Trying to decide which of the many employer-sponsored benefits out there to offer employees can leave an employer feeling lost in a confusing bowl of alphabet soup—HSA? FSA? DCAP? HRA? What does it mean if a benefit is “limited” or “post-deductible”? Which one is use-it-or-lose-it? Which one has a rollover? What are the limits on each benefit?—and so on.
While there are many details to cover for each of these benefit options, perhaps the first and most important question to answer is: which of these benefits is going to best suit the needs of both my business and my employees? In this article, we will cover the basic pros and cons of Flexible Spending Arrangements (FSA), Health Savings Accounts (HSA), and Health Reimbursement Arrangements (HRA) to help you better answer that question. Flexible Spending Arrangements (FSA)
An FSA is an employer-sponsored and employer-owned benefit that allows employee participants to be reimbursed for certain expenses with amounts deducted from their salaries pre-tax. An FSA can include both the Health FSA that reimburses uncovered medical expenses and the Dependent Care FSA that reimburses for dependent expenses like day care and child care. Pros:
Benefits can be funded entirely from employee salary reductions (ER contributions are an option)
Participants have access to full annual elections on day 1 of the benefit (Health FSA only)
Participants save on taxes by reducing their taxable income; employers save also by paying less in payroll taxes like FICA and FUTA
An FSA allows participants to “give themselves a raise” by reducing the taxes on healthcare expenses they would have had anyway
Cons:
Employers risk losing money should an employee quit or leave the program prior to fully funding their FSA election
Employees risk losing money should their healthcare expenses total less than their election (the infamous use-it-or-lose-it—though there are ways to mitigate this problem, such as the $500 rollover option)
FSA elections are irrevocable after open enrollment; only a qualifying change of status event permits a change of election mid-year
Only so much can be elected for an FSA. For 2018, Health FSAs are capped at $2,650, and Dependent Care Accounts are generally capped at $5,000
FSA plans are almost always offered under a cafeteria plan; as such, they are subject to several non-discrimination rules and tests
Health Savings Accounts (HSA)
An HSA is an employee-owned account that allows participants to set aside funds to pay for the same expenses that are eligible under a Health FSA. Also like an FSA, these accounts can be offered under a cafeteria plan so that participants may fund their accounts through pre-tax salary reductions. Pros:
HSAs are “triple-tax advantaged”—the contributions are tax free, the funds are not taxed if paid for eligible expenses, and any gains on the funds (interest, dividends) are also tax-free
HSAs are portable, employee-owned, interest-bearing bank accounts; the account remains with the employees even if they leave the company
Certain HSAs allow participants to invest a portion of the balance into mutual funds; any earnings on these investments are non-taxable
Upon reaching retirement, participants can use any remaining HSA funds to pay for any expense without a tax penalty (though normal taxes are required for non-qualified expenses); also, retirees can use the funds tax-free to pay premiums on any supplemental Medicare coverage. This feature allows HSAs to operate as a secondary retirement fund
There is no use-it-or-lose-it with HSAs; all funds employees contribute stay in their accounts and remain theirs in perpetuity. Also, participants may alter their deduction amounts at any time
Like FSAs, employers can either allow the HSA to be entirely employee-funded, or they may choose to also make contributions to their employees’ HSA accounts
Even though they are often offered under a cafeteria plan, HSAs do not carry the same non-discrimination requirements as an FSA. Moreover, there is less administrative burden for the employer as the employees carry the liability for their own accounts
Cons:
To open and contribute to an HSA, an employee must be covered by a qualifying high deductible health plan; moreover, they cannot be covered by any other health coverage (a spouse’s health insurance, an FSA (unless limited), or otherwise)
Participants are limited to reimburse only what they have contributed—there is no “front-loading” like with an FSA
Participant contributions to an HSA also have an annual limit. For 2018, that limit is $3,450 for an employee with single coverage and $6,900 for an employee with family coverage (participants over 55 can add an additional $1,000; also, remember there is no total account limit)
Participation in an HSA precludes participation in any other benefit that provides health coverage. This means employees with an HSA cannot participate in either an FSA or an HRA. Employers can work around this by offering a special limited FSA or HRA that only reimburses dental and vision benefits, meets certain deductible requirements, or both
HSAs are treated as bank accounts for legal purposes, so they are subject to many of the same laws that govern bank accounts, like the Patriot Act. Participants are often required to verify their identity to open an HSA, an administrative burden that does not apply to either an FSA or an HRA
Health Reimbursement Arrangements (HRA)
An HRA is an employer-owned and employer-sponsored account that, unlike FSAs and HSAs, is completely funded with employer monies. Employers can think of these accounts as their own supplemental health plans that they create for their employees Pros:
HRAs are extremely flexible in terms of design and function; employers can essentially create the benefit to reimburse the specific expenses at the specific time and under the specific conditions that the employers want
HRAs can be an excellent way to “soften the blow” of an increase in major medical insurance costs—employers can use an HRA to mitigate an increase in premiums, deductibles, or other out-of-pocket expenses
HRAs can be simpler to administer than an FSA or even an HSA, provided that the plan design is simple and efficient: there are no payroll deductions to track, usually less reimbursements to process, and no individual participant elections to manage
Small employers may qualify for a special type of HRA, a Qualified Small Employer HRA (or QSEHRA), that even allows participants to be reimbursed for their insurance premiums (special regulations apply)
Funds can remain with the employer if someone terminates employment and have not submitted for reimbursement
Cons:
HRAs are entirely employer funded. No employee funds or salary reductions may be used to help pay for the benefit. Some employers may not have the funding to operate such a benefit
HRAs are subject to the Affordable Care Act. As such, they must be “integrated” with major medical coverage if they provide any sort of health expense reimbursement and are also subject to several regulations
HRAs are also subject to many of the same non-discrimination requirements as the Health FSA
HRAs often go under-utilized; employers may pay an amount of administrative costs that is disproportionate to how much employees actually use the benefit
Employers can often get “stuck in the weeds” with an overly complicated HRA plan design. Such designs create frustration on the part of the participants, the benefits administrator, and the employer
For help in determining which flexible benefit is right for your business, contact us!
by Blake London
Originally posted on ubabenefits.com
As you look through enrollment options for 2019, remember to look back on 2018. Check out your spending on procedures and prescriptions, and which providers are in your network.
We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year. Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.
Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.
Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offered.
Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”
As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.
Nancy Spangler, senior consultant at the Center for Workplace Mental Health of the American Psychiatric Foundation, says that one in five adults has a mental health disorder, and one in 10 has a substance abuse problem. In addition, major depression and its associated conditions cost the U.S. over $210 billion every year. Clearly, mental health is an issue we need to investigate both in our offices and across the country.
Many organizations have found that simply by working with employees to recognize depression, build empathy, and find resources, increased EAP utilization while claim dollars did the opposite. In most cases there was no formal program involved—leadership simply began talking about the issue, and the reduced stigma led to better health (and better offices!).
What can we do besides reducing stigma, especially from the top down?At the 2018 Health Benefits and Leadership Conference, experts listed five “buckets” of challenges in addressing mental health: access to care, cost of care, stigma, quality, and integration. Breaking these down into individual components not only helps employees find the support they need and deserve, but it further reduces stigma by refusing to separate mental health from medical coverage or wellness programs. Experts also recommend inviting EAPs to visit offices in person, instead of simply suggesting employees call when they can. Another increasingly popular technique is text-based therapy. This a great fit for many employees because someone is always available and the conversation is always private, even when the client is sitting at a desk in a shared space.
In addition to reducing stigma through transparency and access, employers can also help increase the quality of care available to employees. One key move is simply asking for data. How do vendors evaluate quality, meet standards, and screen for illness? Do health plan members have confidential ways to report their experiences? Mental health care should be seen no differently from other kinds of health care. Employees who have access to quality, destigmatized mental health care build stronger, more functional, and ever-happier workplaces.
The coals from the Labor Day barbecues have cooled, the beach chairs have been returned to their sheds, the ice cream shops have scaled back their hours, and the white shoes have been set aside for the next nine months. Whatever the end of summer means to you, for millions of families, it signals the return to school for children in preschool through college.
This means your employees will likely need to take a few hours out of their workday occasionally to participate in their children’s education. Parents’ fall calendars are often packed with school events, parent-teacher conferences, and/or parent meetings – some of which will inevitably occur during their usual working hours – and any flexibility you give them to attend these events, or even volunteer in the classroom or chaperone a field trip, will be greatly appreciated.
Where it’s the law
Nine states and the District of Columbia have passed laws protecting parents’ rights to take small increments of time away from work to attend to school matters. They vary widely in their specifics regarding eligibility for leave, whether the time is paid or unpaid, and the amount of time available for use. (ThinkHR customers can get details about each state’s provisions by clicking the act titles listed below after logging into to your ThinkHR account.)
It’s a best practice to offer flexibility to all employees so that they can meet the obligations of daily life while still performing at their peak at work. It goes a long way toward making an employee feel good about where they work when they can see their child perform in a school play, take their dog to the vet, or accept an appliance delivery without worrying about missing a couple hours of work or needing to take a full day off.
The beginning of fall is a great time to review your established time off policies to see how you can accommodate parents and guardians who need to meet school obligations as well as giving all employees the flexibility to attend to the other small necessities of life.
In many cases, your established policies may not need to change. Depending on the needs of your workplace, your state laws, and the employee’s position, this could mean allowing employees to make up a few hours of work, take an extended lunch period, shift their schedule to start earlier or later to still get a full day in, or use personal, vacation, or PTO time in small increments.
How can we help?
ThinkHR customers can get up-to-date information on state and federal leave regulations for just about every kind of leave designation (family and medical, jury duty, voting, military, etc.) on Comply. In addition, the Employee Handbook Builder includes compliant and customizable leave policies specific to each state and our Learn training catalog contains leadership and employment law courses to help your managers handle employee situations with added confidence.
Originally Published By ThinkHR.com
