Few people are prepared to handle the financial burden of long-term health care. In fact, many people have a false sense of security when it comes to long-term care. Let’s separate fact from fiction:

“Medicare and my Medicare supplement policy will cover it.”

FACTS:

  • Medicare and “Medigap” insurance was never intended to pay for ongoing, long-term care. Only about 12% of nursing home costs are paid by Medicare, for short-term skilled nursing home care following hospitalization. (Source: Guide to Long-Term Care Insurance, AHIP, 2013)
  • Medicare and most health insurance plans, including Medicare supplement policies, do not pay for long-term custodial care. (Source: 2017 Medicare & You, Centers for Medicare & Medicaid Services)

“It won’t happen to me.”

FACTS:

  • Almost 70% of people turning age 65 will need long term care services and supports at some point in their lives. (Source: LongTermCare.gov, November 2016)
  • About 67% of nursing home residents and 70% of assisted living residents are women. (Source: Long-Term Care Providers and Services Users in the United States, February 2016, National Center for Health Statistics)

“I can afford it.”

FACTS:

  • As a national average, a year in a nursing home is currently estimated to cost about $92,000. In some areas, it can easily cost well over $110,000! (Source: Genworth 2016 Cost of Care Survey, April 2016)
  • The average length of a nursing home stay is 835 days. (Source: Centers for Disease Control and Prevention, Nursing Home Care FastStats, last updated May 2014)
  • The national average cost of a one bedroom in an assisted living facility in the U.S. was $43,539 per year in 2016. (Source: Genworth 2016 Cost of Care Survey, April 2016)
  • Home health care is less expensive, but it still adds up. In 2016, the national average hourly rate for licensed home health aides was $20. Bringing an aide into your home for 20 hours a week can easily cost over $1,600 each month, or almost $20,000 a year. (Source: Genworth 2016 Cost of Care Survey, April 2016)

“If I can’t afford it, I’ll go on Medicaid.”

FACTS:

  • Medicaid, or welfare assistance, has many “strings” attached and is only available to people who meet federal poverty guidelines.

Whether purchased for yourself, your spouse or for an aging parent, long-term care insurance can help protect assets accumulated over a lifetime from the ravages of long-term care costs.

By Bill O’Quin

Originally Published By Lifehappens.org

It’s not surprising that 2017 stands to be the year many will have an experience to share using a Telemedicine or a Virtual Doctor service. With current market trends, government regulations, and changing economic demands, it’s fast becoming a more popular alternative to traditional healthcare visits.  And, as healthcare costs continue to rise and there are more strategic pricing options and digital models available to users, the appeal for consumers, self-insured employers, health systems and health plans to jump on board is significant.

Check out this short video and contact us to learn more!

The Section 125 cafeteria plan regulations and the Patient Protection and Affordable Care Act (ACA) require employers to take certain actions when an employee reduces hours.

Consider this scenario: An employer has an employee who is reducing hours below 30 hours per week. The employee is performing the same job and duties. The employee was determined to be full-time during the most recent measurement period. The employee is currently in a stability period.

What happens when the employee reduces hours during a stability period?

Answer: The employee must be offered coverage through the entire stability period. The employee must remain classified as full-time for the rest of the stability period. An employee’s full-time status determined in the measurement period determines the employee’s status during the subsequent stability period. This is true regardless of why the individual’s hours were reduced, or who chose to reduce the hours.

By Danielle Capilla
Originally Published By United Benefit Advisors

One of the perks of having a full-time job with a good company is the benefits package that comes with it. Often, those benefits include life insurance coverage, which is great. And everyone who can get life insurance at work should definitely take it, as there are many advantages to company-funded life insurance, also known as group life insurance. These advantages include:

1. Easy qualification. Often, enrollment into group life insurance is automatic. That means everyone qualifies, as there is no medical exam required. So people who have preexisting health conditions, like diabetes or previous heart attack, can get life insurance at work, and may get a better rate compared with what an individual life insurance policy might cost them.

2. Lower costs. Employers’ insurance plans tend to be paid for or subsidized by the company, giving you life insurance at a low cost or even free. You may even have the option to buy additional coverage at low rates. Costs tend to be lower for many people because with group plans, the cost per individual goes down as the plan enlarges.

3. Convenience. It’s easy to subscribe to an employer’s life insurance plan without much effort on your part and if a payment is required, it’s easily deducted from your paycheck in much the same way as your medical costs are deducted.

These are all great advantages, but are these the only considerations that matter when it comes to life insurance? The answer, of course, is no.

Life insurance should first and foremost fit the purpose—it should meet your needs.

Life insurance should first and foremost fit the purpose—it should meet your needs. And the primary purpose of life insurance is to care for those left behind in the event of your death. With group life insurance, it’s often set at one or two times your annual salary, or a default amount such as $25,000 or $50,000. While this sounds like a lot of money, just think of how long that would last your loved ones. What would they do once that ran out?

There are several other disadvantages to relying on group insurance alone:

1. If your job situation changes, you’ll lose your coverage. Whether the change results from being laid off, moving from full-time to part-time status or leaving the job, in most cases, an employee can’t retain their policy when they leave their job.

2. Coverage may end when you retire or reach a specific age. Many people tend to lose their insurance coverage when they continue working past a specified age or when they retire. This means losing your insurance when you need it most.

3. Your employer can change or terminate the coverage. And that can be without your consent, since the contract is between your employer and the insurer.

4. Your options are limited. This type of coverage is not tailored to your specific needs. Furthermore, you may not be able to buy as much coverage as you need, leaving you exposed.

Importance of Buying a Separate Life Insurance Policy
It’s for these reasons you should get an individual life insurance policy that you personally own, in addition to any group life insurance you have. Individual life insurance plans offer superior benefits, and regardless of your employer or employment status, they remain in place and can be tailored to meet your needs and circumstances.

Most importantly, an individual life insurance policy will fit the purpose for which you purchase it—to ensure your dependents continue to have the financial means to keep their home and lifestyle in the unfortunate event that you’re no longer there to care for them.

 

Originally Published By LifeHappens.org

Under Internal Revenue Code Section 105(h), a self-insured medical reimbursement plan must pass two nondiscrimination tests. Failure to pass either test means that the favorable tax treatment for highly compensated individuals who participate in the plan will be lost. The Section 105(h) rules only affect whether reimbursement (including payments to health care providers) under a self-insured plan is taxable.

When Section 105(h) was enacted, its nondiscrimination testing applied solely to self-insured plans. Under the Patient Protection and Affordable Care Act (ACA), Section 105(h) also applies to fully-insured, non-grandfathered plans. However, in late 2010, the government delayed enforcement of Section 105(h) against fully-insured, non-grandfathered plans until the first plan year beginning after regulations are issued. To date, no regulations have been issued so there is currently no penalty for noncompliance.

Practically speaking, if a plan treats all employees the same, then it is unlikely that the plan will fail Section 105(h) nondiscrimination testing.

What Is a Self-Insured Medical Reimbursement Plan?

Section 105(h) applies to a “self-insured medical reimbursement plan,” which is an employer plan to reimburse employees for medical care expenses listed under Code Section 213(d) for which reimbursement is not provided under a policy of accident or health insurance.

Common self-insured medical reimbursement plans are self-funded major medical plans, health reimbursement arrangements (HRAs), and medical expense reimbursement plans (MERPs). Many employers who sponsor an insured plan may also have a self-insured plan; that self-insured plan is subject to the Section 105 non-discrimination rules. For example, many employers offer a fully insured major medical plan that is integrated with an HRA to reimburse expenses incurred before a participant meets the plan deductible.

What If the Self-Insured Medical Reimbursement Plan Is Offered Under a Cafeteria Plan?

A self-insured medical reimbursement plan (self-insured plan) can be offered outside of a cafeteria plan or under a cafeteria plan. Section 105(h) nondiscrimination testing applies in both cases.

Regardless of grandfathered status, if the self-insured plan is offered under a cafeteria plan and allows employees to pay premiums on a pre-tax basis, then the plan is still subject to the Section 125 nondiscrimination rules. The cafeteria plan rules affect whether contributions are taxable; if contributions are taxable, then the Section 105(h) rules do not apply.

What Is the Purpose of Nondiscrimination Testing?

Congress permits self-insured medical reimbursement plans to provide tax-free benefits. However, Congress wanted employers to provide these tax-free benefits to their regular employees, not just to their executives. Nondiscrimination testing is designed to encourage employers to provide benefits to their employees in a way that does not discriminate in favor of employees who are highly paid or high ranking.

If a plan fails the nondiscrimination testing, the regular employees will not lose the tax benefits of the self-insured medical reimbursement plan and the plan will not be invalidated. However, highly paid or high ranking employees may be adversely affected if the plan fails testing.

What Are the Two Nondiscrimination Tests?

The two nondiscrimination tests are the Eligibility Test and Benefits Test.

The Eligibility Test answers the basic question of whether there are enough regular employees benefitting from the plan. Section 105(h) provides three ways of passing the Eligibility Test:

  1. The 70% Test – 70 percent or more of all employees benefit under the plan.
  2. The 70% / 80% Test – At least 70 percent of employees are eligible under the plan and at least 80 percent or more of those eligible employees participate in the plan.
  3. The Nondiscriminatory Classification Test – Employees qualify for the plan under a classification set up by the employer that is found by the IRS not to be discriminatory in favor of highly compensated individuals.

The Benefits Test answers the basic question of whether all participants are eligible for the same benefits.

 

By Danielle Capilla
Originally Published By United Benefit Advisors

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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 Published By United Benefit Advisors

Over the past few years, we’ve seen tremendous growth in Financial Wellness Programs. Actually, as indicated in a recent report by Aon Hewitt, 77% of mid- to large-size companies will provide at least one financial wellness service in 2017; with 52% of employers providing services in more than 3 financial categories. So what are the advantages of these programs and how can the current workforce make the most out of them?

Program Advantages

  • They educate employees on financial management. It’s no doubt, poor income management and cash-flow decisions increase financial stress. This stress has a direct impact on an employee’s physical, mental and emotional state—all which can lead to productivity issues, increased absenteeism, and rising healthcare costs. Financial wellness tools in the workplace can not only support employees in various areas of their finances by expanding income capacity, but can create long-lasting changes in their financial habits as well.
  • They give a foothold to the employer. As more employers are recognizing the effect financial stress has on their employees in the workplace, they’re jumping on board with these programs. As people are extending the length of their careers, benefits like these are an attractive feature to the workforce and new job seekers alike. In fact, according to a recent survey by TIAA, respondents were more likely to consider employment with companies who provide free financial advice as part of their benefit package.

Program Credentials

While financial wellness benefits may differ among companies, one thing is certain—there are key factors employers should consider when establishing a successful program. They should:

  • Give sound, unbiased advice. Financial wellness benefits should be free to the employee—no strings attached. Employees should not be solicited by financial institutions or financial companies that only want to seek a profit for services. Employers should research companies when shopping these programs to determine the right fit for their culture.
  • Encompass all facets. A successful program should cover all aspects of financial planning, and target all demographics. These programs should run the gamut, providing resources for those with serious debt issues to those who seek advanced estate planning and asset protection. Services should include both short-term to long-term options that fit with the company’s size and culture. Popular programs implement a variety of tools. Employers should integrate these tools with other benefits to make it as seamless as possible for their employees to use.
  • Detail financial wellness as a process, not an event. Strengthening financial prosperity is a process. When determining the right fit for your company, continued coaching and support is a must. This may require evaluating the program and services offered every year. Employees need to know that while they have the initial benefit of making a one-time change, additional tools are at their disposal to shift their financial mindset; strengthening their financial habits and behaviors down the road.

Employees must understand the value Financial Wellness Programs can provide to them as well. If your company offers these benefits, keep a few things in mind:

  • Maximize the program’s services. Utilize your financial workplace benefits to tackle life’s financial challenges. Most programs offer financial mentoring through various mediums. Seek advice on your financial issues and allow a coach/mentor to provide you with practical strategies, alternatives and actionable steps to reduce your financial stress.
  • Take advantage of other employee benefits. Incorporate other benefits into your financial wellness program. Use financial resources to help you run projections and monitor your 401k. Budget your healthcare costs with these tools. Research indicates those who tap into these financial wellness programs often are more likely to stay on track than those who don’t.
  • Evaluate your progress. Strengthening your financial well-being is a process. If your employer’s financial wellness program provides various tools to monitor your finances, use them. Weigh your progress yearly and take advantage of any support groups, webinars, or individual one-on-one counseling sessions offered by these programs.

As the workforce continues to evolve, managing these programs and resources effectively is an important aspect for both parties. Providing and utilizing a strong, effective Financial Wellness Benefits Program will set the foundation for a lifetime of financial well-being.

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

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