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July 2, 2014

Employers Score a Win in PPACA Contraception Mandate

Filed under: Benefits,Insurance,Legal Issues — Tags: 10:19 am

Monday, June 30, 2014, the United States Supreme Court in a 5-4 ruling sided with Hobby Lobby when they decided that closely held private corporations do not have to include four of the twenty mandated contraceptive methods in their group health plans due to the sincerely held religious beliefs of the owners.  These four exempted methods of contraception will have to be paid from the employees’ pocket, or possibly the federal government will seek a way to cover the costs in accordance with the Patient Protection Affordable Care Act.




March 27, 2014

Uninsured? Are You Prepared to Pay the Penalty?

The deadline is quickly approaching to sign up for health care insurance using the Affordable Care Act’s (ACA) federal website – March 31, 2014, to be exact.  The ACA made provision for the Internal Revenue Service (IRS) to collect fees for those individuals not insured by their employer, the government, or directly through an independent insurer.  The fee/penalty sounds fairly reasonable for the tax year 2014, $95, per adult or 1% of income, whichever is greater.  However, did you know the penalties increase over the next couple of years?


Per Adult OR Percentage of Family Income

(whichever is greater)





2016 and beyond


The penalties are pro-rated if an individual, their spouse, and children* have partial-year coverage.  If they lack coverage for less than three months in the year, they will have no penalty.  The fees for the uninsured were to encourage and motivate individuals to seek health care insurance coverage, but the law does include a provision to exempt some.

Employers need to stay abreast of the new health care law and its provisions, because they are very detailed and being clarified often.  Communicating regularly with employees about the current status of the law will help employees be prepared to meet the requirements on an individual basis as well.


*A child’s penalty is one-half of the adult dollar amount, e.g. $95 per adult is $47.50 per child.

Source:  Luhby, Tami.  “Uninsured next year?  Here’s your Obamacare penalty.” See article here.


February 13, 2014

ACA “Play or Pay” Undergoes More Refinements

Filed under: Benefits,Insurance,Legal Issues12:07 pm

It was announced this week that additional delays in the “Play or Pay” provision of the Affordable Care Act (ACA) for some small businesses has been delayed yet again.  Employers with 50-99 employees have been relieved from the requirement to provide suitable health insurance coverage or pay a penalty until January 2016.  These smaller employers still have to comply with reporting requirements starting in 2015, though.

As you will recall the ACA has a requirement that employers with 50 or more employees must provide health insurance coverage meeting specific criteria outlined in the law to their employees working 30 or more hours a week or they face penalties for not complying.  This provision was scheduled to begin January 2014, but was delayed last summer postponing the implementation to January 2015.  Employers with 100-plus employees must still comply by 2015.


July 26, 2013

HR Fact Friday: Fourth Circuit Says ACA Employer Mandate Valid, Insurance Regulation Within Commerce

The U.S. Court of Appeals for the Fourth Circuit July 11 declared the Affordable Care Act’s employer mandate a valid exercise of Congress’s power to regulate commerce under the commerce clause of the U.S. Constitution (Liberty Univ. Inc. v. Lew, 4th Cir., No. 10-2347, 7/11/13).

The mandate is “simply an example of Congress’s longstanding authority to regulate employee compensation offered and paid for by employers in interstate commerce,” the court held in an opinion co-authored by Judges Diana Gribbon Motz, James A. Wynn, and Andre M. Davis.

The ruling comes in a case filed by Liberty University Inc. and two individual plaintiffs that challenged both the individual and employer mandates.

The employer mandate requires employers with more than 50 full-time employees to provide health care coverage to employees and their dependents. If an employer fails to do so, or fails to offer coverage that meets the mandate’s affordability requirements, it would be required to make an “assessable payment” collected by the Treasury Department in the same manner as a tax.

The Obama administration recently announced it will delay implementation of the employer mandate until 2015.

Source:  Bloomberg BNA,, Mary Anne Pazanowski


November 7, 2012

Open Enrollment Is Just Around the Corner

Filed under: Benefits,General HR Buzz,Insurance,Wellness — Tags: 6:00 am

Benefits open enrollment is usually a very busy and stressful time of year for HR professionals.  It requires much more time and thought than many in an organization realize.  Whether your open enrollment plan year is on the calendar year or on another fiscal year, there are several things to consider when preparing for open enrollment.  Following are some suggestions:

Plan Ahead – - – Begin communicating with your broker or other insurance provider at least three months prior to the plan year.  This will allow them to gather the necessary information on your current plan along with the new proposed costs, so that you and your executive team will be able to make informed decisions whether to continue the current plan, make changes to it, or shop for other options.

Make a List – - – Put your wish list in writing!  If you want to propose additional insurance coverage, such as adding a High Deductible Health Plan with a Health Savings Account option, dental insurance, vision or supplemental insurances, now is the time to do it.  Make sure you have thoroughly prepared and you have the numbers to support the reasons why you have proposed the changes and how they will satisfy your employees’ insurance usage needs.  An employee benefits survey can be of great value in this area when it is completed in the “off” season.

Decide if wellness initiatives will be included in helping employees offset some of the cost of their ever increasing premiums.  Educating them in a healthier lifestyle and teaching them the long term benefits of changing their behaviors can have lasting value.  Assisting employees to make the connection between health care costs and their health can have a huge positive impact on their dollar.  Thus, it is a win-win for both employee and employer.

Communicate with Others – - – Always remember that HR is usually on a different planning schedule than other departments.  Arrange open enrollment meetings with that in mind.  Inquire of managers and make sure your open enrollment meetings won’t interfere with the organization’s other key business plans.  You will gain their support and they will know they have yours!

Keep It Simple – - – Whether you have paperless enrollment or not, communicate any changes in insurance programs to your employees early and educate them as to where they can find answers to their questions.  This will help them to understand how the changes will affect them and their dependents.   Publicizing open enrollment early, will encourage the mindset for employees to begin making their choices in coverage.

Ask for Help! – - -You don’t have to go it alone.  Use other team members to review all documents and communications before publishing to employees to make sure all the information is correct.  This will save lots of time and hopefully keep you from making apologies and corrections later!  Utilize your broker and any representatives from your insurance companies that can be available onsite for interaction with your employees and allow employees to ask them specific questions.

Once the rush is over, keep good notes for the next year to map your strategy.  Record what went well and what needs to be creatively adjusted.  And, by all means, give yourself and your team a pat on the back!


October 8, 2012

Medicare Disclosures Due Prior to October 15!

Filed under: Benefits,COBRA,Compliance,Insurance — Tags: 6:00 am

The Medicare Modernization Act requires certain disclosures be distributed annually regarding prescription drug coverage to Medicare eligible individuals.  This annual disclosure must be made prior to October 15.

If a group health plan offers prescription drug coverage, it must notify all Medicare eligible participants covered by the plan whether the prescription drug coverage offered is deemed, “creditable coverage,” meaning it is as good or better than what the standard Medicare prescription benefit (Part D) would cover.  Besides the active employee, notice would also have to be provided to the following individuals covered by the prescription drug coverage of the group plan:

  • Dependents of the actively working employee
  • Medicare eligible individuals covered under the COBRA provision and their dependents
  • Medicare eligible disabled employees
  • Medicare eligible retirees and their dependents

Besides the annual distribution of such disclosures, notice must also be given when the Medicare eligible individual joins the plan.

A second annual disclosure must be made to The Centers for Medicare & Medicaid Services (CMS) using the Online Disclosure to CMS Form to keep the government agency abreast of the status of the creditable coverage of their prescription drug plan.  This disclosure notice is to be made no later than 60 days from the beginning of the renewal date of the plan year, within 30 days of the termination of a prescription drug plan or within 30 days after a change in the creditable coverage status.


March 28, 2012

EAPs – A Benefit You May Want to Check Out

Monday’s blog alluded to the reality of the high cost of providing health insurance benefits to employees.  As a result, many medical insurance plans are being redesigned to include higher deductibles and copays to counteract the increase in premiums.  Employers still want to provide a well-rounded offering of benefits to employees, but it is becoming increasingly difficult to do so without affecting the overall budget.

A benefit worth checking out is EAPs – Employee Assistance Programs.  EAPs have been around for decades, but have generally been used as a resource to help workers with substance-abuse issues on a confidential basis.  That is no longer the case.  EAPs are getting a makeover, partly as a result of employers concern about everyday stress in employee’s lives.  According to Stella Antonakis, senior associate of total health management at Mercer, “It’s everything under the umbrella of behavioral and mental health.”

So how can an EAP help?  Below are a few of the services they provide:

  • Find affordable child care or elder care
  • Financial services, such as refinancing a mortgage
  • Sort through health care costs
  • Referral for tax accountant
  • Legal services
  • Planning a wedding
  • Health and wellness services
  • Management training

The reason EAPs are so attractive as an “add-on” benefit is that they are relatively cheap for employers, costing about $1 to $3 per month.  However, the utilization of services is only 2% – 6% of the employee population.

As an employer, if you have an EAP, it may be a good time to re-educate your employee population about the vast array of services that can be provided.  Many mental and behavioral issues in an employee’s life affect their worklife and productivity.  If you don’t have an EAP, it may be time to explore adding one as an additional inexpensive benefit which could provide valuable services to your employee population.  For more information, click here.

EAPs Modernize, But Employees Are Slow to Catch On


November 16, 2011

Weekly Wednesday Acronym – ROI

If you approach senior management with a plan to implement a wellness program in your organization, one of the first words out of his or her mouth will most likely be “How do you plan to measure the ROI?”  What ROI refers to is Return on Investment (ROI), a calculation which complicates executive buy-in of wellness programs as it isn’t always easy to obtain significant data of ROI.

We all know wellness programs are important and they have become a staple of many corporate benefit packages.  Some organizations start small, offering reimbursement to employees for gym memberships or holding a wellness fair once or twice a year.  Other organizations simply have a deeply engrained principle that forms the basis for decisions about health and wellness offerings.  And larger organizations may offer monetary incentives for participation in wellness initiatives.

No matter how exciting your wellness plan is or how well received it is by employees, ROI will most likely be the measuring stick for success of the plan in the eyes of your CEO.  Fortunately, some organizations have had plans in place that have been able to measure ROI.  One such example is a state program implemented in Delaware in 2003, appropriately named DelaWELL.  First year’s savings were estimated at $62,000 simply through the reduction of emergency room visits.  Currently, health insurance premiums haven’t increased for the last three years.

As wellness programs have now been in place for several years, we are hearing more about the success of these programs and the resulting ROI.  So although ROI may be a difficult measurement, it’s not impossible.  For more information and free resources, check out the Wellness Council of America (WELCOA) by clicking here.


October 5, 2011

Weekly Wednesday Acronym – Why should I Consider a CDHP?

More than likely, you have already received your group health insurance renewal or are anxiously awaiting (or dreading) that email containing your rates for next year.  Good news, however.   Mercer reports that 2012 average growth in U.S. health benefit cost is expected to slow to 7.1% for group health plans (as compared to 9.8% for 2011).  Still, that percentage increases inflation and wage growth, so you still may be looking at cost-reduction options.

One option you may want to consider is a Consumer-Directed Health Plan (CDHP).  This is the umbrella name for High Deductible Health Plans (HDHPs) whose distinguishing component includes an employee-controlled spending account, either a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA).

You may be thinking to yourself, “Enough with the acronyms!  As if health care reform isn’t confusing enough!”  Well, keep reading, because although CDHPs have been around for awhile, Mercer predicts we may see a spike in 2012 in both the number of employers offering CDHPs and the number of employees enrolling in them.  The reason being, these plans are seen by employers as a way to provide more value to employees while at the same time managing costs.  Additionally, the HSA plan allows employees to save, on a pre-tax basis, account dollars not only for the current year but for future years.  So what are the differences between HSAs and HRAs?  For a brief summary, please refer to the table below:

This is just a brief glimpse into CDHP plans.  Depending on your specific situation, they may be worth looking at further.  The links below will give you some additional insights and considerations.

SHRM:  Consumer-Driven Decision:  Weighing HSAs vs. HRAsFor 2012, Higher Limits for HSA Contributions

Mercer:  Latest survey finds health benefit cost growth for 2012 likely to be the lowest in 15 years

Aetna:  Health Fund Study – Seventh Annual Aetna HealthFund Study


September 21, 2011

Are You Getting the Most Bang for Your Buck with Your Benefit Offerings?

Filed under: Benefits,General HR Buzz,Insurance,Total Rewards12:52 pm

As we near the typical time for health benefit renewals – January 1 – we may be thinking “Are we really spending our money in the right places”?  If creating happiness in the workplace is one of your goals, then yes, you are.  A 2011 analysis conducted by CareerBliss, a career development website and online community, revealed that a comprehensive benefit mix was a top factor in worker’s happiness outpacing even salary.   Key factors of organizations were reviewed and values assigned to determine how important those factor were to the employee’s overall happiness.  Benefits, along with career advancement opportunities and work/life factors, were the top three factors influencing employee satisfaction.

Competitive benefit packages of the 250,000 organizations surveyed included the following:

  • Above-average health insurance coverage
  • Dollar-for-dollar 401(k) match,
  • Free financial planning services
  • Life and disability insurance
  • Tuition reimbursement
  • Commuter benefits
  • Legal benefits
  • Adoption benefits
  • Long-term care insurance
  • Pet Insurance

So as you analyze your annual benefit renewal, keep in mind that the expense may result in happy employees which creates a positive workplace.  Something to make you smile.


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