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You have a business and it is growing – Congratulations!

As your company grows and you hire more employees, there are milestones that you will hit.  Some of these milestones come with additional responsibilities that you need to attend to, such as Cobra, HCSO, FMLA, Sexual Harassment Prevention Training and the Affordability Care Act’s Large Employer Mandate.

For example, if you are a company based in California and offer an employee benefits plan that includes medical insurance, you are obligated to allow former or terminated employees and their enrolled dependents to enroll in Cal-COBRA if they are no longer eligible to be enrolled in your plan.  Once you reach 20 employees or more for an average of 50% or more of the previous calendar year, then you are obligated to start offering enrollment in Federal COBRA for those plan participants and enrolled dependents if they are no longer eligible to be enrolled in your plan.

Additionally, if you have any employees working in the City of San Francisco, you would also need to comply with the Health Care Security Ordinance (HCSO).  However, these two things would not happen at the same time because while they both require you have 20 or more employees before you have to comply, they count those employees differently, and over a different length of time.

Federal COBRA counts employees by their classification.  A full-time employee is counted as 1, and part-time employees are counted in fractions.  So you may have 15 full-time employees, and 5 part time employees and you would NOT be subject to Federal COBRA because your part time employees work an average of 20 hours per week, meaning all together they only count as 2.5 full-time equivalents which when combined with your full-time employees puts your count at 17.5.

The HCSO counts employees by head count, and they do it per quarter.  So if you have 19 employees during one quarter of the year, you don’t need to comply.  But if you have 20 employees for at least 13 weeks of the following quarter, you would need to comply.

Is your head spinning yet?

As you move further along and you reach 50 employees, there are more regulations that may now be applied to your company.  They are the Family Medical Leave Act (FMLA), Sexual Harassment Prevention Training for California businesses, and the Pay or Play provision of the Affordable Care Act.  As one might expect, each regulation counts employees in a different way.

When you have had 50 or more employees over 20 weeks during the current or previous calendar year, you are subject to FMLA.  The weeks do not have to be consecutive weeks.  Additionally, FMLA counts the employees on your payroll register even if they are not being paid.  If they are on your payroll register, they are counted.  Each person is counted as 1, regardless of the number of hours worked.

For sexual harassment prevention training in California, once you have 50 or more employees (regardless of full-time or part time status) for 20 or more consecutive weeks, you have to begin offering training for your management staff every 2 years, and within 6 months of promoting an employee to a managerial position.

The Applicable Large Employer or ALE classification under the Affordable Care Act counts employees in yet a different way.  With regards to determining ALE status, you generally count each full-time employee as 1, and for part-time, seasonal, and variable-hour employees you count the number of hours they all worked collectively during a month (do not include more than 120 hours for any employee), then divide the total hours by 120 hours to get how many Full-Time Equivalent Employees (FTEs) you have.  You then add the number of full-time employees, to your FTE’s to get your total employee count.  If you average 50 or more employees during the calendar year, you are considered an ALE the following tax year.  For example, if you average 50 or more employees during the 2018 calendar year, you would be subject to the Pay or Play Mandate and the reporting requirements associated with it for the year 2019.

If your employee count stays at 50 or above in 2019, you would continue to be an ALE with all associated requirements in 2020.  If your employee count dips below 50 in 2019, then you would not be considered an ALE in the year 2020.

The Pay or Play Mandate (Employer shared responsibility) means that as an ALE you are required to offer minimum value, affordable coverage to your full-time employees and their dependent children, or potentially face a penalty from the IRS.

No one is an expert in all things, which is likely why your business is doing well and thriving: because you fulfill a need or expertise in the area that you specialize in.  As a successful business owner you know it is advantageous to have strong partners in your corner to help lend their strengths to your areas of weakness.

Having a strong benefits advisor to assist you in navigating these hurdles, speed bumps, and curves in the road is essential.  Whether you have the resources to handle these regulations in-house, or if you need someone to recommend a trustworthy third party vendor to handle it for you, we are pleased to be able to fulfill that need for you.

 

by Elizabeth Kay

Managing pay can be tricky. Handled incorrectly, pay can create problems for an employer — everything from the inability to attract the right candidates and losing great employees to the competition to presenteeism (employees who are physically in the workplace but not engaged in their work), employee relations issues, compliance audits, and lawsuits. These outcomes impact productivity. They infect the company culture. And they tarnish the employer brand.

In your role as a trusted advisor to clients who may be struggling with their total compensation programs, you need to be ready to help them determine how to make the right decisions. This requires you to be aware of new trends while also helping clients manage risk by complying with wage and hour rules.

Pay Versus Employee Motivation and Retention

Many employee engagement reports note that pay doesn’t impact motivation as much as other work factors, such as:

  • The quality of the company and its management.
  • Belief in the organization’s products.
  • Alignment with the company’s mission, values, and goals.
  • Ability to make a meaningful contribution.
  • Ability to develop new professional skills.

IBM’s Smarter Workforce Institute’s 2017 study looked at employees’ decisions to leave their jobs and found that the three generations comprising most of today’s workforce would be open to considering new job opportunities for better compensation and benefits: Millennials at 77 percent, Generation X at 78 percent, and Baby Boomers at 70 percent. Those are big numbers, and they shouldn’t be ignored when designing pay plans.

Further, while pay may not be a motivator, it can be a powerful dissatisfier when employees believe that they aren’t being paid correctly for the value they are bringing to the organization, or at the market value of their jobs. Worse yet is the perceived — or real — belief that their pay is lower than what their co-workers are earning. In some markets, this problem is genuine, as companies in hot labor markets struggle with paying new people more than current employees, causing pay compression. Employees do talk and pay information is readily available.

Considering every variable that goes into compensation planning can be complicated. Your clients can start by: setting a compensation strategy to fit their company’s needs and budget; developing compensation programs to fit that strategy, the talent marketplace, and employee demographics; and then administering the compensation program fairly and in compliance with federal, state, and local laws.

Equal Pay Mandates

The Equal Employment Opportunity Commission’s (EEOC) Strategic Enforcement Plan prioritizes enforcing the Equal Pay Act (EPA) to close the pay gap between men and women, and the Trump administration has been silent about changing this direction. This topic is trending, as legislators in more than 40 jurisdictions introduced bills related to equal pay in 2017. California, New York, Massachusetts, and Maryland are setting the pace with laws addressing this issue. These states have set rules that more broadly define the equal pay standard requiring different factors, such as skill, effort, working conditions, and responsibility, in justifying gender pay disparities. These states are also broadening the geographic restrictions for employee pay differentials.

We expect that more states will enact equal pay rules in 2018. Companies should review gender pay differences in their workforce, document the bona fide business reasons for the differences, and correct wage disparities as needed. Permitted differences could include seniority, documented merit performance differences, pay based on quantity or quality of production or sales quotas, or geographic differentials.

Salary History Ban

The issue of pay has traditionally been an inevitable topic of discussion in any job interview. However, in a growing number of places throughout the country, an employer can no longer ask an applicant about his or her salary history. At least 21 states and Washington, D.C., along with several municipalities, have proposed legislation that would prohibit salary history questions. California (effective January 2018), Delaware (effective December 2017), Massachusetts (effective July 2018), and Oregon (effective January 2019) have enacted laws impacting private employers. More bans are expected at both the state and local level.

While the provisions of each law vary, they make it illegal for employers to ask applicants about their current compensation or how they were paid at past jobs. The rationale for these laws stems from the equal pay issue and the premise that pay for the job should be based on the value of the job to the organization, not the pay an applicant might be willing to accept. These laws are designed to reverse the pattern of wage inequality that resulted from past gender bias or discrimination.

For employers, this means:

  • Establishing compensation ranges for open positions and asking applicants if the salary range for the position would meet their compensation expectations.
  • Updating employment applications to remove the salary history information.
  • Training hiring managers and interviewers to avoid asking questions about salary history.

Pay Transparency

Outside of certain industries, the public sector, and unionized environments where pay grades and step increases are common knowledge, historically many employers have had a practice of discouraging employees from openly discussing their compensation. That practice is fast becoming history, due to another notable trend in state legislatures: enacting laws that allow employees to discuss their wages and other forms of compensation with others. Although the provisions of the laws vary, California, Colorado, Connecticut, Delaware, Washington, D.C., Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, New Hampshire, New Jersey, New York, Oregon, and Vermont now have laws in place allowing pay transparency.

In addition to these state laws, Section 7 of the National Labor Relations Act (NLRA) allows employees to engage in pay discussions as “concerted and protected activities for the purpose of collective bargaining or other mutual aid or protection.” During the Obama administration, the National Labor Relations Board (NLRB) broadly interpreted the NLRA’s Section 7 to side with employees’ rights to discuss wages and other terms and conditions of employment. Unless the Trump administration’s NLRB changes direction on this issue, which is not expected, the clear message for employers is to remove any prohibitions of employees discussing pay or working conditions with others.

Be Vigilant

Employee compensation has always been a hot topic, and this year the temperature will continue to rise. Keep abreast of legislative and regulatory changes that impact pay practices to help your clients stay in compliance with the pay laws that are spreading throughout the country.

Now is a good time to suggest that your clients consider conducting pay audits, updating compensation plans, making compensation adjustments where needed, training managers regarding pay strategy and practice, and communicating the company’s compensation strategy and incentive plans to employees.

 

By Laura Kerekes, SPHR, SHRM-SCPz

Originally posted on thinkHR.com

IRS Releases Publication 15 and W-4 Withholding Guidance for 2018

On January 31, 2018, the federal Internal Revenue Service (IRS) released Publication 15 — Introductory Material, which includes the following:

  • 2018 federal income tax withholding tables.
  • Exempt Form W-4.
  • New information on:
    • Withholding allowance.
    • Withholding on supplemental wages.
    • Backup withholding.
    • Moving expense reimbursement.
    • Social Security and Medicare tax for 2018.
    • Disaster tax relief.

Read Publication 15 and further details here.

EEOC Penalty Increases for Failure to Post Required Notices

On January 18, 2018, the U.S. Equal Employment Opportunity Commission (EEOC) released a final rule increasing the penalty amount from $534 to $545 for violations of Title VII of the Civil Rights Act (Title VII), the Americans with Disabilities Act (ADA), and the Genetic Information Nondiscrimination Act (GINA) notice posting requirements.

The final rule is effective February 20, 2018.

Originally Published By ThinkHR.com

 

What an informative luncheon (on Wednesday 10/25) with our very own Elizabeth Kay discussing the most recent updates of the Affordable Care Act! She discussed the most recent executive order and how if it takes effect, it will more likely impact the individual market, not the group market. Thank you to the San Mateo County EAC and the Employment Development Department for putting it all together!

 

Many of us have seen or heard about the various wellness programs referred to as “participation–based” programs. These participation-only programs continue to be the starting point for many organizations when they enter the world of workplace wellness. Participatory programs typically include a few individual and team-based activities, offer a level of electronic or onsite seminar education, and offer employees biometric screening and personal health risk assessments. Organizations may even award prizes, hold drawings, or offer giveaways.

These programs are typically created with the goals of promoting and encouraging healthier lifestyles for their employees and their families, reducing healthcare costs of the organization, or simply because ownership feels it is the right thing to do.

Fast forward a few years, and the same program is being offered. In most cases, employees have received some education and had fun, but the organization has yet to meet its original goals or experience a real culture change. Employees still seem to be leading unhealthy lifestyles, productivity and morale seem lower than ever, and healthcare claims continue to skyrocket. So why do you even have this wellness program?

In my eight years working as Wellness Program Manager for a mid-sized benefits consulting firm, I have been a part of and have seen the good, the bad, and the ugly of the programs. I have learned from mistakes made early on, and I value sharing those experiences with those I have the opportunity to consult with. I share firsthand examples from my own company’s program, as well as the experiences of my clients and other business partners. A program set up successfully – with the right support, tools, partners, and initial incentives – will absolutely reap the reward, and your organization should recognize a true cultural change.

These are the key factors that I believe contribute most to the success of a wellness program.

1. Secure senior management commitment and participation.

It is easy for business owners to say they want a wellness program, but it is a different story when they actually embrace the concept, support the process, and engage in the program themselves. Owners of organizations have come to me for help in implementing a wellness program. They assign one person to be in charge of the program, typically someone whose time is already limited, and for one reason or another the program stalls. If the top leadership of the organization is not supportive or engaged, it could take anywhere from six months to five years trying to get a sustainable wellness program off the ground. The program may not even take off at all.

I have seen these programs fizzle for many reasons, including a shift in business objectives, lack of established goals, or lack of participation or role-modeling from management or ownership. It can be recognized early whether a program is going to succeed by the support it has from its leaders. Think of a successful program much like the game “follow the leader.” Good leaders and owners should not only sponsor the program, but should also be actively engaged and supporting it, leading by example. When employees see owners and employers participating and supporting the program, they too will “follow the leader.” Once you have backing from the people who invoke change within your organization, laying the groundwork for the program will become a smoother process.

2.  Survey the organization and gather aggregate data to establish need and risk areas.

Once you have built the foundation, it is a good time to collect and gather data to determine need and evaluate aggregate risks in the organization. Of those organizations that created the participatory programs we discussed earlier, how many of them do you think actually asked their employees first what they wanted or needed in order to change unhealthy behaviors or lead a healthy lifestyle? What lifestyle-related claims is the organization experiencing that might be able to be controlled with interventions? What health risks exist within the organization? Organizations typically roll out the program before they gather the data, and then look back and wonder why their participation in their program was so low. Logically, it is because the employees didn’t want or need it or see the value.

When working with a benefits consulting firm, organizations ask for employees to be surveyed annually on their likes and dislikes in medical and dental coverage. It only makes sense that employees also be surveyed about their needs in a wellness program. The employee wellness survey may include questions about areas where they may want help, programs they would be willing to participate in, what would motivate them to engage in the program, and whether or not they are even looking to make any changes. Do not worry or be discouraged, as there is always five to ten percent of a population that is resistant to anything and will never participate regardless of what you provide.

Additional data is then obtained by analyzing your organization’s aggregate claims, if data is available. Along with claims data, organizations may also compile aggregate data through health screenings, biometrics, health and fitness diagnostics and assessments, blood work, and more.

3.  Utilize existing tools and resources, establish partnerships and seek guidance.

Many organizations may not be aware of the variety of wellness program tools and resources available to them. First, look to your benefits insurance consultant. Qualified, reputable benefit consulting firms now have credentialed wellness program managers or coordinators on staff to work alongside you and your team. Consultants can help navigate what is available to you from your insurance carrier or third party administrator and are likely tapped into local and national resources, wellness vendors, and other workplace wellness tools. One of the best parts of my role as a Wellness Program Manager is to share my passion for wellness with our clients and help them design a sustainable program. If you have a benefits consultant that is not providing this level of support or staff, it is worth inquiring.

Establish a partnership with a wellness vendor. This is one resource that is often overlooked because organizations try to do it themselves. Sustainable programs have vendors that can design programs based on need and risk, manage day-to-day program tasks, provide ongoing reporting, and recommend best practices for goal achievement.

Over the last few years, hundreds of new wellness vendors have entered the marketplace. I have worked with great vendors and vendors that I will not work with again. Employers should not settle for a “cookie cutter” program. Look for a partner that shares a similar view on wellness, one who will customize a program to satisfy your organization’s objectives. Ensure that you partner with a vendor that offers actual guidance and management of your program. CAUTION: Many vendors promote account management as a top service they provide, but few deliver. A great way to find the right vendor is through the partnerships your employee benefits consultant has established or from other business referrals and testimonials. When I place a client with a vendor, the most important thing I look for is the type of service my client will receive. Accept nothing but high quality and service.

Originally posted by www.ubabenefits.com

 

 

By Mathew Augustine, GPHR, REBC, CEO of Hanna Global Solutions, a UBA Partner Firm

EmployeeAttentionExit or remain, welcome refugees or build a wall to keep them out, guns or no guns, black or white, include all or be exclusive… the list of extreme positions that people are taking goes on and on. What is driving this sudden increase in polarized thinking in the world? The world was getting smaller, technology was supposed to ”level the playing field,” and people were supposed to become more connected. What happened to the ”it’s a small world after all” thinking we hoped to grow up to realize?

There is a surfeit of complexity in the world, and we are under more and more pressure from this complexity. We cannot live in our simple silos of thinking any more. There is more travel, more migration, more interaction between people who come from different life situations and history. As these complex systems collide, it creates even more complex problems to which there are no simple solutions.

Yet we search for simple solutions. We come to realize that there is a limit to the complexity that can be tolerated by a normal human mind. The reduction of complex domestic and foreign policy strategies into text that scores at a fourth-grade reading level, and the nave sound bites that seem to make the world simple and ring with truth, have filled our world politics for over a decade. We search for simplicity, and when we find it, are willing to pay an additional price for it. We pay more for a phone with just one button. We can see that less is more.

However, this desire for simplicity can lead to some complex problems. The Brexit vote is an example of what appeared to be a simple referendum where people were asked to vote for Britain to exit or remain in the European Union. In reality, it required that simple people with a limited appreciation of the complexity and implications of the situation make a world-changing decision. Could Britain have found a consensus-building process that allowed the complex issues to surface and address the desire for exit? Could it have found a way to work with the rest of the EU and make necessary adjustments to the hard line position? That sort of complex analysis and consensus cannot be done by the average person. We rely on and trust elected representatives and other subject-matter experts to better engage with the complex questions to arrive at the best available option. That is the democratic system – that uses the will of the people as a guide, while giving itself the ability not to be overwhelmed by it.

What does all this mean to the employee benefits business? The issues are too important for employers and employees to make choices about benefits without proper study and assessment, but the overwhelming complexity of coverage options and regulations make this difficult. For this we need experts who can be trusted to understand all dimensions of complexity and present the non-experts with easy-to-understand solutions. There will be trade-offs and fewer options, but the options would take into account the complex underlying issues.

The recommendation engine that helps employees choose an appropriate health plan is an example. Instead of the employee doing the what-if analysis on different plans for their specific family status and need for health services, a better starting point is a tool that looks at their current plan utilization and presents the option that would best suit them if all things stayed the same.

Similarly, employers have so many options to choose from – fully-insured, self-funded, level funding, unbundled stop-loss, captive, different methods of stop-loss gain sharing arrangements, so on and on. Short of a system with artificial intelligence capabilities, there is no way to have a simple interface to this problem-solving method. Except—if you get help from an advisor you can trust, an advisor who has the wisdom, insight and experience to understand your situation, your risk tolerance, business model, and employee demographics and their risk tolerance, and can recommend the best options for you from among the plethora of those available. Good benefits advisors will embrace this challenge to make complex things simple for their clients without losing integrity. It is not easy. Employers should seek out advisors who can adapt to the new complexity of this world and rise to the challenge of simplifying it for their clients.

How do you identify the right advisor? You have to avoid being mesmerized by the exaggeratedly simple solution that disregards underlying complexity, and look for those who make the complex simple for your benefit, without subjecting you to the complexity that hides the simple solution. A quote attributed to Einstein, who grappled with the most complex of concepts, goes “Everything should be made as simple as possible, but not simpler.” Evaluating employee benefits options is tough work, but the right employee benefits advisor can make it seem simple. The duck swimming across a pond seems to glide across the water effortlessly. Under the water, however, its feet are paddling like mad!

United Benefit Advisors is full of such ”ducks” – paddling tirelessly to make the complex world of employee benefits simple for our employer clients and their employees.

Read more here …

By Erica Oh Nataren
www.lifehappens.org

moneybankMany people in their 40s are facing an uncomfortable fact: They simply aren’t where they’d hoped to be financially. Fortunately, all their life experience can help correct for past mistakes.

“There’s a different trigger moment for everybody,” says Jay Howard, financial advisor and partner at MHD Financial in San Antonio, Texas. “But regardless of when it comes, people find themselves looking down the barrel of a gun as they consider retirement.”

One challenge is that it’s impossible to advise 40-somethings based on tidy “life stage” demographics. Some are just starting families, while others are sending offspring to college. They’re married, single, divorced, and just about everything in between.

But for those still grappling with financial instability, these four principles can help in moving forward with confidence:

1. Acknowledge what you’ve done right.
It could be one great decision sandwiched in between some fails, or just a single good habit that can mitigate the impact of a host of wrongs.

Take the example of Kiera Starboard, a 46-year-old controller at a San Diego software firm. A mom to two adult sons and a teenage stepson, she always made having sufficient life insurance—both term and permanent—a priority, the result of her previous training as a financial advisor. “Even if it was tight, I made the payments,” she says. “It was a priority for my family’s sake, and for my own peace of mind.”

Unlike the 40% of Americans who have no life insurance, Starboard was protected when the unthinkable happened last August. Less than two years into her marriage, her husband, Steve, was killed while riding his motorcycle to work—one month after they purchased a small, additional life insurance policy to supplement his employer coverage.

“To have had to deal with financial stress on top of everything else, it would have been unbearable, incapacitating,” says Starboard. “My stepson and I are certainly in a much better position today than we would have been, had Steve and I not followed the advice I used to give to others.”

2. Take action to shore up the decades ahead.
For many, the hardest part can be learning to put your own long-term future first—sometimes for the first time in your life.

“I see people focusing on their kids’ college savings, and not enough on retirement or an emergency fund for themselves,” says Starboard. Many advisors point out that kids can borrow for college if necessary, but no one can borrow for retirement.

The most important step is clear, says Howard: “You must have a written financial plan, period. Because that plan will dictate what you must do to be successful for the entirely of your life.

“The financial plan is your road map,” he continues. “In it will be your portfolio requirements, your savings goals, and your insurance-related needs.”

Finally, make sure your plan takes inflation into account, commonly estimated at 3% a year. Says Howard, “Inflation is the silent assassin that eats away at your nest egg.”

3. Apply the hard-fought wisdom you’ve gained.
“Treat the numbers determined by your plan—such as monthly savings—as bills that need to be paid,” advises Howard. When money comes in, it’s easy to start thinking of a new kitchen or a trip to Tulum. “Just be patient and keep the bills paid.”

Using that wisdom also applies to the big stuff. As the executor to her husband’s estate, Starboard has held back making any major decisions. “In a prior loss, I committed to real estate transactions and other things prematurely. At the time, it really felt like the right thing to do but my grief clouded my perception. I had a painful, expensive learning lesson.”

4. Focus on your shining future—really.
Forward thinking is an essential part of your financial plan, says Howard. “Get help really envisioning what kind of retirement you want. For each aspect, really drill down. For instance, where do you want to live? Do you want to be near your grandkids? Will you have the money to go see them? How often? It’s not just financial planning, it’s life planning.”

If all that forward thinking feels presumptuous, Howard recalls the eminently quotable Yogi Berra, who once said, “If you don’t know where you’re going, you might not get there.”

And finally, remember the simple refrain: it’s never too late.

Read more here …

By Mary Drueke-Collins, FSA
Vice President of Employee Benefits for Swartzbaugh-Farber & Associates, Inc.
A UBA Partner Firm

RxBlogMail order has always been a convenient way for individuals to keep their maintenance drug prescriptions filled. Employers often wonder, are there other advantages to using mail order other than convenience? As an employer, should we be incentivizing mail order? The answers to some of these questions can be found in results from the latest UBA Health Plan Survey.

Mail order can provide cost savings to both the employee and the employer. In the past, mail order provided much larger savings because it allowed for a 90-day supply, something not available through traditional retail settings. These days, however, more retail pharmacies are offering 90-day supplies, so the cost savings achieved by using mail order are slightly lower than they have been historically. We anticipate those savings will diminish even more as the costs of prescription drugs continue to increase.

Many employers pass on these savings to employees by requiring fewer copays when filling a prescription for 90 days via mail order. Unfortunately, not every employer has the luxury of incentivizing their employees to utilize mail order. Some states, like Nebraska, have laws that limit an employer’s ability to do so. These states prohibit fully insured plans from incentivizing mail order over retail, thus requiring individuals covered by a fully insured health plan to pay the same number of copays for a 90-day supply through the retail and mail order setting.

Those employers that are self-funded, or are not limited by state laws, have the ability to structure the copays of the mail order plan to encourage individuals to use mail order. According to the UBA Health Plan Survey, nationally 85% of employers that offer mail order require the individual to pay something other than three copays for a 90-day mail order supply. Nearly 39% of the respondents call for only one or two copayments for a 90-day mail order prescription.

As you look more closely at the data, you can see trends appearing by industry. Employers in educational services tend to provide the most incentive to utilize mail order, with only 4.6% of the plans needing three copayments for a 90-day supply, followed closely by the public administration and information industries.

BestMailOrderPlansChartONE

Conversely, 34.4% of employers in the mining, oil and gas extraction industry required three copays or the least incentive to utilize mail order. The agriculture, forestry, fishing and wildlife plans were next in line with 20.3% of the plans of the survey had three copayments.

WorstMailOrderPlansChartTWO

Even if there is no cost incentive to the covered individual, most employers still offer the opportunity for their employees to use mail order prescription services. In 2015, nationally only 4.9% of plans did not offer the mail order option. As you focus the data into industry groupings, you see 98.5% of employers responding to the survey that operate in the utilities industry offer mail order to their employees. The education services industry follows with 97.3% of the plans offering mail order services. On the other hand, just over 10% of the plans responding in both the agriculture, forestry, fishing and wildlife industry and management of companies and enterprises offered mail order as an option in the prescription drug plan.

Industry differences are likely due to the involvement of union negotiations, their employees’ access to retail pharmacies (or convenience of non-mail order facilities), and level of overall benefit richness. The utilities and educational industries have historically offered richer benefit plans, and allowing the covered participants a lower cost mail order option continues that trend.

As the prescription drug industry evolves, we anticipate the cost benefits of providing a mail order program will shrink and eventually the copay incentives we see now will diminish. Mail order will continue to be a more convenient method of filing prescriptions and may actually improve the health of individuals on maintenance drugs by keeping them compliant with their prescriptions. For now, if you are an employer wondering whether mail order is worth incentivizing, the answer is still primarily “Yes!”

For more information on prescription drug trends, subscribe to the UBA blog, read our breaking news release or download UBA’s free (no form!) publication: Special Report: Trends in Prescription Drug Benefits.

Read more here …

Marvin H. Feldman
www.lifehappens.org

moneybankSome people equate life insurance with tragedy and death. In truth, life insurance is for the living. Without it, the sudden demise of a key breadwinner could leave a family stranded without the resources to maintain their lifestyle—or even retain their home.

Not so long ago, professionals recommended that families carry a life insurance policy with a death benefit of 10 times their annual household income. Today, however, in light of rising house prices in many parts of the country, spiraling college costs and low interest rates most advisors now recommend up to 20 times your household income.

Unfortunately, most American families are underinsured. The gap between what households have and what they need is nearly $320,000, according to LIMRA’s study Closing the Life Insurance Gap, 2015.

If you’d like to get a working idea of how much life insurance you may need (or how much more you may need), you can use our quick Life Insurance Needs Calculator.

A Cornerstone of Your Financial Plan
Life insurance is a cornerstone of your financial plan, for these reasons.

1. It provides income replacement. For most people, their most valuable economic asset is their ability to earn a living. If you have dependents, then you need to consider what would happen to them if they could no longer rely on your income. A life insurance policy can also help supplement retirement income, which can be especially useful if the benefits of your surviving spouse or domestic partner will be reduced after your death.

2. It covers outstanding debts and long-term obligations. Without life insurance, your loved ones must shoulder burial costs, credit card debts, and medical expenses not covered by health insurance using out-of-pocket funds. The policy’s death benefit might also be used to pay off a mortgage, supplement retirement savings, or fund college tuition.

3. It can be used for estate planning. The proceeds of a life insurance policy can be earmarked to pay estate taxes so that your heirs will not have to liquidate other assets to do so.

4. You can use it to support a charity of your choice. If you have a favorite charity, you can designate some or all of the proceeds from your life insurance to go to this organization.

Read more here …

By Barb Nefer
www.livestrong.com

toothInsurance is designed to offset major expenses in various life areas. For example, a homeowner’s policy covers damage to your house, while car insurance pays for repairs after an auto accident. Medical policies do not cover dental work, but you can get dedicated dental insurance. Dental policies vary, and many limit or exclude coverage for pre-existing conditions.

Definition

Dental insurance is a type of insurance that pays for dental care. It covers preventative procedures like cleanings, and the Dental Insurance Helper information site states it often covers problems like cavities or chipped teeth and restorative work like crowns and bridges. Coverage levels may vary depending on the type of procedure. For example, a plan might pay 100 percent of cleanings, 80 percent of fillings and 50 percent for restorations. You may get dental insurance through your employer or purchase it on your own.

Limitations

Dental insurance often has limitations on coverage for pre-existing conditions, according to the Animated Teeth dental information site. The term “pre-existing condition” usually refers to major work rather than minor problems like cavities or deep fillings that eventually need to be crowned. For example, replacement of a missing tooth would be considered a pre-existing condition if it was lost or removed before you joined the insurance plan. The insurance might also exclude replacement of crowns, bridges and dentures unless they are older than a certain number of years.

Considerations

Certain conditions have a waiting period for coverage. The insurance plan will pay for them once that period has passed. Animated Teeth explains this commonly applies to procedures like fillings, root canals or crowns. Initially your dental insurance might pay only for cleanings, X-rays and other preventative treatments. It will pay for the other work after a predetermined period, which typically runs between six months and a year. Sometimes there will be immediate coverage, but the payment level will be lower until the designated time period passes.

Timeframe

Your dental insurance benefits are often capped at an annual limit. You may pass the six-month waiting period for coverage of expensive procedures or root canals, but they may not be covered fully because of the cap. For example, your plan may only pay $2,000 per year for restorations. You are liable for $2,000 if you get two crowns that cost $3,000 each. You may be able to avoid this restriction by delaying some work until the next annual period begins.

Alternatives

You may have some payment alternatives for pre-existing conditions if your dental insurance does not cover them. Many dental offices work with finance companies specializing in dental care loans. You can borrow funds to cover the treatment if your credit is reasonably good. You also can purchase a dental discount plan. This is different than insurance because it does not pay directly for treatment. It pre-negotiates discounts on various procedures. Members who use participating dentists pay the lower rates. The Dental Plans information site explains most plans do not have caps or pre-existing condition exclusions. Discount plans have an annual fee, so you do not have to renew the plan once your work is completed.

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