An opioid toolkit to help Ohio’s employers

In 2017, 14 people in Ohio died each day from a drug overdose — and opioids were the main driver of those deaths. Our businesses are not exempt from the impact of this terrible plight. In fact, the majority of people who use illicit drugs, including the non-medical use of prescription medications, are employed.

More than ever, we’re challenged to find a ready, drug-free workforce, and to react to existing employees who are dealing with drug-related issues of their own or someone they care about.

We know businesses are being impacted because we’re hearing from them. The opioid epidemic has turned into a workforce and workplace issue. Employers can’t find employees who can pass drug tests. Employers have employees who are dealing with their own or a family member’s addiction. Employers want to do something, but have no idea where to begin.

Upon a recommendation from our board, we convened a task force to explore ways to help Ohio’s employers respond to the opioid problem as it relates to their workplaces. After meeting and listening to speakers on the front line, it was evident Ohio’s business community needed help.

With support from Ohio Chamber member companies Working Partners and Anthem BlueCross/BlueShield, we acted on the key recommendation to arm employers with a free toolkit of resources to help prevent and manage the problem. Two of the elements of the developing toolkit are online courses, available at

Dose of Reality for Employers: a toolkit to help mitigate the risks associated with Ohio’s opioid crisis is approximately 60 minutes long, with downloadable resources. It can be viewed at once or in modules. It includes lessons about the impact of the substances, legal and operational issues an employer must consider, best practice drug-free workplace guidance including how, when and why to drug test, and how to handle a situation if an employee confesses or is discovered misusing substances. There are also downloadable handouts to use within your company.

Dose of Reality for Employees: being a safe and critical consumer of prescription (Rx) drugs (funded by the Cardinal Health Foundation) addresses the dangers of misusing prescription drugs. It provides a simple five-step plan with downloadable reference pages employees can use to talk to their medical practitioner and pharmacist about the drugs they’re taking, possible conflicts with other drugs, alternatives for specific medicines, how to check whether there is a less expensive or safer generic version of the drug, how to properly dispose of medications and more.

We encourage you and your employees to use these resources and watch for more to come. Please share it with other business owners. The workplace is a powerful place to both prevent and intervene in the harmful use of substances. It is also the ideal environment to arm adults with information and strategies to help keep their children, or those they influence, drug-free.

With these tools, operating a comprehensive drug-free workplace program can increase safety, decrease liability, protect an organization’s reputation and profitability, and contribute to building an economically thriving and healthy Ohio.


Julie Wagner Feasel is the vice president of Communications at Ohio Chamber of Commerce, Ohio’s largest and most diverse statewide business advocacy group, has been a consistent voice for business since 1893.

Private sector adds 192,000 jobs in January: ADP

NEW YORK, Wed Jan 30, 2013 — Private employers added 192,000 jobs in January, more than economists were expecting, in a sign of growth in the labor market, a report by a payrolls processor showed on Wednesday.

Economists surveyed by Reuters had forecast the ADP National Employment Report would show a gain of 165,000 jobs. December’s private payrolls were revised down to an increase of 185,000 from the previously reported 215,000.

The report is jointly developed with Moody’s Analytics.

How employers and employees are finding health cost savings through education

Mike Debo, Senior Sales and Renewal Executive, HealthLink

Employers — and subsequently, their employees — are becoming more savvy about the decisions involved in choosing and administering a health plan, often a business’s second- or third-biggest cost of operations. Just as safety initiatives can help reduce property and casualty insurance premiums, health insurance savings can often be achieved through self funding, says Mike Debo, senior sales and renewal executive at HealthLink.

“By instituting wellness programs and encouraging routine physicals and post-condition care for not only employees but for covered dependents, employers can reduce premium and claims costs while increasing productivity,” Debo says. “Instituting wellness programs, encouraging routine physicals and promoting post-condition care are especially beneficial to self-funded groups as they see the savings in the form of fewer claims spent, which can reduce reinsurance costs.”

Smart Business spoke with Debo about how increased involvement on the part of employers and employees can lead to lower health plan costs.

What is driving employers to be more involved with their health plans?

For many employers, the No. 1 reason they are becoming more involved is that they have no other option. They may have already maxed out what they can do from a plan design perspective with greater participant out-of-pocket costs. In addition, fully insured employers are constantly getting rate increases, but over the years, often no one has been able to fully explain the increases.

What are some tools an involved and educated employer can use to lower health costs?

An employer’s decisions are only as good as its information. That is why many business owners move into self-funding, where there is greater reporting about their group and its claims, whether medical or pharmacological.

One of the first tools businesses use is to have participant biometric testing, which provides the employer with information on how many people in the group have high cholesterol, hypertension, weight or smoking issues. From that — combined with reporting and claims — employers can create wellness programs and condition management programs. Wellness programs eventually save money from a claims perspective, but it might take a year or two to absorb the initial cost of testing.

With a year’s worth of information from claims and wellness programs, businesses can begin to change their plan design to address health conditions, utilization patterns or provide unique coverage for their plan participants. For instance, a business may find its participants are frequently visiting chiropractors because of their job type. With that information, they can look at not only how many visits they are allowing for chiropractors and the cost but also institute a condition management program strictly for back injury care.

Then, they can look at pharmacy claims. Are participants using generics as often as they can, brand names as necessary or mail order whenever possible? What does the employer need to do regarding the pharmacy benefit to not only ensure that people get the drugs they need but also to make it cost effective for the group?

By changing the plan design and addressing the specific needs of a group, employers often find they don’t need a particular program, such as condition management or a 24-hour nurse line, further cutting costs.

How can employers overcome initial resistance to wellness programs and other initiatives?

Most people aren’t going to participate in biometric testing, a smoking cessation program, a weight loss program or a condition management program unless there are cost differentials to participants in the form of incentives or disincentives. Plan participants often think such programs are an invasion of privacy or that they require too much of a time commitment, but when there is a 10 to 30 percent difference in premium costs, they get involved.

How can employers communicate to employees the true costs of health care?

One of the easiest ways is to use a plan with no co-pays, where everything goes toward deductible/coinsurance, so that participants understand how getting an X-ray at an outpatient facility versus a hospital can mean the difference between a bill of $700 or one of $1,800.

Reporting is extremely important because it provides the knowledge to make wise decisions. Communication is equally important, whether via traditional posters and payroll stuffers or new technology smartphones, emails and blast texting.

To be effective, the communication must address how to get the most out of plan benefits and programs while avoiding unnecessary costs to the participant and the group.

How do self-funded plans give employers so much more control of their health program?

Employers have full control, outside of federal mandates, to do what is best for plan participants and plan costs. For example, if an employer has a population with an average age of 45 and people taking off work for elderly parents going into nursing homes or going to the doctor frequently, the employer can bring in a vendor to work with employees on how to make decisions about their parents. This takes pressure off employees. They show up to work more regularly and are more committed to the company because of the service their employer provided.

With self-funding, it’s at least a three-year commitment of time and effort to cut costs and provide better benefits for employees. The employer has to sit down on a quarterly to semi-annual basis to go through reports and have someone scrutinizing claims. Employers with healthy groups may stay fully insured because they think there is no risk involved, but the risk is that they pay $2 million for something that costs $1.5 million. With self funding, employers have a program that they are in charge of, a program better suited for them and for their plan participants.

Mike Debo is a senior sales and renewal executive at HealthLink. Reach him at (866) 643-7094, ext. 1, or [email protected]

Insights Health Care is brought to you by HealthLink®

How employers can address employees who abuse alcohol

Albert Moore, Account Representative, LifeSolutions, UPMC Insurance Services Division

Many myths surround alcohol and alcohol abuse, and those myths can often affect attitudes in the workplace, as well.

The most common myth may be that people who abuse alcohol are easily identifiable as “bums,” or “losers,” and that they are unlikely to be employed. The truth is that only a small percentage of alcoholics could be so categorized and that 90 percent of alcohol abusers are employed.

“There are hidden costs with alcohol abuse that employers don’t always see,” says Albert Moore, account representative for LifeSolutions, a division of the UPMC Insurance Services Division. “Its effect shows up in absenteeism, lower productivity, workplace injuries and accidents, increased health care costs and even workplace morale.”

Smart Business spoke with Moore about alcohol abuse in the workplace and how employers can address it.

Is there a reliable estimate as to how much alcohol abuse costs businesses each year?

The National Institute on Alcohol Abuse and Alcoholism estimates that untreated cases of alcohol abuse costs businesses $185 billion a year. For an individual company, it is estimated that alcohol abuse costs a company about $7,000 a year per employee, and that affects in some way 15 percent of the work force. That means that a company with 500 employees is probably spending more than $500,000 a year on the effects of alcohol abuse.

How should an employer react when there is a suspicion that an employee has an alcohol problem?

Supervisors and managers often lack confidence that they can effectively address problems that appear to be the result of alcohol abuse.  But each potential situation provides an opportunity to demonstrate leadership. The employee’s peers will gain respect for a supervisor’s problem-solving ability and appreciate the concern expressed for a co-worker. Untreated abuse always gets worse. The sooner the intervention, the better the result for the employee, the employer, and the workplace.

Are there specific things a supervisor can do?

Many factors can complicate a supervisor’s ability to take action, including the fact that alcohol consumption is legal and employers have no way to control the behavior of employees away from work.  However, employers can do what is necessary to ensure that their employees perform their duties effectively and safely, which includes banning alcohol on a work site. An employer has the right to set rules that can discourage or eliminate alcohol in the workplace.

How does a supervisor know when it’s time to act?

It helps if a supervisor is both aware and available. Listen to employees and take note of problem behaviors. Sometimes employees might confide in a manager or supervisor, sharing the fact that they are struggling with an alcohol problem or admitting that they are worried about their drinking.

In such instances, a recommendation that they contact an Employee Assistance Program (EAP) is often all the motivation and direction they need. A manager should always refer to company policy and/or speak with a human resources representative regarding self-disclosures to assure confidentiality.

How can EAPs be of assistance?

EAPs are a good place to turn to for help if you have an alcohol problem because these programs can recommend very specific things you can do to start to address the problem. The service that EAPs provide is confidential, and because most EAPs are independent of the employer, they are trusted by employees. EAP representatives are experts in this area and have the experience to steer employees in the right direction.

An EAP health or alcohol addiction coach is a great place to start. Many people are hesitant about asking for help because they are embarrassed, or in denial, or worried they might not like what they hear. However, even the best athletes in the world need a coach, someone who can take an objective view and provide that fresh look at things that you may be missing. This is what alcohol abusers need.

EAP coaches will often refer someone with an alcohol problem to other experts who can help, depending on what they need. In this way, EAP coaches are like brokers. They know the business and can help find the best deal in terms of care and counseling.

What are some signs employers can look for that may be indicative of alcohol problems?

An impaired employee may be the last to recognize the problem. It is essential for a supervisor to focus on job performance, documenting specific examples of behaviors that are unacceptable or substandard per company policy.

Again, it is recommended that the manager consult HR before speaking to the employee. Focusing on behaviors, instead of opinions or diagnoses, allows a supervisor to avoid potentially inflammatory reactions. EAP consultation can help identify signs of deteriorating performance.

There are times when a supervisor or manager may have to deal with an employee who is impaired on the job. This requires prompt action to ensure the safety of the employee and others in the workplace. EAPs can offer guidance on making a referral and on handling the employee.

Albert Moore, MPM, CEAP, SAP, is an account representative for LifeSolutions, a division of the UPMC Insurance Services Division. Reach him at (412) 647-8124 or [email protected]

Insights Health Care is brought to you by UPMC Health Plan

How health insurance companies and employers are dealing with the new Medical Loss Ratio mandate

Mark Haegele, Director, Sales and Account Management, HealthLink

The Medical Loss Ratio (MLR) mandate, within the Patient Protection and Affordable Care Act, requires insurance companies to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement. This provision just started in August, but how will it impact the insurance industry and employers?

“The MLR Legislation has a perverse incentive; when utilization and costs increase, an insurance company makes more money,” says Mark Haegele, director, sales and account management, with HealthLink.

Smart Business spoke with Haegele about what MLR does and the ramifications for health insurance companies, brokers and, ultimately, employers.

How does the MLR mandate work?

Medical loss ratios refer to the percentage of premium dollars an insurance company spends on providing health care and improving the quality of care, versus how much it spends on administrative and overhead costs and, in many cases, salaries or bonuses.

In August, health insurance companies paid $1.1 billion in total rebates to customers when less than 80 percent (for individual and small group markets) to 85 percent (for large group markets) of premiums were not used for health care costs. Approximately 31 percent of Americans with individual insurance got the rebate, with an average check of $127, according to the Kaiser Family Foundation. Rebates went directly to businesses that sponsor their own plans and they decided whether to distribute them or put the funds toward lowering future premium costs.

Why does MLR create a problem for insurance companies and, subsequently, employers?

Many insurance companies have had to make up a gap of up to 10 percent by balancing their administrative costs in order to pay for overhead, employee salaries, etc., and to run their business. In the individual market, for example, typically 70 to 85 percent of a premium is used to pay for the claim, according to a 2010 report by the American Academy of Actuaries.

Now, if you are an insurance employer, suddenly you have to spend 85 percent of the premium that you take in on claims. That means that 15 percent is the only bucket of dollars that you have for profit, administration, overhead, etc. So, logically, there are only two ways that insurance companies make more money year over year and increase their profits. They can either reduce their administrative overhead by cutting staff or have a claims increase.

For instance, if your premium was $1,000, $850 goes back to claims and $150 goes to profit and overhead. Let’s say next year your premium is $1,500; now the insurance company has increased its potential for profit by 50 percent — to $225 rather than $150. Artificially increasing utilization isn’t good for our health care system, and increasing premiums wasn’t part of the reform game plan.

The more realistic and impactful method is reduction. Insurance companies are in it to win it; they are not going to sacrifice profits. With insurance companies facing huge budget constraints, what does that mean for employers and their employees? It means a lower level of service because there are fewer people answering phones and less staff to handle claim issues as insurance companies are forced to squeeze their administration expenses.

In addition, employers will want to know if their group is subsidizing other employers. Insurance companies will need to provide information about the cost of claims, how much is being spent administratively and where are the funds going, and how groups compare. The president of an insurance company recently received a call from an employer who was very upset about the payment of his rebate check because he knew that his premiums were artificially high for many years and that he’s been subsidizing other employers.

How have insurance brokers been negatively impacted by MLR?

The U.S. Department of Health and Human Services has decided that agent commissions are not exempt from the administrative calculations. This creates a difficulty because brokers rely on incentives/bonuses from insurance companies to sell their business.

With the MLR mandate, the broker’s commissions have been cut considerably, if not all together. The National Association of Insurance Commissioners recently released a study that reported that a significant number of health insurance companies have reduced commission levels, particularly for the individual market. Brokers and agents are worried that this will run them out of business.

In the era of health care reform, it is important for employers to have consultants to ask questions, which often is the broker’s role and where that person earns his or her 6 to 10 percent fee. This will be even more vital if insurance companies themselves are giving lower service.

Are there other health care solutions not affected by MLR?

Self-funded programs are not held to the MLR and other PPACA mandates. Therefore, consultants who work off commissions could be suggesting self-funding more frequently. If business owners feel their group is not benefiting from MLR requirements, they also could look at self-insured models.

There’s no doubt that the MLR is clearly another driver to push employers to look at alternative methods of health care, including self-funded insurance. This already has been demonstrated by more interest from brokers and others entertaining a self-funded solution; they are not all buying it, but they are all looking at it.


Mark Haegele is a director, sales and account management, with HealthLink. Reach him at [email protected] or (314) 753-2100.

Insights Health Care is brought to you by HealthLink®

How employers can be preparing now for the upcoming health care mandates

Marty Hauser, President, SummaCare, Inc.

On June 28, 2012, the Supreme Court announced its decision to uphold the majority of President Barack Obama’s 2010 healthcare law. Known as the 2010 Patient Protection and Affordable Care Act (PPACA), the law includes hundreds of provisions.

The Supreme Court upheld the mandate that all nonexempt individuals maintain a minimum level of health insurance coverage or pay a tax penalty. It also upheld new reporting requirements and mandates for employers that offer coverage to their employees, as well as coverage and benefit requirements for health insurers.

While the Supreme Court’s decision confirmed that Americans will see significant changes to the health care industry in the coming years, it also left many individuals wondering about the personal impact this decision will have on them, their families and their businesses.

“While the Supreme Court’s ruling does not affect current coverage for most health insurance policy holders, it is understandable that many are wondering how the ruling affects them personally in the future,” says Marty Hauser, president of SummaCare, Inc. “And although we don’t have all the answers, we do know some things to help employers and individuals work their way through the mandates and provisions of PPACA that may affect them.”

Smart Business spoke with Hauser about what the Supreme Court’s decision will mean to individuals and employers in the coming years, as well as what employers should be doing now to prepare for the upcoming mandates.

What does the Supreme Court’s ruling mean for the average American?

The ruling of the Supreme Court and the provisions under PPACA affect everyone, from the individual with pre-existing conditions to someone who can’t afford health insurance, to the employer that provides coverage to employees and the health insurance company that administers the plan and benefits. Overall, the goal of PPACA is to make health care coverage available to more individuals than ever before.

The ruling not only affects the availability and affordability of health care, but it offers peace of mind for individuals by requiring insurers to provide 100 percent coverage of some benefits, including preventive care and wellness visits, immunizations and some types of counseling and testing.

What are the next mandates and/or provisions that will affect employers and individuals?

Effective Aug. 1, health insurers are required to cover women’s preventive services at 100 percent. This includes well-woman visits; gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes; human papillomavirus DNA testing every three years; sexually transmitted infection counseling and HIV screening and counseling; contraception and contraceptive counseling; breastfeeding support, supplies and counseling; and domestic violence screening.

In addition to newly covered preventive services for women, another provision of PPACA that will affect employers and individuals is the Summary of Benefits and Coverage provision. The SBC provision applies to both fully-insured and self-funded group health plans and is meant to help employers and individuals compare benefits between different insurers and/or plans.

The SBC document is designed to describe health plan benefits, including what the plan will cover, limitations and coverage examples. The SBC document must be provided to participants of a health plan enrolling or re-enrolling on or after Sept. 23, 2012. Check with your insurer to determine their process for providing the SBC.

What mandates go into effect in 2013 that will impact employers and/or plan sponsors?

Upcoming mandates slated to go into effect in 2013 for employers and/or plan sponsors include Form W-2 reporting for the 2012 tax year; a $2,500 limit on employee contributions to health Flexible Spending Accounts for plan years beginning in 2013; a requirement for employers to notify employees of the availability of health insurance exchanges; a 0.9 percent tax on earned income of high-income individuals under the Federal Income Contributions Act; and a 3.8 percent Unearned Income Medicare Contribution tax for high income individuals/families.

What mandates go into effect in 2014 that will impact employers and/or plan sponsors?

Mandates effective in 2014 include the ‘pay-or-play’ mandate; employer certification to Health and Human Services regarding whether the group health plan offered to employees provides minimum essential coverage; an increase in permitted wellness incentives from 20 percent to 30 percent; automatic enrollment of new employees in a group health plan for large employers with 200 or more employees; a 90-day waiting period limit for coverage; coverage of certain approved clinical trials for non-grandfathered plans; guaranteed availability and renewability of insured group health plans; prohibition on pre-existing condition exclusions; and complete prohibition on annual dollar limits, which will primarily impact those in the individual market.

What should employers/plans sponsors be doing now to prepare for upcoming mandates?

The most important thing employers or plans sponsors should do now is to start talking to their insurer about insurance options available to them and consider their long-term goals and strategies. It’s also important to figure out when the mandate and provisions will affect the coverage and benefits offered to employees, as some mandates and provisions go into effect upon renewal and are not automatically required, and not every provision applies to each plan type.

Because parts of the mandates and rules aren’t fully written, guidance is still needed. Employers and plan sponsors should pay attention to information regarding upcoming items as information is released.

Marty Hauser is the president of SummaCare, Inc. Reach him at [email protected]

Insights Employee Benefits is brought to you by SummaCare, Inc.

Transitional work grants available for employers in Ohio

Randy Jones, Senior Vice President, TPA Operations, CompManagement, Inc.

As an employer, does your organization have departments with tasks or duties that never seem to get done? If you are like many employers in Ohio, the answer to this question is yes.

One possible solution to create a win-win scenario for both your organization and your injured workers is to consider implementing a transitional work program with the assistance of grants offered by the Ohio Bureau of Workers’ Compensation (BWC). Transitional work is a cost containment strategy for workers’ compensation that helps injured workers return to productivity in the workplace by providing modified job duties that accommodate their medical restrictions due to work-related injuries.  In turn, the employer reduces the costs associated with long-term claims and improves overall company productivity.

“Implementing a transitional work program is an ideal way to keep injured workers engaged in their employment and assist them with their income stream,” says Randy Jones, senior vice president, TPA Operations for CompManagement, Inc. “But it also offers the employer an alternative to downtime, the retention of knowledgeable and experience employees, and lower premium costs by preventing a loss in wages and payment of compensation by BWC.”

Smart Business spoke with Jones about the monies that are now available for your business in Ohio.

Who is eligible to receive a grant?

All active employers, both public and private, participating in the state-funded workers’ compensation program are eligible for the grant. Self-insured employers and state agencies are not eligible.

An employer must also be current with respect to all payments due to the BWC and have no cumulative lapses in coverage in excess of 40 days within the 12 months preceding the application date. Employers that received a transitional work grant through the BWC’s prior program from 2001 to 2006 will not be eligible for a new grant but will be eligible for a performance bonus. Employers that may have an existing transitional work program without use of a prior grant are also eligible only for a performance bonus after their current program is reviewed and approved by BWC.

Why should my organization apply for this grant and implement a transitional work program?

A transitional work program provides an alternative to lost time and allows an employer to minimize workers’ compensation disability costs associated with lost work days, compensation, and reserves. Often with minor modification in job duties or hours, an employee is able to return to work following an injury. The idea is to return an injured employee to gainful employment activities as soon as possible to avoid the so-called ‘disability trap.’

Injured workers receive a full paycheck, with the goal of returning to their original job. The advantages include a reduction in costs associated with long-term claims, improved productivity, lower injury downtime, improved employee recovery time, increases in employee morale and a protection of your work force investment, as the loss of experienced employees will result in costs associated with hiring new employees.

How is the amount of the grant determined?

BWC determines the amount of the grant based on employer size and the complexity of services needed for transitional work.  Factors include the employer’s payroll, job classifications, job analyses needed and collective bargaining units.

How does the application for grant monies work?

Applications are received and reviewed by BWC. The application form is available on its website at Key components will include policies and procedures, job analyses, program evaluation criteria, medical provider listing and employee education.

Who can develop a transitional work program for my organization?

Transitional work developers certified to participate in the Health Partnership Program as a vocational rehabilitation case manager, occupational therapist or a physical therapist can assist your organization.  Your developer of choice must also complete BWC-sponsored transitional work development training prior to delivering programs and have verified experience in developing programs or verified mentoring experience according to BWC’s transitional work policy.

Any costs associated with a transitional work developer preparing and submitting a proposal to an employer are not reimbursable under the grant.

Can my organization receive additional monies for participation?

A separate application may be filed to receive a performance bonus of up to 10 percent. The calculation occurs at six months following the end of the applicable policy year (June 30 for private employers, Dec. 31 for public) and is dependent on the number of eligible claims and successful use of the program.

All claims with injury dates within the applicable policy year will be evaluated to determine how many had the potential for transitional work services and how many of those actually utilized those services. Say an employer had 12 claims during the policy year and 10 met the requirements for transitional work. Of those 10, five injured workers were offered and accepted transitional work services. Because 50 percent of eligible claims were helped by transitional work, the employer would receive 50 percent of the possible 10 percent bonus, which equals 5 percent.

Are there deadlines for applying for the grant?

There is no deadline for applying for the grant, but there is for the performance bonus. For private employers the deadline is the last business day of April; for public employers it is the last business day of October.

Randy Jones is the senior vice president of TPA Operations for CompManagement, Inc. Reach him at (800) 825-6755, ext. 65466, or [email protected]

Insights Workers’ Compensation is brought to you by CompManagement, Inc.





How health care reform will potentially impact employers

Marty Hauser, President, SummaCare, Inc.

The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010, and since then, the health care delivery system has experienced rapid change. Health care reform will be the biggest change to the U.S. health care system since Medicare was established in 1965. According to KPMG and Milliman reports prepared for the Ohio Department of Insurance, nearly 1 million more Ohioans will shift to Medicaid in 2014 at a cost of $250 million to taxpayers. It is estimated that this will increase to $600 million in 2019, while another 524,000 individuals could shift into the proposed government subsidized exchange. It’s also estimated that 660,000 fewer Ohioans will get their health insurance coverage from their employers. Not only does health care reform impact the way health care services are covered and administered, it also changes the delivery of health care and the ways consumers will obtain insurance. In addition, employer groups that offer benefits to their employees will experience change due to health care reform laws. Therefore, many employers have questions regarding how they can continue to offer comprehensive benefits to their employees while maintaining the costs of such benefits. “The small- to medium-sized employer will definitely be affected by the new legislation,” says Marty Hauser, president of SummaCare, Inc. “Many employers plan to continue offering benefits to their employees, but the way these benefits will be offered and the contributions made by the employer will likely change.” Smart Business spoke with Hauser about changes and mandates under the health care reform law, as well as post-reform strategies employers may use when offering benefits. What changes under PPACA have already gone into effect? In 2010, changes include coverage of children with pre-existing conditions; coverage of dependents up to age 26 under federal law and up to age 28 under Ohio law; elimination of lifetime limits of coverage; regulation of annual dollar limits of coverage; and a prohibition against rescission of coverage. In addition, certain preventive services became covered at 100 percent for most policies. What changes under PPACA are up next? While many of the changes under the PPACA law will go into effect in 2014, others will take effect in the coming months, and insurance companies are busy making appropriate preparations now. In August 2012, new women’s health preventive services, including contraception, will be covered at 100 percent if received in-network. These services fall into the categories of evidence-based screenings and counseling, routine immunizations and other preventive services for women. For policies issued or renewed after Sept. 23, 2012, insurance issuers will be required to distribute Summary Benefits of Coverage (SBC) documents to potential enrollees upon application and upon renewal. These documents will allow consumers to easily compare plans from different insurance companies. Under the law, two new resources scheduled to be available for consumers to purchase policies. Consumer Orientated and Operated Plans (CO-OPs) go into effect in 2014 and will offer consumers more choice when it comes to purchasing an insurance policy. CO-OPs are nonprofit groups designed to offer individuals and small businesses more affordable options, and their customers will direct them. Low-interest federal loans will be available to eligible private, nonprofit groups to help set up and maintain the CO-OPs, which can be operated locally, statewide or across several states. The second new resource for consumers in 2014 will be exchanges. Exchanges are state-based transparent, competitive insurance marketplaces, administered by a governmental agency or nonprofit organization, where individuals and small businesses with up to 100 employees can buy affordable and qualified health benefit plans. Standard benefit tiers will be offered on each exchange, and states will have broad latitude in design of the exchanges. All plans offered on the exchanges will be guaranteed issue with no medical underwriting, and some consumers may be eligible for subsidies based on their income. What strategies might employers use so they can continue to offer health insurance to their employees in the post-reform market? Strategies include providing employees with a stipend to pay for health insurance in the individual market or providing a defined contribution and moving to the purchase of policies on the exchanges. Another strategy is offering a policy that promotes a culture of wellness that features a smaller network, larger employee contribution or incentives for meeting wellness and/or preventive care goals. Employers may also continue offering benefits in the same manner as they have in the past. What changes are insurance carriers making? While the focus of most carriers has always been to provide cost-effective care in the most appropriate setting, insurance carriers now are participating with providers in creating Accountable Care Organizations (ACO) and Patient Centered Medical Homes (PCMH) that aim to further provide savings and promote coordinated, appropriate care.  More information and education about these activities will be forthcoming in the near future. Where can employers get more information? Begin with your current insurance carrier or broker. Share questions or concerns. You can work together to determine the best option for your business. Also, provides information that outlines the basics of the reform law and its provisions.  Regardless of the final outcome of PPACA, health care delivery will be changing. With the spotlight on quality, effective outcomes and transparency, the move toward improving the delivery system is certainly well under  way. MARTY HAUSER is the president of SummaCare, Inc. Reach him at [email protected] Insights Health Care is brought to you by SummaCare, Inc.