The old saying “timing is everything” may even apply to when you eat your meals, according to Michael Pollan, author of In Defense of Food. Skipping breakfast or having an occasional late dinner is fine, but sticking to an earlier eating schedule may contribute to healthier living by helping you maintain a healthy weight. Findings were based on a small study implemented over an 8-week period in which adults had three meals and two snacks between 8 a.m. and 7 p.m., followed by a two week break and eight weeks of a later schedule, which included three meals and two snacks eaten between noon and 11 p.m.
The later eating schedule resulted in weight gain and a negative impact on insulin levels, cholesterol and fat metabolism. The study also showed that when people ate earlier, they stayed satisfied longer, which helped them prevent overeating. Given our hectic schedules, eating later occasionally is hard to avoid. But it will help if you can make an effort to get back to an earlier schedule.
According to a Medscape survey of more than 19,000 physicians, the average patient spends between 13 and 16 minutes with their physician during an office visit. Given the short amount of time, it is probably best to focus on two or three things you want your doctor to address. It may also help to prepare a list of questions ahead of time. Here are a few you may want to consider.
- Which health websites do you trust?
- What is this medication I’m taking and why am I taking it?
- If you’re a smoker, how can I get help to stop?
- Are my screenings and vaccinations up to date?
- What is a healthy weight for me and how can I get to that?
- What do you do to stay in shape?
- If you’re taking a prescribed opioid painkiller, ask if it’s really necessary and what else you might take?
- What are some things I can do before my next appointment to make me healthier?
- If a test is ordered, ask what it is for and what are you trying to learn from it.
- When a specific treatment is recommended, don’t hesitate to ask about other alternatives.
We often hear of professional athletes succeeding under pressure by staying “in the moment” and remaining focused on the things that are within their control. This challenge can be applied to the uncomfortable position all of us find ourselves in today – somewhere between complying with existing laws and anticipating the unknowns coming from Washington.
While the IRS has relaxed enforcement of the individual mandate and acknowledged problems in the ACA reporting system, it has confirmed that an applicable large employer is still subject to an employer shared responsibility payment if it fails to offer coverage to 95% of its full-time employees. We continue to help large employers offer minimum essential coverage to avoid penalties, when appropriate, and track offers of coverage to comply with reporting requirements on IRS forms 1094 and 1095.
Other matters remain up in the air as well, including the so-called Cadillac tax on high-cost health plans and any changes in maximum contributions that may be made to HSAs, which would require legislative action. While any significant ACA repeal, replace or repair efforts appear to be overshadowed by the Administration’s interest in tax reform, we continue to monitor developments in healthcare reform and keep our clients and partners informed. It’s our way of doing what we can and remaining “in the moment.”
The gradual transition to high deductible health plans is having a significant impact on out-of-pocket costs, according to a study released by the Kaiser Family Foundation/Health Research & Educational Trust. In 2016, for the first time, just over half of all workers (51%) with single coverage faced a deductible of at least $1,000. The study also showed that 29% of workers were in high-deductible plans compared to just 20% two years earlier.
An analysis by FAIR Health, an independent nonprofit that reviews health and dental claims filed by individuals, shows that severe allergic reactions to foods like peanuts have increased five-fold in the past 10 years. Studies now show that as many as 8% of children have a food allergy, with nearly 40% reflecting a history of severe reactions. More than a fourth of all claims were linked to peanuts, while tree nuts such as walnuts, pistachios and seeds accounted for 18%. One interesting fact is that a third of all claims were in people over the age of 18.
In a recent legislative update from SIIA, it was noted that the New Jersey Department of Banking and Insurance (DOBI) approved regulations lowering minimum stop-loss attachment points for large groups of 51 lives and above, effective in late August.
This move allows the large group individual attachment points to be $20,000 per individual, reduced from $25,000 and sets the minimum aggregate attachment point at 110% of expected claims, down from 125%. These changes broaden the levels of stop-loss or excess risk coverage available to self-funded health plans and brings New Jersey’s definition in line with the NAIC Stop Loss Insurance Model Act.
With time running out on an opportunity for Congress to repeal and replace the Affordable Care Act and open enrollment season approaching, thousands of small and mid-sized businesses are likely bracing for another round of premium increases. A growing number of employers, however, will choose to avoid the uncertainty plaguing traditional group insurance markets by moving to a self-funded health plan – an option that provides an opportunity for savings and far more plan design flexibility.
Healthcare benefits continue to be perhaps the biggest obstacle facing small and mid-sized businesses. The Self Insurance Institute of America reports that between 2011 and 2016, the average annual deductible for employer-sponsored plans increased by 49% and the percentage of firms with fewer than 200 employees still providing health benefits fell from 68% in 2010 to 55% in 2016.
Self-funding on the other hand, has proven to be a far more responsible alternative for employers, enabling thousands to not only use their health benefit plan to attract and retain high quality employees, but to do so at an affordable cost. While self-funding has long been a staple for the nation’s largest employers, nearly a third of companies with 200 or more employees now offer at least one self-funded option.
Everyone Benefits from Flexibility
There are many reasons for the growth of self-funding, with flexibility and access to valuable claims data high on the list. Since self-funded plans are governed by ERISA, they avoid many of the costly mandates governing fully insured plans. To manage risk, stop loss coverage is obtained to cover claims that exceed anticipated levels. If claims are below anticipated levels, the plan retains the savings that would have been paid to an insurance carrier in the form of non-refundable premiums. Benefits can be customized to meet the unique needs of the group. When an independent TPA is engaged to administer the plan, claims data can be analyzed to identify chronic conditions and other key cost drivers. Services such as telemedicine and mobile transparency tools can be added to make physician access more convenient and more affordable. From plan design to data analysis, everyone benefits from the flexibility that a self-funded plan can provide. It’s the biggest reason why more small and mid-sized companies continue to move to self-funding with help from an independent TPA.
As a result of identical ordinances passed by both City Councils, workers in the Twin Cities became entitled to paid sick time leave on July 1st of this year. While the state legislature tried to protect employers, businesses are now required to offer employees one hour of paid sick leave for every 30 hours worked. The Minneapolis ordinance allows companies with five or fewer workers to offer unpaid time, but St. Paul does not offer this exemption. Overall, employees can accrue up to 48 hours per year and roll that over to the next year.
Time off can be used for illness or medical care of the employee or family, a closure of daycare facilities or schools and for counseling, legal support or related services due to an incident of domestic or sexual violence.
According to Deloitte Consulting LLP, small and medium sized employers with 100 or more workers are contributing considerably more towards the cost of employee and dependent healthcare benefits than legally required – about 73% of the total cost, on average. Regional differences also exist, with companies in the Northeast contributing more toward the cost of family coverage and companies on the West coast contributing more to individual coverage.
Even as healthcare costs continue to increase, consultants agree that employers of all sizes will continue to contribute significantly to healthcare benefits as the job market continues to tighten and retaining top talent remains a top priority.
In New York, industry efforts to support self-funding for smaller groups have led to legislation extending the grandfathering of existing stop-loss policies for groups of 51 to 100 for an additional year, through January 1, 2019.
Other legislation impacting access to stop-loss insurance products by smaller groups has taken effect in Minnesota and is slated to become effective in New Mexico on July 1st. Attachment points are still being discussed in New Mexico and it appears that new opportunities for smaller groups may emerge in Minnesota as well. Since our last newsletter, legislation prohibiting small group stop-loss failed to advance beyond committee debate in the State of Maine.