Your company’s benefits package is a surefire way to attract and retain staff; however, this only works if your employees know how and when to take advantage of what is offered.
Because of the explosive growth of social networking sites such as Facebook and Twitter, combined with the increasing popularity of PDAs, the number of avenues employers have to communicate with their employees continues to grow, says Renay Gontis, communications coordinator for JRG Advisors, the management company for ChamberChoice.
As benefits managers become less apprehensive about publicly communicating benefits plans, the use of social networking sites to reach employees with general benefit information is becoming more common.
Smart Business spoke with Gontis about how utilizing social networking sites as a platform to break down potentially confusing and overwhelming amounts of benefit information can be a great way to reach out to your employees.
Why utilize social networking in the workplace?
Social networking can enhance everyday communications. It provides an innovative avenue for employees to locate information relative to employee benefits, business policy, wellness and other business-related material. Social networking is no longer limited to personal use and can be used by employers to effectively expand upon business initiatives both internally and externally.
The idea of using social networking in the workplace may evoke feelings of both fear and excitement in the minds of employers, and it should. This phenomenon has the potential to change the way companies do business. Social networking not only helps your company connect with patrons and other interested parties, it is also a valuable resource for drawing in potential employees and recruiting the finest candidates for jobs. Social networking has the ability to get your message across to thousands of people quickly, which makes it priceless to public relations.
What are the perks to using social networking to communicate benefits?
Social networking is a quick and flexible way to get information out to your employees and can be a powerful addition to your benefits communication initiative. Sending fast and frequent updates to your employees helps to keep them thinking about their benefits year round.
? Short messages entice your employees to link to more detailed information.
? Quite often, benefits communication is delivered in a one-size-fits-all package, with so much technical information that employees cannot find what they are looking for. Social networking allows for the message to be broken down into short and concise posts.
You can pull social networking information into your employee intranet, allowing employees to choose how they want to receive information from a variety of outlets.
How can you protect your company’s reputation online?
According to Facebook’s statistics page, Facebook — the largest social networking site today based on monthly unique visitors — has more than 250 million active users. The fastest-growing group of users is people older than 35, which means it is becoming increasingly likely that your work force is getting involved with social networking.
While this has many potential benefits, you also want to take steps to ensure that no one — whether it is a competitor, a patron, or a former or current employee — is tarnishing your company’s name or reputation. The same holds true for blogs, where damaging content may appear without your consent.
The key to keeping your risk low is identity management. The best way to prevent Internet buzz from becoming a hazard is to monitor the use of your company name. Periodically type it into a search engine to make sure that your official website is the top hit and that nothing offensive comes up in the first 20 hits, which is statistically as far as most people will dig in a search.
What steps can you take if you find negative references online?
If you do find references to your company name in the first 20 hits that could be hazardous to your business or reputation, you have a few options. If social networking sites are the culprit, consider enacting a policy prohibiting employees from mentioning the company name on their personal sites. Explain the negative outcomes that this could have for business and help employees understand how acting as poor representation of the company through scandalous photos or negative comments on a social networking site could affect them directly.
If negative or derogatory comments about your company have seeped into other sites outside the control of your employees, the risk to your business is even greater. This type of hazardous publicity is more difficult to manage.
One approach is to flood the Internet with positive information about your company so that the negative write-ups are no longer within the top search results. Contacting sites and asking them to remove fictitious and defamatory material is another option.
Although social networking is a great way to get information out to your employees and their families, comprehensive resources are still necessary. A mix of online, interactive, print and in-person communication provides a well-rounded benefits communication strategy. Companies should consider how to integrate social networking into their robust employee communication platform.
Renay Gontis is the communications coordinator for JRG Advisors, the management company for ChamberChoice. Reach her at (412) 456-7011 or email@example.com.
When it comes to prescription drug benefits, most are familiar with the terms “generic” and “brand name.” But do employees understand what a prescription drug formulary is? Do they understand the purpose and how a prescription drug formulary saves money?
A drug formulary is a list of prescription drugs — both generic and brand name — that are preferred by a particular health plan. The purpose of the formulary is to steer subscribers to the least costly medications that are sufficiently effective for treating a specific health condition. Medications on the formulary have been evaluated and researched for effectiveness and are the most cost-effective versions of popular prescribed medications. By using a single set of prescriptions for most routine treatments, health plans can provide quality care and keep costs at a minimum.
“Formularies change as new drugs and research become available,” says Michael Galardini, a sales executive for JRG Advisors, the management company for ChamberChoice. “In most health plans, the formulary is developed by a committee of pharmacists and doctors from various medical specialties. The committee reviews new and existing medications and develops the formulary based on safety and how well certain drugs work. The committee then selects the most cost-effective drugs.”
Smart Business spoke with Galardini about prescription drug formularies, the difference between generic and brand-name drugs and how employers can get employees to take an active role in their prescription treatment plans.
How do drug formularies work?
Health plans frequently ask doctors to prescribe medications included within the formulary whenever possible. Many health plans review whether or not doctors are using the formulary and, if they’re not, encourage them to do so. Most formularies have procedures to limit or restrict certain medications. This is done to encourage the doctor to use medications appropriately as well as to save money by preventing medication overuse.
Common restrictions include:
- Prior authorization, which requires the doctor to obtain approval from the health plan before a subscriber can obtain coverage for a medication on the formulary. These are often medications that may have a safety issue, a high potential for inappropriate use, or lower-priced alternatives on the formulary.
- Quality care dosing, where the health plan checks prescription medications before they are filled to ensure the quantity and dosage are consistent with FDA recommendations.
- Step therapy, where the health plan requires a subscriber to first try a certain medication to treat their health condition before using another (more costly) medication.
What is the difference between generic and brand-name drugs?
People often have the misconception that generic versions of their prescription medications are inferior or weaker than the brand-name product. The fact of the matter is that the FDA requires generic drugs to meet the same standards as a brand-name drug. The difference between generic and brand-name drugs involves the research, development and marketing investment that go into the original brand-name product. The drug manufacturers, when developing an original brand-name product, spend millions of dollars. Once a generic equivalent becomes available, it has the same active ingredients and chemical purity as the brand-name drug. There may be differences in some of the inactive ingredients such as tablet fillers, binders, coatings or flavors, but the active ingredients are identical. It costs substantially less to develop generic drugs, which means the consumer costs are also substantially less in comparison to the brand-name equivalent.
Prescription drugs are one of the most costly elements of employer-sponsored health care plans. As drug costs rise and more prescriptions are dispensed each year, employees must do their part to ease the burden. Educate your employees to ensure they understand the value of a generic equivalent. Employees who understand this important component of their benefits plan will make more informed choices, reducing not only their out-of-pocket costs but, ultimately, their employer’s cost in the long run.
How can someone be a better consumer of prescription drugs?
You can cut costs by up to 90 percent by becoming an informed consumer and using the same buying techniques that you use when shopping for other goods and services. As more individuals begin comparison-shopping for drugs, more retailers will compete to win their business, which will drive prices lower. Other ways to lower costs include buying in bulk, utilizing mail-order pharmacies and/or discount prescription programs and buying generic or over-the-counter drugs whenever possible. Also, many drug companies and states offer drug assistance programs for the elderly, low-income patients and/or people with disabilities.
Does a pharmacist make a difference?
Your pharmacist is an important member of your health care team. He or she can help you understand your medications and how to take them safely and effectively. By keeping accurate and up-to-date records and monitoring your use of medications, he or she can help protect you from taking improper medications, unwanted side effects and dangerous drug interactions.
Here are some points to cover with your pharmacist:
- How and when to take the medication.
- How much to take and for how long.
- What foods, drinks, other medications or activities you should avoid while taking this medication.
- Any potential side effects.
- What to do if you miss a dose.
- Any concerns you have with taking this prescription.
Michael Galardini is a sales executive for JRG Advisors, the management company for ChamberChoice. Reach him at (412) 456-7235 or firstname.lastname@example.org.
How many of your employees can answer these seemingly simple questions: What is my job? What components of my job are most relevant? How well am I doing? What part do I play in my company’s overall success?
Not sure? Then consider conducting an informal investigation of your employees. Talk with a few and ask those four simple questions. The responses may surprise you. Studies show that less than 20 percent of managers and employees can answer these questions with any measure of confidence.
“An ‘engaged’ employee is one who is fully involved in and enthusiastic about his or her work and will act in a way that furthers his or her organization’s interests,” says Mark Brown, a strategic partner to JRG Advisors, the management company for ChamberChoice. “Engaged employees will not only answer these questions with absolute confidence, but live it every day of their professional lives.”
A lack of employee engagement has an impact on your company’s bottom line. Regardless of company size or industry, the impact could be huge, adds Brown.
Smart Business spoke with Brown about employee engagement and what employers can do to improve it.
Why is employee engagement so important?
A recent study concluded that companies excelling at employee performance management post earnings that are 15 percent higher than companies where talent management is lacking. In addition, companies with engaged employees show 22 percent improvement in net profit margin, and spend 6 percent less on HR overall.
All employers spend large amounts of time and money analyzing their financials, since it is necessary in order to survive and prosper. Why isn’t the same level of attention given to analyzing and monitoring their most valuable asset of all — employee performance and focus? The small percentage of companies that do understand and have implemented formal employee engagement programs and tracking systems are able to reduce business costs and show hard dollars being contributed to the bottom line.
How does employee engagement boost a company’s bottom line?
Employee engagement boosts a company’s bottom line in three key ways:
- Increased employee productivity — A landmark study of Performance Management Effectiveness by Hewitt Associates demonstrated a 35 percent employee productivity benefit from utilizing employee performance management systems as a result of staff working on projects and tasks that they should be working on. With clearer visibility of goals and how they will be monitored, employees work harder and focus their efforts on appropriate tasks. A conservative 5 percent increase in overall productivity results in a weekly gain of two hours per employee.
- Reduction in absenteeism — According to Gallup (2008 and 2010), engaged employees average 37 percent less absenteeism. Employees with preset, time-sensitive objectives are less likely to take unscheduled time off, unless truly necessary. If each staff member understands they are part of a larger team and their performance is crucial to overall success, unnecessary/unscheduled time off will be reduced.
- Reduction in undesirable turnover — In the same study, engaged work groups show 25 percent less turnover in high turnover organizations, and 49 percent less turnover in low turnover organizations. Replacing those departed employees has a negative impact on a company’s financial resources. Engaged employees are loyal employees and loyal employees are less likely to leave. Continuous feedback through performance tools helps employees improve, succeed and feel valued.
Where can an employer begin?
There are four steps to engaging employees — planning, communication, execution and tracking progress to completion. Yogi Berra, one of the great philosophers of modern time (pretty good baseball coach as well), once said, ‘You’ve got to be very careful if you don’t know where you are going, because you might not get there.’ As bizarre as it sounds, Yogi was right with regard to employee performance management. If we do not plot a course for each of our employees that blends into the company’s ‘big picture,’ how will they, or the company, succeed?
Company goals and objectives need to be clear, well thought out and visible to every member of the organization. Once you define ‘the plan,’ it has to be clearly communicated to every team member regardless of position. The company’s president, the line worker, the person answering the phones and the one emptying the waste cans are all critical to the ‘big picture’ success. Everyone needs to hear it, understand it, embrace it and own it. Once the entire team understands the overall objectives as well as their individual roles and expectations, it is time to begin the performance management game.
Once the plan is in place and communicated, what’s the next step?
You can’t stop there. Once the plan is in action, progress and individual performance have to be constantly monitored and adjusted to stay on track to reach the objectives. The bottom line is this — when each team member is focused and understands that their successful execution is in conjunction with the same effort from all other team members, you will achieve the desired ‘big picture’ outcome.
Many will feel as though strategic planning and performance evaluation are not new or unique concepts. If this approach is not new or revolutionary then why are fewer than 13 percent of U.S. companies increasing their bottom line profits by engaging in employee performance? Is your company included in that 13 percent? If not, maybe it is time to walk a different path. As Yogi put it: ‘If you come to a fork in the road, take it.’
Mark Brown is a strategic partner to JRG Advisors, the management company for ChamberChoice. Reach him at (412) 456-7000 or email@example.com.
In today’s economy and with the continuous changes associated with employer-sponsored health care benefits, companies are seeking creative ways to enhance the benefits offered to employees without adding new cost.
The most popular benefits package enhancement is offered at the worksite on a voluntary basis. The products can supplement medical, life and disability coverages through policies such as critical illness, accident, disability and long-term care. While these traditional voluntary benefits have become increasingly useful in supplementing employer-sponsored benefit plans, growing employer demands leave employees wanting and expecting even more.
“In a world where employees are constantly connected to their jobs through technology, they are struggling to find work-life balance,” says Ron Smuch, a sales executive for JRG Advisors, the management company for ChamberChoice. “As an employer, it is more important than ever to offer creative solutions to assist employees with personal needs such as auto, homeowner’s and renter’s insurance, financial planning and energy cost management.”
Smart Business spoke with Smuch about voluntary benefits, including personal insurance, and why providing employees with innovative and unique benefits can benefit them and the overall company.
Are personal insurance options expensive?
As with traditional voluntary benefits, there is no cost to the employer, and personal insurance options can further improve the ability to recruit and retain quality employees. With employees absorbing increased health insurance costs, providing access to potential cost saving solutions for their personal needs is a great way to improve employee satisfaction and commitment.
Why are these ‘extra’ benefits so vital in today’s business world?
The common reality of today’s work force, given our fast-paced society, is the fact that employees are increasingly pressed for time. As employees struggle to maintain work-life balance, it can be difficult to research and fully understand all components of personal insurance coverage such as auto, homeowner’s and renter’s insurance. By making these products available to employees on a voluntary basis at the workplace, employers can address this reality while boosting employee morale and productivity.
Introducing personal insurance options is a ‘win-win’ solution for the employer and employee. Affording employees the time and opportunity to have their personal insurance coverages reviewed can produce valuable savings that will enhance the current employee benefits package without adding cost. Employees will appreciate the extra effort, which will positively impact morale and productivity.
What other types of insurance can be offered?
Disability and life insurance products provide the best benefit for the dollars spent. Because they provide protection against lost wages, long- and short-term disability insurance plans are popular voluntary benefits. Buying disability insurance coupled with life insurance is more cost effective than purchasing coverage separately. Recently, there has been a renewed interest in permanent life insurance such as universal life. During these uncertain economic times, the security of life insurance makes it a highly sought benefit.
Another voluntary benefit that has become increasingly popular is ‘gap’ insurance. As health insurance premiums continue to increase, many employers are moving toward high-deductible plans in an effort to lower costs. This often requires employees to pay the difference between what their health insurance covers and what the services cost. Gap insurance offers a solution to help protect employees against increasing out-of-pocket expenses. Gap insurance pays lump-sum benefits for medical expenses resulting from inpatient hospitalization, outpatient services, diagnostic testing and rehabilitation services. For example, an employee who needs outpatient surgery may be responsible for a $1,000 deductible before the health insurance pays for any services. With gap insurance, the employee would receive a lump-sum payment for outpatient services and could use it to help satisfy the deductible. Gap insurance can be tailored to fit the needs of the employee’s out-of-pocket expenses.
How can a company go about offering personal insurance?
Introducing personal insurance options to employees can be as simple as partnering with a trusted insurance agency that offers value to your employees and has a good reputation. Employers should promote the opportunity and allot time for interested employees to meet one-on-one with a specialist to review their personal insurance needs and objectives. From this point on, the employer becomes the conduit, as the premium is paid entirely by the employee. There is no administrative paperwork or human resources concern for the employer. Should any employee decide to enroll, he or she owns the personal insurance coverage directly. The coverage is portable and would follow the employee if he or she leaves the employer. It is important to note that the coverage is a contract between the employee and insurance company and the claims are administered directly by the insurance company.
Ron Smuch is a sales executive for JRG Advisors, the management company for ChamberChoice. Reach him at (412) 456-7017 or firstname.lastname@example.org.
Health care costs, and consequently, employee health benefit costs, have been increasing at an alarming rate during the past decade. According to Kaiser Family Foundation, the cost of providing family coverage under a group health plan has increased by 114 percent since 2000 to a staggering average of $13,770 per year.
This varies by region as the average cost to provide family coverage under the most popular type of plan, a PPO (Preferred Provider Organization), in the Northeast is $14,917. Employees are also under financial pressure as their contributions have increased by 147 percent during the same period. Employees spend, on average, nearly $4,000 per year to cover their family.
“The financial impact of your annual renewal is significant to both your company and your employees,” says Chuck Whitford Jr., CLU, ChFC, a consultant for JRG Advisors, the management company for ChamberChoice. “It is important to be prepared and to understand what your renewal consists of. This includes knowing what alternatives exist to ensure you select the best plan for your company and employees.”
Smart Business spoke with Whitford about medical benefits renewals and what to evaluate when doing them.
When should a business begin preparing for benefits renewal?
Preparations should begin well in advance of when you receive the renewal from your insurance company. Experience rated employers that have access to claims utilization (generally those with 100 or more insured employees) should review their claims at least quarterly with their benefits advisor, who should also be analyzing this data to find cost-saving opportunities and monitor the actual group’s experience prior to renewal projections.
Regardless of size, all employers should review benchmarking data to compare their plan to other companies based on factors such as demographics, average cost, employee contributions and plan design (deductibles, co-payments, coinsurance, out-of-pocket maximums, etc.). This information can be useful when evaluating plan design changes (such as raising deductibles or co-pays, offering a consumer-driven plan or increasing employee cost-sharing in other ways) as you prepare for the renewal.
How are potential savings projected?
Once you have identified potential changes, your benefits advisor should project the savings (relative to current cost) that each will provide. This is also the time to consider conducting an employee feedback survey. The survey can serve a dual purpose by foreshadowing possible changes and assessing the relative popularity of the choices presented. For example, a majority of employees might want to choose a lower-cost plan or they might prefer to contribute more each month to maintain the current plan. The survey results can be used effectively in employee education communications.
Employers that provide a traditional health plan (typically an HMO or PPO with a low or no deductible) should consider a high deductible health plan (HDHP). These plans encourage employees to better understand the real cost of services and lead them to become better health care consumers. It is important to provide ongoing education to achieve a successful HDHP enrollment.
What items factor in to a benefits renewal?
One of the most significant factors in calculating any renewal is trend. Trend is a prediction of how much health care costs will rise over the next policy year. Every year, insurance companies set their own trend level based on last year’s health care inflation rate, analysts’ forecasts and their own experience. For 2010, the annual trend for PPO plans is approximately 11 percent.
- Inflation — the increase in the per unit cost of service.
- Cost shifting — providers shifting costs to make up for ‘discounted payers,’ typically government programs and the uninsured.
- Utilization/new technology — the increases in the number of services consumed as well as the introduction of new technologies, drugs and therapies.
- Leveraging — as employee cost-sharing (such as co-pays and deductibles) remains unchanged for a number of years, there is greater claim cost to the plan because the cost of services increases. For example, if a plan has a $500 deductible, a service costing $2,500 costs the plan $2,000 in the first year. In year 2, that service now costs, say, 10 percent more, or $2,750. The deductible is still $500, so the cost to the plan increases to $2,250.
What else should be evaluated in a benefits renewal?
After looking at costs, savings and trends, evaluate your current insurance company. Are you utilizing every service that they offer? Consider the in-network provider access and usage level, the tools they can provide to help employees make the best purchasing decisions based on quality and cost, and online services that assist with plan administration. Be sure to compare these items to other insurance companies if you request bids from other insurers.
Developing a renewal strategy with reasonable timelines and appropriate communication with your employees will make the renewal process more effective. Your benefits advisor should be an integral part of the renewal process as well as your long-term strategic planning.
Chuck Whitford Jr., CLU, ChFC, is a consultant for JRG Advisors, the management company for ChamberChoice. Reach him at (412) 456-7257 or email@example.com.
Between the status of our economy, inflation, unemployment and the ever-increasing cost of daily necessities — including, but certainly not limited to, gasoline — the overall mood of much of the population is one of woe.
Because of this, employers of all sizes are feeling the pain and will continue to see changes in their businesses. Those who can turn the “woes” into “wows” have the best opportunity to create a competitive advantage during these challenging times.
“Individually we cannot change the fundamentals of the economy,” says Amy Broadbent, the vice president of JRG Advisors, the management company for ChamberChoice. “One thing we can do is get back to basics. And, one of the basics of doing business is customer service.”
Smart Business spoke with Broadbent about customer service and what companies can do to provide quality customer service — even during challenging economic times.
In today’s unique business environment, what does customer service mean?
In these times, customer service means more than what occurs after the sale; it becomes a task of needs assessment prior to the sale. If you can satisfy the needs of a potential customer by identifying how they will benefit from spending the money they have with you versus your competitor, you have a much better chance at making the sale. It is critical to determine the needs of your prospects, explain the benefits your solutions provide, and bring the two together in a smooth and supportive way.
Should the focus be on finding new customers or retaining existing ones?
Research shows that it costs five times as much to bring in a new customer than to keep an existing customer. By no means can any employer forego seeking new customers, but now is the time to get back to basics by focusing on genuine and sincere customer service. Customers want to be loyal. It takes work on their end to find another company to meet the needs that you presently fill (or perhaps the needs you should be filling). More often than not, they leave due to the lack of good old-fashioned customer service.
Continuing to serve the customer after the sale results in a long-term client that no recession can change. This is the opportunity to turn a customer into a client and develop long-term relationships. A customer buys once, oftentimes because you have what they were looking for or offered the right product/price at the right time. A client buys from you repeatedly, renewing year after year and purchasing multiple product lines, building a long-term relationship that is often stronger than the lure of a lower price your competitor might offer.
How can a company improve its relationships with its clients?
You are presented with an opportunity to improve the relationship with customers every time they contact your company. The goal is to make all customer contacts as meaningful and helpful to the customers as possible. A few basic customer service practices that can easily be forgotten or overlooked include telling the customer what you can do for them (don’t tell them what you cannot do for them); acknowledging customers’ feelings and allowing them to vent if they are frustrated (this shows that you care about how they are feeling); remembering customers’ names and using them repeatedly; presenting acceptable solutions to the customers’ problems; making sure you are actively listening and giving your undivided attention to the customer; and remembering the importance of ‘please’ and ‘thank you.’
One of the ‘golden rules’ of customer service is speaking in a manner that is professional, friendly and polite at all times, regardless of the situation. It is critical to pay attention to the tone of your voice to ensure you do not come across as disrespectful or condescending. Remember the adage that people can ‘hear’ a smile through the phone. Once you have resolved the customer’s issue, ask if there is anything else they need. Taking the time to ask shows the customer that you value them, which can lead to increased customer satisfaction, and, ultimately more business. Finally, follow up on the solution you proposed to the customer at a later date to be sure the problem has been resolved and that they are pleased with the outcome.
How can a company use customer service to gain an advantage over its competitors?
There is competition in every industry. Competitive advantage is not always achieved by how much money you have or the size of your organization. Oftentimes, you can gain competitive advantage by focusing on the basics and making your clients feel like they are important and cared for. Having a can-do attitude, raising the bar and going above and beyond what is expected can go a long way in making people feel good. This something extra and doing the unexpected is the ‘wow’ factor that differentiates good from great. If you can get everyone in your organization to embrace this philosophy, you will not only survive these challenging times; you will also achieve competitive advantage because of the ‘wow’ factor that differentiates you from your competitors.
Amy Broadbent is the vice president of JRG Advisors, the management company for ChamberChoice. Reach her at (412) 456-7250 or firstname.lastname@example.org.
If you are feeling confused about health care reform, you are not alone. Last year brought many big changes for health and welfare plans as the Patient Protection and Affordable Care Act (PPACA) was passed and the implementation of health care reform began.
Significant provisions to this new legislation took effect in 2010, including tax credits for small businesses (based on specific parameters), the expansion of dependent coverage to age 26, the elimination of lifetime and annual plan limits, the elimination of exclusions for pre-existing conditions and limits on rescissions or the retroactive cancellation of health insurance policies.
“We will continue to see changes to existing and pending legislation into 2011 as the legislation evolves, beginning with Flexible Spending Account (FSA) plans eliminating reimbursement for over-the-counter medications — with the exception of insulin — unless prescribed by a doctor,” says Joanne Tegethoff, an account executive with JRG Advisors, the management company for ChamberChoice. “Another change will impact those who have a Health Savings Account (HSA) and withdraw funds for non-medical expenses — their penalty will be larger this year.”
As of 2011, the HSA money your employees spend for non-qualified expenses will be taxable income, plus a 20 percent fine.
Smart Business spoke with Tegethoff about health care reform and how companies can begin to understand how it will affect them and their employees.
How does health care reform look right now?
The PPACA, along with the Health Care and Education Reconciliation Act of 2010, make up the new health care reform law. This legislation creates a number of issues for employers that sponsor group health plans. The changes are intended to be implemented over the next several years, but employers need to be aware of some impending plan design issues for the upcoming plan year. These issues include:
- Extended dependent coverage for adult children up to age 26.
- Restrictions on annual benefit limits and elimination of lifetime limits.
- Elimination of pre-existing condition exclusions for children.
- Prohibitions on rescission of health care coverage.
- Limits on reimbursing over-the-counter medications.
- Compliance with nondiscrimination rules for fully insured plans.
Are there any other provisions companies should be aware of?
On November 22, 2010, the Department of Treasury, Labor and Health and Human Services jointly announced the Interim Final Regulation for the PPACA Medical Loss Ratio (MLR) provision. This provision states that beginning in 2011, insurers and HMOs must annually calculate their MLR and provide rebates to policyholders if their MLR (percent of premium revenue spent on claims/medical care) is less than 85 percent for large groups and 80 percent for small groups or individuals. MLR applies to insured plans only, regardless of grandfathered status.
Whether certain provisions of the health care reform law will apply to a group health plan depends on whether the plan is considered a ‘grandfathered plan.’ A grandfathered plan is one that was in existence on March 23, 2010, the day the main legislation was passed. Certain health care reform provisions do not apply to grandfathered plans, even if they renew the coverage or allow new employees or current participants’ family members to enroll. It is unclear what could cause an existing plan to lose its grandfathered status, but additional guidance is expected. Special rules apply to collectively bargained plans.
How does this affect insurers?
Insurance companies that are not meeting the MLR standard will be required to provide rebates to their customers. Insurers will be required to make the first round of rebates to consumers in 2012. Rebates must be paid by August 1st each year. Enrollees owed a rebate will see a reduction in their premiums, receive a rebate check, or, if the enrollee paid by credit card or debit card, a lump-sum reimbursement to the same account that the enrollee used to pay the premium. In some cases, the rebate may go to the employer that paid the premium on the enrollee’s behalf. Regardless of whether the rebate is provided to enrollees directly or indirectly through their employer, each enrollee must receive a rebate that is proportional to the premium amount paid by that enrollee.
Are more changes on the horizon?
Additional changes will continue through 2014 as a result of health care reform, none of which are optional and many of which will increase the cost of coverage. To go along with these changes, there will be requirements that everyone carry a minimum level of health insurance coverage or be subject to a fine (some may be exempt if they have very low income). Employers with more than 50 employees generally will be required to offer a minimum threshold of health insurance coverage or potentially be subject to one or more fines. Employers could also be subject to fines if their employees choose government subsidized coverage through the exchange.
A variety of taxes are scheduled to go into effect at different times between 2011 and 2014 that may increase tax liability for certain individuals or increase the cost of your health plan. Your insurance and employee benefits advisor can help you determine the most cost-effective options for your needs, as health care reform continues to evolve.
Joanne Tegethoff is an account executive with JRG Advisors, the management company for ChamberChoice. Reach her at (412) 456-7000 or email@example.com.
how they could eventually lessen the demand and cost of healthcare over
For additional information on this topic, please see Transitioning to a Consumerism Model
Michael Galardini is a sales executive for JRG Advisors, the management company for ChamberChoice. Reach him at (412) 456-7235 or firstname.lastname@example.org.
discusses successful workplace wellness programs, how to implement them and how to get employees involved with them.
For additional information on this topic, please see: Workplace Wellness: An Employer’s Guide to Promoting Wellness at the Workplace
Also, please see Gontis's article from the February 2010 edition of Smart Business Pittsburgh on How to continually promote wellness throughout your organization
Renay Gontis is the communications coordinator for JRG Advisors, the management company for ChamberChoice. Reach her at (412) 456-7011 or email@example.com.
Jessica Galardini, the COO of JRG Advisors, the management company for ChamberChoice, discusses the three areas you should focus on when shopping for an employee benefits advisor: strategy, service and execution.
A clear strategy for employee benefits will save you time, headaches and money.
Also, Galardini shares these tips on saving money on employee benefits while still attracting and retaining the best and the brightest people.
Jessica Galardini is the COO of JRG Advisors, the management company for ChamberChoice. Reach her at (412) 456-7231 or firstname.lastname@example.org.