The Kaiser Family Foundation reports that annual premiums for employer-based, family coverage increased to $20,576 in 2019. This represents a one year increase of about 5 percent and a pattern of similar increases each year throughout the past decade, significantly outpacing the rate of annual inflation over the same period.
Everyone knows that a routine vision exam is important, but few may know that an optometrist or ophthalmologist can identify more 30 medical conditions, often before any outward symptoms occur. Heart disease, diabetes, liver disease and certain cancers are just a few of the serious conditions that are often detected early on by an eye care professional.
This is surprising to many, but the fact is that because our eyes are extremely sensitive organs, they are often one of the first areas affected by changes to our nervous or circulatory systems. And because the eyes and brain are so close to each other, an eye exam can often predict dementia and Alzheimer’s disease years before they begin to affect memory. If vision care is not a part of your current benefits plan, consider using your FSA or HSA funds to schedule an eye exam. Doing so just may help save your life or that of a loved one.
A recent survey by a data analytics firm found that benefits objectives often vary based on company size. Results showed that while smaller companies were focused on increasing employee productivity, mid-range employers were more concerned with employee satisfaction levels. Very large employers identified employee health and well-being as their main objective.
One interesting finding was that regardless of objectives, a high percentage of employers expressed concern that their health benefits were falling behind those of industry peers. If you share that concern, be aware that even though expectations vary by industry and workforce demographics, the days of doing things because “that’s the way we’ve always done it” are over.
Stay Open to New Ideas
Top workplaces are committed to innovation in every part of their operation and health benefits are no exception. By self-funding, most use claims data to respond to member needs and take advantage of new opportunities. Health concierge services, price transparency tools, bundled pricing and the trend to low or no deductibles and copays are just a few of the ways health plans are innovating to rein in rising costs and help employees get the care they need – important objectives of a high quality health plan.
Nearly 1 in 5 U.S. adults live with a mental illness. Since it has become virtually impossible to avoid a condition at work, here are some of the factors involved. First, professionals tell us that multiple cycles can impact health and productivity in different ways. Conditions can trigger at any time and while early symptoms can be mild, a supportive work environment is critical. Symptoms often increase during later phases, causing work performance to suffer. Mental health benefits and disability insurance will come into play as everyone works together to help the employee remain at work or return to work as soon as possible. Symptoms can become severe during advanced phases, making a disability leave, family leave or access to an EAP or in-network providers likely.
Because fewer than half the people who need help ever receive treatment, meeting the issue of mental health head on is very important. Having a general conversation or town hall about behavioral health can go a long way in creating a safe, healthy, supportive environment.
Even though Labor Department reports show that fewer than 15% of private sector employees are covered by paid leave programs, more states are looking for ways to help employees cope with the difficulties of caring for family members of all ages. In addition to California, New Jersey and Rhode Island that have had programs in place for a long time, New York, Washington and the District of Columbia have passed similar laws.
While most private sector programs provide paid maternity and parental leave, more and more employers are looking for ways to help employees caring for elderly parents or family members facing serious health conditions. An increasing number of employers are providing on-site daycare facilities to reduce absenteeism. Those that lack the facilities are lowering stress levels for parents by helping to subsidize their daycare expenses.
Whether you refer to it as Reference Based Pricing, Medicare Reference, Cost Plus or something else, the important thing is to understand what it is and why it’s being used to lower health plan costs.
Health plans with reference based pricing provide high quality coverage at a lower cost by using Medicare fee schedules as a base. Then they negotiate with hospitals and physicians to determine an acceptable percentage margin over and above Medicare. Margins often fall within a range of 25% to 65%. The absence of PPO networks takes many of the “unknowns” out of play. Rather than operating at the mercy of networks that traditionally save their largest discounts for the largest health plans, reference based pricing takes the mystery out of network discounts by fixing fees for covered services. In addition to lower out-of-pocket expenses, members also gain the flexibility they need to search for a physician that meets their needs rather than settling for a smaller network in order to save on out-of-pocket expenses.
Experience Makes the Difference
Administration is always important when a health plan is self-funded. But reference based pricing requires much more than claims administration. Supporting a health plan with reference based pricing requires a TPA with the skills to make providers comfortable with this form of reimbursement and the resources to protect the plan against issues such as balance billing.
Many employers fear reference based pricing because of balance billing, which can occur when the established fee does not pay a provider’s bill in full and the provider chooses to bill the unpaid balance to the member directly. Even though resourceful TPAs point out that concerns about balance billing are often overblown, they typically integrate measures to protect members against it. In most cases, these include adding the services of attorneys or consultants to enforce the terms of the reimbursement agreement or negotiate a payment settlement with hospitals that may not be subject to negotiated reimbursement rates.
Experienced TPAs know that the competitive landscape for providers can often determine the potential for referenced based pricing in a given community. While it may not be appropriate for all employer groups, the ability to control future healthcare costs certainly makes it worth exploring.
Following the President’s signing of the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act of 2020 into law, we wanted to provide a brief overview of the two primary financing options for businesses that have been negatively impacted by the COVID-19 pandemic: (1) U.S. Small Business Administration (“SBA”) Economic Injury Disaster Loans (“EIDLs”) and (2) SBA 7(a) loans under the CARES Act.
Read the full CARES Act of 2020 here.
Click here for additional COVID-19 Resources.
As more and more employer-sponsored health plans become self-funded, the trend from PPOs to direct provider contracting is growing. High quality health plans continue to demonstrate that direct contracting promotes a more level playing field where both parties can agree on pricing that is fair rather than trying to determine the real value of network discounts.
“The information shared below was received from our legal services partner, Enquiron. It is one of the best, most comprehensive employer guides that I have received. I hope you find it equally as informative and helpful. Thank You and Stay Well.”
– Bruce Flunker, Bruce Flunker, President of EBSO, A 90 Degree Benefits Company
EMPLOYER ALERT – EMERGENCY PREPAREDNESS IN THE WORKPLACE – GUIDE TO PREPARE FOR COVID-19
In the midst of dealing with an emerging situation in the workplace, which can include natural disasters, mass shootings, or pandemic such as COVID-19, employers may have questions related to their workplace and their employees. This Alert is designed to address common questions that affected businesses and employers may be asking in the midst of such a situation – and remember we are here to help!