by admin | May 21, 2024 | Compliance
FEDERAL TRADE COMMISSION BANS NON-COMPETE CLAUSES
On April 23, 2024, the Federal Trade Commission (FTC) finalized a rule banning most employers and employees from entering into non-compete clauses, effective 120 days post-publication in the Federal Register. This move aims to eliminate these clauses across all levels of workers, with a narrow exception for senior executives’ pre-existing agreements.
The rule broadly defines non-compete clauses, including any terms that prevent or penalize employees from seeking employment elsewhere after their current employment ends. It also outlaws “forfeiture-for-competition” clauses, where employees must choose between severance and working for a competitor.
Moreover, the rule mandates that employers notify all employees, except senior executives, that their non-compete clauses are no longer enforceable, providing suggested language for such notifications.
An exception remains for non-compete clauses entered into during the bona fide sale of a business, which now potentially includes certain employee scenarios.
EMPLOYER CONSIDERATIONS
This rule marks a significant shift in U.S. employment practice, and employers are urged to reassess their compensation and retention strategies immediately.
PORTAL OPEN FOR RXDC SUBMISSIONS
On April 10, 2024, the Centers for Medicare and Medicaid Services (CMS) announced through its RegTap portal that the Health Insurance Oversight System (HIOS) is now open to Prescription Drug Data Collection (RxDC) submissions for 2023. Any plan sponsor submitting the RxDC report on its own must be registered with HIOS.
CMS has provided several resources for navigating the registration process:
HIOS Access Training
HIOS Access RxDC User Guide
RxDC User Manual
EMPLOYER CONSIDERATIONS
While this is a one-time registration, the first time can take several weeks, so plan sponsors are encouraged to register early. The 2023 reference year submission is due June 1, 2024.
PREGNANT WORKERS FAIRNESS ACT ISSUED
On April 15, 2024, The Equal Employment Opportunity Commission (EEOC) issued final regulations for the Pregnant Workers Fairness Act (PWFA), effective June 18, 2024. This law mandates that employers with 15 or more employees must handle accommodation requests for pregnancy, childbirth, or related conditions as they would under the Americans with Disabilities Act (ADA).
Key aspects of the PWFA include a broad definition of “pregnancy, childbirth, or related medical conditions” that covers a wide range of situations from fertility treatments to lactation. Employers are required to provide reasonable accommodations, which might include job restructuring, flexible working hours, and modifications to the work environment, among others.
The regulations emphasize that accommodations need not be based on the severity of conditions, and employers can deny accommodations only if they pose an undue hardship, which must be carefully assessed through an interactive process.
EMPLOYER CONSIDERATIONS
Employers should review and update their HR policies and training to ensure compliance with the PWFA, considering any additional local or state regulations.
2024 PRIVACY RULE AMENDED TO STRENGTHEN PROTECTIONS FOR HIGHLY SENSITIVE PHI
On April 22, 2024, the Department of Health and Human Services (HHS) introduced new regulations under the Health Insurance Portability and Accountability Act (HIPAA) to safeguard protected health information (PHI) related to reproductive health care. This action follows concerns that PHI could be misused under new state laws following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. This regulatory update aims to preserve patient confidentiality and uphold individuals’ rights under shifting legal landscapes in reproductive health.
Key features of these regulations include:
- Enhanced P\protection of PHI: The new rule prevents regulated entities, like healthcare providers and health plans, from using or disclosing PHI to investigate or penalize individuals or providers related to lawful reproductive healthcare.
- Definition of reproductive health care: The scope covers a broad range of services, including contraception, prenatal care, pregnancy termination, and fertility treatments, among others.
- Attestation requirement: Regulated entities must obtain a signed attestation confirming that any request for PHI is not for the purpose of investigating or penalizing lawful reproductive health care.
- Updated Notice of Privacy Practices (NPP): Covered entities are required to revise their NPPs to clearly inform individuals about the use and disclosure of their PHI concerning reproductive health care, with updates to be completed by February 16, 2026.
EMPLOYER CONSIDERATIONS
It’s crucial to stay updated with HHS guidance, ensure NPPs are current, and consult legal counsel when handling PHI related to reproductive health care.
HARASSMENT PREVENTION GUIDANCE RELEASED
The Equal Employment Opportunity Commission (EEOC) has recently published final enforcement guidance on workplace harassment. This comprehensive document updates and consolidates previous guidance from 1987 to 1999 into a unified resource that reflects changes in law and evolving workplace dynamics, including virtual environments and the influence of digital technology.
Key highlights of the guidance:
- Protection from harassment: It reaffirms that federal laws protect employees from harassment based on race, color, religion, sex, national origin, disability, age (40 or over), or genetic information.
- Scope of harassment: Harassment can occur not only between coworkers and supervisors but also through interactions with customers, contractors, and other third parties.
- Legal and technological updates: The guidance incorporates recent legal precedents, such as the Supreme Court’s decision in Bostock v. Clayton County and addresses new challenges like online harassment.
EMPLOYER CONSIDERATIONS
Employers should review the Summary of Key Provisions, and consider whether their employees may experience barriers to understanding the law. Employers should:
- Have a clear, easy-to-understand anti-harassment policy.
- Have a safe and effective procedure that employees can use to report harassment, including more than one option for reporting.
- Provide recurring training to all employees, including supervisors and managers, about the company’s anti-harassment policy and complaint process.
- Take steps to make sure the anti-harassment policy is being followed and the complaint process is working.
QUESTION OF THE MONTH
Q: If an enrolled employee’s dependent loses coverage and needs to enroll under the employee’s plan, is that an opportunity to switch medical plans and carriers, or are they restricted to their current plan?
A: The employee can enroll the dependent in any plan option offered by the employee’s employer. This is a HIPAA special enrollment right and the right extends to any benefit plan option, even if the employee was not previously on that option.
Here is an example from the HIPAA special enrollment regulations:
Facts. Individual A works for Employer X. X maintains a group health plan with two benefit packages—an HMO option and an indemnity option. Self-only and family coverage are available under both options. A enrolls for self-only coverage in the HMO option. A’s spouse works for Employer Y and was enrolled for self-only coverage under Y’s plan at the time coverage was offered under X’s plan. Then, A’s spouse loses coverage under Y’s plan. A requests special enrollment for A and A’s spouse under the plan’s indemnity option.
Conclusion. In this example, because A’s spouse satisfies the conditions for special enrollment under paragraph (a)(2)(ii) of this section, both A and A’s spouse can enroll in either benefit package under X’s plan. Therefore, if A requests enrollment in accordance with the requirements of this section, the plan must allow A and A’s spouse to enroll in the indemnity option.
This information is general in nature and provided for educational purposes only. It is not intended to provide legal advice. You should not act on this information without consulting legal counsel or other knowledgeable advisors.
©2024 United Benefit Advisors
by admin | May 13, 2024 | Health & Wellness
Overview
Mental health includes emotional, psychological, and social well-being. It is more than the absence of a mental illness—it’s essential to your overall health and quality of life. Self-care can play a role in maintaining your mental health and help support your treatment and recovery if you have a mental illness.
How can I take care of my mental health?
Self-care means taking the time to do things that help you live well and improve both your physical health and mental health. This can help you manage stress, lower your risk of illness, and increase your energy. Even small acts of self-care in your daily life can have a big impact.
Here are some self-care tips:
- Get regular exercise. Just 30 minutes of walking every day can boost your mood and improve your health. Small amounts of exercise add up, so don’t be discouraged if you can’t do 30 minutes at one time.
- Eat healthy, regular meals and stay hydrated. A balanced diet and plenty of water can improve your energy and focus throughout the day. Pay attention to your intake of caffeine and alcohol and how they affect your mood and well-being—for some, decreasing caffeine and alcohol consumption can be helpful.
- Make sleep a priority. Stick to a schedule, and make sure you’re getting enough sleep. Blue light from devices and screens can make it harder to fall asleep, so reduce blue light exposure from your phone or computer before bedtime.
- Try a relaxing activity. Explore relaxation or wellness programs or apps, which may incorporate meditation, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy activities you enjoy, such as listening to music, reading, spending time in nature, and engaging in low-stress hobbies.
- Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new tasks if you start to feel like you’re taking on too much. Try to appreciate what you have accomplished at the end of the day.
- Practice gratitude. Remind yourself daily of things you are grateful for. Be specific. Write them down or replay them in your mind.
- Focus on positivity. Identify and challenge your negative and unhelpful thoughts.
- Stay connected. Reach out to friends or family members who can provide emotional support and practical help.
Self-care looks different for everyone, and it is important to find what you need and enjoy. It may take trial and error to discover what works best for you.
Learn more about healthy practices for your mind and body .
When should I seek professional help?
Seek professional help if you are experiencing severe or distressing symptoms that have lasted 2 weeks or more, such as:
- Difficulty sleeping
- Changes in appetite or unplanned weight changes
- Difficulty getting out of bed in the morning because of mood
- Difficulty concentrating
- Loss of interest in things you usually find enjoyable
- Inability to complete usual tasks and activities
- Feelings of irritability, frustration, or restlessness
How can I find help?
Originally posted on National Institute of Mental Health
by admin | May 6, 2024 | Employee Benefits
Life Insurance at Work: Your Guide to Voluntary Coverage
We all juggle life’s different responsibilities, and ensuring our loved ones are financially secure in case of our passing should be a top priority. Life insurance offers a safety net but typically the amount of coverage included as a standard company-paid life insurance policy isn’t enough to cover the financial needs of your dependents. This is where voluntary life insurance comes in – an option your employer might offer as part of your benefits package.
What is Voluntary Life Insurance?
Unlike mandatory benefits like health insurance, voluntary life insurance is an add-on you can choose. It functions similarly to regular life insurance: you pay a monthly premium, typically deducted from your paycheck, and if you pass away, a designated beneficiary receives a cash benefit.
Why Consider Voluntary Life Insurance?
Here are some key advantages:
Affordability: Because it’s a group plan, voluntary life insurance is often cheaper than individual policies. Employers may even contribute to the cost, making it even more attractive.
Convenience: Premiums are often deducted from your paycheck.
Easy Qualification: Unlike individual policies that might require medical exams, voluntary life insurance often offers guaranteed coverage, making it easier to obtain.
Additional Perks:
Some voluntary life insurance plans offer extra features like:
Coverage for Spouses and Dependents: Extend your financial protection to your family.
Portability: Continue your coverage even if you leave your job (check your specific plan details).
Accelerated Benefits: In some cases, you may access a portion of the death benefit if diagnosed with a terminal illness.
Is Voluntary Life Insurance Right for You?
While voluntary life insurance offers a convenient and affordable starting point, consider your individual needs. Think about:
Your current financial situation: Do you have existing life insurance?
Your dependents: How much would your loved ones need financially in your absence?
The coverage amount offered: Does it meet your family’s needs?
Taking the Next Step
If your employer offers voluntary life insurance, carefully review the plan details during your benefits enrollment period. Consider factors like coverage amount, available riders, and portability options. Don’t hesitate to ask your HR representative any questions you might have.
Voluntary life insurance can be a valuable tool in your financial planning. By understanding your options and weighing your needs, you can make informed decisions to ensure your loved ones are taken care of, no matter what.
by admin | Apr 16, 2024 | Health Insurance
Insurance Costs
Consumers typically pay the following types of costs when they have insurance.
- Premium: The premium is an amount of money a consumer pays for a health insurance plan. The consumer and/or their employer usually make this payment bi-weekly, monthly, quarterly, or yearly. The premium must be paid regardless of how many services, if any, the consumer uses.
- Cost Sharing: Cost sharing is the share of costs for covered services that consumers must pay out of pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for out-of-network providers, or the cost of non-covered services. Cost sharing in Medicaid and Children’s Health Insurance Program also includes premiums.
- Deductible: The amount a consumer must pay for covered health care services received before their plan begins to pay. For example, if a consumer’s deductible is $1,000, their plan won’t pay anything until the consumer has paid $1,000 for covered health care services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. For example, a plan may have separate in-network and out-of-network deductibles.
- Copayment: A fixed amount ($20, for example) that a consumer pays for a covered health care service after they’ve paid their deductible.
- Coinsurance: The percentage of the costs of a covered health care service that a consumer pays (for example, 15% of the cost of a prescription) after paying a deductible.
See Appendix A for examples of how cost sharing works.
Tips to Know:
- Sometimes consumers with most types of health insurance don’t have to pay any cost sharing for certain services. This is often true for preventive services like flu shots and some cancer screenings. The goal is to keep enrollees healthy and catch health problems early.
- Many health insurance plans have an out-of-pocket maximum. This is the most a consumer could pay during a coverage period (usually one year) for their share of the costs of covered services. After they meet this limit, the plan will usually pay 100% of the allowed amount. This limit never includes the premiums, balance-billed charges, or care that the consumer’s plan doesn’t cover. Some plans don’t count all of a consumer’s copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.
- In the majority of situations, the most important document for tracking health insurance costs is usually called an Explanation of Benefits (EOB). The EOB is a summary of health care charges that a health plan may send after a consumer receives medical care. It is not a bill. It shows the consumer how much their provider is charging the health plan for the care they received, and the amount the plan will cover. If the plan does not cover the entire cost, the provider may send the consumer a separate bill, unless prohibited by law.
Appendix A
Examples of Health Insurance Cost Sharing
This appendix provides some examples of how health insurance cost sharing works for consumers. These examples show different outcomes depending on whether a consumer has met their deductible and whether their health insurance includes out-of-network coverage. This information is intended to illustrate some of the basic steps that are typically used to calculate cost sharing in the absence of consumer surprise billing protections (or when such protections don’t apply).
IN-NETWORK:
A consumer receives covered items or services from an in-network provider or facility.
If the services are covered by the consumer’s health plan and furnished by an in-network provider or facility, the amount a consumer pays will vary based on whether the consumer has met their in-network deductible as well as the level of their coinsurance. Note the “allowed amount” is the maximum payment the plan will pay for a covered health care item or service and is generally the basis for cost-sharing calculations. In the next two examples, assume the consumer’s health plan specifies that coinsurance is 20 percent of the allowed amount after the consumer has met a $2,000 deductible for in-network coverage.
OUT-OF-NETWORK:
The consumer receives covered items or services from an out-of-network provider.
If the covered items or services are received out-of-network, a consumer’s billed amounts will vary based on whether the consumer’s health plan provides any out-of-network coverage and whether the consumer has met their out-of-network deductible.
In some circumstances, the No Surprises Act may limit what a consumer may be billed in each of the following examples. See the No Surprises Act: Overview of Key Consumer Protections.
In the next two examples, the plan covers out-of-network services with consumer coinsurance of 40 percent after the consumer has met a $4,000 deductible for out-of-network services. If the consumer has not paid anything toward the out-of-network deductible, the provider would bill the consumer for the full amount of the charges if the charges are less than $4,000 (example 4). If the consumer has already paid their full deductible, a provider might balance bill a consumer for the difference between what the provider receives from the health plan and the provider’s initial billed amount (example 5).
Originally posted on CMS.gov
