Factoring in wellness programs during open enrollment

wellness-programs-webThis article was published on November 5, 2018 on Employee Benefit News, written by Ann Marie O’Brien.

This fall, millions of employees are deciding which health plan to select for 2019. They are reviewing and comparing a variety of factors when making this important decision, such as costs, benefits and care provider networks.

Another component that crops up to the surprise of many workers? Wellness programs.

Employers know that a healthy employee can make for a more productive, satisfied employee. And many workers want to improve their health and are often surprised to learn that employers offer wellness programs. That mutual interest is behind the rise of workplace wellness programs.

Wellness programs usually are made available to employees by their companies directly or through health benefit plans. In either case, employees can factor in the value of wellness offerings, such as weight-loss programs, tobacco-cessation programs or health screenings when determining a health plan that best meets their needs.

A recent UnitedHealthcare report, “Employee Wellness Programs Bring Results,” suggests that companies that strengthen their wellness offerings can yield cost-savings and improve employee health over the long-term.

Many companies, like those highlighted in the report, have successfully established a culture of well-being through their wellness programs.

While each company’s wellness program may be strongest when tailored to its employees’ needs, successful programs often include offering meaningful financial incentives, or a mental health focus through offerings like mindfulness classes and relaxation rooms, or a financial well-being component, like estate-planning seminars. And, many employers find offering the services of a wellness coordinator or nurse liaison onsite encourages a culture of health.

The report compared companies with award-winning wellness programs alongside a peer group of similar companies. It found those that make positive changes to their health offerings over the years may reap the rewards of healthier employees and reduced healthcare costs down the road.

For example, these companies experienced 14.2% per-member, per-month lower costs, even with a 7.5% greater claim risk score (based on their employees’ health status), than the peer group, and the employees at the high-performing companies experienced 24% fewer emergency room visits. Also, the report finds that it can take time for employer wellness programs to yield significant benefits.

Strengthening wellness programs strengthens employees.

The report revealed that the companies with the most effective programs had several common characteristics that contribute to their plan’s positive results and encourage a culture of health, including enthusiastic involvement by senior leaders, positive encouragement from internal advocates, offering employee incentives and putting in place measurable success barometers.

Also, these companies conduct health surveys and challenges, biometric screenings and financial well-being programs, and they all survey their employees to gather feedback to refine their programs.

The informational benefits meetings that are often part of open enrollment offer companies a good opportunity to collect and analyze employee feedback to further strengthen their wellness offerings. It is also an ideal time for employers who have not yet done so to consider offering a wellness program that supports their employees’ health and may improve their well-being while reducing costs for employees and the company.

IRS Releases Adjusted PCOR Fee

The Patient-Centered Outcomes Research Trust Fund fee is a fee on issuers of health insurance policies and plan sponsors of self-insured health plans that helps to fund the Patient-Centered Outcomes Research Institute (PCORI), which was established by the Affordable Care Act (ACA). The institute assists, through research, patients, clinicians, purchasers and policy-makers, in making health decisions by advancing the quality of evidence-based medicine. The institute compiles and distributes comparative clinical effectiveness research findings. Under the ACA, all medical plans are responsible for paying the Patient-Centered Outcomes Research fee to the IRS, based on the number of plan participants. If the plan is fully-insured, the insurance carrier pays the fee on behalf of the policyholder. If the plan is self-insured, the employer/plan sponsor must file the Form 720 for the second quarter and pay the fee to the IRS directly.

The IRS recently published its PCOR fee for policy and plan years ending:  January through September 2018 the applicable dollar amount is $2.39, which is multiplied by the number of covered lives determined for the appropriate period. For policy and plan years ending October through December 2018, the applicable dollar amount is $2.45.

All self-insured medical plans, including health FSAs and HRAs must pay the fee unless they are considered an excepted-benefit:

  • A health FSA is an excepted-benefit as long as the employer does not contribute more than $500/year to the accounts and offers another medical plan with non-excepted benefits.
  • An HRA is an excepted-benefit if it only reimburses for excepted-benefits (e.g., limited-scope dental and vision expenses or long-term care coverage) and is not integrated with the group medical plan.

The PCORI fee is calculated off the average number of lives covered during the policy year. That means that all parties enrolled will have to be accounted for such as dependents, spouses, retirees, and COBRA beneficiaries. For HRA and health FSA plans, just count each participating employee as a covered life.

Payment of the PCOR fee for the calendar 2018 plan year — the last year the fee applies — will be due by July 31, 2019 (payments may extend into 2020 for non-calendar-year plans).

Clients who have elected to have Diversified Group assist with the PCOR fee calculation can expect an email in June 2019, which will include a copy of the completed Form 720 and a PCOR calculation worksheet with supporting documentation. Clients will need to file the Form 720 by July 31, 2019.

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MassHealth Reinstates HIRD Reporting for Employer Sponsored Health Plans

The Health Insurance Responsibility Disclosure (HIRD) form is a new state reporting requirement in Massachusetts beginning in 2018. This form differs from the original HIRD form that was passed into law in 2006 and repealed in 2014. The 2018 form is administered by MassHealth and the Department of Revenue (DOR) through the MassTaxConnect (MTC) web portal. The HIRD form is intended to assist MassHealth in identifying its members with access to employer sponsored health insurance who may be eligible for the MassHealth Premium Assistance Program. The HIRD form is required annually beginning in 2018. The reporting period opens on November 1 and must be completed by November 30 of the filing year. 

Any employers with six or more employees in Massachusetts in any month during the past 12 months preceding the due date of the form (November 30th of the reporting year) are required to annually submit a HIRD form. An individual is considered to be an employee if they were included on the employer’s quarterly wage report to the Department of Unemployment Assistance (DUA) during the past 12 months. This includes all employment categories, full-time and part-time.

The HIRD form is reported through MassTaxConnect (MTC) web portal (https://mtc.dor.state.ma.us/mtc/_/#1). The MTC is where employer-taxpayers register to file returns, forms and make tax payments. To file your HIRD form, login to your MTC withholding account and select the “file health insurance responsibility disclosure” hyperlink. If you do not have a MTC account or you forgot your password or username, follow the prompts on the site or call the DOR at 614-466-3940.

INFORMATION REQUIRED FOR HIRD REPORTING

The HIRD Form will collect information about the employer’s insurance offerings, including:

  • Plan Information – plan year, renewal date.
  • Summary of benefits for all available health plans – information regarding in and out of network deductibles and out-of-pocket maximums can be found on the plan’s summary of benefits and coverage.
  • Eligibility criteria for insurance offerings – minimum probationary periods and hours worked per week to be eligible for coverage.  Employment based categories, such as full-time, part-time, hourly, salaried.
  • Total monthly premiums of all available health plans
  • Employer and employee shares of monthly premiums – information on employer and employee monthly contributions toward the cost of medical. Employer cost of coverage is your COBRA rate less 2% and less the employee contribution.

Due to the nature of the filing online, employers with employees in Massachusetts will need to complete this reporting themselves. However, Diversified Group may be able to assist you in the gathering of the required information. Please contact us by November 15th  if you need assistance with accumulating data.

Mass.gov has compiled a list of frequently asked questions regarding the HIRD form here.

Maine is Reinstituting the Per Member Per Month Assessment to Fund the Maine Guaranteed Access Reinsurance Program

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA. Recently several states have applied for waivers and have been approved. Among these is the State of Maine, which sought to reestablish the Maine Guaranteed Access Reinsurance Association – MGARA (originally established in 2012 but later suspended in light of the ACA’s transitional reinsurance program which expired in 2016). Maine’s Section 1332 waiver to reestablish MGARA was approved by the Department of Health and Human Services earlier this year. MGARA is a state instituted reinsurance program that automatically cedes high-risk enrollees with one of eight conditions (including various types of cancer, congestive heart failure, HIV and rheumatoid arthritis) and voluntary cedes other high-risk enrollees to the pool in an attempt to help stabilize individual medical premiums by about 9 percent each year beginning in 2019. The program is slated to initially run from January, 2019 through December, 2023. The Governor’s Office pushed to get the program up and running by January, 2019 in an attempt to substantially lower premiums in the individual market.

One of the funding sources supporting MGARA’s operations is a quarterly assessment due from each insured and self-insured plan that writes or otherwise provides medical insurance in Maine (other than federal or state government plans) beginning in 2019 at $4.00 per month for each covered person enrolled under each such policy or plan. Only federal and state employees are exempt from the assessment. The 2019 Quarterly Assessment will apply to policies and plans initiated or renewed on or after January 1, 2019, with the first assessment due on May 15, 2019, and 45 days from the end of each calendar quarter thereafter. Self-funded plans using a Third Party Administrator (TPA) will be assessed and reported through their TPA similar to other state assessments.

Diversified Group will collect and report the MGARA on behalf of our self-insured clients who have members residing in Maine.

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Donate with Diversified This Holiday Season

DG Food Bank

Diversified Group is celebrating the season of giving and will be holding a food drive for our local food bank, the Food Bank of Marlborough, Connecticut. Please consider donating this holiday season as this is the time of year when food banks are in the most need. Donations will be collected until December 13th.

The food bank provides hams for Christmas dinners, so anything that you can think of that would accompany a ham dinner, whether side dishes or supplies, would be helpful. Below is a list of some suggested items:

Cake Mixes
Frostings
Pie Crusts (Boxed)
Muffin/Bread Mixes
Cranberry Sauce
Any Canned Goods
Spray Shortening (Pam)
Cooking Oil
Salt & Pepper
Rice Packages (Flavor or Regular)
Any Cereals/Bars
*Please No Paper Goods

Please drop off all donations to our offices at 369 North Main Street in Marlborough, Connecticut. And if you would like more information on the Food Bank, please visit http://www.foodbankofmarlborough.org/.

Who Are All the Stakeholders Really Looking out For?

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Controlling Health Plan Costs Is Everyone’s Responsibility

Recent trade publication articles have featured tales of large carriers offering bonuses and quarterly incentives to advisors who agree to move their clients from a self-funded health plan to fully-insured.

After managing self-funded health plans for more than 50 years, we’ve seen just about every scheme you can think of. And while we believe in marketing as much as the next guy, we place a far greater priority on accountability.

When we help an employer self-fund their health plan, we unbundle the component parts in order to design a plan that meets the client’s specific needs. There are no “one size fits all” solutions. From broker to stop loss carrier, PBM to nurse navigators, it takes a dedicated team of experts to achieve our client’s goals and objectives.

To develop a winning team, we partner with brokers, advisors and vendors who are not only experts in their field – they share our commitment to cost transparency and accountability.

While others may be willing to work with stakeholders who consider huge claims and annual premium increases as status quo, we’ll continue to partner with those who are dedicated to delivering the best possible outcomes for plan members at the lowest possible cost. Because when our clients succeed, we succeed. Period.

Tell Us How You Feel!

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