wants to know how many physical therapy visits they can have in a year, or if their child’s insulin pump will be covered on their plan.

A simple online enrollment platform does not always meet the needs of all employees, and not all platforms will offer the level of detail some will require. Aside from posting the evidence of coverage, or insurance contract, at a place that is easily found on the portal, there may not be a way to achieve that level of detail. However, even for those that don’t need that level of detail, critical information must be communicated easily and effectively.

Costly mistakes can be made when benefits are not communicated effectively, or when important information is simply omitted. For example, since the Patient Protection and Affordable Care Act (ACA) was implemented, some employers have opted to offer minimum value plans (MVPs), or plans that cover very few procedures such as office visits, preventive care, and hospital room and board, but they do not cover a wide range of other services such as ambulance, surgery, medical devices, physical or occupational therapy, etc.

When an employee sees a number of choices or plans from which to choose, they will likely compare the various plan options by looking at the carrier, if the plans are HMOs or PPOs, and the cost. From there, an employee may look at the office copays, deductibles, prescription drug costs, and coinsurance.

If the comparison shows MVP plans as well as traditional health plans, but does not call out in big, bold letters, all of the items the MVP plan does not cover, one could come away with the understanding that if they choose the MVP plan, they are selecting a plan that is a comprehensive insurance plan just like the other plans shown, or like they have had in the past.

Most of us don’t read our car insurance policy in detail until we get in an accident and the insurance adjustor says, “sorry, your policy does not cover that.” The same is usually true for our health insurance plans.

You could argue that it is the responsibility of the employee to verify that the plan they are choosing meets all of their needs, certainly. But if that information is not easy to locate, you could find fault with the employer, or insurance carrier, if there were to be a problem. Furthermore, an employer would want to show their employees that they want to take care of them, and not set them up for failure in the event of a crisis.

Let’s walk through a scenario. An employee named “Joe” is 28, and is enrolling in his company’s health plans during open enrollment. His company recently merged with another larger company, and so the benefits being offered are slightly different, but look pretty close to what they had been last year. There are four plans offered, two that are HMO plans with Kaiser and two that are PPO plans, one is labeled Silver, the other Gold.

Joe is young and single, and when he was living at home with his parents, he had never had Kaiser and always traditionally had PPO coverage. Last year, Joe enrolled in the Silver PPO plan so he could continue to see the doctors that had been managing his care for all of his adult life, so he elects the same plan this year. The online system shows a $250 deductible, $40 office visit copay, and 30% coinsurance. In addition, the Kaiser premiums have gone up considerably from what he remembered them to be last year, and are higher than the PPO plan options, so he feels comfortable that he has made the choice that is best for him.

Later in the year, he comes down with a bad cold. The pressure in his head that is caused by the cold is so severe that when he sneezed, he blew out his right ear drum. He goes to the doctor, and his doctor orders a CT scan of his ear. The CT scan shows he has perforated his ear drum and will need surgery to repair it. The surgery is scheduled for two weeks after that. He contacts the hospital and surgeon to confirm they are contracted, in-network providers under his health plan, and asks them to do a pre-determination of benefits so he will know up front how much he should expect to pay as his 30% of the cost of the procedure.

While waiting for the surgeon and hospital to get back to him regarding the out-of-pocket costs, he receives the bill for the CT scan and explanation of benefits from his doctor for the office visit and CT scan. They show his office copayment that he paid at the time of service, and his $250 deductible, plus 30% of the remaining cost of the CT scan, which came out to a total of $500. He pays the bills and continues to work even though he is in extreme discomfort from his right ear.

The surgeon and hospital both get back to him and let him know the surgery itself will cost approximately $20,000 because his plan does not cover surgery, period. Joe is not an executive in a large company; he does not have the money to pay for a $20,000 surgery and also afford to take three weeks off of work in order for him to recover. So, what is he to do?

He can’t enroll in another plan offered by his employer for another nine months when they go through open enrollment again. It is March, so he has missed the state Exchange open enrollment window, and he has not experienced an involuntary loss of coverage that would enable him to enroll in a state Exchange plan. If he were to purchase a short-term, comprehensive medical plan it won’t cover any pre-existing conditions, which his perforated ear drum would certainly be considered. So, unless he gets married and enrolls on his new spouse’s plan if they were offered one by their employer, he is out of options. He will simply have to wait until open enrollment next year.

How do you think Joe is feeling about his employer right now? Do you think he is counting his blessings that he only ruptured his ear drum and was not diagnosed with cancer that needed to be removed before it spread any further? Or is he going to be using a few choice words to describe an employer that offers a medical plan to its employees that has a longer list of services not covered than are covered? I can’t say that I know for sure, but I can guess.

Now, the question becomes how does an employer prevent their employees from running into these kinds of pitfalls? It comes down to clear communication—multiple forms of communication that are easily accessible to employees and their family members that may also play a role in making plan decisions. Having someone to partner with your company, such as a UBA Partner Firm that will not only help you develop long-term plan strategies for your employee benefits package, but can be an integral part of developing and implementing online systems, hard copy communications, and give you access to tools such as smartphone applications that not only give employees access to essential information, but also push out important communications that contain relevant information at the appropriate times like open enrollment. Making plan details easily accessible in the online platform, with clear and bold statements if there are essential benefits that are not covered on the plan such as a warning, should be clearly stated so that employees are well informed.

An ounce of prevention is worth a pound of cure. Insurance is a complicated business and you, as an employer, would not want to make decisions about the health care you offer your employees without someone to guide you through the various options and possibilities. As responsible employers, our employees should not have to either.

By Elizabeth Kay
Originally Published By United Benefit Advisors

I am proud to say that I have been involved in corporate wellness since the mid-1980s. Helping employees live healthier and happier lives, as well as supporting employers with best-in-class tools to improve their cultures, have been my passion and purpose. I have witnessed and worked on corporate wellness since the time when physical health was the most important aspect of workers’ health. I cannot say I have worked with wellness since its inception, though. Corporate wellness has been around longer than many people think. To predict the future of wellness, we must understand its past.

Writings about the effects of work exposure on workers and how to improve workers’ health and well-being can be found as early as the 1700s1. Later, the industrial revolution brought many health issues to workers such as working 14 to 16 hours a day, low wages, and very poor working conditions2. The World Health Organization’s (WHO) definition of health in the 1940s as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” opened our eyes to the concept of health and wellness as a more complex one3. In addition, the work of Halbert Dunn in 1959 helped the word “wellness” circulate more widely in the public health field, but it was the CBS 60 Minutes program with Dan Rather in 1979 titled, “Wellness, there’s a word you don’t hear every day,” that created curiosity about what corporate wellness was at that time – emphasis on physical health4. Corporate wellness has evolved since then and many studies have been published leading to a wealth of knowledge on best practices, return on investment (ROI), value of investment, risk reduction, health improvement, and more. The March 2017 edition of Health Affairs was dedicated exclusively on the relationship of work and health, and health and work highlighting important recent studies on wellness. Wellness has moved from physical health to thriving in other dimensions such as emotional, financial, spiritual, social, and intellectual health. In addition, many theories on behavior change and behavior economics have been adopted in wellness programs and its incentive designs. Wellness has changed from a “nice to have” to a “must have” benefit, but it must be done right and implemented consistently in order to provide positive results that align with your company’s goals.

I don’t have a crystal ball or special powers, but I believe the future of wellness lies in the following:

  • Millennials in the workforce will demand more sophisticated technology.
  • The traditional health risk assessment will be replaced by a more holistic kind – check out the True Vitality Test from The Blue Zones. (The UBA Health Plan Survey finds that although 72.5 percent of wellness programs include health risk assessments, their use has been declining, dropping 10.5 percent in three years.)
  • Wellness will be part of all successful companies’ business objectives – the Chief Wellness & Well-being Officer’s ultimate goal will be to build a culture of health, self-responsibility, and emotional balance. Wellness will be an important piece of this. For great examples of companies ahead of our time, check out Dr. Ron Goetzel’s work at the Institute of Health and Productivity Studies at John Hopkins School of Public Health.
  • Non-traditional workplace environments will replace the health-damaging sitting and sedentary work environment of today.
  • Wellness will be more integrated with benefits in general, but more specifically with high-deductible health plans (HDHPs) as a way to help employees fund them.
  • ROI will no longer be the focus, and instead it will be part of a long-term business strategy.
  • Wellness will have a wider impact overall where employees will thrive in the workplace and bring their health improvement skills to their families and communities.

We now know how to deliver wellness that positively affects cultures and population health. We don’t need any additional studies. All we need are brave and open-minded companies to embark on the journey of optimal wellness and well-being. This journey is full of trials and errors, but also full of self-discovery and growth that can build very profitable companies filled with employees who truly engage at work and thrive every day. Who is with me in this journey?

By Valeria S. Tivnan, Originally Published By United Benefit Advisors

In the first part of this two-part blog, I recommended a number of important items to keep in mind as you select a stop loss carrier. Additionally, here are a few other things you will want to look for, or ask about, when selecting a stop loss carrier. While this is not an exhaustive list, these are some of the most frequent items I have seen that cause issues or gaps in coverage.

Plan Mirroring

Does the stop loss carrier “mirror” its policy to your employee benefit plan document? I like to think of this whole plan mirroring approach as kind of hand in glove. The relationship between the employee benefit plan document and the stop loss policy should be a complement to one another.

Your employee benefit plan document and your stop loss policy are two separate documents containing many different provisions and terms. Without plan mirroring, stop loss carriers will audit to their stop loss contracts, which can, and do, result in gaps in coverage. Make sure you work with a carrier who will provide plan mirroring.

Medical Necessity Determinations

Although a stop loss carrier can follow plan language, some do, and will, question determinations made by the plan for medical necessity. Stop loss carriers differ on their level of scrutiny in this area. The reality is the medical field is not always black and white on how to treat a patient. It is important to understand the carrier’s position and also the medical guidelines used by your administrative services only (ASO) carrier or third-party administrator (TPA) in making medical determinations.

Recognition of Network Requirements

With your employee benefit plan, you are most likely using a preferred provider organization (PPO) network where provider claims are subject to payment based on an agreed schedule. The agreement you have to access this network predicates what the plan will pay the provider for their services.

A stop loss carrier who is not party to this agreement may question the payment methodology, or feel it can do better on certain claims. They rely on cost containment vendors to review claims and determine what they might feel would be “reasonable” payments. If this is the case, you, as an employer, may be left with a gap in coverage as you are required under your employee benefit plan to reimburse the provider at the contracted rate, but your stop loss carrier may not reimburse you to that level.

It is important to know your stop loss carrier’s position on this type of situation.

Claim Turnaround

Find out what the carrier’s commitment is to paying claims. Many carriers have standards that can vary greatly by carrier. With stop loss, you are typically dealing with large dollar amounts and from a cash flow perspective, you want to know what your carrier’s policy is regarding claims payment.

Will the carrier allow for “advanced funding?” If so, the claim is first adjudicated and processed, but not paid until the stop loss carrier has reimbursed the portion over the stop loss deductible. This, in turn, minimizes the disruption to your cash flow. Many, but not all, carriers offer advanced funding and some will charge an additional fee.

You will want to check with your broker or administrator on the carriers you are considering and what their specific requirements are for advanced funding.

Reasonable and Customary (R&C)

R&C is also known as usual and customary (U&C). As noted earlier, most employee benefit plans take advantage of PPO networks, where provider claims are subject to payment based on an agreed schedule. Outside of claims through a PPO, most plans limit claims payments or reimbursements to R&C charges. This describes the amount an ASO carrier or TPA decides to use as the starting point in the payment for a service.

In each case, it is important to ensure that the employee benefit plan’s definition agrees with the stop loss policy, or that the stop loss policy will follow the provisions of the employee benefit plan.

Secondary Network Access Fees

Typically, a TPA or ASO carrier will provide access to a “secondary” or specialty-type network, such as a transplant-only network. The advantage is that the employee benefit plan and member gain access to discounts, or additional discounts above and beyond that of the primary network offering.

In these cases, there is typically an access fee usually set as a percentage of the savings achieved that is the responsibility of the employee benefit plan. These fees are NOT always reimbursable by the stop loss carrier, or the stop loss carrier may put a limit on the amount reimbursed.

Check with your broker or administrator on whether stop loss carriers you are considering will reimburse you for these types of fees.

While these six considerations are not a comprehensive list, they will certainly set you on the right path for discussions with your broker, or administrator, on selecting a stop loss carrier that not only meets your needs, but also provides the protection necessary for your employee benefit plan and company.

By Steven Goethel, Originally Published by United Benefit Advisors

It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits.  And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

In a recent study conducted by the Aloft Group on the state of Telemedicine, 47.7% of respondents weren’t sure about what Telemedicine meant, but it’s possible they may have experienced it, as 52.4% have had interaction with a physician or clinician via email or text. Further, 78.5% of respondents indicated they would be comfortable talking with a physician using an online method.

Dr. Tony Yuan, an experienced ER doctor in San Diego, who also consults for Doctor on Demand, provides insight into this increasing trend during a recent Q and A session. Currently, over half of the patients he sees in his ER could utilize a digital healthcare model. In fact, 90% of patients who head to the ER for minor illnesses can be treated through this service. So, the next sinus, ear infection, or other minor health issue just may provide you and your family the chance to try what will become the new standard in minor healthcare.

Here are few benefits TeleMedicine has to offer:

It’s Fast and Simple

There’s no question apps are available for everything to make our lives easier—and TeleMed is no exception. Within minutes, standard first time users can set up an account, complete a few medical profile questions, then create and save a session. Having the ability to log on with a board-certified physician or clinician 24/7/365, using any PC, smart device, and even phone in some cases, saves time and money. Many services, like Teledoc and MDLive, will connect you with a licensed doctor or clinician online in just a few minutes – no scheduling or wait required. Once on, you can discuss your healthcare needs confidentially. After the visit, the doctor will update his/her records, notify your primary care physician of the call, and send an electronic prescription to the pharmacy of your choice, if necessary—all in the time it takes for a lunch break.

 

It’s Flexible

The ability to connect with a professional whether you are at home, work, or traveling makes getting the care you need invaluable. How often have you experienced the symptoms—or the full blown-effect—of getting sick while traveling? Many, no doubt, have had to adjust flight/travel plans to get the help needed from their PCP, in order to avoid getting worse.  By using an app or online service from your smart phone or laptop, you’re able to get the antibiotics you need quicker without cutting trips short or missing work to do so.

 

In addition, patients in smaller communities without the resources available of classically- trained, emergency-med physicians, see the benefit and flexibility of tapping into these online doctor services. Not only is it a plus for the patient to access more advanced care if needed, doctors in these rural areas value this as well. These digital healthcare models provide immediate, life-saving tools for both doctors and their patients who may not have access to higher, acute facilities.

 

It’s Affordable

Many TeleMedicine services now accept insurance, making a patient’s visit free, or at minimum the same as most deductible or co-insurance amounts for office visits; around $40. For those on a high-deductible plan, paying $40 for an online doctor service is a much cheaper alternative than paying $150 or more for an Urgent Care visit, or over $1200 for a trip to the ER. For employers, group options are low cost and can be a clear asset when creating solutions EEs will value.

 

It’s Beneficial to Employers

Today, 3 of 5 corporations, or 59% of employers provide digital healthcare benefits to their employees. As an employer, the benefits are straightforward. First, employees can participate in professional consultations for their family members or themselves without taking away from productivity. Second, when employers incorporate these services into their benefit plans, non-emergency care is redirected from expensive ER visits, ultimately saving thousands of dollars or more to the bottom line. Additionally, TeleHealth services offer frequent monitoring from clinicians for those employees who may need regular support due to more chronic issues, reducing trips to the hospital. Reducing these costs have a direct ROI for the employer and relieves the stress on the employee’s pocketbook. Third, many companies are now adding this digital benefit to their packages as a way to recruit new talent.

 

There’s no doubt 2017 will see a greater opportunity for all to experience the increasing trend of Telemed. Creating a clear communication strategy to make sure employees know how to find, access and utilize this service to the highest potential is key.

Most health insurance plans cover emergency treatment, hospital stays and medical exams. If you are injured in an accident, your health insurance plan might not pay for all the incurred medical expenses. Supplemental accident insurance coverage pays cash benefits for illnesses or injuries caused by an accident, including fractures and physical therapy. The coverage is designed to help alleviate the burden of unexpected costs. Depending on how the policy is paid, the payouts may be classified as taxable income.

How it Works

Accident insurance coverage generally covers death or injuries caused by accidents on or off the job. There are a variety of coverage options available. Some employers offer the accidental coverage as a voluntary supplemental plan. You can also purchase private accident insurance to protect yourself if the coverage is not offered through your employer.

Self-Paid Plans

According to the IRS, if you paid the premiums on an accident or health insurance policy, the benefits are not taxable. Payouts from an insurance policy taken out through the employer are not taxed if you paid the premiums with after-tax dollars. If you pay the premiums of an accident insurance plan through a cafeteria plan, the premium was not included as taxable income and is considered paid by the employer and therefore the benefits are taxable.

Employer-Paid Plans

Accidental insurance payouts are taxable if the employer paid for the insurance plan. If you paid for an accidental insurance plan through the employer using pre-tax dollars, your benefits are taxable income. Any benefits received from your employer while injured are considered salary or wages and taxable as ordinary income. Additional taxable disability benefits include income from a welfare fund, state sickness or disability fund and association of employers or employees.

Withholding and Reporting

Report any taxable insurance payouts as wages, salaries, tips, etc., on your taxes. If you are suffering a long-term disability and receive taxable benefits, avoid a hefty tax bill by submitting a Form W-4S, Request for Federal Income Tax Withholding From Sick Pay, to the insurance company.

By Jeannine Mancini, Originally Published By LiveStrong

There is no denying our industry is changing rapidly, and it’s not about to slow down. Combined with disruptive advances in technology and evolving consumer expectations, we’re seeing consumer-driven health care emerge. Take, for example, the fact that employees now spend more than nine hours a day on digital devices.

There’s no doubt that all this screen time takes a toll.

  • Device screens expose users to blue light. It’s the light of the day and helps us wake up and regulate our sleep/wake cycle.
  • Research suggests blue light may lead to eye strain and fatigue. Digital eye strain is the physical eye discomfort felt by many individuals after two or more hours in front of a digital screen.
  • In fact, digital eye strain has surpassed carpal tunnel syndrome and tendonitis as the leading computer-related workplace injury in America1.

Employees are demanding visibility into health care costs and transparency in the options available so they can take control of their own health. Consumers are more knowledgeable and sensitive to cost, and as a result becoming very selective about their care.

Technology Exposure Spends more than nine hours
a day on digital devices
Millennials 2 in 5
Gen-Xers 1 in 3
Baby Boomers 1 in 4

 

Lack of preventive care

Preventive screenings are a crucial piece of overall health and wellness. In fact, the largest investment companies make to detect illnesses and manage medical costs is in their health plan. But if employees don’t take advantage of preventive care, this investment will not pay off. Only one out of 10 employees get the preventive screenings you’d expect during an annual medical visit2.

It’s a big lost opportunity for organizations that are looking for a low-cost, high-engagement option to drive employee wellness.

How a vision plan can help

The good news is that the right vision plan can help your employees build a bigger safety net to catch chronic conditions early. It all starts with education on the importance of an eye exam.

Eye exams are preventive screenings that most people seek out as a noninvasive, inexpensive way to check in on their health; it’s a win-win for employers and employees.

  • A comprehensive eye exam can reveal health conditions even if the person being examined doesn’t have symptoms.
  • The eyes are the only unobtrusive place in a person’s body with a clear view of their blood vessels.
  • And, an eye exam provides an opportunity to learn about the many options available to take control of their health and how to protect their vision.

By screening for conditions like diabetes, high blood pressure, and high cholesterol during eye exams, optometrists are often the ones to detect early signs of these conditions and put the patient on a quicker path to managing the condition. In a study conducted in partnership with Human Capital Management Services (HCMS), VSP doctors were the first to detect signs of3:

  • Diabetes – 34 percent of the time
  • Hypertension – 39 percent of the time
  • High cholesterol – 62 percent of the time

 

By Pat McClelland, Originally Published By United Benefit Advisors

 

Recently, the Department of the Treasury, Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) issued FAQs About Affordable Care Act Implementation Part 34 and Mental Health and Substance Use Disorder Parity Implementation.

The Departments’ FAQs cover two primary topics: tobacco cessation coverage and mental health / substance use disorder parity.

Tobacco Cessation Coverage

The Departments seek public comment by January 3, 2017, on tobacco cessation coverage. The Departments intend to clarify the items and services that must be provided without cost sharing to comply with the United States Preventive Services Task Force’s updated tobacco cessation interventions recommendation applicable to plan years or policy years beginning on or after September 22, 2016.

Mental Health / Substance Use Disorder Parity

Generally, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance use disorder (MH/SUD) benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits.

A financial requirement (such as a copayment or coinsurance) or quantitative treatment limitation (such as a day or visit limit) is considered to apply to substantially all medical/surgical benefits in a classification if it applies to at least two-thirds of all medical/surgical benefits in the classification.

If it does not apply to at least two-thirds of medical/surgical benefits, it cannot be applied to MH/SUD benefits in that classification.

If it does apply to at least two-thirds of medical/surgical benefits, the level (such as 80 percent or 70 percent coinsurance) of the quantitative limit that may be applied to MH/SUD benefits in a classification may not be more restrictive than the predominant level that applies to medical/surgical benefits (defined as the level that applies to more than one-half of medical/surgical benefits subject to the limitation in the classification).

In performing these calculations, the determination of the portion of medical/surgical benefits subject to the quantitative limit is based on the dollar amount of all plan payments for medical/surgical benefits in the classification expected to be paid under the plan for the plan year. The MHPAEA regulations provide that “any reasonable method” may be used to determine the dollar amount of all plan payments for the substantially all and predominant analyses.

MHPAEA’s provisions and its regulations expressly provide that a plan or issuer must disclose the criteria for medical necessity determinations with respect to MH/SUD benefits to any current or potential participant, beneficiary, or contracting provider upon request and the reason for any denial of reimbursement or payment for services with respect to MH/SUD benefits to the participant or beneficiary.

However, the Departments recognize that additional information regarding medical/surgical benefits is necessary to perform the required MHPAEA analyses. According to the FAQs, the Department have continued to receive questions regarding disclosures related to the processes, strategies, evidentiary standards, and other factors used to apply a nonquantitative treatment limitation (NQTL) with respect to medical/surgical benefits and MH/SUD benefits under a plan. Also, the Departments have received requests to explore ways to encourage uniformity among state reviews of issuers’ compliance with the NQTL standards, including the use of model forms to report NQTL information.

To address these issues, the Departments seek public comment by January 3, 2017, on potential model forms that could be used by participants and their representatives to request information on various NQTLs. The Departments also seek public comment on the disclosure process for MH/SUD benefits and on steps that could improve state market conduct examinations or federal oversight of compliance by plans and issuers, or both.

Originally published by www.ubabenefits.com

 

Question: Are we required to allow employees (either exempt or nonexempt) to work from home if we must close the office due to bad weather?

Answer: No, employers are not required to allow employees to telework (work from home or another location; virtual work) under any specific weather conditions regardless of Fair Labor Standards Act (FLSA) exemption status. However, employers may allow employees to telework. Company policy should delineate procedures for both teleworking and notice requirements when inclement weather affects the workplace; for instance, notice from the employer that the workplace is closed and notice from the employee that they cannot travel to the workplace due to weather-related or other emergency conditions. These policies should be in the employee handbook, and should also detail whether the employer will allow nonexempt employees to make up missed time.

Note that if the employer closes the workplace for weather-related reasons, nonexempt employees are not entitled to pay because such employees are only entitled to compensation for hours actually worked. However, an employer may allow nonexempt employees to use accrued paid time off so as to receive compensation during such an absence. If paid time off is not available, then the time off remains unpaid.

Alternatively, exempt employees who are able and available to work but do not work because the employer closed the workplace due to inclement weather are still entitled to their full week of pay. This is because the exempt employee is available to work but rather the employer made the work unavailable. As a general rule, if an exempt employee performs any work during the workweek, they must be paid their full salary amount. An employer may not make deductions from an exempt employee’s pay for absences caused by the employer or by the operating requirements of the business. If the exempt employee is ready, willing and able to work, an employer cannot make deductions from the exempt employee’s pay when no work is available. Additionally, the U.S. Department of Labor specifically states that an example of an improper deduction from an exempt employee’s pay includes deduction of a days’ pay because the employer was closed due to inclement weather.

Originally published by www.thinkhr.com

I have joined the class that Ron invited me to regarding HR and FMLA, etc. Thank you for your ongoing support and assistance; it is a pleasure doing business with you.”

- Preschool Director

Categories