by admin | Nov 5, 2024 | Compliance, Health Insurance
As the year comes to an end, a crucial compliance deadline looms for employers with health plans. Under the Consolidated Appropriations Act (CAA), health plans and insurance issuers must submit a Gag Clause Compliance Attestation by December 31, 2024.
Since its enactment in 2020, this regulation prohibits health plans from including gag clauses—provisions that limit transparency around provider pricing, quality, and claims data. These clauses are especially important for employers looking to make informed decisions about their healthcare offerings.
Key Information:
Who Must Comply?
Fully insured and self-insured group health plans, including ERISA plans, nonfederal government plans, and church plans, must file the attestation. While grandfathered health plans are not exempt, plans offering only excepted benefits or HRAs are not required to submit.
- Fully Insured Plans: If the issuer of the health plan submits the attestation, employers do not need to file it themselves. This ensures the plan remains compliant with CAA requirements.
- Self-Insured Plans: Employers are responsible for ensuring timely submission, even if a third-party administrator (TPA) handles the attestation. Some TPAs may not agree to submit the attestation, so employers must verify compliance themselves.
Why It’s Important:
Employers should review their contracts to confirm they align with these requirements. Failure to comply may lead to penalties, making immediate action essential. It’s vital that agreements with healthcare providers, TPAs, or service providers do not contain gag clauses that restrict access to key cost and quality-of-care data.
Next Steps:
- Review Contracts: Ensure your contracts with healthcare providers, TPAs, or service providers don’t include gag clauses.
- Confirm Submission: Ensure your health plan’s attestation is filed before the December 31, 2024, deadline.
- Use CMS Resources: The attestation process can be completed through the CMS web form, with detailed instructions, user manuals, and FAQs available on the CMS website.
For more information or assistance with the attestation, feel free to reach out. Compliance goes beyond meeting deadlines; it ensures your health plan operates transparently and with integrity for the benefit of your employees.
This reminder is crucial for employers managing healthcare compliance. Don’t let the December deadline catch you off guard!
by admin | Oct 29, 2024 | ACA, Compliance
The Department of Health and Human Services (HHS) has issued a final rule that significantly expands the Mental Health Parity and Addiction Act (MHPAEA) requirements under the Affordable Care Act (ACA). This rule aims to ensure that health plans provide equal coverage for mental health and substance use disorder (MH/SUD) benefits as they do for medical benefits.
Key Changes in the Final Rule:
Expanded Parity Definition: The rule expands the definition of mental health conditions to include substance use disorders and conditions associated with autism spectrum disorder.
Expanded Treatment Limitations: The rule prohibits health plans from imposing stricter limitations on mental health benefits than those applied to medical benefits. This includes limitations on the number of visits, days of service, or types of treatments.
Enhanced Enforcement: The rule strengthens enforcement mechanisms to ensure compliance with mental health parity requirements.
Implications for Health Plans and Employers
Compliance Review: Health plans will need to review their benefit plans to ensure they comply with the expanded parity requirements.
Benefit Design Changes: Some plans may need to be modified to eliminate discriminatory treatment of mental health benefits.
Increased Costs: The expanded parity requirements may lead to increased costs for health plans.
Improved Access to Care: The rule is expected to improve access to mental health and substance use disorder treatment for individuals with health insurance coverage.
Next Steps for Employers and Employees
Review Your Plan: Employers should review their health plans to ensure compliance with the expanded parity requirements.
Understand Your Benefits: Employees should become familiar with their mental health benefits and how they are covered under their plan.
Seek Assistance: If you have questions or concerns about your mental health benefits, contact your health plan or your employer’s human resources department.
The final rule represents a significant step forward in ensuring that individuals with mental health and substance use disorders have access to the same level of care as those with medical conditions. By understanding the expanded parity requirements, employers and employees can work together to improve access to mental health treatment and promote overall well-being.
by admin | Oct 21, 2024 | Human Resources
Will employees ever re-gain leverage and grow more engaged in their work?
More than 40 years ago, workers could retire from the same company where they started their career. That implied employment guarantee shifted when the American economy changed from consistent growth to a boom/bust cycle that created uncertainty and volatility, impacting job stability. Since then, the employee-company relationship has entered a push-pull cycle. Companies push employees away via layoffs or involuntary job changes because of updated business models, advances in technology, mergers/acquisitions, consumer habits, and globalization.
Employees, in turn, push companies away by decreasing their level of engagement, causing companies to try to pull workers toward the business with programs or branding designed to re-engage them. According to Gallup, “The first quarter of 2024 continued this downward trend, with engagement dropping three percentage points to 30% among both full- and part-time employees. This decline represents 4.8 million fewer employees who are engaged in their work and workplace, marking the lowest reported level of engagement since 2013.” The cost of lost productivity is estimated at 8.8 trillion dollars.
Meet Employees Where They’re At
When employees are fully engaged, they tend to give a company more of their discretionary effort to help their organization achieve its goals. Less engaged employees tend to not feel excited about their job or experience fulfillment at the workplace. The downward trend of engagement was exacerbated by the COVID 19 pandemic which resulted in many more employees choosing to use their discretionary effort for their personal lives, and not their work. Although employee survey data can pave the way for incremental improvement in employee engagement, one layoff can remind employees of their tenuous relationship with work. Companies will continue to navigate this volatile world with an inevitable impact on their people so maybe it is time to ask a new question – how can companies satisfy employees instead of engaging them?
Factors that affect employee satisfaction with their job include work conditions, total rewards, nature of the work, relationships, advancement, career development, balance, recognition, leadership quality etc. These factors work together to influence an employee’s decision to stay or leave a company. Therefore, focusing on satisfaction is critical to retention and company success because talented individuals produce the products and services that keep a company going and growing. Of all the factors to prioritize, the one that can significantly impact retention is total rewards.
According to Randstad, studies show a direct link between higher pay and higher employee retention rates. A recent study conducted by Harvard University shows that a $1 per hour pay increase among warehouse workers resulted in a 2.8% increase in retention. Even more alarming results show that every $1 per hour loss in pay resulted in a 28% increase in turnover rates. It’s quite simple, if a company isn’t offering competitive salaries, workers are more likely to leave.
A Whole New World at Work
Many people are rethinking their relationship with work and their employers. It’s not just about more pay, more time off, or more expansive benefits. People view total rewards as a continuing negotiation of what they get for what they give. Therefore, a rigorous and ongoing analysis of a company’s total reward program is critical to ensure fair, competitive and equitable pay and benefits. A holistic organizational assessment of compensation and benefit programs can inform how to rebalance total rewards in a fiscally responsible way. Compensation includes guaranteed components like salary and other non-guaranteed parts like incentive, production bonuses, extra shift pay, to name a few.
Sometimes those components become unbalanced, and an assessment can inform the required changes. Even if more investment is required to bolster compensation and benefit programs, those costs can be offset. For example, in the healthcare industry, if average base salaries are below market, and staffing bonuses are overutilized, a company can increase base salaries which enable recruitment of staff and reduce the use and amount of staffing bonuses which contribute to burn-out.
Regarding benefits, hearing the voice of the customer is extremely important. Although changing benefit programs can be stymied by the enormity of effort required, a thorough analysis of program utilization and perceived value of benefits is critical to enable recruitment and retention. Focus groups or surveys can ensure that the benefits offered are valued by employees. Conduct a deep analysis of plan costs and utilization to determine the required changes. This review is also required to fulfill fiduciary responsibilities. Rather than viewing the assessment of total rewards as having the potential to add expense, view the balancing process as a mechanism to shuffle existing investments leading to a more effective use of budgeted dollars.
The shift from engagement to satisfaction can be predicated on a more practical and transparent employee value proposition that resets mutual employment expectations. Transparency in business means that leadership is open, honest, and straightforward about the true nature of the employment relationship. Here is what that proposition could be:
“We will operate our business with the utmost thoughtful decision-making. We will invest in programs to bolster your job satisfaction in exchange for your services and support of the company. However, there may be times when we must make difficult business decisions that will directly affect our people. During those occasions, we will be transparent, fair and respectful to all, especially those impacted.”
An employee proposition such as this one is honest and balanced. Business reality and the importance of employee satisfaction are not mutually exclusive. They can coexist because one does not negate the other. Focusing on employee satisfaction and retention in the context of a new employee proposition can help workers and companies find a healthier, balanced and realistic relationship.
By Vaso Peramenis
Originally posted on HR Exchange Network
by admin | Oct 15, 2024 | Employee Benefits, Flexible Spending Accounts
When it comes to health insurance, there is a lot of jargon and plenty of acronyms. Many people have heard of FSAs, but may not actually know — what is a flexible spending account, exactly?
If you have an employer-sponsored health plan, a flexible spending account (FSA) is often available as part of the benefits package. There are two types of FSAs: one for health and medical expenses and another for dependent care/childcare costs. Both are designed to help you set aside money during the year for out-of-pocket expenses while enjoying tax benefits.
When you contribute to an FSA, the money is taken from your paycheck before taxes are removed and is never taxed. The Federal FSA Program estimates that those with an FSA save 30 percent on healthcare expenses on average.
How Does an FSA Work?
- Contributions: You contribute a portion of your pre-tax salary to your FSA. You set a contribution amount to be deducted from each paycheck, up to the federal limit, which for 2024 is $3,200.
- Rollovers, etc.: Employers have the option of allowing employees to roll over up to $640 in 2024 or they can provide a 2 ½ month grace period during which employees can spend their remaining contributions, but they can’t offer both.
- Reimbursement: Use your FSA funds to pay for qualified medical expenses. You typically submit receipts for reimbursement.
- Tax Benefits: Contributions are made with pre-tax dollars, reducing your taxable income.
What Can You Spend Your FSA Money On?
- Medical expenses: Doctor’s visits, prescriptions, dental care, vision care, and mental health services
- Over-the-counter medications: Many OTC medications, like pain relievers and allergy medications
- Medical equipment: Items such as crutches, wheelchairs, and diabetic supplies
- Dependent care expenses: Childcare or elder care costs, which can include before and after school care, preschool, and adult day care. In 2024, employees may contribute up to $5,000 if filing jointly or $2,500 if filing taxes separately.
Key Points to Remember:
- Use-It-or-Lose-It: Generally, any unused FSA funds at the end of the year are forfeited. However, some plans offer a grace period or carryover options.
- Contribution Limits: There are annual contribution limits for FSAs, set by the IRS.
- Dependent Care Expenses: If you have dependent care expenses, you can use your FSA to pay for them up to a certain limit.
Is an FSA Right for You?
Opening an FSA is a great way to save money on taxes and prepare for healthcare costs. As with other types of savings accounts, it allows you to contribute and stash away money, but in this case, that money is taken out of your paychecks in a set amount and is nontaxable. Check to see if your employer matches contributions as well.
Understanding the rules, benefits, and limitations of these accounts will allow you to maximize their value and ensure you’re making the most of this valuable employee benefit.
by admin | Oct 7, 2024 | ACA, Compliance
