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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

Online enrollment platforms are great, but communication and understanding are terribly important for the end-user.

I always say, “technology is great, when it works.” Online enrollment platforms have been around for years, and the technology that powers them has grown and advanced at an exponential rate. Who would have guessed that we would be enrolling in our employee benefits directly from our own phones and tablets, without being given the huge enrollment packets from HR?

In this virtual communication age, you can’t take the “human” out of Human Resources, and you can’t take the confusion out of insurance benefits just because you wrap it in a nice, pretty website with fancy graphics and videos.

An employee’s health concerns and needs are as diverse and different as hair colors are at Comic Con, so while a brief overview of plan details is fine for one person, someone else wants to know how many physical therapy visits they can have in a year, or if their child’s insulin pump will be covered on their plan.

A simple online enrollment platform does not always meet the needs of all employees, and not all platforms will offer the level of detail some will require. Aside from posting the evidence of coverage, or insurance contract, at a place that is easily found on the portal, there may not be a way to achieve that level of detail. However, even for those that don’t need that level of detail, critical information must be communicated easily and effectively.

Costly mistakes can be made when benefits are not communicated effectively, or when important information is simply omitted. For example, since the Patient Protection and Affordable Care Act (ACA) was implemented, some employers have opted to offer minimum value plans (MVPs), or plans that cover very few procedures such as office visits, preventive care, and hospital room and board, but they do not cover a wide range of other services such as ambulance, surgery, medical devices, physical or occupational therapy, etc.

When an employee sees a number of choices or plans from which to choose, they will likely compare the various plan options by looking at the carrier, if the plans are HMOs or PPOs, and the cost. From there, an employee may look at the office copays, deductibles, prescription drug costs, and coinsurance.

If the comparison shows MVP plans as well as traditional health plans, but does not call out in big, bold letters, all of the items the MVP plan does not cover, one could come away with the understanding that if they choose the MVP plan, they are selecting a plan that is a comprehensive insurance plan just like the other plans shown, or like they have had in the past.

Most of us don’t read our car insurance policy in detail until we get in an accident and the insurance adjustor says, “sorry, your policy does not cover that.” The same is usually true for our health insurance plans.

You could argue that it is the responsibility of the employee to verify that the plan they are choosing meets all of their needs, certainly. But if that information is not easy to locate, you could find fault with the employer, or insurance carrier, if there were to be a problem. Furthermore, an employer would want to show their employees that they want to take care of them, and not set them up for failure in the event of a crisis.

Let’s walk through a scenario. An employee named “Joe” is 28, and is enrolling in his company’s health plans during open enrollment. His company recently merged with another larger company, and so the benefits being offered are slightly different, but look pretty close to what they had been last year. There are four plans offered, two that are HMO plans with Kaiser and two that are PPO plans, one is labeled Silver, the other Gold.

Joe is young and single, and when he was living at home with his parents, he had never had Kaiser and always traditionally had PPO coverage. Last year, Joe enrolled in the Silver PPO plan so he could continue to see the doctors that had been managing his care for all of his adult life, so he elects the same plan this year. The online system shows a $250 deductible, $40 office visit copay, and 30% coinsurance. In addition, the Kaiser premiums have gone up considerably from what he remembered them to be last year, and are higher than the PPO plan options, so he feels comfortable that he has made the choice that is best for him.

Later in the year, he comes down with a bad cold. The pressure in his head that is caused by the cold is so severe that when he sneezed, he blew out his right ear drum. He goes to the doctor, and his doctor orders a CT scan of his ear. The CT scan shows he has perforated his ear drum and will need surgery to repair it. The surgery is scheduled for two weeks after that. He contacts the hospital and surgeon to confirm they are contracted, in-network providers under his health plan, and asks them to do a pre-determination of benefits so he will know up front how much he should expect to pay as his 30% of the cost of the procedure.

While waiting for the surgeon and hospital to get back to him regarding the out-of-pocket costs, he receives the bill for the CT scan and explanation of benefits from his doctor for the office visit and CT scan. They show his office copayment that he paid at the time of service, and his $250 deductible, plus 30% of the remaining cost of the CT scan, which came out to a total of $500. He pays the bills and continues to work even though he is in extreme discomfort from his right ear.

The surgeon and hospital both get back to him and let him know the surgery itself will cost approximately $20,000 because his plan does not cover surgery, period. Joe is not an executive in a large company; he does not have the money to pay for a $20,000 surgery and also afford to take three weeks off of work in order for him to recover. So, what is he to do?

He can’t enroll in another plan offered by his employer for another nine months when they go through open enrollment again. It is March, so he has missed the state Exchange open enrollment window, and he has not experienced an involuntary loss of coverage that would enable him to enroll in a state Exchange plan. If he were to purchase a short-term, comprehensive medical plan it won’t cover any pre-existing conditions, which his perforated ear drum would certainly be considered. So, unless he gets married and enrolls on his new spouse’s plan if they were offered one by their employer, he is out of options. He will simply have to wait until open enrollment next year.

How do you think Joe is feeling about his employer right now? Do you think he is counting his blessings that he only ruptured his ear drum and was not diagnosed with cancer that needed to be removed before it spread any further? Or is he going to be using a few choice words to describe an employer that offers a medical plan to its employees that has a longer list of services not covered than are covered? I can’t say that I know for sure, but I can guess.

Now, the question becomes how does an employer prevent their employees from running into these kinds of pitfalls? It comes down to clear communication—multiple forms of communication that are easily accessible to employees and their family members that may also play a role in making plan decisions. Having someone to partner with your company, such as a UBA Partner Firm that will not only help you develop long-term plan strategies for your employee benefits package, but can be an integral part of developing and implementing online systems, hard copy communications, and give you access to tools such as smartphone applications that not only give employees access to essential information, but also push out important communications that contain relevant information at the appropriate times like open enrollment. Making plan details easily accessible in the online platform, with clear and bold statements if there are essential benefits that are not covered on the plan such as a warning, should be clearly stated so that employees are well informed.

An ounce of prevention is worth a pound of cure. Insurance is a complicated business and you, as an employer, would not want to make decisions about the health care you offer your employees without someone to guide you through the various options and possibilities. As responsible employers, our employees should not have to either.

By Elizabeth Kay
Originally Published By United Benefit Advisors

I want to let you know how very much I appreciate all the advice and excellent direction you've given us over the years. I know our account wasn't particularly profitable but you always treated us as though we were supremely important. It would have been much easier for you let us drift away but you always hung in there and went the extra mile, two, three or four.

- President, Event Production Company

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