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Biden Administration Clamps Down on Short-Term Health Insurance

by Inoventive Solutions
April 23, 2024

The Biden administration has rolled back regulations that allow Americans to stay on short-term health insurance plans for up to three years while still satisfying the Affordable Care Act’s individual mandate.

The new rules will limit these controversial plans to no more than four months and they require more disclosure on behalf of the insurers and agents that sell these plans to help consumers understand what they are buying.

These plans are not full-fledged health plans; they offer limited scope of coverage that caps insurance for many services, and they are not subject to ACA consumer protection rules that bar discrimination and guarantee coverage regardless of pre-existing conditions.

The ACA originally limited short-term plans to just three months to fill temporary gaps in coverage when someone is transitioning from one source of coverage to another. The Trump administration enacted new regulations that allowed people to stay on a plan for 12 months, with the option to renew for three years.

These plans have gotten a lot of bad press citing horror stories of people finding out their policies were virtually useless, leaving one man more than $43,000 in debt after his plan wouldn’t pay for his treatment after it deemed his cancer a pre-existing condition.

Critics say the plans are deceptively marketed and consumers are duped into buying health insurance that has stripped-down coverage. Proponents say that these plans serve a valuable purpose in helping people transition from one type of coverage to another.

Many people who have purchased these plans thought they were receiving comprehensive coverage but were surprised later when the insurance wouldn’t cover certain procedures or capped coverage.

Some common features of short-term plans are:

  • They often use health histories to determine who can get coverage.
  • They often exclude key service categories from covered benefits, such as maternity.
  • They can decline coverage due to pre-existing conditions.
  • They may limit or cap coverage both on a per-service or daily rate basis or in the aggregate (like capping total payments during the year at $100,000).
  • They are not required to cover the 10 essential health benefits that the ACA requires compliant plans to cover at no cost to the enrollee.

What the final rule does

The new regulations only apply to new plans that are launched on or after June 17, the day the final rule takes effect.

New plans that claim to be “short-term” health insurance will be limited to just three months, with renewal for a maximum of four months total, if extended.

Also, the final rule restricts how these plans may be marketed and requires new levels of disclosure. Plans will now be required to provide consumers with a clear disclaimer that explains the limits of what services they cover and how much they cover. 

It should be noted that the new rule does not affect fixed indemnity plans like critical illness, which pays a lump sum if someone is diagnosed with a covered illness. Other plans pay a pre-determined amount on a per-period or per-incident basis, regardless of the total charges incurred.

Plans might pay $200 upon hospital admission, for example, or $100 per day while a person is hospitalized to help with out-of-pocket costs.

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Employee Mental Health Leave Requests Skyrocketing

by Inoventive Solutions
April 16, 2024

If you’ve noticed a lot of employees asking for time off for a “mental health day,” you aren’t alone.

A recent study found that the number of mental health leave-of-absence requests has grown by a third since the COVID-19 pandemic. And, data from ComPsych, a provider of employee assistance programs (EAPs), shows that such leave requests have skyrocketed by more than 300% in the past six years.

Roughly seven out of 10 of leave requests for mental health reasons are from women — in part but not entirely because of the burden and added stress of childcare.

Poor mental health is a serious problem in the workplace. Stress, anxiety, depression and substance abuse lead to reduced focus and concentration, increased absenteeism and presenteeism, higher turnover costs, and more dangerous workplace accidents.

If you’re seeing a broad increase in the number of mental health-related absences, it’s a sure sign that something is wrong. It’s time to take action: 

1. Destigmatize mental health problems. Create a culture where it’s ok to discuss mental health issues, and to seek help.

2. Establish an EAP. Workers can use this program to get confidential counseling treatment for a variety of issues. 

3. Invest in mental health training for managers. Your leaders need training on how to recognize and sensitively deal with workers experiencing mental health problems. 

4. Offer flexible work schedules. Many minor issues can be dealt with by allowing employees more control over their time and work-life balance. Working from home, flex hours, job-sharing programs and generous paid-time-off policies can all help employees manage their stressors before they become real mental health problems.

5. Create a less stressful workplace. Work to reduce unrealistic deadlines, spread the workload and maintain adequate staffing levels. Reassign or eliminate “toxic” managers.

6. Address the cost barriers to care. Many employees can’t afford to see a doctor or counselor, even with insurance. Studies show that one in four adults skips needed care or medications due to cost. Consider adding a direct primary care benefit, which allows workers and covered family members unlimited appointments with their primary care physician with no out-of-pocket costs. 

7. Offer mental health or sick day leave. Employers nationwide are responding to the employee mental health crisis by expanding their leave programs. In 2024, over 50% of organizations plan to add paid parental leave, paid mental health days and flexible time off programs. Additionally, 49% are adding bereavement leave, and 37% are adding paid caregiver leave as an employee benefit. 


The takeaway

Employers have a number of tools they can access to help employees who are dealing with stress and anxiety. Work can also be a cause of stress, so it’s important that your staff should feel comfortable approaching their supervisors or managers if they are having trouble coping.

You can’t prevent all mental health problems. But you can alleviate work stressors and provide support so that small problems don’t metastasize into mental health crises.

"Success
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Study Pegs Group Benefits Return on Investment at 47%

by Inoventive Solutions
April 9, 2024

A recent study has found that employers who offer health insurance coverage to their staff had an average return on investment (ROI) of 47%, meaning that for every $1 an employer spends, it will receive $1.47 in benefits.

The analysis by Avalare, a wellness plan provider, and commissioned by the U.S. Chamber of Commerce, found that firms with 100 or more workers to whom they offer group health benefits gained from increased productivity, reduced direct medical costs (for self-insured firms), tax benefits and improved retention and recruitment.

The study confirms that offering health coverage does more than meet a basic need for your staff. Here’s how the 47% ROI is generated:

 

Improved productivity (53% of ROI)

Workplaces where group health benefits are offered have higher productivity thanks to reduced absenteeism and sick days taken, as well as less presenteeism. In addition, workers who maintain their health and have access to a health plan or wellness program when they need one are less sick, and hence more productive at work.

 

Tax benefits (23% of ROI)

Employers that offer group health benefits receive both federal and state income tax deductions, reducing their overall tax bills.

 

Reduced direct medical costs (19% of ROI)

Employers who offer group health plans in addition to associated wellness programs, tend to have healthier employee populations and spend less on direct medical costs. The analysis found that this combination of group health and wellness programs boosted overall ROI for employers.

 

Savings from employee retention (4% of ROI)

Another ROI driver is employee retention thanks to the savings involved in not losing employees to competitors. Providing health insurance reduces staff turnover, lowering how much employers have to spend on recruitment, onboarding and training. Add tens of thousands of dollars if you are paying for a new employee to relocate. 

 

Recruitment costs (0.3% of ROI)

Offering a solid group health plan can also drive down the cost of recruiting as it can positively influence a prospect’s interest in accepting an offer. While the value of recruitment benefits pales in comparison to other benefits, 9% of prospects base their decision to accept an offer on the group health benefits on offer.

 

The takeaway

While the study focused on health coverage, and to some part wellness programs, employers that go beyond just health insurance by creating and offering a balanced benefit program, have the greatest ROI.

Examples include retirement benefits like 401(k) plans, wellness plans, dental insurance, vision coverage, short- and long-term disability protection, critical illness coverage, accident coverage and employer-funded life insurance.

Before the COVID-19 pandemic, most businesses considered health benefits little more than a cost to be managed. But the value of health benefits is rapidly changing — and employers need to keep up with the changes and new offerings.

.The Avalere study reinforces what many companies know: Employer-provided coverage helps create a stronger workforce and gives businesses valuable benefits to provide to their employees.

We have the expertise to help you transform your health benefits and programs from an expense into an investment that will help both your organization and your staff thrive.

"One
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Four Admin Errors That Can Make Employers Overpay for Coverage

by Inoventive Solutions
April 2, 2024

One often overlooked cost driver to your employee benefits plans is administrative errors and oversights that are the result of sloppy record-keeping and a lack of checks and balances among your account and human resources teams.

If you are not diligent in keeping up with outgoing employees, are not paying enough attention to admin details and checking billing for errors, and are not reviewing accounts regularly, you could be leaving money on the table unnecessarily and overpaying for your group health insurance and other employee benefits you offer.

The following are some of the most common administrative mistakes that could lead to overspending on your group health plan.

Failing to keep up with staffing numbers

If your human resources and accounting are not talking to each other, you risk failing to account for personnel that leaves and continuing to include them in the health insurance roster and paying their premium.

Obviously, this is typically not an issue in a small organization of 10 to 15 employees, but the more workers you have, the easier it is for one to slip through the cracks after they leave.

Consider having HR review personnel numbers monthly and updating your files to avoid this happening.

Failing to check for ‘age-outs’

Workers who have turned age 65 may not require your company health plan anymore, since they are eligible for Medicare. You can reduce health care administration and benefits costs substantially by keeping an eye out for age-outs each year.

Missing changes to plans

Before and during open enrollment it’s important to review all of the benefits plans that you offer — health, dental and vision coverage — to make sure there aren’t any changes that will increase the cost of any of the plans.

Sometimes a plan will introduce additional coverage that your employees may not need and, if you are not staying on top of changes, you may miss the opportunity to move them to another plan.

Admin mistakes by insurers

Administrative mistakes made by the insurers you contract with can be overlooked, forcing you to overpay for your employees’ coverage.

Your accounting and HR teams should regularly audit your insurers’ billings to check for errors and ask the companies to correct any that are found. One of the most common mistakes is for an insurer to have an incorrect employee count. But the carriers can make other mistakes in billing, too.

If you notice an increase in your monthly bill with no new staff additions, you may want to delve deeper.

The takeaway

By putting in place administrative controls and a regime for regular billing and personnel-count auditing, you can avoid mistakes that add to your employee benefits costs.

Keep an open line of communication with your insurers in case you need to work with them to address any issues that arise.

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J&J Sued Over Contracting with PBM that Overcharged Health Plan, Enrollees

by Inoventive Solutions
March 19, 2024

A new area of potential liability for employers was recently opened when a class-action suit was filed against Johnson & Johnson, accusing it of mismanaging its pharmacy benefit manager plan, resulting in the health plan and its enrollees overspending millions of dollars on medications.

Health plans contract with PBMs to tamp down pharmaceutical costs, but reports have shown that they often send enrollees to pharmacies they own and which overcharge for medications sometimes by thousands of percent.

PBMs have been drawing increasing flak from states attorneys general as well as Congress and state houses, where multiple measures that would rein them in are in play.

If the lawsuit is successful, it could leave both self-insured and insured employers exposed to lawsuits by disgruntled employees who are forking out significantly more than they should.

The case

The class action, filed Feb. 5 in the US District Court for the District of New Jersey, accuses J&J of breaching its fiduciary duty under ERISA when it mismanaged its employee health plan by paying its PBM, Express Scripts Inc., inflated prices for generic specialty drugs that are widely available at a much lower cost.

The employees suing J&J cite a number of examples of how the company’s plan overpaid for prescription drugs. One of the most egregious examples cited in the lawsuit was an instance when the plan paid more than $10,000 for a 90-pill generic drug to treat multiple sclerosis, which can be purchased without insurance on different retail and online pharmacies for $28 and $77.  

“The burden for that massive overpayment falls on Johnson and Johnson’s ERISA plans, which pay most of the agreed amount from plan assets, and on beneficiaries of the plans, who generally pay out-of-pocket for a portion of that inflated price,” the plaintiffs wrote.

“No prudent fiduciary would agree to make its plan and beneficiaries pay a price that is two-hundred-and-fifty times higher than the price available to any individual who just walks into a pharmacy and pays out-of-pocket,” they added.

It further accuses J&J of agreeing to terms under which plan beneficiaries were financially incentivized to obtain their prescriptions from the PBM’s own mail-order pharmacy, even though that pharmacy’s prices are routinely higher than the prices at other pharmacies.

The case accuses the company of:

  • Failing to regularly put PBM services out to bid.
  • Failing to negotiate favorable terms with PBMs and continually supervise PBM’s actions to ensure that the plan is reducing costs and maximizing outcomes for beneficiaries.
  • Failing to periodically attempt to renegotiate PBM contracts.
  • Failure to independently assess the PBM’s formulary placement of each prescription drug and closely supervise PBM’s formulary management to ensure the plan is paying only reasonable amounts for each prescription drug.
  • Improperly steering plan participants towards their PBM’s mail-order pharmacy, even though that pharmacy’s prices were routinely higher than what retail pharmacies charge for the same drugs.

The fallout

Legal observers say employers that offer their employees group health insurance that includes one of the nation’s large PBMs, could be targeted.

The driving argument would be that employers have been warned through news reports of how PBMs have been accused of not being transparent about their negotiated prices, and how they often pocket rebates that could be used to lower the plan’s and enrollees’ outlays.

Most at risk are employers that are in self-insured or level-funded plans. It’s not clear yet how much liability insured employers may have, but they too could be accused of choosing health plans for their employees that contracted with PBMs that allegedly overcharge for medications.

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Benefits in a Multi-generational Workplace

by Inoventive Solutions
March 12, 2024

With multiple generations working side-by-side in this economy, the needs of your staff in terms of employee benefits will vary greatly depending on their age.

You may have baby boomers who are nearing retirement and have health issues, working with staff in their 30s who are newly married and have had their first kids. And those who are just entering the workforce have a different mindset about work and life than the generations before them.

Because of this, employers have to be crafty in how they set up their benefits packages so that they address these various needs.

But don’t fret, getting something that everyone likes into your package is not too expensive, particularly if you are offering voluntary benefits to which you may or may not contribute as an employer.

Think about the multi-generational workforce:

Baby boomers – These oldest workers are preparing to retire and they likely have long-standing relationships with their doctors.

Generation X – These workers, who are trailing the baby boomers into retirement, are often either raising families or on the verge of becoming empty-nesters. They may have more health care needs and different financial priorities than their older colleagues.

Millennials and Generation Z – These workers may not be so concerned about the strength of their health plans and may have other priorities, like paying off student loans and starting to make plans for retirement savings.

Working out a benefits strategy

If you have a multi-generational workforce, you may want to consider sitting down and talking to us about a benefits strategy that keeps costs as low as possible while being useful to employees. This is crucial for any company that is competing for talent with other employers in a tight job market.

While we will assume that you are already providing your workers with the main employee benefit – health insurance – we will look at some voluntary benefits that you should consider for your staff:

Baby boomers — Baby boomers look heavily to retirement savings plans and incentives, health savings plans, and voluntary insurance (like long-term care and critical illness coverage) to protect them in the event of a serious illness or accident. 

You may also want to consider additional paid time off for doctor’s appointments, as many of these workers may have regular checkups for medical conditions they have (64% of baby boomers have at least one chronic condition, like heart disease or diabetes).

Generation X — This is the time of life when people often get divorced and their kids start going to college. Additionally, this generation arguably suffered more than any other during the financial crisis that hit in 2008. You can offer voluntary benefits such as legal and financial planning services to help these workers.

Millennials and Generation Z — Some employee benefits specialists suggest offering these youngest workers programs to help them save for their first home or additional time off to bond with their child after birth.

Also, financially friendly benefits options, such as voluntary insurance and wellness initiatives, are two to think about including in an overall benefits package.

Voluntary insurance, which helps cover the costs that major medical policies were never intended to cover, and wellness benefits, including company-sponsored sports teams or gym membership reimbursements, are both appealing to millennials and can often be implemented with little to no cost to you.

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Voluntary Benefits Improve Employee Satisfaction and Retention

by Inoventive Solutions
February 28, 2024

As the economy continues roaring, the market for top talent stays exceedingly competitive. Multiple studies have consistently shown that a robust set of employee benefits is a vital component of an overall compensation package.

But it’s tough for smaller companies to compete with their large counterparts, who have the advantage of economies of scale. As a result, many employers are increasingly turning to voluntary employee benefits, which allow them to provide valued, high-demand benefits to employees at little or no cost to the company. 

How voluntary benefits work

Voluntary benefits are arranged by employers but either paid for by staff via payroll deduction or by the employers themselves. Businesses generally set up a menu of options that their workers can select from for themselves, based on their own needs.

The employer deducts any fees or premiums for these benefits from employee paychecks and forwards them in a single batch to the benefit vendors.

Once the employee enrolls in a voluntary benefit plan, payroll services companies routinely automate this process for employers, making ongoing benefits administration hassle-free for small businesses.

And best of all, because premiums and fees are often paid by the employees, even small companies can provide popular and highly valued benefits for little or no cost.

Popular voluntary benefits

There are several types of voluntary employee benefits on the market today, with more innovative new benefits and perks rolling out every year. However, the following are among the most in-demand by employees and commonly offered by their employers:

  • Dental and vision insurance coverage
  • Disability insurance coverage
  • Life insurance — can be term or cash value
  • Legal assistance/prepaid legal services
  • Identity theft insurance
  • Fitness/health club memberships
  • Long-term care insurance
  • Financial planning/counseling services
  • Accident insurance
  • Hospital indemnity plans
  • Pharmacy discount plans
  • Critical illness insurance (e.g., cancer insurance)
  • Pet insurance.

Employees can often buy these benefits and services via their employer’s group voluntary benefits plan much more cheaply than they could buy them on their own.

Voluntary benefits have been becoming more popular among employers in recent years as unemployment falls. One reason: More employers are offering high-deductible plans as health insurance costs continue to increase. 

Critical illness and hospital indemnity policies have seen big gains in enrollment as workers turn to them to help cover those deductibles and copays if they have a costly health event like cancer or another critical illness diagnosis.

According to a recent LIMRA study, seven out of 10 employers surveyed reported that they believe offering voluntary benefits improves employee morale and satisfaction.

A 2023 Harris Interactive poll found that when employers offer voluntary benefits, 55% of workers, on average, report that they are satisfied with their employer’s overall benefit mix. Where the employer did not offer voluntary benefits, the satisfaction rating fell to 32%.

Best practices

  • Don’t overwhelm employees with too many benefit choices at the same time. Roll them out a few at a time, starting with life insurance, dental/vision and/or disability insurance. These are proven high-participation programs.
  • Match benefits to your employees’ life stages. Millennials have different needs and interests than baby boomers.
  • Put effort into your benefits education and communication plan.
"Vision
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Protect Your Workers’ Eyesight with Proper Design, Vision Benefits

by Inoventive Solutions
February 20, 2024

One of the by-products of the digital revolution – with most people staring many hours each day at tablets, smart phones and computers – is eye strain.

According to The Vision Council, the average U.S. adult spends more than two hours a day looking at electronic screens. Looking at such screens for too long can result in dry and irritated eyes, blurred vision and eye fatigue, as well as headaches.

Besides the trouble for eyes, using these devices can also result in back and neck pain from that hunched-over position that many people use when on these devices.

Prolonged use can cause “computer vision syndrome,” which manifests itself in a number of symptoms like eye strain, dry eyes, blurred vision, red or pink eyes, burning, light sensitivity, headaches and pain in the shoulders, neck and back.

To help prevent digital eye strain, you should ensure that:

  • Your employees sit with their eyes about 30 inches from their computer screen,
  • Your employees rest their eyes every 15 minutes, and blink frequently, which helps keep the eyes moist. It’s been found that when people work on computers they blink about one-third as much as they typically would.
  • You have proper lighting in the office. Eye strain often is caused by excessively bright light, either from outdoor sunlight coming in through a window or from harsh interior lighting. When you use a computer, ambient lighting should be about half as bright as that typically found in most offices.
    If possible, turn off the overhead fluorescent lights in your office and use floor lamps that provide indirect incandescent or halogen lighting instead.
  • Upgrade your displays. If you have not already done so, replace your old tube-style monitor (called a cathode ray tube, or CRT) with a flat-panel liquid crystal display (LCD), like those on laptop computers. LCD screens are easier on the eyes and usually have an anti-reflective surface.
  • Adjust computer display settings, which can help reduce eye strain and fatigue. Ask your employees to adjust the brightness of their display so it’s approximately the same as the brightness of the surrounding workstation. They can also adjust text size and contrast.

Consider vision benefits

If you don’t already do so, consider offering your workers vision benefits.

First off, your employees would be more apt to get a much-needed pair of glasses that have anti-glare attributes for when they work on computers.

Computer glasses are specially designed for optimizing vision when viewing content on screens, and they can be provided with or without a prescription.

Wearing computer glasses can help users experience more relaxation, sharper focus and reduced blurriness and pixilation, which can cause discomfort unless corrected. The lens designs allow the eyes to relax, adjusting to intermediate-distance objects and reducing glare during prolonged use of digital devices.

Also, workers with vision benefits tend to get regular eye exams, which can identify serious chronic conditions, including diabetes, high cholesterol, hypertension, multiple sclerosis and some tumors.

Detecting these symptoms can lead to early diagnosis and better treatment of the conditions.

"Yellow
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Mark Cuban: CEOs Don’t Know Where Their Health Benefit Dollars Are Going

by Inoventive Solutions
February 13, 2024

Since billionaire businessman Mark Cuban entered the health care space with Cost Plus Drug Co., which he launched in May 2020, he has gotten a new perspective on the value that most CEOs place on their group health insurance benefits.

And what he has found is a lot of waste and a lack of health care buy-in among corporate chieftains, according to one of his recent posts on X, formerly known as Twitter.

Most chief executives of self-insured companies, he wrote, “don’t know and don’t really want to know where their health care benefit dollars are going.”

In other words, employers —­ with some effort — should be invested in their health plans so they can find ways to reduce costs for themselves and their employees while improving health outcomes for their workers.

While his comments were aimed at CEOs of self-insured companies, business leaders can use them to look a little closer at the health plans they offer their employees and opt for ones that are focused on reducing costs and driving positive health outcomes.

 

Poor management buy-in

After engaging in discussions with numerous CEOs of companies that have contracted with Cost Plus, Cuban concluded that most chief executives pay little attention to how well their self-insured health plans deliver positive health care outcomes because that is not viewed as a core competency of their companies.

“As a result they waste a s**tload of money on less than quality care for their employees,” he wrote on X, “and more often than not it’s their sickest and lowest-paid employees that subsidize the rebates and deductibles. (Sicker employees have to pay up to their deductible, healthy ones don’t.)”

Cuban likened poor management buy-in to their health plan to lackluster execution of diversity, equity and inclusion (DEI) programs.

“Like health care, DEI is not seen as a core competency in most companies. It’s just a huge expense. Intellectually, [CEOs] see the benefit of DEI. But they don’t have time to focus on it,” he wrote. “So it turns into a check box that they hope they don’t have to deal with beyond having HR do a report to the board and legal tells them they are covered.

“When anything that impacts all of your employees is pretty much a check list item to the CEO, there is a good chance that it’s not going [to] work well and you are going to have employees who are not comfortable for a lot of different reasons.”

 

Taking a different approach

Taking a hands-off approach to your company’s employee benefits may be costing you and your employees. And in 2024, when group health insurance premiums have increased 8.5% on average from the year prior, it’s important that employers don’t treat their benefits as just an unavoidable expense.

As the health care and insurance industry innovates, there are growing opportunities for cost savings and better outcomes. For example, some new health plans may have narrow-provider networks with perhaps not as many physicians, however those physicians provide care at centers of excellence that have better outcomes for patients.

Additionally, there are a number of cost-containment strategies available that employers have been loath to use in order to retain and attract talent. As the labor market loosens and costs continue to rise, employers looking to arrest cost inflation may start considering their options.

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