Archive for the ‘Employer News’ Category

2017 Annual Benefit Plan Amounts

November 28th, 2016 by Clemons

Click here for 2017 Annual Benefit Plan Amounts

When the C-Suite Gets Seriously Sick | Panama City Benefits Broker

November 30th, 2015 by Clemons

By Bill Olson, Chief Marketing Officer at United Benefit Advisors

Someone in the C-Suite of a company gets sick. I’m not talking about a cold or flu; I’m talking about a major, possibly even terminal, illness. Depending on the level of severity, what can the human resources department do to help When the C-Suite Gets Seriously Sickcommunicate this information properly to the company’s employees?

There will always be privacy concerns, but there are also requirements with the Securities and Exchange Commission (SEC) that mandate publicly traded companies to disclose information that may impact an investor’s decision to buy or sell stock. A serious illness could be interpreted as something that needs to be reported to the SEC. Other than that, how much information should a C-Suite executive share with HR, when should he or she share it, and should they discuss any plans for a successor – either temporary or permanent? On the HR side, how much of this should they release to the rest of the company?

Based on an article on Human Resource Executive Online titled, “Disclosing Illness in the C-Suite,” when handled correctly, the disclosure of an executive’s illness can do more than satisfy SEC compliance. It can reassure employees and investors that the company has a plan going forward, it can address important questions, and it can stop the almost certain spread of false rumors.

Sharing information today is common and rapid, which makes hiding a major illness next to impossible. Rather than letting the company’s rumor mill disclose the information in a way that could be harmful to the executive and his or her family, detrimental to the company, and potentially completely false, it’s better to have it come directly from a company representative. Current examples include Goldman Sachs CEO and Chairman Lloyd Blankfein, who sent a memo to employees and the SEC just one day after his lymphoma diagnosis. Contrast this with Apple CEO Steve Jobs who withheld his cancer diagnosis for an entire year. The latter example is cited as a textbook case of how not to handle this. The “doom and gloom” speculation of what was happening to Jobs was rampant both internally at Apple and with investors.

This type of speculation almost always leads to decreased employee morale and productivity, which is why HR should communicate information as quickly as possible. That being said, it’s up to the C-Suite executive to determine how much information he or she wants to divulge. The role of HR is to communicate how this is going to impact the company’s daily operations, whether someone will be temporarily assuming those responsibilities, and if the company has a succession plan in place if the executive is not able to return to work.

Because this type of news can disrupt the operations of a company, HR should continually provide updates and put them in a positive light. As it states in the article, you can’t draft this type of plan, especially a plan of succession, after a critical illness diagnosis is announced. This is something that must be thought of ahead of time in order to avoid the turbulent aspect it can produce. Regardless of this, HR also needs to emphasize the seriousness of the issue and that it must be handled with respect, sensitivity, and professionalism.

Hopefully, an HR department will never have to deal with this unfortunate experience. Striking a balance between the C-Suite executive’s privacy and everyone else’s need to know may be one of the most difficult things an HR department can face. This is why planning ahead can often provide that level of confidence during this time of corporate instability.


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Healthcare Cost Reduction: Community Paramedicine as a New Primary Care Delivery Model | Panama City Employee Benefits Broker

November 19th, 2015 by Clemons

By Peter Freska, Benefits Advisor at The LBL Group A UBA Partner Firm

I recently read an article on what some say is the conventional wisdom of healthcare costs in the United States which, as a percent of gross domestic product, are higher than most other countries. The article works to demonstrate that the reason for the higher than average cost and the lack of “better” health outcomes in light of significantly higher spending is attributable to non-healthcare issues such as lack of access, especially for the poor. With the drive of healthcare reform to make sure the U.S. population is insured and address the shortage of primary care physicians increasing as high as 31,000 (“Physician Supply and Demand Through 2025: Key Findings,” Association of American Medical Colleges, April 1, 2015), where will people receive their primary care, and at what cost? What if there were a more efficient and cost effective way to deliver care to populations that lack access or don’t have the ability to easily access care.

Here are some data points to set the stage:

Enter community paramedicine. According to the California Emergency Medical Services Authority, “Community Paramedicine focuses on providing services, where access to care is limited, or a short term intervention is needed. By targeting locally identified health care needs, and offering a creative solution to fill local health care gaps, [Community Paramedicine] helps to increase access to care, and often reduces health care costs by providing the right level of care based on the individuals medical needs.” (Source: Community Paramedicine Fact Sheet, California Emergency Medical Services Authority)

So what is community paramedicine? Paramedics with this additional training (EMT-P designation) operate under strict standards and procedures with clear medical control by a supervising physician as they respond to emergency situations and provide some medical transportation roles in the communities they serve. Community paramedics are experienced paramedics with additional training in patient assessment and familiarization with healthcare providers and social services that are available to the community they serve. The net result is a more direct, integrated and immediate approach to healthcare delivery in a community.

EMS FunctionsChart source: Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders, National Conference of State Legislatures, 2012

How does this impact insurance and benefits? Financing of community paramedicine services faces many hurdles, but there are several bright spots across the country and on the federal level. Several states (Minnesota, Maine, and Colorado) have passed legislation to allow reimbursement for these services under insurance plans. On the federal level, Medicaid doesn’t currently recognize community paramedic services for reimbursement, but alignment to value-based medicine and a patient centered medical home model may allow for alignment of these services in the future. If the states and federal government can come into alignment and allow reimbursement for community paramedicine services, insurance companies will align policies to allow this service. If provider organizations adopt community paramedicine as part of a commitment to value-based medicine and patient-centered medical homes, they will be able to provide more direct, local care, in a timely fashion at a lower cost. With 10,000 baby boomers turning 65 every day and millions of previously uninsured joining the insured ranks, primary care is a focus in the provision of health care now and for many years to come. Community paramedicine is a primary care force multiplier that makes sense.

The National Conference of State Legislatures summarizes the need for community paramedicine by stating “Using community paramedics to deliver basic primary care offers unique opportunities to reduce emergency room contact and improve health outcomes for underserved patients.  As policymakers consider their role within this workforce shift, they will benefit from the experiences of community paramedic pilot programs. Emerging data on cost and quality outcomes will help policymakers and payers assess the impact of these interventions on health care costs and individual and community health.  Policymakers can play an important role in ensuring that these coordinate public and private resources, track health care and cost outcomes, and foster innovation while also protecting patient health and safety.”

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Transitional Reinsurance Fee for Self-funded Group Health Plans | Panama City Employee Benefits

October 29th, 2015 by Clemons

By Jennifer Kupper, In-house Counsel for iaCONSULTING, a UBA Partner Firm

The Patient Protection and Affordable Care Act (ACA) established the Transitional Reinsurance Program to help stabilize premiums in the individual private and public marketplaces. The Transitional Reinsurance Fee (TRF) applies to fully insured and self-funded major medical plans for 2014, 2015, and 2016, regardless of the policy or plan year. Insurers of fully insured major medical plans and sponsors of self-funded major medical plans are responsible Transitional Reinsurance Feefor filing and submitting contributions for the Transitional Reinsurance Program. Self-funded plans include those plans that are partially self-insured and partially fully insured. (There is a limited exception for certain self-insured, self-administered plans.) The self-funded plan’s TPA may assist with the calculation and pay the associated fee on behalf of the plan sponsor.

Contribution Amounts, Tax Implications, and Record Retention

For the 2014 calendar year, the contribution fee was $63 per covered life. The 2015 contribution fee is $44 per covered life, and the contribution fee will be $27 per covered life for 2016. The fee is tax-deductible as a business expense. A plan sponsor may treat the contributions as ordinary and necessary business expenses, subject to any applicable disallowances or limitations under the Internal Revenue Code. This treatment applies whether the contributions are made directly, through a third-party administrator (TPA), or through an administrative-services-only contractor. Plan sponsors must maintain paper or electronic records to substantiate the enrollment count on which the fee is based for at least 10 years.

Contribution Payments Schedules

The Department of Health and Human Services (HHS) gives plan sponsors the option of either paying the fee in full or in two installments. The plan sponsor’s decision is reported at the time the sponsor submits the Contribution Form. If the plan sponsor chose to pay the 2014 fee in full, the payment was due on January 15, 2015. For plan sponsors who chose to pay the fee in two installments, the first installment of $52.50 per covered life was due on January 15, 2015. The second installment of $10.50 per covered life is due on November 15, 2015. For the 2015 payment of $44 per covered life, the plan sponsor may pay the total amount on or before January 15, 2016. If the plan sponsor is making two payments, the first installment of $33 dollars per covered life is due January 15, 2016; the second installment of $11 per covered life is due no later than November 15, 2016.

For comprehensive information on how to calculate covered lives for this fee, including the acceptable methods, request UBA’s ACA advisor, “Frequently Asked Questions about the Transitional Reinsurance Fee (TRF)”.

To understand the difference between the Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee and the Transitional Reinsurance Fee, request UBA’s ACA Advisor, “Comparison of PCORI and TRF” for a side-by-side comparison of each, including start and end dates, reporting methods, fee due dates, exclusions, calculation methods and more. UBA also offers a free download of its ACA Advisor on the PCORI Fee, “Frequently Asked Questions about the Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee.”


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Cafeteria Plans: How to Handle Participant Contributions | Clemons Company

October 22nd, 2015 by Clemons

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

Cafeteria plans, or plans governed by IRS Code Section 125, allow employees to pay for expenses such as health insurance with pre-tax dollars. Employees are given a choice between a taxable benefit (cash) and specified pre-tax qualified benefits, for example, health insurance. Employees are given the opportunity to select the benefits they want, just like an individual standing in the cafeteria line at lunch.

Cafeteria Plans

Only certain benefits can be offered through a cafeteria plan:

  1. Coverage under an accident or health plan (which can include traditional health insurance, health maintenance organizations (HMOs), self-insured medical reimbursement plans, dental, vision, and more)
  2. Dependent care assistance benefits or DCAPs
  3. Group term life insurance
  4. Paid time off, which allows employees the opportunity to buy or sell paid time off days
  5. 401(k) contributions
  6. Adoption assistance benefits
  7. Health savings accounts or HSAs under IRS Code Section 223

Some employers want to offer other benefits through a cafeteria plan, but this is prohibited. Benefits that you cannot offer through a cafeteria plan include scholarships, group term life insurance for non-employees, transportation and other fringe benefits, long-term care, and health reimbursement arrangements (unless very specific rules are met by providing one in conjunction with a high deductible health plan). Benefits that defer compensation are also prohibited under cafeteria plan rules.

Cafeteria plans as a whole are not subject to ERISA, but all or some of the underlying benefits or components under the plan can be. The Patient Protection and Affordable Care Act (ACA) has also affected aspects of cafeteria plan administration.

Employees are allowed to choose the benefits they want by making elections. Only the employee can make elections, but they can make choices that cover other individuals such as spouses or dependents. Employees must be considered eligible by the plan to make elections. Elections, with an exception for new hires, must be prospective. Cafeteria plan selections are considered irrevocable and cannot be changed during the plan year, unless a permitted change in status occurs. There is an exception for mandatory two-year elections relating to dental or vision plans that meet certain requirements. Participants may only make election changes based on IRS provided changes in status, or certain triggering events as contained in the Health Insurance Portability and Accountability Act (HIPAA).

For all the best practices regarding participant contributions, including when participants are unable to pay their required contribution, request UBA’s new ACA Advisor, “Cafeteria Plans: Participant Contributions.”

To benchmark your health plan against others in your industry, region, and group size, be sure to pre-order the 2015 Health Plan Survey Executive Summary to get the most up to date information on premiums, employee/employer contributions, plan design trends and more.


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How to Get Employees’ Attention during Open Enrollment | Panama City Employee Benefits

October 5th, 2015 by Clemons

By Matthew Augustine, GPHR, REBC, CEO of Hanna Global Solutions, a UBA Partner Firm

It’s that time of the year – open enrollment season is here! Insurance carriers are presenting renewals and brokers are presenting ways to alleviate the cost pressure with innovative cost management strategies. HR and benefits Open enrollmentprofessionals are under pressure to think out of the box and come up with new and improved benefit programs to engage employees. Benefits administration companies are busy getting staffed, trained and ready for long hours and last-minute client decisions. And employees are getting ready for the barrage of benefits-related communications that are coming their way.

Are employees really looking forward to this?

My daughter was recently hired by a global pharmaceutical company and had to complete her benefits enrollment online. She was definitely was not looking forward to this part of her onboarding process. For her, it was one of those necessary ”to do” items that had to be checked off, and the less time it took, with the least bit of engagement or attention required from her, the better. That is, until I intervened and pointed out the possibility of higher costs and money being left on the table if she ignored some of the attractive benefit programs.

Employees comparison shop for other purchases, so why aren’t they curious about the price differences between plans and ways they could save money with the right choices? HR and benefits professionals have been looking for better ways to engage employees in the enrollment process for many years, especially as costs have escalated, and employers have had to scale back their share of costs.

Online enrollment systems with attractive presentations of benefit programs and ”engaging” user experiences in enrollment are one method. Forcing employees to select from a portfolio of plans using a combination of their own and employer money is another way. Add to all this a big dose of communications, both in print and online, that attempt to educate employees on their benefit options.

Within a couple of months of her starting her job, my daughter received an award for her contribution to work on a project. The reward was in the form of points that she could redeem for items offered on a rewards website. She was much more interested in browsing the ”stuff” that she could get with her rewards, or with rewards she could earn in future, than in browsing for something as important as insurance coverage.

Maybe a creative blend of shopping for rewards and shopping for insurance and other traditional employee benefits is what we need to get employees engaged in benefits enrollment. Many employers already offer enrollment rewards – gift cards for attending an open enrollment meeting, credits for completing a health risk assessment, and other such ideas. The next step is to integrate the benefits enrollment process with the employee reward program in a seamless experience, using one portal for comparing and enrolling in benefit plans, and offering payroll deduction options for purchases made with reward points.

With added reward products and programs on the shelves, employee benefits enrollment systems will become online marketplaces that attract employees to shop there.

Learn more about UBA’s online private insurance exchange platforms.

For information on how your health plan stacks up against other employers, pre-order the 2015 Health Plan Executive Summary, which highlights the latest findings of the UBA survey, the largest health plan cost survey in the industry.


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Temporary Safe Harbor for Online Posting of SBCs | Employee Benefits Panama City

October 1st, 2015 by Clemons

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

A Summary of Benefits and Coverage (SBC) is a four-page (double-sided) communication required by the federal government under the Patient Protection and Affordable Care Act (ACA). It must contain specific information, in a specific order and with a minimum size type, about a group health benefit’s coverage and limitations. An SBC is Health Insurance Policyrequired whenever application or open enrollment materials are provided to new hires or current employees. If no application or open enrollment materials are given, an SBC must be provided when the person can first enroll.

SBCs must include an Internet address where the individual coverage policy or certificate of coverage can be reviewed and obtained.

The Department of Health and Human Services (HHS) has announced that, due to difficulties for some issuers that have several hundreds of documents that must be posted to comply with the requirement for both individual and group coverage, it will not take enforcement action against issuers that make available individual coverage policy or group certificate of coverage documents no later than November 1, 2015. HHS expects all group and individual health insurance issuers to provide an Internet address for the group certificate of coverage or individual policy documents by the date on which the SBC is otherwise required.

This does not require early posting of SBCs relating to individual policies for coverage beginning on or after January 1, 2016.

An issuer may post a sample group certificate of coverage for each applicable product for plan sponsors that are shopping for coverage, but once the certificate of coverage is executed, it must be available.


For a complete review of what a Summary of Benefits and Coverage (SBC) is, when and how it must be provided, and what these documents must contain, view UBA’s ACA Advisor, “Temporary Safe Harbor for Online Posting of SBCs”.


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UBA Survey Finds Self-Funded Pharmacy Plans Have Increased Nearly 30 Percent in Five Years | Florida Employee Benefits

September 10th, 2015 by Clemons

By Bill Olson, Chief Marketing Officer at United Benefit Advisors

As a result of the Patient Protection and Affordable Care Act (ACA) triggering cost increases for fully insured employer-sponsored health insurance plans, more employers are moving to a self-funded model for pharmacy plans, particularly among large employers (1,000+ employees), according to the 2014 United Benefit Advisors (UBA) Pharmacy PlansHealth Plan Survey.

UBA’s survey, the nation’s largest benchmarking survey with nearly 10,000 employers responding, shows that self-funded pharmacy plans have increased 29.8 percent (from 8.4 percent) in the last five years and fully insured pharmacy plans have decreased 2.7 percent (from 91.6 percent). Although fully funded pharmacy plans still dominate with 89.1 percent of the market, self-funded pharmacy plans now make up 10.9 percent of all plans, as of 2014.

“Despite the large amount of capital necessary to pay for fluctuating claim costs, self-funding can be more affordable for pharmacy benefits,” says a representative from TrueNorth Companies/MedOne, a UBA Partner Firm.

The survey finds that 66.1 percent of employers with 1,000+ employees have self-funded prescription plans, while nearly all small employer plans (1 to 99 employees) are fully insured. Regional differences do have a major impact, however. For example, 99 percent of California plans are fully insured, with only the state’s largest employers offering self-funded plans. North-central employers, on the other hand, have more self-funded plans, at 17.7 percent.

“North-central employers are more likely to self-fund due to the favorable climate for doing so – less competitive workforce, higher-than-average concern for costs, and a greater amount of manufacturing and agricultural businesses,” says TrueNorth Companies/MedOne.


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The Vision in Health Plan Wellness | Benefits Broker Florida

September 8th, 2015 by Clemons

By Peter Freska, Benefits Advisor at The LBL Group A UBA Partner Firm

As one might think, employee wellness programs are still top of mind for many employers. As companies continue to struggle with the rising costs in today’s health care market, they are constantly looking for that silver bullet to kill benefits broker floridatrends. The most current 2014 UBA Health Plan Survey shows the national average cost increase at 5.6% (2015 data will soon be released). So what is the answer to these ever-increasing costs? Is there a silver bullet? While there may not be a silver bullet, there may be a silver lining if employers look inside their own benefits offerings.

VSP® Vision Care reports that eight out of 10 adults need some type of vision correction, and that they are more likely to get an annual vision exam than an annual medical physical. With this in mind, why not capture the data collected by the vision exam and correlate this back into the medical data? In making this small connection along with the standard claims review processes, it is shown that predictive claims modeling reliability can be increased significantly. In fact, the addition of vision data to the standard inputs can increase R2 precision by more than 10%. This is easily corroborated as a VSP study of 120,000 of its members found that, over a four-year period, eye doctors were the first to detect signs of diabetes 34% of the time; hypertension was 39%, and for cholesterol it was 62% of the time.

If you have a self-funded medical plan, inclusion of vision data is likely the least expensive wellness program that can be incorporated into the program. If you are utilizing predictive modeling, then the inclusion of vision data can be the silver bullet to creating a paradigm shift that kills the standard medical trend and shifts your organization’s health plan spending down.

For more information on employer health care costs by size, region and industry—and trends in wellness programs—download UBA’s Health Plan Survey Executive Summary.

To find out if your vision plan is exempt from the Affordable Care Act (ACA), download UBA’s ACA Advisor: “Excepted Benefits – “Limited Scope” Dental and Vision Plans and EAPs”.


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DOL Issues Guidance on Classification of Independent Contractors | Employee Benefits Panama City

September 3rd, 2015 by Clemons

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

The Department of Labor (DOL) has issued an “Administrator’s Interpretation” to assist employers in determining if a worker is an employee or an independent contractor. The DOL has determined that many employers are employee benefits panama cityincorrectly classifying employees as independent contractors, which can harm the worker and open the employer up to various liabilities. Unfortunately, there is no clear-cut checklist or rule in determining a worker’s status. Employers who are unsure about the categorization of workers should consult their legal counsel to review the factors provided by the DOL and its application to a specific situation or worker.

The distinction between employee and independent contractor is important, as employees are entitled to workplace protections such as minimum wage, overtime, and workers’ compensation. Furthermore, under the Patient Protection and Affordable Care Act (ACA) employees are entitled to health benefits if they work for an applicable large employer and work more than 30 hours a week. The ACA regulations specifically state that independent contractors are not considered a common-law employee for purposes of providing health benefits. Because of the difference in protections offered to employees versus independent contractors, employers must be careful to ensure they do not misclassify an individual. The DOL has found that many employers are also incorrectly labeling someone as an “owner,” “partner,” or “member of a limited liability company” rather than properly determining if they are an “independent contractor” in order to avoid having to determine the worker’s status. The DOL was clear that this is inappropriate, and all workers should have their title and classification properly determined.

The DOL’s guidance rests on the fact that when determining employee versus independent contractor, courts use a “multi-factorial ‘economic realities’ test,” which focuses on an individual’s economic dependence on an employer or business.

The DOL advised that the economic realities test should be applied in view of the Fair Labor Standards Act’s (FSLA) broad scope of employment and the “suffer or permit” standard; and that the economic realities factor guides the determination on whether the worker is truly an independent business or is an economically-dependent employee. The DOL provides a variety of factors that should be weighed to answer these questions. The factors should be considered indicators of the broader concept of economic dependence and should not be used as a checklist.

The DOL’s “suffer or permit” standard broadens the scope of employment relationships that are covered by the FLSA and, at its core, finds that an individual is an employee if the individual is economically dependent on the employing entity. The courts look to the economic realities of the relationship, rather than the label the employer gives it. An economically-dependent worker is considered an employee. Someone who is in the business for him or herself is an independent contractor.

For comprehensive information on the factors an employer should consider when determining if an individual is an independent contractor or an employee, download UBA’s ACA Advisor, “DOL Issues Guidance on Classification of Independent Contractors”.

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