by admin | Aug 10, 2021 | Employee Benefits, Open Enrollment
Amid the economic panic last year, workers were unwilling to sacrifice job security for a new work environment. Many workers felt it was foolish to re-enter the job market during a shut down. However, in 2021, employers have experienced high turnover rates and experts are now predicting a “turnover tsunami” in voluntary departures and resignations. Current projections estimate that 3.3 million Americans will leave their jobs by December in search of new ones.
Turnover is expensive: the processes of recruiting, hiring, on-boarding and training cost extensive time but is also a considerable investment. When an employee leaves, the company not only loses a valuable resource but also has to re-distribute duties to other team members in the interim of finding a replacement. The team members who absorb the additional responsibilities reach their own tolerance thresholds.
Employers are always looking for ways to sweeten the attain and retain talented employees. For any job offer, salary will remain a crucial aspect but benefits also play an important role in overall employee compensation. This year more than ever, employers have a unique opportunity to show employees how valued they are and may convince those who are seeking a new job to remain through their benefits. So, what are some of the top benefits employees are looking for right now?
This staple benefit is of the utmost importance to job candidates and typically includes coverage for their families. In fact, 46% of U.S. adults said health insurance was the either the deciding factor or a positive influence in choosing their current job. And 56% said that employer-sponsored health coverage is a key factor in deciding to stay in their current job.
The most common type of retirement benefits is the 401(k) plan. This allows employees to deduct a certain percentage of each paycheck to put towards retirement savings. Some businesses choose to match the employee’s deduction or up to a certain percentage.
Employers can offer short -term disability (STD) or long-term disability (LTD) insurance to their employees. If an insured employee is injured or has a lengthy illness, the benefit pays them during the period of time they are unable to work. STD pays a portion of an employee’s salary if temporarily become sick or are unable to work. LTD payments are paid to employees who have a permanent illness or injury preventing them from performing their duties.
Life insurance and accidental death & dismemberment insurance (AD&D) are important as employees look to the future and want reassurance in protecting their families.
Employers should also consider some perks that have become increasingly sought after. Perks are something that is in addition to the employee’s salary and benefits package that may sway an employee to value one employer over another. Some of the most valued perks in 2021 are:
Wellbeing and mental health provisions have taken on a new significance in the last 12 months. Employers can offer an Employee Assistance Program (EAP) which helps employees to solve problems – whether those relate to finances or other non-work stresses. But employers are also offering more comprehensive mental health services such as counseling or therapy. 48% of employees indicated they had experienced high levels of stress over the last year and are looking for support for stress, burnout, and other mental health issues.
- Flexibility/Remote Work Options
Remote work and flexibility have always been popular among employees but their importance soared in light of the pandemic. Flexibility has been a key factor in providing for employees who have had changes in their life such as caring for a chronically ill loved one or those who suddenly had virtual school for their children. In fact, 76% of workers said they would be more willing to stay with their current employer if they could work flexible hours.
This past year has served as a reminder that employee’s lives don’t just revolve around work. With pets and children crashing our Zoom calls, and other responsibilities – including eldercare and childcare – on many worker’s minds, it’s evident that employees have other responsibilities and priorities that distract us from work. During the pandemic, one in four women considered leaving the workforce or scaled back their work role because of added family caregiving pressures.
Many employees don’t understand the benefits they chose during open enrollment – which means some employees may be looking for a new job for benefits or perks they already have! Now more than ever, it is critical for employers to start communicating early about open enrollment. Getting the word out about open enrollment and available benefits will help employees weigh the advantages of guaranteed perks and benefits with searching for a new job. Giving employees more time to understand their benefits is crucial to employee retention and contentment.
by admin | Aug 2, 2021 | ACA, Compliance, Group Benefit Plans
On July 1, 2021, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM) released an interim final rule with comment period (IFC), entitled “Requirements Related to Surprise Billing; Part I.” This rule related to Title I (the No Surprises Act) of Division BB of the Consolidated Appropriations Act, 2021 establishes new protections from surprise billing and excessive cost-sharing for consumers receiving health care items and services. This IFC implements many of the law’s requirements for group health plans, health insurance issuers, carriers under the Federal Employees Health Benefits (FEHB) Program, health care providers and facilities, and air ambulance service providers.
Background – Surprise Billing & the Need for Greater Protections
Most group health plans and health insurance issuers that offer group or individual health insurance coverage have a network of providers and health care facilities (in-network providers) that agree to accept a specific payment amount for their services. Providers and facilities that are not part of a plan’s or issuer’s network (out-of-network providers) usually charge higher amounts than the contracted rates the plans and issuers pay to in-network providers.
When a person with health insurance coverage gets care from an out-of-network provider, their health plan or issuer usually does not cover the entire out-of-network cost, leaving the person with higher costs than if they had been seen by an in-network provider. In many cases, the out-of-network provider may bill the individual for the difference between the billed charge and the amount paid by their plan or insurance, unless prohibited by state law. This is known as “balance billing.”
A “balance bill” may come as a surprise for many people. A surprise medical bill is an unexpected bill from a health care provider or facility. This can happen when a person with health insurance unknowingly gets medical care from a provider or facility outside their health plan’s network. Surprise billing happens in both emergency and non-emergency care.
In an emergency, an individual usually goes (or is taken) to the nearest emergency department. Even if they go to an in-network hospital for emergency care, they might get care from out-of-network providers at that facility.
For non-emergency care, an individual might choose an in-network facility or an in-network provider, but not know that a provider involved in their care (for example, an anesthesiologist or radiologist) is an out-of-network provider. In both emergency and non-emergency circumstances, the person might not be able to choose the provider or ensure that all of their care is from a participating provider. In addition to getting a bill for their cost-sharing amount (like co-payments, co-insurances, and any applicable deductibles), which tends to be higher for these out-of-network services, the individual might also get a balance bill from the out-of-network provider or facility. This is especially common in the context of air ambulance services, for which individuals generally do not have the ability to choose an air ambulance provider and have little or no control over whether the provider is in-network with their plan or coverage.
When individuals do not have an opportunity to select in-network providers, their health care costs go up overall. Surprise billing is often used as leverage by providers to get higher in-network payments, which result in higher premiums, higher cost sharing for consumers, and increased health care spending overall.[1] Studies have shown that surprise bills can be high.
A recent study found that payments made to providers by people who got a surprise bill for emergency care were more than 10 times higher than those made by other individuals for the same care.
Out-of-network cost sharing and surprise bills usually do not count toward a person’s deductible and maximum out-of-pocket limit. Individuals with surprise bills may have to spend more out-of-pocket because they have to pay their out-of-network cost sharing and surprise billing amounts regardless of whether they have met their deductible and maximum out-of-pocket limits. Nine percent of individuals who got surprise bills paid more than $400 to providers, which may result in financial distress for consumers, given recent findings that show 40% of Americans struggle to find $400 to pay for an unexpected bill.[2][3],
Studies have shown that in the period from 2010-2016, more than 39% of emergency department visits to in-network hospitals resulted in an out-of-network bill, increasing to 42.8% in 2016. During the same period, the average amount of a surprise medical bill also increased from $220 to $628.[4]
Although some states have enacted laws to reduce or eliminate balance billing, these efforts have created a patchwork of consumer protections.[5] Even in a state that has enacted protections, they typically only apply to individuals enrolled in health insurance coverage, as federal law generally preempts state laws that regulate self-insured group health plans sponsored by private employers. In addition, states have limited power to address surprise bills that involve an out-of-state provider.
Summary of IFC
This IFC protects individuals from surprise medical bills for emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances.
If a plan or coverage provides or covers any benefits for emergency services, this IFC requires emergency services to be covered:
Without any prior authorization (i.e., approval beforehand).
Regardless of whether the provider is an in-network provider or an in-network emergency facility.
Regardless of any other term or condition of the plan or coverage other than the exclusion or coordination of benefits, or a permitted affiliation or waiting period.
Emergency services include certain services in an emergency department of a hospital or an independent freestanding emergency department, as well as post-stabilization services in certain instances.
This IFC also limits cost sharing for out-of-network services subject to these protections to no higher than in-network levels, requires such cost sharing to count toward any in-network deductibles and out-of-pocket maximums, and prohibits balance billing. These limitations apply to out-of-network emergency services, air ambulance services furnished by out-of-network providers, and certain non-emergency services furnished by out-of-network providers at certain in-network facilities, including hospitals and ambulatory surgical centers.
Cost-Sharing Amounts:
This IFC specifies that consumer cost-sharing amounts for emergency services provided by out-of-network emergency facilities and out-of-network providers, and certain non-emergency services furnished by out-of-network providers at certain in-network facilities, must be calculated based on one of the following amounts:
An amount determined by an applicable All-Payer Model Agreement under section 1115A of the Social Security Act.
If there is no such applicable All-Payer Model Agreement, an amount determined under a specified state law.
If neither of the above apply, the lesser amount of either the billed charge or the qualifying payment amount, which is generally the plan’s or issuer’s median contracted rate.
Similarly, cost-sharing amounts for air ambulance services provided by out-of-network providers must be calculated using the lesser of the billed charge or the plan’s or issuer’s qualifying payment amount, and the cost sharing requirement must be the same as if services were provided by an in-network air ambulance provider.
Balance Billing:
Under this IFC, surprise billing for items and services covered by the rule generally is not allowed.
Determining Out-of-Network Rates:
Under this IFC, the total amount to be paid to the provider or facility, including any cost sharing, is based on:
An amount determined by an applicable All-Payer Model Agreement under section 1115A of the Social Security Act.
If there is no such applicable All-Payer Model Agreement, an amount determined by a specified state law.
If there is no such applicable All-Payer Model Agreement or specified state law, an amount agreed upon by the plan or issuer and the provider or facility.
If none of the three conditions above apply, an amount determined by an independent dispute resolution (IDR) entity.
The Departments intend to issue regulations soon regarding IDR entities and the IDR process.
In limited cases, a provider or facility can provide notice to a person regarding potential out-of-network care, and obtain the individual’s consent for that out-of-network care and extra costs. However, this exception does not apply in certain situations when surprise bills are likely to happen, like for specified ancillary services connected to non-emergency care, such as anesthesiology or radiology services provided at an in-network healthcare facility.
Notice to Consumers:
This IFC requires certain health care providers and facilities to make publicly available, post on a public website, and provide to individuals a one-page notice about:
The requirements and prohibitions applicable to the provider or facility under Public Health Service Act sections 2799B-1 and 2799B-2 and their implementing regulations.
Any applicable state balance billing limitations or prohibitions.
How to contact appropriate state and federal agencies if someone believes the provider or facility has violated the requirements described in the notice.
Applicability Date & Comment Period
The regulations are generally applicable to group health plans and health insurance issuers for plan and policy years beginning on or after January 1, 2022. The HHS-only regulations that apply to health care providers, facilities, and providers of air ambulance services are applicable beginning on January 1, 2022. The OPM-only regulations that apply to carriers under the FEHB Program are applicable to contract years beginning on or after January 1, 2022. Written comments must be received by 5 p.m. 60 days after display in the Federal Register to be considered.
Visit https://www.cms.gov/files/document/cms-9909-ifc-surprise-billing-disclaimer-50.pdf to read more about the interim final rule.
Originally posted on CMS.gov
[1] Cooper, Z. et al., Surprise! Out-of-Network Billing for Emergency Care in the United States, NBER Working Paper 23623, 20173623; Duffy, E. et al., Policies to Address Surprise Billing Can Affect Health Insurance Premiums. The American Journal of Managed Care 26.9 (2020): 401-404; and Brown E.C.F., et al., The Unfinished Business of Air Ambulance Bills, Health Affairs Blog (March 26, 2021), doi: 10.1377/hblog20210323.911379, available at https://www.healthaffairs.org/do/10.1377/hblog20210323.911379/full/.
[2]Biener, A. et al., Emergency Physicians Recover a Higher Share of Charges from Out-of-network Care than from In-network Care, Health Affairs 40.4 (2021): 622-628.
[3]Board of Governors of the U.S. Federal Reserve System. Report on the Economic Wellbeing of U.S. Households in 2018. (May 2019). Available at https://www.federalreserve.gov/publications/files/2018-report-economic-well-being-us-households-201905.pdf.
[4] Sun, E.C., et al. “Assessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-network Hospitals.” JAMA Internal Medicine, 179.11 (2019): 1543-1550. Doi:10.1001/jamainternmed.2019.3451.
[5] States that have enacted balance billing protections include Arizona, Colorado, Delaware, Indiana, Iowa, Maine, Massachusetts, Minnesota, Mississippi, Missouri, New Mexico, North Carolina, Pennsylvania, Rhode Island, Texas, Vermont, and Washington.
by admin | Jul 27, 2021 | Health & Wellness, Hot Topics
Heartbreaks are painful, but did you know that heart disease is the leading cause of death in the United States, with more than 655,000 people dying from the condition each year. This equates to one in four deaths attributed to this awful disease. The most common form of heart disease is coronary artery disease (CAD), which is what can cause heart attacks.
CAD is caused when a substance called plaque builds up in a person’s arteries. As the buildup grows, the opening of the arteries gradually closes until blood flow is blocked and the patient experiences a heart attack. While these statistics are sobering, there are several ways we can prevent heart disease. Knowing the “why” about this disease can aid in prevention. First, let’s learn about the big three risk factors of heart disease:
High Blood Pressure
High blood pressure (HBP) is the force of blood pushing against blood vessel walls. This is what your nurse checks when she puts the blood pressure cuff on your arm and pumps air into it at your check-up. She is listening for the pressure when your heart beats and the pressure for when your heart is at rest between beats. High blood pressure usually has no signs or symptoms so it is very important to keep your annual physical appointments with your doctor and to follow her recommendations if she diagnoses you with HBP.
High Cholesterol
High cholesterol is when you develop fatty deposits in your blood vessels. These deposits can lead to narrow vessels and increase your chance of a heart attack. It is determined through blood tests. While high cholesterol can be inherited, it can also be prevented through medication, diet and exercise.
Smoking
Smokers are four times more likely to develop heart disease than non-smokers. The nicotine in smoke reduces your blood flow, raises your blood pressure, and speeds up your heart. Quitting smoking will not reverse the damage done to your heart, but it greatly reduces the damage going forward to your heart and arteries.
In addition to the three key risk factors, it’s important to explore what we can do to prevent it. Prevention behaviors can take you from the danger zone of heart disease and put you on the path to a healthy heart.
Healthy Diet
According to the Mayo Clinic, simple tips to prevent heart disease by diet include tips like these: controlling portion size, eating more vegetables and fruits, selecting whole grains, limiting unhealthy fats, choosing low-fat protein, reducing sodium intake, and limiting treats.
Healthy Weight
Being overweight increases your risk for heart disease. One measure used to determine if your weight is in a healthy range is body mass index (BMI). If you know your weight and height, you can calculate your BMI at CDC’s Assessing Your Weight website. When in doubt, consult a physician who can help in calculating whether your health is at risk due to weight.
Physical Activity
Among the many benefits to getting enough physical activity can, it can help you maintain a healthy weight and lower your blood pressure, cholesterol, and sugar levels. From walking, to swimming, to cycling, adding even moderate activity to your routine can have a great impact on your heart health. Just remember, it’s always a good idea to check with your doctor before starting any new exercise regimen.
Quit Smoking
Smoking cigarettes greatly increases your risk for heart disease. If you don’t smoke, don’t start. If you do smoke, quitting will lower your risk for heart disease. Your doctor can suggest ways to help you quit, and you can find many other helpful resources, including creating a tailored plan to help you quit at SmokeFree.gov.
Limit Alcohol
There’s a good reason your doctor asks about routine alcohol consumption at each check-up. Drinking too much alcohol can drastically raise blood pressure and binge drinking can increase heart rate. For heart health, the medical guidelines state that men should have no more than two drinks per day, and women only one. Talk to your doctor if you aren’t sure whether or not you should drink alcohol or how much you should drink for optimal heart health.
Check out these great resources to better educate yourself and others on heart health:
Understand Your Risks to Prevent a Heart Attack
Heart Health Information
Strategies to Prevent Heart Disease
Heart Health Tips
We all know how confusing and complex benefits and healthcare terms can be- the difference between deductible and co-insurance is a common question for many and there are plenty of others like it. When you are comfortable and confident in how your plan works, you can make an informed decision on HOW to use and take advantage of your benefits!
The EEO-1 Component 1 report is a mandatory annual data collection that requires all private sector employers with 100 or more employees, and federal contractors with 50 or more employees meeting certain criteria, to submit demographic workforce data, including data by race/ethnicity, sex and job categories. The filing by eligible employers of the EEO-1 Component 1 Report is required under section 709(c) of Title VII of the Civil Rights Act of 1964, as amended, 42 U.S.C. § 2000e-8(c), and 29 CFR 1602.7-.14 and 41 CFR 60-1.7(a). Employers can find additional eligibility information at 