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Deadline for Employers to Receive 2023 MLR Rebates Is Approaching

Employers with insured group health plans may soon receive a medical loss ratio (MLR) rebate from their health insurance issuers. Issuers who did not meet the applicable MLR percentage for 2022 must provide rebates to plan sponsors by Sept. 30, 2023. These rebates may be in the form of a premium credit or a lump sum payment.

MLR Rules

Employers with insured group health plans may soon receive a medical loss ratio (MLR) rebate from their health insurance issuers. Issuers who did not meet the applicable MLR percentage for 2022 must provide rebates to plan sponsors by Sept. 30, 2023. These rebates may be in the form of a premium credit or a lump sum payment.

Issuers who did not meet their MLR percentage for 2022 must provide rebates by Sept. 30, 2023. As a general rule, an employer who receives a rebate should use it within three months to avoid ERISA’s trust requirement. For rebates received on Sept. 30, 2023, this three-month deadline is Dec. 30, 2023. This deadline should be adjusted for rebates received before Sept. 30, 2023. Employers who receive MLR rebates should also be prepared to answer questions from employees about the rebate and how it is being allocated. The MLR rules require health insurance issuers to spend a minimum percentage of their premium dollars on medical care and health care quality improvement. This percentage is 85% for issuers in the large group market and 80% for issuers in the small and individual group markets. States may set higher MLR standards than the federal 80%/85% thresholds. Issuers must report to the federal government how they spent their premium dollars for each calendar year by July 31 …

By |August 7th, 2023|Broad Reach Benefits, Employee Benefits, Employee Communications, Human Resources|Comments Off on Deadline for Employers to Receive 2023 MLR Rebates Is Approaching
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How Employers Can Manage Talent Debt

The war for talent has been putting stress on many organizations. As employers continue to struggle to retain workers, they must simultaneously deal with talent shortages. As workers resign, there seems to be a lack of qualified candidates to fill open roles. Compounding employers’ labor struggles is the fact that many workers are currently disengaged. According to a 2022 Gallop report, the current level of disengaged workers is the highest in over 10 years. The unique combination of these factors is leading many organizations to accumulate talent debt. If employers don’t prioritize strategies to effectively address their talent debt, their organization’s success and bottom line can be impacted.

What Is Talent Debt?

Talent debt occurs when an employer accumulates outdated or inadequate skills within its organization and workforce. It can deplete an organization’s energy, culture, productivity and resources. Talent debt generally builds similarly to financial or other forms of debt, including when organizations hold onto poor performers or disengaged workers or fail to train and develop their workforce properly.

Causes of Talent Debt

Several factors can contribute to an organization’s accumulation of talent debt, including the following:

  • Lack of training—An employer’s failure to adequately invest in employee training and development can often lead to talent debt. If an organization isn’t providing employees with opportunities to learn and develop their skills, workers’ knowledge and expertise can quickly become outdated.
  • Talent shortages—Shortages of qualified and skilled workers can cause talent debt because they often make it difficult for employers to attract and retain top talent. Failing to hire qualified and skilled employees can easily result in an organization lacking the skills and expertise necessary to remain competitive.
  • Technology changes—Rapid technological advancements can result in some workers’ skills and expertise becoming obsolete. …
By |July 20th, 2023|Broad Reach Benefits|Comments Off on How Employers Can Manage Talent Debt
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Legal Alert- Workplace Wellness Plan Design

Many employers implement wellness plans to encourage healthier lifestyles, reduce absenteeism and help control health care spending.  There are several legal compliance issues that are involved with designing workplace wellness plans. Wellness plans must be carefully structured to comply with both state and federal laws. The three main federal laws that impact the design of wellness plans are:

  • The Health Insurance Portability and Accountability Act (HIPAA);
  • The Americans with Disabilities Act (ADA); and
  • The Genetic Information Nondiscrimination Act (GINA).

These laws each have their own set of legal rules for acceptable wellness program design, which are not always consistent with one another.

This Compliance Overview provides an overview of the requirements for wellness plans under HIPAA, the ADA and GINA. See Page 7 for a chart that compares key wellness plan requirements under these three laws.

HIPAA Requirements

A workplace wellness program that relates to a group health plan must comply with HIPAA’s nondiscrimination rules. HIPAA generally prohibits group health plans from using health factors to discriminate among similarly situated individuals with regard to eligibility, premiums or contributions. However, HIPAA includes a special rule that allows employers to provide incentives or rewards as part of a wellness program, as long as the program follows certain guidelines.

The HIPAA nondiscrimination rules were clarified by the Affordable Care Act (ACA). Under these rules, workplace wellness programs are divided into two general categories: participatory wellness plans and health-contingent wellness plans. This distinction is important because participatory wellness plans are not required to meet the same nondiscrimination standards that apply to health-contingent wellness plans.

Wellness programs that are not part of group health plans (for example, standalone programs that pay health club dues) are NOT subject to …

By |July 6th, 2023|Broad Reach Benefits, Compliance, Employee Benefits, Employee Communications, Human Resources, Voluntary Benefits|Comments Off on Legal Alert- Workplace Wellness Plan Design
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The Differences Between Short- and Long-term Disability Insurance and COBRA

Voluntary benefits are becoming increasingly important to employees as they focus on their physical, mental, social and financial health. As a result, many employers have expanded their voluntary benefits offerings to address employees’ needs and improve their attraction and retention efforts.

Among these offerings are disability benefits, which can provide guaranteed income or job protection to employees who are unable to work due to serious illness or injury. The most common disability benefits are short-term disability (STD) and long-term disability (LTD) insurance. However, understanding the differences between STD and LTD benefits and other laws, such as the Consolidated Omnibus Reconciliation Act (COBRA), can be complicated and difficult for employers to navigate.

This article provides a general overview of STD, LTD and COBRA and explores how both types of disability insurance differ from COBRA.

What Are STD and LTD?

STD and LTD insurance are the most common forms of disability benefits.

Short-term Disability Insurance

STD insurance replaces all or a portion of an employee’s income due to a temporary disability. Under STD plans, employees receive a percentage of their income, typically 40% to 70% of their base pay, but employers can allow employees to supplement their STD benefits with paid sick leave or other benefits. An STD insurance policy is paid either fully or partially by the employer, and the median length of

STD insurance coverage is 26 weeks, according to the U.S. Bureau of Labor Statistics.

To qualify for STD insurance, an employee files a claim under their insurance policy. The employee must prove their illness or injury qualifies as a disability under the plan’s terms. STD insurance generally requires employees to wait for a short period—on average, seven days—before they start receiving benefits to discourage abuse and because many …

By |June 19th, 2023|Broad Reach Benefits, Disability, Employee Benefits, Employee Communications, Human Resources, Long Term Disability, Voluntary Benefits|Comments Off on The Differences Between Short- and Long-term Disability Insurance and COBRA
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Unemployment Claims Trend Up, Reach Highest Level Since 2021

During the week ending June 3, 2023, workers filed 261,000 seasonally adjusted new unemployment claims, an increase of 28,000 from the previous week’s revised numbers. This is the highest number of new claims since Oct. 30, 2021. Before last week, initial unemployment claims had plateaued last month.

In May, the unemployment rate increased to 3.7% from 3.4% in April, even though the economy added 339,000 jobs. May’s unemployment rate represents a seven-month high. However, despite the increase in the unemployment rate, it remains low compared to historical data.

The surge in initial unemployment claims was driven by claim spikes in Ohio and California. Unadjusted initial claims in Ohio increased by 6,345 and by 5,173 in California. This claims data includes the Memorial Day holiday; there’s typically increased volatility in claims numbers during public holidays.

The four-week moving average of unemployment claims increased by 7,500 to 237,250. The four-week moving average is considered to be an accurate measure of current labor market trends.

Takeaways

Since the rise in new unemployment claims can be attributed to increases in a handful of states, it’s likely too early to draw conclusions regarding the pace of layoffs throughout the United States. While an increase in initial unemployment claims could signal a jump in layoffs, the recent volatility of weekly unemployment claims makes it difficult to draw any definitive conclusions.

Economists had expected layoffs to increase in 2023 in response to increases in interest rates. However, this has not happened as predicted, as demonstrated by the U.S. economy’s surprisingly strong job growth in May. While the labor market continues to be stronger than previously believed, many experts still believe a mild recession may arrive during the second half of 2023 or early 2024. As these workforce trends …

By |June 12th, 2023|Employee Benefits Adviser, Human Resources|Comments Off on Unemployment Claims Trend Up, Reach Highest Level Since 2021
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What Employers Need to Know About Medicaid Redeterminations

In 2020, the U.S. Congress passed the Families First Coronavirus Response Act in response to the COVID-19 pandemic, requiring states to maintain Medicaid coverage for most enrollees during the public health emergency (PHE). During this period, individuals receiving Medicaid did not have to reapply to remain eligible for benefits. In December 2022, the 2023 Consolidated Appropriations Act was passed, uncoupling Medicaid redeterminations from the PHE and establishing a timeline for states to restart the Medicaid redetermination process. As a result, as many as 15 million Americans may soon no longer be eligible for Medicaid because of redeterminations, according to U.S. Department of Health and Human Services estimates.

Medicaid provides health insurance to millions of eligible Americans with limited income and resources. Each state administers its own Medicaid program, and enrollees must apply annually to qualify for Medicaid benefits. This process is known as redetermination, renewal or recertification. The Medicaid redetermination process helps evaluate whether Medicaid enrollees are eligible for continued health coverage. Eligibility for continued health coverage depends on various factors, including changes in age, disability status, household size and income. States were able to resume annual Medicaid renewals starting April 1, 2023. This means coverage terminations have resumed for Medicaid enrollees who have been redetermined by state agencies as ineligible for Medicaid, resulting in the loss of their health care coverage. The precise date of resuming coverage terminations will vary by state.

A Primer on Stop-loss Contracts

Stop-loss insurance is coverage self-funded employers purchase to manage their health care costs and protect against unexpected or catastrophic claims by establishing a limit for the amount they pay in health claims. This coverage is not a form of medical insurance, and employers can add stop-loss insurance to an existing …

By |May 15th, 2023|Broad Reach Benefits, Employee Benefits, Employee Benefits Adviser, Employee Communications, Human Resources, Medical, Private Health Care Exchange, U.S. Department of Labor, Wellness|Comments Off on What Employers Need to Know About Medicaid Redeterminations
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Attracting New Employees in the Insurance Industry

Attracting talent is more complex than ever—and the insurance industry isn’t immune from today’s labor challenges. It’s time to figure out ways to keep people engaged in current insurance roles and entice new talent to try the industry. When it comes to talent attraction, the most successful employers will be creative and find ways to make the industry appealing and a great place to start a new career and grow professionally. This article explores how employers in the insurance industry can attract new employees.

Understanding Today’s Challenges

Employee attraction is top of mind for many employers in the insurance industry. According to Zywave’s 2023 Employee Benefits Market Pulse Report, attracting, retaining, and developing talent remains a top challenge facing brokers in 2023 (50.28%), which aligns with recent years. However, in older surveys, brokers ranked attraction and retention as the third most pressing employee benefits challenge. Attracting, retaining, and developing talent moved to the top of the list as organizations struggled to fill a record-high number of job openings in 2022. There was a significant gap between the number of job openings and available workers last year, increasing competition among employers to recruit new hires and retain existing employees. As a result, employees gained the advantage in negotiations, with many feeling confident to leave their jobs to find better opportunities (e.g., higher pay, better benefits). While the labor market has shown signs this may be changing, attraction, retention, and talent development remain major concerns for brokers, and these challenges are expected to continue in 2023. 2 These issues are compounded, as the insurance industry will face some of the most significant labor losses as more baby boomers steadily retire and reduce their participation in the labor force. According …

By |April 25th, 2023|Broad Reach Benefits, Employee Benefits, Employee Benefits Adviser, Employee Communications, Human Resources|Comments Off on Attracting New Employees in the Insurance Industry
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Insurers Take Steps to Overhaul Prior Authorization Processes

Insurers, such as UnitedHealthcare, Cigna, and Aetna, are announcing plans to revamp their prior authorization processes. These decisions were made as insurers await an impending federal regulation that will shorten prior authorization decision time. Prior authorization, also known as preauthorization, is when a physician must get approval from an insurer for medication or treatment before administering it.

A proposed Centers for Medicare and Medicaid Services (CMS) rule would limit the time insurers have to approve prior authorization requests. The rule is expected to be finalized in the near future. Starting in 2026, the CMS rule will require plans to respond to a standard request within seven days—instead of the current 14-day time frame—and within 72 hours for urgent requests. Physicians argue that the additional administrative steps associated with the preauthorization process can delay necessary services and increase the administrative burden.

The Changes

Major health insurers plan to revamp their prior authorization processes by boosting automation and speeding up decision-making. Starting this summer, UnitedHealthcare will reduce the use of its prior authorization process by 20% for nonurgent surgeries and procedures. The company will also implement a national “gold card” program in early 2024, allowing certain eligible providers to perform most procedures without authorization.

Cigna has removed prior authorization reviews from nearly 500 services since 2020. Around 6% of medical services for their customers are subject to prior authorization and Cigna continuously reviews the need for prior authorization on services.

Similarly, Aetna continues to review and assess utilization and the need for prior authorization requirements on select services.

What’s Next?

The CMS is expected to soon finalize its rule to streamline the prior authorization process, easing the burden on providers and patients. We’ll keep you apprised of any notable …

By |April 4th, 2023|Broad Reach Benefits, Employee Benefits, Employee Benefits Adviser, Human Resources, Medical|Comments Off on Insurers Take Steps to Overhaul Prior Authorization Processes
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Family and Medical Leave Act (FMLA): Serious Health Condition

The federal Family and Medical Leave Act (FMLA) requires covered employers to provide eligible employees with unpaid, job-protected leave for qualifying reasons. Qualifying reasons include needing time off due to the employee’s own serious health condition and caring for a spouse, son, daughter or parent who has a serious health condition.

Serious Health Condition

A serious health condition is an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a health care provider. It does not include routine medical examinations, such as a physical, or common medical conditions, such as an upset stomach unless complications develop.

Types of Serious Health Conditions

Inpatient care means an overnight stay in a hospital, hospice or residential medical care facility and any period of incapacity or subsequent treatment in connection with the overnight stay.

Health conditions are also considered serious if they require continuing treatment by a health care provider. Such conditions include:

  • Incapacity plus treatment involving a period of incapacity of more than three consecutive, full calendar days, with follow-up treatment;
  • Any period of incapacity due to pregnancy or prenatal care;
  • Any period of incapacity due to a chronic serious health condition requiring health care provider visits at least twice a year and recurring over an extended period;
  • A period of incapacity due to a permanent or long-term condition for which treatment may not be effective but requires the continuing supervision of a health care provider; and
  • Conditions requiring multiple treatments, which specifically include surgery after an accident or other injury, or a condition that would likely result in incapacity of more than three days without treatment.
By |March 13th, 2023|Compliance, Employee Benefits, Employee Communications, Human Resources, Legislation, Medical, U.S. Department of Labor|Comments Off on Family and Medical Leave Act (FMLA): Serious Health Condition
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