mroberts

Why trim benefits across the board when it's fairly easy to make data driven decisions as long as you have the right consultants working for you? Employers should be very cognizant of what their peers are doing (benchmarking) before making any rash decisions. If you don't get to the root of the problem (wellness, disease management, over utilization on only parts of your program) you're just going to be back in the same situation next year.

Typical stop loss commissions are 15% however. Since that's what the agent is charging as a fee, it doesn't sound like anything is off base here. Just make sure that 15% isn't already built into what you're paying and the agent is then charging you another fee on top of your premiums.

Just tell him the carrier isn't going to allow it and show him the summary plan description supporting your stance.

Why would there be a problem? HDHP's shouldn't be treated any differently as any other scenario dealing with multiple health plans.

I know this used to be ok, but I can't help but feel that I ran across a recent article indicating this was age discrimination. Other variables that could come into play are the verbage of the SPD and types of plans and so on that these retirees are being offered. Are retirees offered the same benefits as active employees? Or is it a scaled back medical plan? Have you thought about doing away with retiree health benefits? This seems to be a common decision by many employers since it can be a burdensome expense down the road if the plans aren't carefully developed.

Agreed.

Not necessarily. Perhaps this group is looking down the road and found that cafeteria plans will be easier to deal with from a financial perspective. For example, if the company provides each employee with $4000, it's a lot easier to budget assuming a 5% increase to that dollar figure then waiting to see what the dreaded medical renewal is going to look like. I would agree that if you're going to have a cafeteria plan, however, you may as well have at least two medical options and a high/low dental plan.

Carrier contracts will always trump an employee handbook since the contract legally governs how benefits are paid. I would suggest providing each of your insurance carriers the verbage in your employee handbook that deals with leaves of absence and see if they can match it in their contract. If for whatever reason they can't, I would highly recommend changing your employee handbook to meet their guidelines since this could lead to potential litigation.

There are a couple ways to do this: 1. If teachers elect to get paid evenly over a 12-month period, which I'm assuming is an option, just continue the deductions as is. 2. If teachers elect to get paid their salary over a 10 month period, figure out what the annual contributions for their particular health plan is and divide by 10. These should be the monthly deductions. Trying to recoup the money after the fact is going to be nearly impossible for any teacher not coming back.

This could be set up as a completely different plan as well, so I don't see any problems here.

I think that could be perceived as sketchy. I suppose if there are enough firewalls in place and the health screenings are done by an outside vendor and nothing on an individual basis is relayed back to the employer, it could possibly work. But I don't think it's worth the potential drawbacks (lawsuit) if some employee disagrees.

I don't think the overall impact would be significant. Most carriers do not increase rates by adding this provision, so something tells me they have monitored the costs associated with this. Plus you're better off from an attraction and retention standpoint.

No you cannot. It would be considered discriminatory. Unfortunately, you can't charge them higher premiums either.

I don't see any problem here. There's nothing saying that an employee can't submit an application for enrollment before becoming eligible. They just won't be on the plan until the 91st day.

It would be near impossible to build in any incentives for disease management or wellness programs. These programs are all theory - while it makes sense that implementing them will save you claims dollars in the long run, there is no proof that they will work. Unfortunately, you can't find two groups of 2000 people with identical demographics and medical conditions and have one utilize a disease management and wellness program while the other does not. I would review what your TPA is doing on a quarterly basis in these areas with your broker. If you do it any less or don't pay attention at all, you run the risk of the TPA charging you a buck or two per employee per month for really not doing much. The next time you market the administration of your self-insured plan, you may want to ask about each bidder's process when it comes to disease management and wellness programs. Get something very detailed and make sure that the administrator sticks to the plan. I've found that carriers tend to do a better job than TPA's when it comes to disease management, however, there's a lot of TPA's out there and I'm sure some of them do a great job.

I'm pretty sure there's nothing that would prevent this. Worse case scenario is that the employer would just need to set up a different Section 105 plan, however, I don't think this would be ncessary. Just call your flex plan administrator to confirm the simplest way to get this done.

You as the employer determine the waiting period. If you want it to be 12 months you can. Why is having a 6 month waiting period not a good idea, however? Your attraction efforts are definitely going to be hampered. If someone leaves his or her job to come work for you and needs to elect COBRA for medical insurance, he or she could be looking at between $1500 and $4500 post tax to continue coverage through the previous employer. Unless you're paying well above market value for all your positions, most people will figure out that it's not worth working for you.

I agree with your logic. HSA's probably are not going to lower the overall costs associated with healthcare and if they do, it will be by a minute amount. If you follow the 80/20 rule, 20% of participants are going to make up roughly 80% of the claims. All the catastrophic claims (premi babies, bypass surgery, transplants...) are going to fall under this 80% figure and having an HSA plan is not going to impact these claims whatsoever. So you're left with trying to contain costs on the other 20% of claims. How many members are actually going to try finding out the least expensive doctor or the hospital with the least expensive MRI and the like? Probably not too many.

Agreed.

I think you're going to find that nothing is standard when it comes to different carriers in different geographic locations. I would say for UHC, Aetna and CIGNA, the PPO plans should be very similar regardless where the plans are written. For BCBS, this isn't going to be the case at all since there are 44 different BCBS's around the country and each does not operate the same. With that being said, I would say that's atypical and should clearly be brought to any employer/client's attention. While many people think that mental health benefits shouldn't be as important as physical health benefits, they are dead wrong. Numerous studies have shown the need for mental health parity and the fact that it will actually lower health care costs in the long run due to the fact that many physical ailments are the result of mental ailments not being treated proactively.

I take back my previous response and agree with the others. For whatever reason I was thinking about qualifying events and being able to enroll in the spouse's plan after losing coverage even though that isn't even close to being what I typed!!

It is legal, but the problem with this kind of arrangement always comes down to how you are going to enforce it. There's obviously a lot more administration involved trying to verify whether a spouse is working and if he or she's offered healthcare coverage at his or her place of employment. It's all about opportunity cost. Additionally, the real reason employers are trying to enforce this isn't really to make sure spouses aren't doubled covered, but to kick them off their plan if possible to lower health insurance premiums. I see the point, however, what do you do if the spouse is offered health insurance and the employer doesn't pay for it, pays very little for it, has a poor plan design, has a carrier with a bad network.....? I don't like this idea too much. Having a good medical plan will only help attract and retain good workers, so I'm not a believer in hacking away at a company's health care benefits. I do understand the employer's perspective, but sometimes you have to look at the "soft costs" along with the "hard costs".

If I'm following your post correctly, yes, a loss in coverage would constitute a qualifying event in which the employer would need to offer the spouse and child(ren) COBRA. Just out of curiosity, why is the employer no longer offering dependent coverage? Why not continue to offer it while not contributing to it?

Most health plans will cover emergency services as if they were in-network benefits if the employee goes to an out-of-network hospital. If employees are utilizing out-of-network doctors for routine visits, then obviously take a hard look at the network of your current health plan to ensure it's adequate, although I don't think this is the case since employees are concerned when traveling.

A very small portion of LTC insurance can be deducted when doing your annual taxes. I forget the exact numbers, but it's nothing considerable. As far as paying the premiums through a medical FSA goes, that I have not heard. Now, if an employer has an HRA within a consumer-driven medical plan, I've seen an employer swing a deal that employees can use this money to pay for other insurances such as LTC. I don't know all the fine details on the subject, however, I would imagine a carrier that deals with HRA's can point you in the right direction.