by admin | Nov 19, 2024 | Flexible Spending Accounts
On October 22, 2024, the IRS announced that the limit on employees’ salary reduction contributions to a health Flexible Spending Account (FSA) will increase to $3,3000 for plan years beginning in 2025. This is an increase from the 2024 limit of $3,200. By understanding the latest contribution limits, individuals can better plan for 2025 and see how the new limits can enhance tax savings.
What is an FSA?
An FSA is a tax-advantaged savings account that allows you to set aside pre-tax dollars to pay for eligible medical expenses. This can help you save money on your tax bill and reduce your out-of-pocket healthcare costs.
Key Points to Remember:
Use It or Lose It: Generally, any unused funds in your FSA at the end of the year are forfeited.
Qualified Expenses: Eligible expenses include doctor visits, prescription medications, dental care, and more.
Employer Contributions: Some employers may offer additional contributions to your FSA.
How to Maximize Your FSA Benefits:
Plan Ahead: Estimate your annual healthcare costs and adjust your FSA contributions accordingly.
Use Your FSA Wisely: Keep track of your expenses and use your FSA funds throughout the year.
Check for Grace Periods and Carryover Rules: Some plans offer grace periods or allow you to carry over unused funds to the next year.
Why Are FSA Contribution Limits Higher for 2025?
FSAs offer significant tax savings by letting individuals use pre-tax dollars for eligible medical expenses like copayments, deductibles, and prescription or over-the-counter medications. With the new 2025 limit of $3,300, participants can allocate even more toward healthcare costs, reducing their taxable income.
For FSAs that permit unused funds to carry over, the maximum carryover has risen to $660, which represents 20% of the new FSA limit. This adjustment aligns with the increased contribution cap, providing greater flexibility for managing healthcare costs from year to year.
by admin | Nov 11, 2024 | Employee Benefits
Employee benefits can be a complex landscape, filled with acronyms and unfamiliar terms. In fact, more than 50% of American adults report that they don’t have a clear understanding of their health insurance. Many people are confused because they reach adulthood without ever learning the basics of health insurance terminology. Illiteracy about health insurance is costly to employees and employers alike. Educating employees on common benefits lingo can help them make informed decisions and maximize their benefits.
We have created a list of the most common terms to help your employees understand and better utilize their health benefits:
- Ancillary (or Voluntary) Benefits: Supplemental benefits not included in most traditional group health insurance plans.
- Co-payment: An amount you pay as your share of the cost for a medical service or item, like a doctor’s visit. Co-pays are most common for emergency room, urgent care and prescription drugs. In some cases, you may be responsible for paying a co‐pay as well as a percentage of the remaining charges.
- Co-insurance: Your share of the cost for a covered health care service, usually calculated as a percentage (like 20%) of the allowed amount for the service. For example, if your plan has a 30% co-insurance rate, the carrier will pay 70% of the allowed amount while you pay the balance.
- Deductible: The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, many plans require an individual to pay $1,000 in cumulative deductibles before they begin paying out.
- Dependent Coverage: Health insurance coverage extended to the spouse and unmarried children up to age 26 who are totally or substantially reliant on their parents for support, thereby defined as “dependent children”.
- Explanation of Benefits (EOB): Every time you use your health insurance, your health plan sends you a record called an “explanation of benefits” (EOB) or “member health statement” that explains how much you owe. The EOB also shows the total cost of care, how much your plan paid and the amount an in-¬network doctor or other healthcare professional is allowed to charge a plan member (called the “allowed amount”).
- Formulary: A list of prescription drugs covered by a health plan that often has different tiers based on the type of covered medication. Prescription medicines listed in one tier may cost you more than those in another tier.
- In-Network Provider: A provider who has a contract with your health insurer or plan to provide services to you at a discount. In-Network providers have contracted with the insurance carrier to accept reduced fees for services provided to plan members. Using in-network providers will cost you less money.
- Open Enrollment: A period during which a health insurance company is required to accept applicants without regard to health history.
- Out-of-Network Provider: A provider who doesn’t have a contract with your health insurer or plan to provide services to you at a pre-negotiated discount. You’ll pay more to see an out-of-network provider.
- Out-of-Pocket Maximum: The limit or most you’ll pay out of your own pocket for services during your insurance plan period (usually one year).
- Premium: The amount you pay for your health insurance or plan each month.
- Qualifying Life Event (QLE): A change in your life that allows you to make changes to your benefits’ coverage outside of the annual open enrollment period. These changes include a change in marital status (marriage, divorce, death of spouse), a change in the number of eligible children (birth, adoption, death, aging-out), and a change in a family member’s benefits eligibility under another plan (losing a job, Medicare or Medicaid eligibility, etc.)
Understanding the terms and acronyms can feel like learning a new language, so it’s helpful to educate your employees. With a good understanding of what some healthcare “benefits lingo” means, it will be easier to find a plan that meets the needs and budget of your company and employees!
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
