Wellness

This is the Wellness category of the Broad REach Benefits blog. At Broad Reach Benefits, we focus on employers that have between 30 and 500 benefit eligible employees. We’re employee benefit specialists, not a big box brokerage firm or payroll company with a sales force peddling policies.

District Court Judge in Texas Strikes Down the ACA – But Law Remains in Effect for Now

On Friday, December 14, a federal judge in Texas issued a partial ruling that strikes down the entire Affordable Care Act (ACA) as unconstitutional. The White House has stated that the law will remain in place, however, pending the appeal process. The case, Texas v. U.S., will be appealed to the U.S. Court of Appeals for the Fifth Circuit in New Orleans, and then likely to the U.S. Supreme Court.

The plaintiffs in Texas (a coalition of twenty states) argue that since the Tax Cuts and Jobs Act zeroed out the individual mandate penalty, it can no longer be considered a tax. Accordingly, because the U.S. Supreme Court upheld the ACA in 2012 by saying the individual mandate was a legitimate use of Congress’s taxing power, eliminating the tax penalty imposed by the mandate renders the individual mandate unconstitutional. Further, the individual mandate is not severable from the ACA in its entirety. Thus, the ACA should be found unconstitutional and struck down.

The court in Texas agreed, finding that the individual mandate can no longer be fairly read as an exercise of Congress’s Tax Power and is still impermissible under the Interstate Commerce Clause—meaning it is unconstitutional. Also, the court found the individual mandate is essential to and inseverable from the remainder of the ACA, which would include not only the patient protections (no annual limits, coverage of pre-existing conditions) but the premium tax credits, Medicaid expansion, and of course the employer mandate and ACA reporting.

Several states such as Massachusetts, New York and California have since intervened to defend the law. They argue that, if Congress wanted to repeal the law it would have done so. The Congressional record makes it clear Congress was voting only […]

By |December 18th, 2018|Compliance, Employee Communications, Health Care Reform, Legislation, Wellness|Comments Off on District Court Judge in Texas Strikes Down the ACA – But Law Remains in Effect for Now

EEOC Releases Final Rules for Wellness Programs under ADA and GINA

On Monday, May 16, the Equal Employment Opportunity Commission (EEOC) released final regulations (Final Regulations) under Title I of the Americans with Disabilities Act (ADA) and Title II of the Genetic Information Nondiscrimination Act (GINA) governing wellness programs.  The ADA rules cover an employer’s requests for health information from employees and the GINA rules cover requests for health information from family members.

The Final Regulations can be found here (ADA) and here (GINA).  Additional Q&A guidance and information for small employers can be found here.  The Final Regulations are effective for plan years beginning on or after January 1, 2017, and they apply to all workplace wellness programs, including those offered to employees or their family members that do not require participation in a particular health plan.

The rules clarify the EEOC’s stance on wellness programs and how to determine limits on incentives for spouses, although it is not all good news for employers.  As discussed below, there continues to be significant disconnect between EEOC and U.S. Department of Labor (DOL) rules on wellness programs, most notably on the treatment of health risk assessments (HRAs) and biometric screenings when used as a gateway to eligibility.

Overview of the Final Regulations

The Final Regulations apply to any wellness program—both participation-based and outcome-based—that includes disability-related inquiries and/or medical examinations.  In other words, if there’s no medical exam or inquiry, the program isn’t subject to the Final Regulations.

Under the ADA rules, the maximum reward (or penalty) attributable to an employee’s participation in a wellness program is 30% of the total cost of self-only coverage.  Likewise, under GINA, the maximum reward (or penalty) attributable to a spouse’s participation in a wellness program is also 30% of the total cost […]

By |May 26th, 2016|Compliance, Human Resources, Legislation, Medical, Wellness|Comments Off on EEOC Releases Final Rules for Wellness Programs under ADA and GINA

EEOC Reminded that Congress Writes Laws- But Will It Do Any Good?

“I’m just a bill, yes I’m only a bill, and I’m sitting here on Capitol Hill…”

A generation of Americans first learned of the legislative process from the 1976 “Schoolhouse Rock” cartoon segment called “I’m Just a Bill.”  In the song, “Bill”—a fictitious bill proposed in Congress—starts as an idea by “some folks back home.”  A Congressman hears the call and brings Bill to Washington, where he first sits in committee and then is passed by the House of Representatives and then by the Senate.  If Bill is lucky enough to get signed by the President, he becomes law.  Bill reminds us near the end of the song that “it’s not easy to become law.” That’s true.  But the sequel to “I’m Just a Bill” might focus on the desire of some federal regulators to rewrite the laws after the process described in “I’m Just a Bill” is completed.

A case in point:  the Equal Employment Opportunity Commission’s (EEOC’s) position on the use of health risk assessments, biometric screening and other wellness-related tools (collectively referred to in this Alert as “HRAs”) used by employers across the country in their fight to control health insurance costs. […]

By |January 13th, 2016|Compliance, Medical, Wellness|Comments Off on EEOC Reminded that Congress Writes Laws- But Will It Do Any Good?

It’s 2014 and Tobacco Use Surcharges are Here

The Affordable Care Act (ACA) now allows health insurance issuers in the individual and small group markets to impose a tobacco use surcharge, within a ratio of 1.5 to 1. Beginning in 2014 health insurance issuers in the individual and small group markets may vary insurance premiums based on a policyholder (or dependent’s) tobacco use, up to 1.5 times the regular premium. In addition, issuers of qualified health plans (QHPs) offered through an Exchange may also impose up to a 1.5:1 tobacco use surcharge.

The tobacco use surcharge is part of the ACA’s premium rating restrictions that apply for health insurance issuers in the individual and small group markets. The ACA’s rating restrictions do not apply to grandfathered plans, large group plans or self-funded plans.

On Feb. 22, 2013, the Department of Health and Human Services (HHS) issued a final rule to implement the ACA’s rating restrictions for health insurance premiums. The guidance in the final rule is effective for 2014 plan (or policy) years.

Overview of the Tobacco Use Surcharge

A tobacco use surcharge allows in insurance carrier to vary insurance premiums based on a policyholder’s (or dependent’s) tobacco use. Under the ACA, the premium rate charged by an issuer for non-grandfathered health insurance coverage offered in the individual or small group market may vary for tobacco use. However, the ACA limits this variation by not allowing insurance companies to charge those who use tobacco products more than 1.5 times the non-tobacco user’s rate.

States have the option of reducing or eliminating the tobacco surcharge altogether. However, states that wished to establish tobacco rating bands more protective than the federal requirements were required to report this decision to HHS by March 29, 2013.
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By |May 9th, 2014|Employee Benefits, Health Care Reform, Medical, Wellness|Comments Off on It’s 2014 and Tobacco Use Surcharges are Here

Encourage your Workers to Live Healthier Lifestyles- Tips for Employers

Today’s culture is centered around instant gratification. We all want it now.  People in decades past had to reheat food on the stove or in the oven before microwaves appeared. Black-and-white television sets would take a long time to warm up in the past, but modern devices display a vivid color picture almost instantly when powered on. The idea that not everything can be obtained without putting forth some effort and waiting seems to be a concept that is dying quickly.

When it comes to adopting healthy habits and getting rid of the unhealthy ones, a person’s gratification will certainly take time. Diet pills, miracle creams and other concoctions seem to promise quick or instant results for various health issues or conditions, but the truth is that quality results take time and effort. Some steps such as quitting smoking also take a great deal of commitment. The same is true for other addiction programs and weight loss programs. Workplace wellness programs can be very useful for employers to encourage healthy habits among their workers, but these programs need to leave room for the important points. They must also include ways to engage employees. […]

By |January 10th, 2014|Employee Benefits, Wellness|Comments Off on Encourage your Workers to Live Healthier Lifestyles- Tips for Employers

Taking Time to Make Good Open Enrollment Decisions

It’s unfortunate that many people take more time to choose their cell phone calling plan than they do making their annual employee benefit decisions during open enrollment. Making wise decisions about your benefits does require planning. By selecting benefits that provide the best care and coverage, you can optimize their value and minimize the impact to your pocket book.

Many people get tripped up when asked to select benefits for themselves and their families because these decisions can be complicated, and it is often easier to elect the same coverage that you had during the previous plan year. However, last year’s coverage may not suit you again, and there may be new plans that better meet your needs. Here are a few tips to help you make the best benefit decisions for you and your family: […]

By |November 6th, 2012|Employee Benefits, Employee Communications, Medical, Voluntary Benefits, Wellness|Comments Off on Taking Time to Make Good Open Enrollment Decisions

Health Care Cost Projections for 2011

The main objective of many HR professionals today is to temper costs by getting employees more involved in their medical care decisions, expenses and overall health. This may be at least partially attributed to the fact that many experts expect health care costs to increase in 2011.

Health Care Cost Projections for 2011

Cost trends are now available for 2011 from various research organizations. The following health insurance cost predictions are based on recent employer surveys.

Hewitt Associates reports that health care cost increases will be the highest levels in the last five years due to rising medical claim costs, the aging population and the changing health care reform landscape. The organization projects an 8.8 percent average premium increase for employers in 2011, up from 6.9 percent in 2010 and 6.0 in 2009. Also, the average health care premium for an employee at a large organization is expected to be $9,821 in 2011, up from $9,028 in 2010. Employees will be asked to contribute $2,209 (22.5 percent) of their total health care premium, which is up 12.4 percent from 2010, when employees contributed $1,966. Employee out-of-pocket costs are also projected to increase to $2,177 in 2011 from $1,934 in 2010.

Hewitt also reports that employers were able to mitigate costs in this difficult economy by cost shifting, negotiating costs with health plans and increasing their efforts to promote preventive care. Of respondents, 95 percent indicate that managing costs is a top business concern. They will reduce these costs by increasing employee cost sharing, conducting dependent eligibility audits, encouraging spouses to enroll in their own employer’s plans when available, consolidating vendors and taking measures to improve their employees’ health.

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By |March 15th, 2011|Employee Benefits, Medical, Wellness|Comments Off on Health Care Cost Projections for 2011

Cost-Shifting Initiatives

In an effort to reduce benefit costs, many employers are of course implementing cost-containment strategies.  Below are some examples:

–    Rewards For Good Health

  • Offer financial incentives to employees who have healthy habits and lifestyles or those who participate in wellness programs at work. Penalize workers with higher premiums for engaging in unhealthy activities, such as smoking.
  • Offer discounted rates for those who participate in wellness programs and maintain good health.

–    Preventive Care Benefits

  • Offer full coverage for employees who seek preventive medical care and preventative drugs without a deductible, including vaccinations, exams and screenings for diseases such as breast, colon and cervical cancer, blood pressure and cholesterol. Starting on the first plan year on or after Sept. 23, 2010, certain plans are required to cover preventive care services at no cost-sharing to the employee under PPACA.

–    On-site Health Centers

  • Offer on-site health centers and staff health coaches to provide advice on personal health needs.

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By |February 15th, 2011|Employee Benefits, Medical, Wellness|Comments Off on Cost-Shifting Initiatives

Individual Behavior Costs Billions in Health Care Annually

A recent report from a leading pharmacy benefit manager suggests behavioral factors are a cause of hidden costs in prescription drugs. According to Express Scripts’ Drug Trend Report approximately $163 billion dollars is needlessly spent on health care because of the bad habits of the American consumer.

Express Scripts released its findings during a two-day conference hosted by the St. Louis pharmaceutical manager. Express Scripts, one of the largest pharmacy benefits management (PBM) companies in the United States, handles an estimated 750 million prescriptions a year through a network of over 60,000 retail pharmacies.

Their latest findings disclosed that Americans would save a tremendous amount of money if they took their drugs as prescribed, chose generic over brand name prescriptions and ordered their prescriptions by mail.

Dr. Steven Miller, the company’s chief medical officer stated that Americans spend almost twice as much as other countries on health care and if patients would follow the guidelines offered by Express Scripts, the savings would be in the neighborhood of $163 billion.

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By |February 2nd, 2011|Employee Benefits, Wellness|Comments Off on Individual Behavior Costs Billions in Health Care Annually