Archive for the ‘UBA Employer News’ Category

UBA Health Plan Survey: Plans Popular with Employers Aren’t Always Tops with Employees | Florida Employee Health Insurance

December 3rd, 2015 by Clemons

By Bill Olson, Chief Marketing Officer at United Benefit Advisors

The UBA Health Plan Survey tracks plans offered by region as well as enrollment by region. From a prevalence perspective, preferred provider organization (PPO) plans are most prevalent in the Central U.S., though they generally dominate nationwide, except in the Northeast where consumer-directed health plans (CDHPs) are most prevalent.

2015 Health Plan Survey Plan Prevalence by Region

From an enrollment perspective, PPO plans have the greatest enrollment in the Central U.S. The Southeast and Northeast saw the biggest increase in PPO enrollment (7% and 8% respectively) this year. Enrollment in health maintenance organizations (HMOs) is down across most of the country, but is on the rise in the Central and Western U.S. Point of service (POS) plan enrollment has stayed virtually flat from last year. CDHP enrollment is highest in the Northeast U.S. at 29.2%, an increase of 11.5% over 2014. But the Southeast saw nearly a 23% increase in CDHP enrollment from 2014. Conversely, the North Central U.S. saw a 23.5% decrease in CDHP enrollment.

2015 Health Plan Survey Enrollment by Plan Type by Region

Sometimes, plans offered by employers are also equally desired by employees; in other words, what is offered most is also what employees opt to enroll in the most. For example, CDHPs and PPO plans are the most prevalent plans in the Northeast and also the top two plans employees enroll in. But it is interesting to note that those employees flip the order of their preference, favoring PPO plans more than CDHPs, while CDHPs are most popular among employers. Employers and employees in the Southeast, North Central and Central states mostly see eye-to-eye when prioritizing PPO plans, followed by CDHP plans as a distant second. In the West, employees enroll in PPO plans at a far greater rate than the prevalence rate of these plans among employers.

This information can be very helpful when choosing your plan offerings. Download the free 2016 Health Plan Survey Executive Summary for additional information on health plan cost trends across the U.S., including employer contributions and costs for employees.

To benchmark your plan against others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

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2015 UBA Health Plan Survey: Preliminary Findings Are Out! | Panama City Employee Benefits

September 21st, 2015 by Clemons

By Bill Olson, Chief Marketing Officer at United Benefit Advisors

UBA’s annual Health Plan Survey, the largest of its kind, provides data on 10,804 employers sponsoring 18,186 health plans. While the full findings will be released soon, preliminary data on average health plan costs, premiums, and contributions is now available.

The average annual health plan cost per employee for all plans in 2015 is $9,736, a 2.4 percent increase from the previous year; employees picked up $3,333 of that cost, while employers covering the balance of $6,403.


The average premium for all employer-sponsored plans was $509 for single coverage and $1,211 for family coverage.

20.6 percent of all plans required no employee contribution for single coverage (a 5.1 percent decrease since 2014), and 7.3 percent required no contribution for family coverage (a 3.9 percent decrease since 2014).

For plans requiring contributions, employees contributed an average of $140 for single coverage and $540 for family coverage, which is only a slight increase from 2014 results – 3.7 percent and 5.5 percent respectively.

Employer Coverage

Among all employers surveyed, more than half (53.7 percent) offer only one health plan choice to employees, with 28.7 percent offering two choices. As far as plan choices, preferred provider organizations (PPOs) continue to dominate the market (46.8 percent of plans offered and 54.8 percent of employees enrolled), and health maintenance organization (HMO) plans continue to decrease, as they’ve done since 2012 when they accounted for 19.1 percent of the market but now account for only 17.3 percent. Consumer-directed health plans (CDHPs) continue to show the greatest increase in growth, up 10 percent from 2012 through 2015.

Most employers (72.5 percent) define full time work as 30 hours per week, and 7.6 percent define it as 40 hours per week. Only 9.9 percent of employers require fewer than 30 hours per week.

Read UBA’s full press release announcing the initial findings.

Pre-order a copy of the 2015 UBA Health Plan Survey Executive Summary which will be published soon with comprehensive data.

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New Drugs for Some … Will They Ultimately Cost Everyone an Arm and a Leg? | Panama City Employee Benefits Broker

August 24th, 2015 by Clemons

By Elizabeth Kay, Compliance & Retention Analyst
AEIS Advisors
A UBA Partner Firm

Advancements in science and technology can be absolutely amazing. The types of treatments that are available now are light years ahead of where we were even 10 years ago. For example, there are some new anti-viral drugs that have become available. One in particular that is for treating Hepatitis C has been very successful. It can actually cure patients of Hepatitis C, in just weeks for some cases.

So why might these drugs not be available to those who could really use them? The Hepatitis C drug is currently priced at $1,000 per pill. So one pill a day, for 8 to 12 weeks, would cost approximately $56,000 to $84,000. The Prescription medicationmember may only have to pay between $50 to $500 (depending on the insurance plan) for a 30-day supply of the medication, leaving most of the cost of the drug as the insurer’s responsibility.

In the past, insurance carriers have designed their plans so that if a patient needs a high cost prescription drug, the patient pays a higher copay, or coinsurance versus a lower copay for a low-cost generic drug. This may have been more effective in the past because on most insurance plans, even if you hit your maximum out-of-pocket for the year for medical services, you would continue to pay prescription drug copays or coinsurance.

However, due to the Patient Protection and Affordable Care Act (ACA), insurance carriers have now had to integrate the prescription drug costs paid by the insured into the medical maximum out-of-pocket for the calendar year. So now, even if an insurance carrier charges 30% coinsurance for the Hepatitis C drug ($9,000 is 30% of $30,000 for a one month supply), the patient would only have to pay up to $6,350 if that was their maximum out-of-pocket for the year on their plan. Once they hit that maximum out-of-pocket, all other expenditures, whether medical or prescription related, would be covered at 100% by the carrier, as long as the claims were made at an in-network provider.

After the maximum out-of-pocket is met, there is nothing to hold someone back from utilizing their plan as much as they can. For example, they may get that knee surgery that they have been putting off, just because it will now be covered at 100% with no expense to them. Or perhaps they will get those allergy shots they have been thinking about doing for the past couple of years.

While there is nothing wrong with getting the treatments that you need, or that would make your life more enjoyable, sustainable, or increase your quality of life, it places a heavy burden on the insurance carriers, and the rest of the insured population because someone will have to pay for those services, and the high cost of the specialty medications.

So I am curious – with all of these new medications and new advancements that are about to hit the market, will they even be available for consumers? The insurance carriers are doing what they can to keep costs down, even with the exponential increase in the cost of health care, but when the prescription costs go up this much, it is going to blow up, and in a big way.

According to an insurance carrier in northern California, the cost of specialty drugs was $87 billion in 2012, and is projected to be $192 billion in 2016, which is a 120% increase. By 2020, they are projecting $402 billion in specialty drug spending, which is a 400% increase from 2012. How can they incur an increased cost of prescription drugs without raising premiums for all of their members?

Insurance carriers publish prescription drug lists every year to show which drugs fall into different categories and which drugs the insurance carrier will cover. There are usually between three and four different tiers: generics (Tier 1), formulary or brand name (Tier 2), non-formulary (Tier 3), and specialty or injectable (Tier 4). Even though some of these prescriptions have been found to be very effective, they may be left off the list of available prescription drugs simply because they will raise the cost of the claims too significantly for the insurance carrier to be able to maintain their premiums for their members.

The ACA has made it very clear that the prescription drug costs are to be integrated with the medical maximum out-of-pocket for the insured. So unless legislation is passed that will, in some way, allow the insurance carriers to make certain drugs exempt from that requirement, or allow them to have a separate maximum out-of-pocket for specialty medications, I don’t know another way that the insurance carriers will be able to keep costs down without denying access to the drug through their insurance plans.

I am amazed that there have been so many advancements in recent years, thrilled that the quality of life for many people is improving, and excited that curing or treating individuals for these conditions now may reduce their cost of care in the future, which in turn may reduce costs for everyone down the road. But I don’t see how it will be sustainable without increasing the insurance costs for everyone, which has skyrocketed in the past five years. Perhaps a name change of the Patient Protection and “Affordable” Care Act is in order?

For more information on rising pharmacy copays, 4-tier plans, and coinsurance models, or to benchmark your pharmacy plan, read UBA’s press release with the latest Rx data.

For comprehensive health plan cost trends, download the UBA 2014 Health Plan Survey Executive Summary. To benchmark your plan to others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

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Pharmacy Copays in Upper Tiers on the Rise, Coinsurance on the Rise | Panama City Employee Benefits

August 13th, 2015 by Clemons

By Bill Olson, Chief Marketing Officer at United Benefit Advisors

UBA recently released new pharmacy data from the 2014 UBA Health Plan Survey which shows a significant increase in the use of 4-tier plans. UBA also released the findings related to pharmacy copay design. Not surprisingly, the majority (67.8 percent) of prescription drug plans utilize copays. Many used to offer copay only; in the last five years, however, most plans required the patient to pay coinsurance after the copay. UBA’s survey shows that, since 2010, the number of 2-tier plans with a prescription copay only (no coinsurance) decreased 42.9 percent, and the number of 3-tier plans with a copay only decreased 20.6 percent.

Surprisingly, median copays in 2-tier plans stayed flat the last three years at $10/$30. The median copays in tiers 2 and 3 of 3-tier plans, however, increased 16.7 percent and 10 percent respectively, from 2013 to $10/$35/$55. Four-tier plans have median copays of $10/$35/$55/$100.

5-Year Trend in Prescription Drug Plan CoPay

Read UBA’s full press release for the latest commentary from UBA Partners on these trends.

Download the UBA Health Plan Survey Executive Summary with complete findings on plan design and costs by region, industry and employer size.


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Stop-loss Contract Periods Explained | Panama City Employee Benefits

June 2nd, 2015 by Clemons

By Michael Humphrey, MLHR, Sr. Employee Benefits Advisor at The Wilson Agency
A UBA Partner Firm

In last week’s blog, we explained the different types of stop-loss insurance. This week we will go over another important aspect of stop-loss: contract periods. Stop-loss contract periods are perhaps the most complicated aspect Contractof understanding how stop-loss insurance works. A contract term will define the period when a claim is incurred and when it is paid. Contract terms are set up as such because claims incurred within a year are often not paid until the next year due to the lag of time between when they are incurred (have the medical appointment) and when the paperwork gets submitted by the provider’s office. Let’s take a look at the three most common types of contracts:

12/12 – This covers only claims incurred and paid within the policy year. This type of contract is typically only used for the initial year of coverage.

12/15 – This covers claims incurred within the policy year and paid within three months after the policy year ends. This type of contract is often referred to as a “run-out policy.”

15/12 – This covers claims paid within the policy year that are incurred during the policy year and the three months before the policy year begins. This type of contract is often referred to as a “run-in policy.”

When negotiating the terms of the contract, it is extremely important to ensure that the contract period you have chosen will give you adequate coverage. If not, you may end up with thousands of dollars of uncovered claims. Be sure to work with your benefit advisor to ensure coverage issues such as these are identified and preemptively managed.

Topics: The Wilson Agency, stop-loss insurance, insurance contracts, run-out policy, run-in policy, insurance claims

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Cost Sharing Limits Changing for 2016 | Florida Employee Benefits

April 14th, 2015 by Clemons

By Danielle Capilla, Chief Compliance Officer at United Benefit Advisors

In the Benefit and Payment Parameters for 2016 Final Rule issued in February 2015, federal agencies included a money billsclarification that annual cost-sharing limitations for self-only coverage apply to all individuals, regardless of whether the individual is covered by a self-only plan or is covered by another kind of plan. Cost sharing refers to out-of-pocket expenses and deductibles that are paid by the beneficiary. In both self-only and other plans, an individual’s cost sharing for essential health benefits (EHBs) may never exceed the self-only annual limitation. The information was only included in the preamble of the Final Rule, and was not included into the regulatory language. As a result, the benefits industry was left unsure of the implications.

On March 10, 2015, a “Cost-Sharing FAQ” was released, confirming that self-only limitations will apply to each individual regardless of whether the individual is enrolled in a self-only plan or a plan that is not self-only. It appears that this requirement will apply to both high-deductible health plans (HDHPs) and non-high-deductible plans, and is in response to consumer complaints about high deductibles and out-of-pocket limits. This means the limits are applicable to all health plans beginning in 2016. The FAQ includes an example of an HDHP with a $10,000 family deductible, and states that the plan must apply the out-of-pocket limitation on cost sharing at the individual level, even if the amount is below the $10,000 family deductible limit.

Going forward, the family’s cost sharing to the deductible limit can continue to be offered under the HDHP policy, as long as the self-only annual out-of-pocket limitation is applied to each individual on the plan. The annual self-only out-of-pocket limit for 2016 will be $6,850. In addition, an annual out-of-pocket limit will apply to HDHPs associated with health savings accounts (HSAs), but that limit has not yet been released.

For practical purposes, the new limitation acts as an embedded limit, and will apply to all plans starting in the 2016 plan year. The cost-sharing limitation only applies to EHBs, however, employers might find it administratively difficult to parse out EHB costs and non-EHB costs.

For more information on EHBs, download UBA’s PPACA Advisor, “Essential Health Benefits, Minimum Essential Coverage, Minimum Value Coverage: What’s the Difference?

Topics: health care costs, essential health benefits, PPACA Affordable Care Act, Cost-Sharing, out-of-pocket limits, High Deductible Health Plans

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Final Rule Issues Standards for Insurers and Marketplaces in 2016 | Panama City Benefits Broker

March 31st, 2015 by Clemons

By Linda Rowings, Chief Compliance Officer at United Benefit Advisors

Recently, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services issued a Final Rule with standards for insurers and Marketplaces in 2016, covering topics such as transparency in health gavelinsurance rate increases, formulary drug lists, drug mail order opt out provisions, determination of minimum value, and benefits discrimination. Open enrollment for the 2016 benefit year will begin on November 1, 2015, and end on January 31, 2016.

The Final Rule reminds issuers that benefits are not Essential Health Benefits (EHBs) if the benefit design, or implementation of a benefit design, discriminates based on an individual’s age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions. The agencies became aware of benefit designs that would discourage enrollment by older individuals or those with health conditions, which it noted were a violation of discrimination prohibitions. Three noted examples of potentially discriminatory practices include labeling a medically necessary benefit as a “pediatric service,” refusing to cover a single-table drug regimen or extended release regimen that is as effective as a multi-tablet regimen, without appropriate reason for the refusal, and placing most or all drugs that treat specific conditions on the highest cost tiers. For more information on EHBs, download UBA’s PPACA Advisor, “Essential Health Benefits, Minimum Essential Coverage, Minimum Value Coverage: What’s the Difference?

Both fully insured and self-funded plans must pay a transitional reinsurance fee (TRF) for 2014 through 2016. For 2016, the annual contribution for the transitional reinsurance program is $27 per enrollee. The contribution was $44 per enrollee for 2015, and funds reinsurance to the individual market. The contribution is assessed to health insurers and self-insured group health plans providing major medical coverage, although some exceptions exist. Request UBA’s “Frequently Asked Questions about the Transitional Reinsurance Fee (TRF)” for the answers to nearly 30 questions about filing, due dates, calculation methods, payment, submission and more.

The maximum annual limit on cost-sharing for 2016 has been set. The limit will be $6,850 for self-only coverage and $13,700 for coverage that is not self-only. For a reminder on the 2015 limits, request UBA’s 2015 Annual Limits Card.

Topics: PPACA, essential health benefits, PPACA Affordable Care Act, Transitional Reinsurance Fee, cost-sharing limit, transparency in health insurance rates, insurance Marketplace, benefits discrimination

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Survey: Employer Contributions to HSAs Decreasing | Florida Employee Benefits

March 26th, 2015 by Clemons

Posted by: Bill Olson

United Benefit Advisors Health Plan Survey Finds Higher HSA Contributions Correlates to Increased Enrollment in High Deductible Health Plans

In 2014, employees saw a 10 percent decrease in their average single Health Savings Account (HSA) employer contribution from the previous year, from $574 in 2013 to $515 in 2014, according to new data released from the 2014 Health Plan Survey of United Benefit Advisors, the largest health benefits survey in the nation. Average family contributions also decreased 7 percent during the same period, from $958 to $890. Survey results reveal a correlation between enrollment in HSAs and Consumer Driven Health Plans (CDHPs), linking higher HSA contributions to increased surveyenrollment in the cost-saving plans.

“Employer HSA funding strategies have changed in recent years in response to the Patient Protection and Affordable Care Act (PPACA) and its impact on employer-sponsored health insurance plans,” says Brian M. Goff, President & CEO of Insurance Solutions, a UBA Partner Firm. “When HSA products were new, the employer could take the premium savings and fully fund the deductible. Now, however, premium reductions are not as great as they once were. As premiums increase, employers naturally opt to put their contributions toward premiums first and will slowly reduce their HSA funding to the point where, in some cases, it becomes entirely the employee’s responsibility,” says Goff.

There are many additional factors that will impact an employer’s HSA contribution strategy, says Mark Sherman, Principal of LHD Benefit Advisors, another UBA Partner Firm. Sherman says such factors include the deductible amount, the employee premium contribution, the out-of-pocket maximum, and whether there are other types of plans offered.

“At the end of the day, employers typically have a budget that they work within,” advises UBA Partner, Andrea Kinkade, President/Benefit Advisor at Kaminsky & Associates, Inc. “Either employee payroll deductions (premiums) increase or employer HSA contributions decrease to keep benefit costs within the budget.”


Smaller employers (1 to 50) are exceeding the average HSA contribution for singles, while larger employers (50 to 1,000+) have been less generous, according to the survey. Even larger employers (1,000+), in fact, show the lowest average contribution at $426. Similarly, for families, HSA contributions by smaller employers tend to be above the average $890 contribution, while large employers (1,000+) fund an average of $760.

“There are a few reasons for this,” says Goff, “The larger the group, the more impersonal some of these decisions are. Plus, many large groups are self-funded where premium equivalents between HSA plans, health maintenance organizations (HMOs) or preferred provider organizations (PPOs) are not as great. As a result, the expectation is that the employer contribution to the HSA will not be as great and some employees will enroll in non-HSA plans — making the high-deductible plan not as worthwhile.”

Findings show large employers also have lower CDHP enrollment. Even though 25.5 percent of large employer plans are CDHPs, only 16.6 percent of their employees are enrolled in them.

“Generous HSA contributions among small groups are typically designed to help compensate for higher deductibles than those that are offered in larger group plans,” says Kinkade.


The correlation between high HSA contributions and high enrollment in high-deductible health plans (HDHPs) is consistent across different industries and regions, with the exception of California, which has the most generous HSA contributions ($808 for singles and $1,316 for families) yet the lowest enrollment in CDHPs: only 11.3 percent of plans in California are CDHP plans and only 8.1 percent of employees are enrolled in them.

“Market dominance of Kaiser and a strong HMO preference in California offsets the rate relief offered by CDHPs, making the high deductible not worthwhile,” says Goff.

“In the Midwest, we still see some employers continuing to offer higher HSA contributions or lower premium contributions as a way to entice employees to these cost-saving plans,” says Kinkade.

New England, which typically has the most generous health care packages overall, sees average HSA contributions of $685 for singles and $1,342 for families. South Central states have the lowest contributions: $360 for singles and $554 for families. Nearly 36 percent of North Central states offer CDHP plans (the highest of any region) and more than 40 percent of employees in this region are enrolled in such plans (also the highest in the nation).

“Since the North Central region is largely comprised of Anthem BCBS states, carrier motivations play into these stats,” says Sherman. “Specifically, low regional interest in HMOs and Anthem BCBS’ purchase of Lumenos, a CDHP marketing specialist, made it easy for employers to move from a PPO to a CDHP.”



In looking at the survey data by industry, construction, health care/social assistance, mining/oil and gas extraction, retail and wholesale provide the lowest HSA contributions for singles and families. Conversely, government employees have the most generous HSA contributions ($791 for singles and $1,431 for families).

“Construction companies typically hire young men who demographically don’t place a lot of value in benefits. Government, on the other hand, has traditionally substituted salary for benefits; one way to move those employees off an expensive plan is to fully fund their deductible,” says Goff. “But carrier motivations can also be at play. Some carriers give a certain premium discount to go to the high deductible plan. So if you have a low premium, i.e., construction because of a young male demographic, the premium may only come down $800 a year to add a $1,500 deductible. On the other hand, take a nursing home that has expensive premiums, the savings may be $1,700 to add a $1,500 deductible, making it a no-brainer to switch to an HSA plan.”

The strategy of attracting employees to CDHP plans with generous HSA contributions has worked in the finance and insurance industry, as well, where 32.3 percent of plans are CDHPs (the highest of any industry) and enrollment is 32.1 percent (also the highest enrollment of any industry). HSA contributions in the finance and insurance industry are at $634 for singles and $1,074 for families, 20.7 percent and 18.7 percent above average, respectively.

The opposite trend can be seen in the mining/oil and gas extraction industry, however, where only 16.7 percent of plans offered are CDHPs, and employer HSA contributions are also among the lowest. Correspondingly, CDHP enrollment in this industry is a mere 8.5 percent.


CDHPs have proven to generate cost savings, according to UBA surveys. The average annual health plan cost per employee for all plan types in 2014 was $9,504. CDHPs appear to have the lowest annual costs per employee, specifically 6.4 percent less expensive than average. In contrast, PPO plans cost 9.7 percent more than CDHPs, yet they continue to dominate the market in terms of plan distribution and employee enrollment.

“While CDHP offerings are up 8 percent from 2012, they are largely unchanged from 2013,” says Les McPhearson, CEO of UBA. “From an enrollment standpoint, however, CDHPs have seen increases of more than 30 percent in the last two years (15.6 percent to 20.6 percent), despite overall decreases in employer contributions to HSAs. For large employers and the mining/oil and gas extraction industry, even modest increases in HSA contributions can be a key part of the puzzle in migrating employees to lower cost CDHP plans.”

“HSA based plans are still growing in popularity,” continues Sherman. “In fact, for many employers (especially those who have already offered HSA-based plans), the current movement is to offer a full replacement solution, often with two or more HSA-based plans to allow for employee choice,” says Sherman.




Download a copy of the 2014 UBA Health Plan Survey Executive Summary by visiting

About the UBA Health Plan Survey

Data in the 2014 UBA Health Plan Survey is based on responses from 9,950 employers sponsoring 16,967 health plans nationwide. The survey’s focus is intended to provide a current snapshot of the nation’s employers rather than covered employees. Results are applicable to the small to midsize market that makes up a majority of American businesses, as well as to larger employers, providing benchmarking data on a more detailed level than any other survey. The 2014 UBA Health Plan Survey offers more than just national data and UBA recommends that employers benchmark with local data, which is more effective when adjusting plan design, negotiating rates, and communicating value to employees.

For a customized benchmark survey based on industry, region and business size, contact your local UBA Partner Firm.

Topics: employers, HSA, survey, High Deductible Health Plans

Getting the Most out of Your Vision Benefit

March 23rd, 2015 by United Benefit Advisors

Did you happen to miss this webinar that was hosted on March 5, 2015? Are you interested in learning more about maximizing your vision benefit?

Think 2014 tax forms are bad? Here come the 1094 and 1095 for 2015! | Clemons Company

March 9th, 2015 by Clemons

By Bill Olson, Chief Marketing Officer at United Benefit Advisors

Our recent blog reviewed the highlights of the new employer and insurer reporting requirements. UBA has created this quick reference chart to help you sort out who should use which form, and when:


For comprehensive information on coverage requirements, due dates, special circumstances, controlled groups and how to complete the forms—including sample situations—request UBA’s PPACA Advisor, “IRS Issues Final Forms and Instructions for Employer and Individual Shared Responsibility Reporting Forms”.

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