by admin | May 23, 2017 | Benefit Management, Health & Wellness
Your wellness program seems to have it all – biometric screenings, lunch and learns, and weight loss challenges. So, why do you struggle with engagement, or to see any real results? While traditional wellness components are still a large part of plans today, emerging trends, coupled with generational differences, make for challenges when designing an impactful program.
As wellness programs begin to be viewed as a part of the traditional benefits package, the key differentiator is creating a culture and environment that supports overall health and well-being. Visible engagement and support from front-line and senior leadership drives culture change. By prioritizing health through consistent communication, resource allocation, personnel delegation, and role modeling/personal health promotion practices, employers gain the trust of their employees and develop an environment situated around wellness. When employees recognize the importance of wellness in the overall company strategy and culture, and feel supported in their personal goals, healthy working environments begin to develop, resulting in healthier employees.
Looking beyond traditional wellness topics and offering programs that meet the goals of your employees also leads to higher engagement. The American Heart Association CEO Roundtable Employee Health Survey 2016 showed improving financial health, getting more sleep, and reducing stress levels are key focus areas for employees as part of overall wellness. More so, employees see the benefits of unplugging and mentoring, two new topics in the area of overall well-being. While most employers feel their employees are over surveyed, completing an employee needs or preference survey will ensure your programs align with your employees’ health and wellness goals – ultimately leading to better engagement.
Wellness programs are not immune to generational differences, like most other facets of business. While millennials are most likely to participate and report that programs had an overall impact, they prefer the use of apps and trackers along with social strategies and team challenges. Convenience and senior level support are also important within this group. Generation X and baby boomers show more skepticism toward wellness programs, but are more likely to participate when the programs align with their personal goals. Their overall top health goal is weight loss. Ultimately, addressing the specific needs of your member population and providing wellness through various modalities will result in the greatest reward of investment.
Evaluation and data are the lynchpins that hold a successful program together. Consistent evaluation of the effectiveness of programs to increase participation, satisfaction, physical activity, and productivity – all while reducing risk factors – allow us to know if our programs are hitting the mark and allow for additional tailoring as needed.
By Jennifer Jones
Originally Posted By www.ubabenefits.com
by admin | May 19, 2017 | Benefit Management, HSA/HRA
In a world of insurance and acronyms, the term “HRA” is thrown around a lot, but it has a variety of meanings.
HRA can mean health reimbursement account, heath reimbursement arrangement, or health risk assessment, and all of those mean something different. I want to be clear that in the following article I am going to be discussing the use of health reimbursement accounts with fully insured health plans. We can leave the other meanings of HRA for another time.
An HRA can be “wrapped” with a high-deductible, fully insured health plan and this can lead to savings for an employer over offering a traditional health plan with a lower deductible.
Offering a high-deductible health plan and self-funding, the first $2,000, or $3,000, in claims on behalf of the employees can translate to significant savings because the employer is taking on that initial risk instead of the insurance carrier. Unlike a consumer-driven health plan (CDHP) that has a high deductible and can be paired with a health savings account (HSA) where an employer can contribute funds to an employee’s HSA account that can be used to pay for qualified medical expenses, an employer only has to pay out of the HRA if there is a claim.
With an HSA that is funded by the employer, the money goes into the HSA for their employees and then those funds are “owned” by the employee. The employer never sees it again. Under an HRA, if there are no claims, or not a high number of claims, the employer keeps those unused dollars in their pocket.
An HRA component to a health plan is subject to ERISA and non-discrimination rules, meaning everyone that is eligible should be offered the plan, and the benefits under the HRA should be the same for everyone enrolled. It is advisable that an HRA be administered by a third-party that pays the claims to the providers, or reimburse plan enrollees under the terms of the plan, in order to keep employees’ and their dependents’ medical information private from the employer as to avoid potential discrimination.
The HRA component of a health plan is essentially self-funded by the employer, which gives the employer a lot of flexibility and can be tailored to their specific needs or desired outcomes. The employer can choose to fund claims after the employee pays the first few hundred dollars of their deductible instead of the employer paying the claims that are initially subject to the high deductible. An employer can have a step arrangement, for example, the employer pays the first $500, the employee the second $500, the employer pays the next $500, and the employee pays the final $500 of a $2,000 deductible.
If an employer has a young population that is healthy, they may want to use the HRA to pay for emergency room visits and hospital in-patient stays, but not office visits so they can help protect their employees from having to pay those “large ticket items,” but not blow their budget. While an employer with a more seasoned staff, or diverse population, may want to include prescription drugs as a covered benefit under the HRA, as well as office visits, hospital in-patient stays, outpatient surgery, etc. Or, if an employer needs to look at cost-saving measures, they may want to exclude prescriptions from being eligible under the HRA.
Keep in mind, all of these services are essential health benefits and would be covered by the insurance carrier under the terms of the contract, but an employer can choose not to allow the HRA to be used to pay for such services, leaving the enrollee to pay their portion of the claims. In any case, the parameters of what is eligible for reimbursement from the HRA is decided and outlined at the beginning of the plan year and cannot be changed prior to the end of the plan year.
If you are thinking about implementing a high-deductible health plan with an HRA for your employees, be sure you are doing it as a long-term strategy. As is the case with self-funding, you are going to have good years and bad years. On average, a company will experience a bad, or high claims, year out of every four to five years. So, if you implement your new plan and you have a bad year on the first go-round, don’t give up. Chances are the next year will be better, and you will see savings over your traditional low-deductible plan options.
With an HRA, you cap the amount you are going to potentially spend for each enrollee, per year. So, you know your worst-case scenario. While it is extremely unlikely that every one of your employees will use the entire amount allotted to them, it is recommended that you can absorb or handle the worst case scenario. Don’t bite off more than you can chew!
HRA administrators usually charge a monthly rate per enrollee for their services, and this should be accounted for in the budgeting process. Different HRA third-party administrators have different claims processes, online platforms, debit cards, and business hours. Be sure to use one that offers the services that you want and are on budget.
Another aspect of offering a high-deductible plan with an HRA that is often overlooked is communication. If an employee does not know how to utilize their plan, it can create confusion and anger, which can hurt the overall company morale. The plan has to be laid out and explained in a way that is clear, concise, and easy to understand.
In some cases, the HRA is administered by someone other than the insurance carrier, and the plan administrator has to make sure they enroll all plan enrollees with the carrier and the third-party administrator.
The COBRA administrator also has to offer the HRA as part of the COBRA package, and the third-party administrator must communicate the appropriate premium for the HRA under COBRA. Most COBRA enrollees will not choose to enroll in the HRA with their medical plan, as they are essentially self-funding their deductible and plan costs through the HRA instead of paying them out of their pocket, but many plan administrators make the mistake of not offering the HRA under COBRA, as it is mandated by law.
Offering a high-deductible plan with an HRA is a way for small employers to save over offering a low-deductible health plan, and can be a way for an employer to “test the waters” to see if they may want to move to a self-funded plan, or level-funded plan, in the future.
By Elizabeth Kay
Originally Posted By www.ubabenefits.com
by admin | May 16, 2017 | HIPAA, Hot Topics
The U.S. Department of Health and Human Services Office for Civil Rights (OCR) issued its Man-in-the Middle Attacks and “HTTPS Inspection Products” guidance. The OCR warns organizations that have implemented end-to-end connection security on their internet connections using Secure Hypertext Transport Protocol (HTTPS) about using HTTPS interception products to detect malware over an HTTPS connection because the HTTPS interception products may leave the organization vulnerable to man-in-the-middle (MITM) attacks. In an MITM attack, a third party intercepts internet communications between two parties; in some instances, the third party may modify the information or alter the communication by injecting malicious code.
OCR provides a partial list of products that may be affected. Also, OCR provides a method that organizations can use to determine if their HTTPS interception product properly validates certificates and prevents connections to sites using weak cryptography.
OCR emphasized that covered entities and business associates must consider the risks presented to the electronic protected health information (ePHI) transmitted over HTTPS. Further, OCR encouraged covered entities and business associates to review OCR’s recommendations for valid encryption processes to ensure that ePHI is not unsecured and the U.S. Computer Emergency Readiness Team’s recommendations on protecting internet communications and preventing MITM attacks.
HIPAA Enforcement in the News
Below is a round up of the settlements recently in the news related to ePHI.
OCR Announces HIPAA Settlement for Impermissible Disclosure of ePHI, Insufficient Risk Analysis, and Insufficient Risk Management Processes
The U.S. Department of Health and Human Services Office for Civil Rights (OCR) announced its $2.5 million settlement with a wireless health services provider for impermissible disclosure of ePHI. OCR’s investigation revealed that the provider had insufficient risk analysis and risk management processes in place at the time of the impermissible disclosure, including failing to implement policies and procedures regarding ePHI safeguards. The settlement requires the provider to implement a corrective action plan.
OCR Announces HIPAA Settlement for Insufficient Security Management Process for ePHI
OCR announced its $400,000 settlement with a federally qualified health center (FQHC) based on the FQHC’s failure to have a security management process, including risk analyses sufficient to meet the Security Rule’s requirements. The settlement requires the FQHC to implement a corrective action plan. OCR’s announcement also provided a link to its guidance on the Security Rule.
OCR Announces HIPAA Settlement for Failure to Have Business Associate Agreements
OCR announced its $31,000 settlement with a small, for-profit health care provider based on the provider’s failure to produce a signed business associate agreement with its business associate who stored records containing PHI. The settlement requires the provider to implement a corrective action plan.
Employers Ask…
UBA’s question of the month from employers addressed breach notification requirements:
Q. Under what circumstances do HIPAA’s breach notification requirements not apply when a breach of protected health information (PHI) occurs?
A. Generally, breach notification must be provided when a breach of unsecured PHI is discovered. HHS provides only two methods of creating “secured PHI” that would not be subject to the notification requirements if there is a breach:
This means that if PHI/ePHI is encrypted or destroyed and a breach occurs, HIPAA’s notification requirements are not triggered.
By Danielle Capilla
Originally Posted By www.ubabenefits.com
by admin | May 12, 2017 | ACA
On May 4, 2017, the U.S. House of Representatives passed House Resolution 1628, a reconciliation bill aimed at “repealing and replacing” the Patient Protection and Affordable Care Act (ACA). The bill, titled the “American Health Care Act of 2017” or “AHCA,” will now be sent to the Senate for debate, where amendments can be made, prior to the Senate voting on the bill.
It is widely anticipated that in its current state the AHCA is unlikely to pass the Senate. Employers should continue to monitor the text of the bill and should refrain from implementing any changes to group health plans in response to the current version of the AHCA.
The AHCA makes numerous changes to current law, much of which impact the individual market, Medicare, and Medicaid. Some provisions in the AHCA also impact employer group health plans. For example, the AHCA removes both the individual and the employer shared responsibility penalties. The AHCA also pushes implementation of the Cadillac tax to 2025 and permits states to waive essential health benefit (EHB) requirements.
The AHCA removes the $2,500 contribution limit to flexible health spending accounts (FSAs) for taxable years beginning after December 31, 2017. It also changes the maximum contribution limits to health savings accounts (HSAs) to the amount of the accompanying high deductible health plan’s deductible and out-of-pocket limitation. The AHCA also provides for both spouses to make catch-up contributions to HSAs.
The AHCA provides for a “continuous health insurance coverage incentive,” which will allow health insurers to charge policyholders an amount equal to 30 percent of the monthly premium in the individual and small group market, if the individual failed to have creditable coverage for 63 or more days during an applicable 12-month look-back period. This provision is slated to begin in 2019, or in the case of a special enrollment period, beginning in plan year 2018. The AHCA also allows states to obtain a waiver and underwrite policies for individuals who do not maintain continuous coverage.
The AHCA would also return permissible age band rating (for purposes of calculating health plan premiums) to the pre-ACA ratio of 5:1, rather than the ACA’s 3:1. This allows older individuals to be charged up to five times more than what younger individuals pay for the same policy, rather than up to the ACA limit of three times more.
It is unknown at this time if the AHCA can pass the Senate, or what might be changed in the text of the bill in order to earn votes in an attempt to pass the bill.
By Danielle Capilla
Originally Posted By www.ubabenefits.com
by admin | May 10, 2017 | ACA, Group Benefit Plans, Health & Wellness
Workplace wellness programs have increased popularity through the years. According to the most recent UBA Health Plan Survey, 49 percent of firms with 200+ employees offering health benefits in 2016 offered wellness programs. Workplace wellness programs’ popularity also brought controversy and hefty discussions about what works to improve population health and which programs comply with the complex legal standards of multiple institutions that have not really “talked” to each other in the past. To “add wood to the fire,” the Equal Employment Opportunity Commission (EEOC) made public some legal actions that shook the core of the wellness industry, such as EEOC vs. Honeywell International, and EEOC vs. Orion Energy Systems.
To ensure a wellness program is compliant with the ACA, GINA and the EEOC, let’s first understand what each one of these institutions are.
The Affordable Care Act (ACA) is a comprehensive healthcare reform law enacted in March 2010 during the Obama presidency. It has three primary goals: to make health insurance available to more people, to expand the Medicaid program, and to support innovative medical care delivery methods to lower the cost of healthcare overall.1 The ACA carries provisions that support the development of wellness programs and determines all rules around them.
The Genetic Information Nondiscrimination Act of 2008 (GINA) is a federal law that protects individuals from genetic discrimination in health insurance and employment. GINA relates to wellness programs in different ways, but it particularly relates to the gathering of genetic information via a health risk assessment.
The U.S. Equal Employment Opportunity Commission (EEOC) is a federal agency that administers and enforces civil rights laws against workplace discrimination. In 2017, the EEOC issued a final rule to amend the regulations implementing Title II of GINA as they relate to employer-sponsored wellness program. This rule addresses the extent to which an employer may offer incentives to employees and spouses.
Here is some advice to ensure your wellness program is compliant with multiple guidelines.
- Make sure your wellness program is “reasonably designed” and voluntary – This means that your program’s main goal should be to promote health and prevent disease for all equally. Additionally, it should not be burdensome for individuals to participate or receive the incentive. This means you must offer reasonable alternatives for qualifying for the incentive, especially for individuals whose medical conditions make it unreasonably difficult to meet specific health-related standards. I always recommend wellness programs be as simple as possible, and before making a change or decision in the wellness program, identify all difficult or unfair situations that might arise from this change, and then run them by your company’s legal counsel and modify the program accordingly before implementing it. An example of a wellness program that is NOT reasonably designed is a program offering a health risk assessment and biometric screening without providing results or follow-up information and advice. A wellness program is also NOT reasonably designed if exists merely to shift costs from an employer to employees based on their health.
- Do the math! – Recent rules implemented changes in the ACA that increased the maximum permissible wellness program reward from 20 percent to 30 percent of the cost of self-only health coverage (50 percent if the program includes tobacco cessation). Although the final rules are not clear on incentives for spouses, it is expected that, for wellness programs that apply to employees and their spouses, the maximum incentive for either the employee or spouse will be 30 percent of the total cost of self-only coverage. In case an employer offers more than one group health plan but participation in a wellness program is open to all employees regardless of whether they are enrolled in a plan, the employer may offer a maximum incentive of 30 percent of the lowest cost major medical self-only plan it offers. As an example, if a single plan costs $4,000, the maximum incentive would be $1,200.
- Provide a notice to all eligible to participate in your wellness program – The EEOC made it easy for everyone and posted a sample notice online at https://www.eeoc.gov/laws/regulations/ada-wellness-notice.cfm. Your notice should include information on the incentive amount you are offering for different programs, how you maintain privacy and security of all protected health information (PHI) as well as who to contact if participants have question or concerns.
- If using a HRA (health risk assessment), do not include family medical history questions – The EEOC final rule, which expands on GINA’s rules, makes it clear that “an employer is permitted to request information about the current or past health status of an employee’s spouse who is completing a HRA on a voluntary basis, as long as the employer follows GINA rules about requesting genetic information when offering health or genetic services. These rules include requirements that the spouse provide prior, knowing, written, and voluntary authorization for the employer to collect genetic information, just as the employee must do, and that inducements in exchange for this information are limited.”2 Due to the complexity and “gray areas” this item can reach, my recommendation is to keep it simple and to leave genetic services and genetic counseling out of a comprehensive wellness program.
WellSteps, a nationwide wellness provider, has a useful tool that everyone can use. Their “wellness compliance checker” should not substituted for qualified legal advice, but can be useful for a high level check on how compliant your wellness program is. You can access it at https://www.wellsteps.com/resources/tools.
I often stress the need for all wellness programs to build a strong foundation, which starts with the company’s and leaders’ messages. Your company should launch a wellness program because you value and care about your employees’ (and their families’) health and well-being. Everything you do and say should reflect this philosophy. While I always recommend companies to carefully review all regulations around wellness, I do believe that if your wellness program has a strong foundation based on your corporate social responsibility and your passion for building a healthy workplace, you most likely will be within the walls of all these rules. At the end, a workplace that does wellness the right way has employees who are not motivated by financial incentives, but by their intrinsic motivation to be the best they can be as well as their acceptance that we all must be responsible for our own health, and that all corporations should be responsible for providing the best environment and opportunities for employees to do so.
By Valeria S. Tivnan
Originally Posted By www.ubabenefits.com
