GBS Benefits

Suicide Prevention & Awareness Mini-Series

GBS Benefits — Mon, 07 Oct 2024 19:29:05 +0000

This September, our Health & Wellness team put a spotlight on suicide prevention and awareness through a 4-part video mini-series. These 15-minute sessions held via Zoom provided the tools needed to approach conversations about suicide, educate loved ones, and feel confident in their ability to respond to concerns.

You can find the recordings below.

Suicide Prevention Basics

Presented by Molly Signoretty
GBS Population Health Consultant

Suicide Prevention Basics provides the opportunity to learn how to identify signs and risk factors, how to speak to mental health and suicide without judgment and how to create a safe environment when responding to concerns.

Safe & Effective Messaging for Suicide Prevention

Presented by Alyssa Mitchell
Utah Department of Health & Human Services

How we talk about suicide matters. Messaging can either increase risk for vulnerable individuals or increase protective factors such as hope and helpseeking. The goal of this training is to better support others in sharing suicide prevention messages that inspire hope and healing and empower positive actions to prevent suicide.

Firearm Safety & Suicide Prevention

Presented by Kristy Jones
Intermountain Health Community Health Initiatives Director

Discover the role of firearm safety in suicide prevention.

Data on firearm involvement with suicide deaths will be shared as well as tactics for keeping persons in crisis safe. Putting time and distance between someone in a suicidal crisis can reduce suicide attempts and death.

Equipping Your Workplace: Tools & Resources for Suicide Prevention

Presented by Catherine Van Tassell
GBS Behavioral Health Director

Equip yourself with practical tools and resources for suicide awareness in the workplace.

This final session will provide actionable strategies for both employees and leadership to create a supportive environment. Together, we can ensure that our colleagues receive the support they need.

Wondering how you can best equip your employees with resources for talking about suicide prevention and awareness?

Reach out to our wellness team at wellness@gbsbenefits.com.

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2024 October Health & Wellness Resources: Embrace Diversity

GBS Benefits — Fri, 20 Sep 2024 14:48:13 +0000

Embrace Diversity

Global Diversity Month is an opportunity to celebrate different ethnicities, cultures, heritages, experiences, abilities, and attributes that contribute to more dynamic, innovative, and efficient communities. Diversity is a large part of what makes life interesting. Review this month’s resources to learn how you can celebrate, embrace, and create a safe space for the people around you.

Take a minute to watch a quick video explaining this month's healthy habit and download the resources below.

QR CODE FLYER

Print & Share with Your Employees

CALENDAR

Embrace Diversity

ASK THE EXPERT

Russell Vinik, MD

Celebrate & Embrace
Diversity

Boletin informativo

Celebre y Acepte la
Diversidad

Flyer

Embrace a World
of Differences

FEATURED RECIPE

Sweet Potato Chickpea
Fritters

SEASONAL FLYER

Bone Robbers &
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Compliance Monthly Update: August 2024

GBS Benefits — Tue, 17 Sep 2024 17:24:28 +0000

Compliance Monthly Update: August 2024

A brief update on what happened the prior month in group health plan compliance at the federal level, organized chronologically. An update for the state and local level are further down. If you would like additional information, please reach out to the GBS Compliance Team.

Fiduciary breach lawsuit filed against Wells Fargo.

On July 30, a class-action lawsuit was filed by health plan participants against the Wells Fargo group health plan alleging a breach of ERISA fiduciary duties related to the plan’s prescription drug benefits. This is the second case following up on the ongoing and similar Johnson & Johnson case discussed in the February compliance update. These cases are likely the first in a new trend of fiduciary litigation against group health plans. With that in mind, plan sponsors should engage in prudent fiduciary decision-making processes for designing their benefit plans and in their selection of PBMs and other vendors. ERISA does not require plan fiduciaries to select the lowest cost vendors, rather they should make prudent decisions taking in the various factors in the vendor selection process to ensure the plans are designed and administered in participants best interests. Having good documentation and a process in place for making prudent group health plan decisions will generally be the most effective shield against potential lawsuits.

Updated model CHIP Notice released.

The DOL has released a new model employer CHIP Notice (available HERE) with information current as of July 31, 2024. As a reminder, group health plans that maintain a plan with participants who reside in a state that provides premium assistance under Medicaid or CHIP have an annual notice requirement to notify employees of the potential opportunities for premium assistance. The model CHIP notice is updated periodically to reflect changes in the states that offer premium assistance and changes to the relevant state contact information.

Fifth Circuit affirms vacation of portions of surprise billing regulations.

On August 2, the Fifth Circuit affirmed a lower court ruling to vacate key portions of the final regulations implementing the independent dispute resolution (IDR) provisions of the No Surprises Act (NSA). The NSA expanded patient protections to shield individuals from surprise medical bills for certain out-of-network services. The regulatory agencies had issued final regulations related to the “qualifying payment amount” (QPA) and plan payment procedures through the IDR process. Citing the recent Supreme Court Loper Bright decision, the Fifth Circuit held that the regulations improperly restricted the arbitrators’ authority to consider the various factors specified in the NSA when deciding on reimbursement amounts for out-of-network providers’ services. The court held that the regulations wrongly put a thumb on the scale in favor of one factor, the QPA, which is determined exclusively by the insurer and would result in lower reimbursement amounts. This is the latest in a series of rulings leaving the IDR regulations in flux. The regulatory agencies have previously advised in FAQ guidance that plans and insurers are expected to calculate QPAs using a good faith, reasonable interpretation of the NSA and the regulations that remain in effect.

HHS increases civil monetary penalties for HIPAA, MSP, and SBC noncompliance.

On August 8, HHS announced adjusted penalty amounts effective for penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015. The indexed amounts for violations are as follows:

The HIPAA Privacy and Security Rules have four tiers of violations that reflect increasing levels of culpability, with minimum and maximum penalty amounts within each tier and an annual cap on penalties for multiple violations of an identical provision.
- No Knowledge. For violations where the covered entity does not know about the violation (and by exercising reasonable diligence, would not have known about the violation) the penalty amount is between $141 and $71,162 for each violation. The calendar year penalty cap is $2,134,831 for all violations of an identical requirement.
- Reasonable Cause. If the violation is due to reasonable cause, the penalty amount is between $1,424 and $71,162 for each violation. The calendar year penalty cap is $2,134,831 for all violations of an identical requirement.
- Willful Neglect (but corrected within 30 days). For corrected violations that are caused by willful neglect, the penalty amount is between $14,232 and $71,162 for each violation. The calendar year penalty cap is $2,134,831 for all violations of an identical requirement.
- Willful Neglect (but not corrected within 30 days). For violations caused by willful neglect that are not corrected, the penalty amount is between $71,162 and $2,134,831 per violation. The calendar year penalty cap is $2,134,831 for all violations of an identical requirement.
Medicare Secondary Payer (MSP) rules prohibit plans from “taking into account” the Medicare entitlement of employees and dependents. The violation for offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary is $11,524.
Summary of Benefits and Coverage (SBC) generally must be provided to participants and beneficiaries before enrollment and during open enrollment. The penalty for a willful failure to provide an SBC is $1,406.

State/Local Compliance Update: July 2024

A brief update on what happened the prior month in group health plan compliance at the state and local level, listed alphabetically. If you would like additional information, please reach out to the GBS Compliance Team.

California

San Francisco 2025 HCSO expenditure rates posted.
San Francisco has posted the 2025 minimum healthcare expenditure (HCE) rates under the San Francisco Health Care Security Ordinance (HCSO). The HCSO applies to employers that must obtain a San Francisco business registration certificate and have at least 20 employees in any location if at least one works in the city or county of San Francisco. The HCE is the minimum amount covered employers must spend on healthcare for each hour worked by a covered employee. Employers subject to the HCSO also need to submit an annual reporting form by each April 30 and comply with notice posting requirements. Also note that self-insured employers have until February 1 each year to top-off expenditure rates for the prior year if the employer failed to make the required healthcare expenditures during the prior year.

Colorado

Maximum number of employees to qualify for fully insured, small group market coverage in Colorado is reducing in 2026.
Governor Polis signed SB24-073 that effective January 1, 2025, amends the definition of “small employer” (for purposes of providing fully insured health insurance coverage) as any person that employs an average of at least one but not more than 50 employees during the calendar year.

- Current law defines a “small employer” as any individual, firm, corporation, partnership, or association that employs between one and 100 employees during a calendar year.
- An employer that has a small group health benefit plan before January 1, 2026, and would no longer qualify as a “small employer” under the changes made by SB24-073 may elect to keep their small group health benefit plan for 5 years after the date of issuance. Such employer may also switch between small group health benefit plans offered by the carrier during those 5 years but may only switch to plans that are one metal level above or below their existing plan. Once an employer elects to enter the large group health benefit market, the employer may not return to the small group health benefit market within the 5-year period.
- Note also that the law requires the commissioner of insurance to conduct an actuarial review of rate filings submitted by insurance carriers that offer small group health benefit plans to determine whether the change to the definition of “small employer” would increase premiums for the majority of individuals covered by small group health benefit plans by more than 3%. If the premiums would increase by more than 3%, then the change to the “small employer” definition made by SB24-073 will be repealed.

Colorado amends regulations on when small group health plans can terminate adult dependent coverage due to age.
Under Amended Regulation 4-2-43, for small employer group plans, dependent coverage cannot be terminated, on the basis of age, before the end of the plan year in which the dependent attains age 26. This expands on the ACA requirement, where if a plan provides dependent coverage for children, the coverage must be available until age 26—which in most cases was administered so that coverage would be available until the end of the month in which the dependent turned 26.

Illinois

Illinois enacts laws regulating AI use in employment.
On August 9, Governor Pritzker signed HB 3773 to prohibit (effective January 1, 2026) the use of artificial intelligence (AI) in a manner that results in illegal discrimination in employment decisions and employee recruitment.

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Medicare Part D Creditable Coverage

GBS Benefits — Wed, 11 Sep 2024 17:41:12 +0000

Medicare Part D Creditable Coverage

Employers that sponsor a group health plan with prescription drug coverage are required to determine whether that prescription drug coverage is creditable or non-creditable. A plan’s prescription drug coverage is considered creditable if its actuarial value equals or exceeds the actuarial value of standard Medicare Part D prescription drug coverage. Employers have no requirement to offer creditable coverage and may offer coverage that is non-creditable, but they do have certain disclosure requirements that must be followed. Compliance with these disclosure requirements are also an important step to help Medicare-eligible employees avoid Medicare Part D enrollment penalties.

This summary first addresses the timing and general rules surrounding the Medicare Part D creditable coverage disclosure requirements. Second, the summary addresses the impact of non-creditable coverage on Medicare-eligible employees. Third, the summary addresses important recent changes to the process and methodology of determining whether prescription drug coverage is creditable or non-creditable. The last section outlines what this means for employers and next steps.

Creditable Coverage Disclosure Requirements

For each offered group health plan that includes prescription drug coverage, an employer has two annual disclosure tasks: 1) online disclosure to CMS, and 2) notice to Medicare-eligible individuals.

1) Employers must disclose to CMS whether the plan is creditable or non-creditable.

This is completed online within:

60 days after the beginning of each plan year
30 days after any change in creditable status of the prescription drug plan

For additional information and the online submission form, see the Disclosure to CMS Form page.

2) Employers must provide the Medicare Part D Notice of Creditable (or Non-Creditable) Coverage to all Medicare-eligible individuals who are enrolled or seeking to enroll in the employer’s group health plan.

Most employers distribute this notice to ALL eligible employees at open enrollment and with enrollment materials for newly hired and/or newly eligible employees.

This is because it can be difficult to identify which employees are Medicare eligible, especially when an individual’s eligibility for Medicare is based on a factor other than age, such as disability or end-stage renal disease.

In addition to providing notice at the above-mentioned times, should provide the notice again to employees sometime between October 1 and October 14.

Medicare open enrollment typically runs each year between October 15 and December 7, so the timing of this notice (immediately prior to this event) can be particularly helpful to Medicare-eligible employees.

Additional important information

Employers are not required to offer prescription drug coverage that is creditable. Employers can offer either (or both) creditable and non-creditable coverage.
- If an employer offers both, it must provide both notices and clearly indicate which plans are creditable and which plans are non-creditable
- This notice is typically based on the current group health plan if provided just prior to Medicare open enrollment and is typically based on the upcoming group health plan if provided at employer’s open enrollment. To avoid confusion, and depending on the month the plan year starts, an employer may consider providing both current plan year and upcoming plan year notices with clear identification of the plan year for each.
If a creditable plan changes to a non-creditable plan mid-year due to design changes or if creditable status occurs at renewal, an employer must notify Medicare-eligible employees within 30 days.
- Notice of this plan change triggers a Medicare Special Enrollment Period that gives individuals 60 days to enroll in a Medicare Part D plan (or Medicare Advantage Plan with prescription drug coverage).

Impact of Non-Creditable Coverage on Medicare Eligible Employees

After an individual becomes eligible for Medicare, they are not required to enroll in Medicare, but they are required to enroll in some form of creditable prescription drug coverage in order to avoid potentially significant Medicare Part D late enrollment penalties. An individual could enroll in just a Medicare Part D plan and not Medicare A, B or C to fulfill this requirement. Alternatively, an individual could enroll in an employer’s prescription drug plan that is creditable, or in another plan offered in the private market.

If after becoming eligible for Medicare, a Medicare-eligible individual is not enrolled in creditable prescription drug coverage for more than 62 days, they will be subject to a lifetime late enrollment penalty. This penalty is added to their Medicare Part D premium (when they later enroll) and increases the longer they go without creditable coverage. The penalty can result in higher out-of-pocket costs for the individual over their lifetime.

If a Medicare-eligible individual experiences either: 1) a loss of creditable coverage, or 2)
notification that prescription coverage in which they are enrolled is no longer creditable, it triggers a 60-day Medicare Special Enrollment Period. To avoid late enrollment penalties, an individual should (within these 60 days) enroll in a Medicare Part D prescription or some other creditable prescription drug plan. This is the reason it is important for employers to notify employees whether its prescription drug coverage is creditable or non-creditable, and the reason it is important for Medicare-eligible individuals to pay attention to this notice.

INTENT

The intent of these rules is to encourage individuals to enroll in prescription drug coverage when they first become eligible. This helps prevent adverse selection, where only individuals who need significant medication would enroll in Medicare, which could drive up costs for everyone.

PENALTIES

Penalties (higher monthly costs) are based on an extra 1% for each month (that’s 12% a year) and also, depending on income, a higher premium.
See HERE for more information.

Recent Changes to the Process of Determining Whether Coverage is Creditable or Non-Creditable

Employer compliance with Medicare Part D Creditable Coverage rules is garnering more attention recently due a provision in the 2022 Inflation Reduction Act (IRA) that impacts the richness of Medicare Part D plans, and in turn, impacts whether employer sponsored prescription drug plans meet creditability. The associated IRA regulations also impact the methodology for determining creditability starting January 2025.

Before the Inflation Reduction Act (IRA)

Under existing CMS guidance that applies through 2024, there are specific allowed methods to determine whether prescription drug coverage is creditable: 1) the simplified method, and 2) actuarial determinations.

For employers offering multiple plan options (for example: a PPO, an HDHP, and/or an HMO), the creditable coverage status must be determined separately for each plan option.

The actuarial determinations are generally implemented by an actuary, usually at an extra, sometimes significant, cost to employers. Note the actuarial method is required for an employer sponsored retiree plan that participates in the Retiree Drug Subsidy (RDS).

The simplified method is a less complex approach and is intended to allow determination without a full actuarial analysis. Most employers use this method.

In past, employers that sponsored an insured group health plan could typically rely on its insurer to apply an approved method and determine whether each offered plan is creditable or non-creditable.

For example, as a first step, an employer would ask their carrier whether the plan’s coverage is creditable, and carriers would usually provide these determinations.
An employer would then ensure that it:
- Disclosed each plan’s status online to CMS, and
- Provided notice of each plan’s status to all Medicare-eligible employees

In past, employers that sponsored a self/level funded plan would generally need to make the creditable or non-creditable determination itself by using either of the approved methods. Most employers in this situation took advantage of the simplified method.

For example, as a first step, an employer would ask its TPA/PBM whether the prescription drug coverage is creditable.
If the TPA/PBM did not provide that confirmation, an employer would then typically make the determination itself by applying the simplified method.
- Note that actual application of the simplified method varied. Although this method is simplified compared to an actuarial determination, it generally is not as simple a process as the name suggests.
  - This is because some of the design requirements require additional criteria and calculations. As a result, rather than apply these calculations, some employers would compare their plan to other otherwise identical insured plans that were already determined to be creditable or non-creditable.
- Instructions for the simplified method and the factors that are considered under this method are found on the CMS website.

Vendors have emerged that will analyze, for a relatively low fee, each prescription drug plan using its own a calculator based on the
“simplified method”.

For more details on this option, please contact your GBS team.

Alternatively, some “simplified method” calculators created by insurers exist online and may be used by employers that wish to have a self-service option.

Changes due to the Inflation Reduction Act (IRA)

The IRA made several changes that impact the structure of the standard Medicare Part D drug benefit. The changes, including (but not limited to) the federal government’s new ability to negotiate drug pricing for Medicare Part D, increase overall the richness (or the actuarial value) of Medicare Part D plans. For example, the changes provide a cap of $2,000.00 on out-of-pocket spending, beginning in 2025 (down from $8,000.00 in 2024).

These upgrades to Medicare Part D prescription drug plans, in turn, impact the creditable coverage status of prescription drug plans offered with an employer’s group health plan. That means, beginning in 2025, some (but not all) prescription drug plans sponsored by employers that in past were creditable plans will now be non-creditable plans. This may come as a surprise to certain employers who are used to their plans meeting creditable status each year. However, offering some plans that are non-creditable will be the new normal, particularly because High Deductible Health Plans (HDHPs) will now likely be non-creditable.

After the IRA passed, CMS issued draft regulations and instructions applicable to the creditability provisions. More recently, CMS issued final regulations and instructions, entitled Calendar Year 2025 Part D Redesign Program Instructions.

DRAFT INSTRUCTIONS

The draft instructions explain that the previously available simplified method to determine whether a plan is creditable or non-creditable will no longer be available. This leaves only the more complex and costly actuarial method to assess the actuarial value.

FINAL INSTRUCTIONS

In the final instructions, CMS acknowledged receiving numerous comments from stake holders expressing concern that, because the Part D benefit changes in the IRA will increase the actuarial value of the Part D benefit, this in turn means some employer sponsored prescription drug coverage that has been creditable prior to 2025 may no longer meet the requirements.

For 2025 plans, CMS pivoted from the draft instructions and clarified that it will continue to permit the use of the simplified method to determine creditability.
For 2026 and beyond, CMS will reevaluate the continued use of the existing creditable coverage simplified determination methodology or establish a revised methodology.

What this Means for Employers

Employers are not required to provide a plan that offers creditable coverage. If a plan is changing from creditable to non-creditable status, employers need to notify both CMS and employees. Employers must inform CMS annually of the creditable status of their plans within 60 days after the beginning of the plan year. Employers must also report to CMS and to employees within 30 days if a plan’s status changes. To assist employees and help them avoid late enrollment penalties, employers should also disclose the plan’s status to employees just prior to Medicare open enrollment in October.

Medicare Part D plan designs are richer starting 2025. This changes the creditability threshold for employer sponsored prescription drug plans and will cause some plans to lose creditability status, starting with plans that begin on or after January 1, 2025. Note that 2024 non-calendar year plans that overlap with some 2025 months should not be affected because the determination is based on the actuarial value of defined standard prescription drug coverage under Part D in effect at the start of such plan year. See HERE.

To start the process, employers should reach out to their carrier/TPA/PBM to learn if it will confirm (for each employer’s plan) the creditability status. If this service is not offered, the employer will need to work with an actuary or with a simplified method calculator. After receiving or determining creditability status, it would next make the required disclosures.

For example, if an employer is preparing for its January 1, 2025 plan year, and if a plan’s status will be changing from creditable to non-creditable starting with this new plan year, the employer must disclose the plan’s new status within 30 days (by January 31, 2025).
Instead of providing a new disclosure by January 31, 2025 as required, which is just a couple of months after the annual open enrollment period where several notices are already provided, an employer could consider providing the 2025 notice in the 2025 plan year open enrollment materials during fall of 2024 as well as the additional helpful communications. For example, notice could include:
- The 2024 plan year Medicare Part D Notice
- The 2025 plan year Medicare Part D Notice
- An additional communication explaining the notices spanning both plan years, the impact of the plan’s loss of creditable status, and information to help Medicare-eligible (and soon to be eligible) employees understand the importance of making an educated and timely decision about whether to enroll in Medicare Part D during the Medicare special enrollment period (due to the change in creditable status).

- - With this communication, keep in mind the Medicare Secondary Payer (MSP) rules which prohibit employers from suggesting or encouraging employees to drop employer coverage in favor of enrolling in Medicare.

Next Steps

1) First, employers should gain a foundational understanding of timing and the general disclosure and notice obligations. These rules have not changed.
2) Second, employers should understand the appropriate process to determine whether its prescription drug coverage is creditable or non-creditable. In other words, as in past years, employers still need to know whether each of its prescription drug coverage is creditable or non-creditable.
3) Third, employers must understand the impact the Inflation Reduction Act (IRA) has on Medicare Part D (prescription drug plans) and in turn, the impact on employer sponsored prescription drug plans. In sum, and starting with 2025:

Medicare Part D plans are now richer plans.

- To be a creditable prescription drug plan, an employer plan must be at least as rich as Medicare Part D prescription drug plan.
- Because Medicare Part D is now richer, some plans that in past were creditable will now not meet the threshold and will be non-creditable.
- It will be common for an employer to offer both creditable and non-credible plans.

Creditability Determination

- - If an employer does not have confirmation from its carrier/TPA/PBM that a plan is creditable or non-creditable, it must ensure that determination is completed by using an actuarial service or using the simplified method. Guessing is not an option.
  - Remember, the simplified method is no longer an option according to proposed regulations. However, based on final regulations, for the 2025 year at least, the current simplified method will be allowed.
    - For a relatively low per plan fee, an employer can engage a vendor to analyze each plan using the vendor’s simplified method calculator
    - Some “simplified method” calculators created by insurers exist online and may be used by employers that wish to have a self-service option
  - In some cases, an employer may need to start using actuarial services to confirm creditability. If a carrier/TPA/PBM offers a special negotiated rate with a vendor for these services, it would be valuable to consider this option.

Creditability Disclosure

- Employers must annually provide notice of each offered prescription drug plan to CMS through the online portal.
- Employers must annually provide notice of each prescription drug plan to Medicare-eligible employees. For convenience, this is usually given to all employees.
- If a plan’s status is changing from creditable to non-creditable based on the new Part D benefit design requirements, employers should:
  - Provide the notice of non-creditable coverage within 30 days of change.
  - Consider creating/providing a special employee communication explaining the change and how it impacts Medicare-eligible employees
    - For this communication, keep in mind the Medicare Secondary Payer (MSP) rules which prohibit employers from suggesting or encouraging employees to drop employer coverage in favor of enrolling in Medicare
- If this notice was not provided close to Medicare open enrollment (typically starts October 15), provide the notice of creditability status again sometime between October 1 and October 14.
Remember:
- Medicare eligible employees have a 60-day Special Enrollment period starting with that latter of: (1) a loss of creditable coverage or (2) notification that coverage is no longer creditable.
- Medicare eligible employees should determine if they should enroll in Part D (or some other prescription drug coverage that is creditable) to avoid a future Medicare late enrollment penalty.

DOWNLOAD NOW

Employee Communication Template

GBS has prepared an editable template to help you communicate important changes regarding creditable coverage to your employees.

Click the link below to download and personalize the document for your company’s needs.

Employee Communication Template >

September 2024

This document is not intended to be exhaustive, nor should any information be construed as tax or legal advice. Readers should contact a tax professional or attorney if legal advice is needed. Although we have made every effort to provide complete, up-to-date, and accurate information in this document, such information is meant to be used for reference only. If there is any inconsistency between the information contained in this document and any applicable law, then such law will control.

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8 Tips for Effective 2025 Open Enrollment Communication

GBS Benefits — Wed, 04 Sep 2024 18:13:26 +0000

8 Tips for Effective 2025 Open Enrollment Communication

Now more than ever, employees are looking to their employers for guidance on navigating their available benefits and how to stretch their dollars further.

Many of today’s workers want help understanding how much money to put aside for retirement, emergency savings and health care expenses. That means employers have an opportunity to shine by effectively communicating and guiding employees throughout the open enrollment process and even the rest of the year.

As the 2025 open enrollment season approaches, employers are poised to provide their employees with resources they can use to better understand and act with more confidence when making benefits decisions.

This article highlights eight open enrollment communication tips for employers.

Communicating With Employees

Effective Communication is An Integral Part of Open Enrollment

Educating and informing employees about their benefits package is an integral part of open enrollment. However, Voya Financial reports that one-third (35%) of employees don’t fully understand any of the employee benefits they enrolled in during their most recent open enrollment period.

Effective communication is critical to educate and inform employees about new, returning or expanded benefits options.

Consider these eight open enrollment communication tips:

1. Start early.

Get the word out early about benefits offerings so employees have ample time to understand their benefits, consult with family members and determine their needs for the following year. There’s no such thing as communicating “too soon” about enrollment. Research shows that repetitive messaging and reminders increase the odds of an employee seeing enrollment information and understanding the upcoming benefit changes and how they work.

2. Develop key messaging.

After solidifying benefits options, employers need to plan their communication strategies. The first step is figuring out key messaging, focusing on new or updated benefits offerings, and developing FAQs to address common concerns quickly.

3. Select a mix of appropriate channels.

Just as many workplaces operate in a hybrid model, employee communications can be successful when done in a similar manner.

For example, digital channels can help distribute and house information virtually, allowing employees to access it when and where they need it. Chat functionality with benefits vendors can also be a helpful digital tool to assist employees in figuring out which benefits they need. Alternatively, there’s still a time and place for companywide on-site meetings and mail-to-home print communication. Postcards and other mailers are still relevant and can serve as a reminder to discuss and review benefits options at home.

Every workplace is different, so it comes down to selecting various channels that are relevant and engaging to each organization’s specific employees.

4. Keep it simple.

It’s vital to simplify any benefits information being shared. Employees don’t need to know everything, so employers should highlight what’s necessary to understand about the benefit and the information to help them decide if they need it. Links or attachments could explore the benefits further and offer the fine print.

5. Make it digestible.

It’s crucial to catch employees’ attention and present the key message immediately before they lose interest. Traditional benefits booklets can be lengthy; instead, employers could deliver bite-sized information to employees through methods such as videos and emails. If all open enrollment information is given at once, it’s easy for employees to become overwhelmed and, ultimately, disengage with employer-provided information. Digestible communication makes it easy for employees to know what to focus on and take action.

6. Use real-world examples.

When possible, employers can put benefits offerings in context with real-world scenarios. Employees can relate to stories, so find ways to bring the options to life. For example, instead of describing telemedicine as a 24/7 benefit, highlight that an employee could get health care answers in the middle of the night when they or a child are running a high fever. The chances of employees needing to use health care benefits during the next year are highly likely, so help reiterate the importance of complete coverage.

7. Avoid jargon.

To help make benefits easier to understand, avoid HR or benefits-related jargon. Additionally, many benefits are acronyms, so employers should help decode and explain the alphabet soup to employees.

8. Personalize communication.

Ultimately, employers want to engage employees with open enrollment information, and a personalized approach can help. It’ll depend on the workforce and their working environments, but employers will likely need to segment their employee audience and tweak messaging so it resonates. For example, open enrollment methods and communication would look different for remote, on-site and nonwired employees.

Benefits can be complicated. Although open enrollment is the most pivotal time to highlight benefits to employees, employers have an opportunity to educate employees throughout the year. Ongoing communication after open enrollment can help encourage employees to understand and utilize the benefits available to them.

Summary

Educating and informing employees about their benefits options is an important part of open enrollment. Effective employee communication is an ongoing process, but it comes down to helping employees feel well-informed about their benefits options and confident about their choices.

Reach out to GBS for additional open enrollment support, including employee communication resources.

This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.

© 2024 Zywave, Inc. All rights reserved.

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Strategies for Identifying and Resolving Gaps in Benefits Offerings

GBS Benefits — Wed, 04 Sep 2024 17:39:00 +0000

Strategies for Identifying and Resolving Gaps in Benefits Offerings

In today’s competitive employment landscape, many organizations recognize that employees are their most valuable asset. To attract and retain top talent, employers must go beyond competitive salaries and create holistic and meaningful employee benefits packages that address diverse workforce needs.

Understanding and addressing any gaps in employee benefits is crucial for employers who aim to create an engaged, supported and satisfied workforce.

Well-rounded benefits packages often translate to enhanced employee well-being, boosted retention rates and a positive work culture.

Well-rounded benefits packages often translate to: enhanced employee well-being, boosted retention rates, and a positive work culture.

This article highlights proactive steps employers can take to assess and identify gaps in employee benefits offerings.

Employer Considerations

Identifying gaps in benefits offerings can be a complex task, as it requires a careful assessment of employee preferences, trends and organizational resources. Consider the followings strategies for identifying and addressing these gaps:

Review existing benefits.

Start by reviewing the current employee benefits package.

While taking inventory of benefits, organizations should assess if they offer the basics (e.g., health insurance, sick and family leave) or anything unique compared to competitors or other employers in their industry.

This is also a good time to review benefits utilization to better understand if there are any benefits that employees do not or rarely use.

Analyze employee demographics and specific needs.

Demographics, such as age, gender and marital status, can influence employees’ preferred benefits. Recognize that those needs can shift over time, so this is an ongoing exercise.

Gather employee feedback.

Conduct surveys, focus groups or collect feedback through other methods to gather information and opinions directly from employees.

Employers could inquire about employee satisfaction with existing benefits, what they value most and if there are any benefits they feel are missing from their package or that could be improved.

Benchmark against industry standards.

Research industry standards and best practices to understand what benefits competitors, and similar or local organizations provide. This can help employers identify any gaps in their offerings compared to competitors.

Explore emerging trends and employee preferences.

Stay informed about employee benefits trends. Current trends include flexible work arrangements, mental health support and student loan assistance.

This is also the time to consider employee feedback results and reported preferred benefits.

Prioritize benefits based on budget and resources.

While employers may be faced with a long list of attractive or preferred benefits, the reality is that they must also consider organizational finances and resources to determine the feasibility of new or different offerings. It may be helpful to prioritize the benefits that would have the most significant impact on employee satisfaction and overall well-being.

Communicate changes effectively.

Employers should ensure clear and effective communication with employees when introducing or modifying benefits.

Education is critical to utilization, so employers should clearly describe any changes, provide their rationale and explain how benefits changes align with employee feedback, emerging trends or organizational goals.

Monitor and reassess.

Benefits needs and preferences change over time, so it’s important for employers to regularly monitor utilization and effectiveness of offerings. If drastic changes were made, checking in with some employees to gauge their feedback could be worthwhile.

Lastly, keep the conversation going with employees to keep a pulse on their preferred benefits and reassess available options to ensure they meet evolving needs.

Summary

Savvy employers continually evaluate their existing benefits, gather employee feedback, benchmark against industry standards and strategically address any identified gaps. By periodically reassessing benefits offerings, employers can ensure they remain competitive in the labor market and meet the evolving needs of the workforce.

By taking a proactive approach to understanding needs and preferences, organizations can create benefits packages that truly support current and prospective employees. This concerted effort can lead to increased workplace engagement and satisfaction, and, ultimately, organizational success.

Contact GBS Benefits, Inc. for additional employee benefits guidance.

This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.

© 2023 Zywave, Inc. All rights reserved.

The post Strategies for Identifying and Resolving Gaps in Benefits Offerings appeared first on GBS Benefits.

Preparing for the 2024 Election

GBS Benefits — Tue, 03 Sep 2024 22:42:35 +0000

Preparing for the 2024 Election

Federal, state and local elections are scheduled for Tuesday, Nov. 5, this year. Employers should be aware of the number of ways elections impact the workplace. For instance, some employers are subject to voting leave requirements, and elections can lead to employee behavior challenges.

As voting approaches, savvy employers can prepare by taking steps to establish clear workplace conduct expectations, comply with applicable voting leave requirements, and bolster employee engagement through voting initiatives and strategic communications.

Workplace Conduct

In recent election years, politically charged environments have created conflict in the workplace. Employers have found themselves in the middle of inappropriate workplace behavior, social media activism, free speech disputes, dress code controversies, among other conflicts regarding conduct. With the 2024 election around the corner, workplace conduct challenges will likely return—if they have not already. A well-planned approach can help deter inappropriate behavior and allow employers to use the election cycle to engage employees.

A recent survey from Glassdoor found that 61% of employees have discussed politics with a colleague over the past year. Many employees who discuss politics are well-intentioned, but these conversations may cause friction within teams.

Employers who establish clear expectations for appropriate workplace behavior may get ahead of potential issues; however, organizations are required to comply with all applicable laws, such as the National Labor Relations Act, which protects employees right to engage in protected concerted activity.

To set clear expectations for employee behavior, employers may consider revisiting the following employee handbook policies:

Code of conduct
Social media
Dress code

These policies aren’t specific to elections but establish clear expectations for employee behavior in general. Fairly enforced policies set clear expectations for employees and clarify what type of behavior is allowed. For example, some employers may implement a dress code that allows for a higher degree of political expression; others could enforce a stricter dress code. It’s important to keep in mind that employers may create potential legal risks if these policies aren’t enforced equally among employees.

Voting Leave

When election time draws near, employers should be prepared to handle employee requests for time off from work to vote. Federal law does not require employers to provide their employees with time off to vote. Yet, many states have voting leave laws that allow employees to take time off to vote in certain circumstances; over 30 states have some provision for voting leave. The specifics vary by state, including variations as to whether:

The leave must be paid
Notice is required
Employers may designate the hours during which employees may be absent to vote

Employers should be aware of the voting leave laws that apply to their organizations and be prepared to comply with any applicable requirements.

Not all employers are subject to state and local voting leave laws, but organizations may voluntarily offer voting leave to workers. Employers in states without formal voting requirements often choose to offer lenient voter leave options or adopt a policy to allow employees time to vote.

Employee Voting Initiatives

Employers can play a key role in voter participation through voting initiatives. These types of initiatives are intended to encourage voter participation and build goodwill with employees and the general public. In fact, a 2021 report from the Civic Responsibility Project found that 82% of Americans would feel more favorably toward a company if it supported policies to make it easier for Americans to vote and register to vote.

Common employee voting initiatives include:

Providing employees with accurate voting information and resources—Employers can help bridge voter knowledge gaps by giving employees voting information. These efforts can include providing:

Voter registration resources
Voter registration deadlines
Voter location resources

Promoting absentee or early voting—Employers can choose to encourage employees to vote absentee or early and suggest appropriate resources to do so.

Sending out communications to employees—Ahead of Election Day, employers can send employees reminders via email and employee intranets.

Offer flexibility and resources—In addition to formal voting leave policies or paid time off to vote, employers may offer flexibility to employees or provide resources to help them get out and vote. For Election Day, employers can consider:

Offering scheduling flexibility and avoiding events, including meetings
Closing the workplace for the day
Reducing work hours
Offering transportation resources for getting to the polls
Providing child care resources

This list highlights examples of voting initiatives, but every workplace is different; what is feasible for one workplace may not be realistic for another. As such, employers should carefully consider whether voting initiatives are right for their organizations and, if so, which specific voting initiatives make sense.

For additional information on voting, check out these federal resources: Voting and Elections in the United States and the U.S. Election Assistance Commission.

Summary

Taking measures ahead of the election cycle may allow employers to mitigate potential issues and provide an opportunity to engage employees. Organizations should ensure compliance with all applicable rules and regulations. Employers should consult with local legal counsel for assistance with compliance.

Reach out today for more election resources.

This HR Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.

© 2024 Zywave, Inc. All rights reserved.

The post Preparing for the 2024 Election appeared first on GBS Benefits.

2024 September Health & Wellness Resources: Celebrate Healthy Aging

GBS Benefits — Mon, 19 Aug 2024 17:01:54 +0000

Celebrate Healthy Aging

Healthy Aging Month is celebrated every September to promote longevity and wellbeing. Maintaining or adopting healthy behaviors, managing health conditions, and fostering relationships are just a few ways you can stay active and independent as you age.

Take a minute to watch a quick video explaining this month's healthy habit and download the resources below.

QR CODE FLYER

Print & Share with Your Employees

CALENDAR

Celebrate Healthy Aging

ASK THE EXPERT

Molly Signoretty
MS, CHES

Wellness Around
the World

Boletin informativo

Bienestar en todo el mundo

Flyer

Celebrate Healthy Aging

FEATURED RECIPE

Pumpkin Protein Balls

Mini challenge

Support Your Elders

The post 2024 September Health & Wellness Resources: Celebrate Healthy Aging appeared first on GBS Benefits.

Compliance Monthly Update: July 2024

GBS Benefits — Tue, 13 Aug 2024 20:22:58 +0000

Compliance Monthly Update: July 2024

Supreme Court permits (at least temporarily) emergency abortions in Idaho.

On June 27, the U.S. Supreme Court considered whether the federal Emergency Medical Treatment and Active Labor Act (EMTALA) preempts a more restrictive Idaho state law. Idaho has an almost total ban on abortion, with exceptions (a) to prevent the death of the pregnant woman and (b) in the first trimester for rape and incest. However, the federal EMTALA law prohibits hospitals with emergency departments from refusing to provide stabilizing treatment to individuals with an emergency medical condition. The question is whether EMTALA preempts the state’s more restrictive ban, thereby allowing abortion in an emergency medical situation where a physician determines it is necessary to stabilize a patient’s condition (not just to save the pregnant woman’s life). The Supreme Court found that the appeal was not ready for review, vacated the district court’s preliminary injunction, and reinstated a previous lower court order blocking enforcement of the Idaho ban in medical emergencies. The impact of the ruling is that physicians in Idaho are permitted to provide abortions to stabilize patients with emergency conditions (including those threatening the health of the pregnant woman) on a temporary basis while the litigation continues. And while this case only involves Idaho law, a decision by the Supreme Court on the merits would resolve the debate of whether EMTALA preempts the most restrictive state law bans on abortion. Currently, Texas, Arkansas, Oklahoma, and South Dakota ban abortion except when a person’s life is at risk, which is narrower than EMTALA’s requirement to treat emergency medical conditions.

Temporary injunctions on ACA Section 1557 regulations.

A Mississippi court issued a nationwide injunction on portions of recently released regulations under ACA Section 1557. As a reminder, Section 1557 prohibits discrimination in certain health programs and activities on the basis of race, color, national origin, sex, age, or disability. Separately, a Texas court stayed all provisions of the Section 1557 regulations in Texas and Montana.

As background, HHS published final regulations earlier this year that provided that “discrimination on the basis of sex” specifically includes discrimination based on sexual orientation, gender identity, sex characteristics, pregnancy, and sex stereotypes.
Several states sued to block HHS from enforcing the regulations and to stay the effective date, arguing that the regulations’ redefinition of sex discrimination was, among other things, unlawful under the Administrative Procedure Act (APA). The Mississippi and Texas court rulings each invoked the recent Supreme Court Loper Bright decision (that overruled Chevron deference and was discussed in last month’s compliance update) to find that HHS had exceeded its statutory authority.
- - Under the Mississippi ruling, HHS is now enjoined nationwide from implementing or enforcing the 1557 provisions as to gender identity.
  - The Texas ruling stayed the effective date of all portions of the regulations—not just portions relating to the interpretation of sex discrimination to include discrimination on the basis of gender identity—for Section 1557 covered entities in Texas and Montana.
  - Remember that employers (which are generally not covered by Section 1557 directly) may still be sued under Title VII—which prohibits discrimination in the workplace on the basis of race, religion, national origin and sex. In Bostock, the Supreme Court ruled that “sex” is a distinct characteristic but inseparable from the concepts of sexual orientation and gender identity, and therefore workplace discrimination on that basis is illegal.

HHS updates HIPAA privacy rule resources.

HHS has updated their HIPAA and Reproductive Health webpage with tools and resources to help covered entities and business associates comply with the HIPAA Privacy Rule to Support Reproductive Health Care Privacy (“Final Rule”) that was issued in April earlier this year. Under the Final Rule, when a regulated entity receives a request for PHI relating to health oversight activities, judicial or administrative proceedings, law enforcement purposes, or disclosures to coroners or medical examiners, and the PHI is potentially related to reproductive health care—the regulated entity must obtain a signed attestation. With their updates to the HIPAA and Reproductive Health webpage, HHS has now provided a model attestation that can be used when a regulated entity receives a request for PHI potentially related to reproductive health care. Note also that the Final Rule will require the notice of privacy practices to be updated, but this has a later compliance date of February 16, 2026, and HHS has not yet updated their model notices of privacy practices to reflect the changes that will be required under the Final Rule. We will be monitoring this and notify you when the model notices are updated.

State/Local Compliance Update: July 2024

California

New California workplace violence prevention mandate takes effect. On July 1, California SB 553 went into effect that requires California employers to implement a workplace violence prevention plan (WVPP), provide training to employees regarding the WVPP, and keep records of workplace violence incidents. As of January 1, 2025, the law also expands employers’ and employee representatives’ rights to obtain restraining orders on behalf of employees impacted by threats of workplace violence.

Illinois

New Illinois law bans step therapy and prior authorization for emergency mental health care. Illinois HB 5395 was signed into law by Governor Pritzker on July 10 and will take effect on January 1, 2025. The new law prohibits fully insured plans issued in Illinois from (a) requiring step therapy (a practice in which physicians are required to treat covered patients with less expensive treatments before moving to more expensive ones) for certain emergency mental health treatments or (b) requiring prior authorization for those emergency mental health treatments. The law does not cover self-insured ERISA plans.

Maryland

Maryland amends pay transparency law to require wage range disclosure in job postings. As background, Maryland implemented a pay transparency law in 2020 that requires employers, when requested by an applicant, to provide the wage range for the position to which the applicant applied. With HB 649, Maryland has now broadened that law (effective October 1, 2024) to require employers to proactively disclose in their public and internal job postings the wage range for the position. Note that this law only requires that the wage range be disclosed for a position where the work will be physically performed in Maryland “at least in part.”

Michigan

Michigan Supreme Court reinstates 2018 version of state’s paid sick leave. On July 31, the Michigan Supreme Court ruled that Michigan’s current paid sick leave law (the Paid Medical Leave Act) is unconstitutional and reinstated Michigan’s original Earned Sick Time Act of 2018. This revision, that takes effect February 21, 2025, will (among other things) expand the paid sick leave available to eligible employees, provide a faster accrual rate, and require smaller employers that were previously exempt to have to comply. The decision also held that Michigan’s Amended Wage Act was similarly unconstitutional—which will result in an increase to Michigan’s minimum wage rate to $12/hour. Employer should monitor the Michigan Department of Labor and Economic Opportunity website for updated regulations and guidance.

Pennsylvania

Pennsylvania expands use and reimbursement of telemedicine. SB 739 was signed into law by Governor Shapiro on July 3 to expand the use of and ensure reimbursement for telemedicine services provided by health care providers in Pennsylvania. The law specifically requires health insurance policies to provide coverage for medically necessary health care services provided through telemedicine and delivered by a participating network provider who provides a covered health care service through telemedicine consistent with the insurer’s medical policies. And the law mandates that a health insurance policy may not exclude a health care service from coverage solely because the health care service is provided through telemedicine.

Pennsylvania enacts PBM legislation. On July 17, Governor Shapiro signed HB 1993 into law to increase transparency, provide patient protections, and increase regulatory oversight of PBMs. This law will apply to health plans not exempted by ERISA (e.g., fully-insured plans). Highlights of the legislation include:

- Prohibiting certain “steering” practices, such as requiring a policyholder to purchase drugs exclusively through a mail order pharmacy or at a pharmacy owned or controlled by the PBM.
- Prohibiting a pharmacy from charging a price that is more than the consumer would pay if they walked in off the street and paid in cash or that is more than the pharmacy would receive from the insurer or PBM.

Providing network adequacy requirements that will require a PBM to establish a network that meets or exceeds federal Medicare access standards.

Minnesota enacts data privacy law. Minnesota has become the latest state to enact a comprehensive consumer data privacy law. The Minnesota law adopts a similar framework as most other state privacy laws. The law applies to legal entities that conduct business in Minnesota or produce products or services targeted to Minnesota residents and: (a) during a calendar year, control or process personal data of 100,000 consumers or more, excluding personal data controlled or processed solely for the purpose of completing a payment transaction; or (b) derive over 25% of gross revenue from the sale of personal data and process or control personal data of at least 25,000 consumers. Note, however, that the law exempts covered entities and business associates subject to HIPAA and exempts data that is considered PHI under HIPAA.

Rhode Island

Rhode Island enacts comprehensive data privacy law. The Rhode Island Data Transparency and Privacy Protection Act (RIDTPPA) was passed into law on June 28 and makes Rhode Island the 20^th state to enact comprehensive data privacy legislation. Note that the law contains entity-level exemptions—including for covered entities or business associates regulated by HIPAA. And the law contains data-level exemptions—including for protected health information (PHI) subject to HIPAA.

Rhode Island increases length of Temporary Caregiver Insurance benefits. Governor McKee signed into law amendments to the Temporary Caregiver Insurance (TCI) law that will increase the amount of paid leave benefits available to employees beginning January 1, 2025. Currently, eligible employees can take six weeks of leave under TCI to care for a newborn, newly adopted child, or to care for a family member with a serious health condition. As of January 1, 2025, employees will be entitled to seven weeks of leave. Then as of January 1, 2026, employees will be entitled to eight weeks.

The post Compliance Monthly Update: July 2024 appeared first on GBS Benefits.

Affordable Care Act Masterclass

GBS Benefits — Tue, 06 Aug 2024 16:43:13 +0000

Masterclass: Affordable
Care Act

This four-week masterclass covers the ins-and-outs of the Affordable Care Act (ACA). Taught by Susan L. Grassli, Director of Health Benefits Compliance at GBS.

Find each session recording and accompanying presentation slides below.

ACA 101: Foundations

August 1, 2024

This session provides a comprehensive high-level overview of the ACA, breaking down the key components and requirements to provide context to help you navigate compliance with confidence.

Watch the Recording

Download Presentation Slides

Steps to Success: Navigating the Employer Mandate

August 8, 2024

In this session, we focus on the Employer Mandate provision as well as introduce and explain the GBS 4-step process which was created to help you understand and navigate the rule correctly.

Watch the Recording

Download Presentation Slides

Cracking the Code: Understanding the Measurement Methods

August 15, 2024

We narrow in on the 4th step of the GBS 4-step process to get a firm grasp on the measurement methods. Heads up, measurement methods can be challenging. We will finish by touching on the importance of creating a written measurement method policy to ensure a useable framework for consistency.

Watch the Recording

Download Presentation Slides

Policy in Practice: Mastering the Measurement Methods

August 22, 2024

Expect a short review of the measurement methods before focusing on applying your written measurement method policy to real eligibility examples which will empower you to use your policy with confidence.

Watch the Recording

Download Presentation Slides

The post Affordable Care Act Masterclass appeared first on GBS Benefits.

2024 August Health & Wellness Resources: Reimagine Wellness

GBS Benefits — Tue, 23 Jul 2024 20:51:35 +0000

Reimagine Wellness

August is National Wellness Month and serves as an important reminder to reevaluate current habits. Prioritizing your health, in all aspects is critical to improving longevity and quality of life.

Take a minute to watch a quick video explaining this month's healthy habit and download the resources below.

QR CODE FLYER

Print & Share with Your Employees

CALENDAR

Reimagine Wellness

ASK THE EXPERT

Catherine Van Tassell
LCSW, PA-C, DipACLM

Reimagine Wellness

Boletin informativo

Reimaginar el Bienestar

Flyer

Start Small to Create
a Healthy Lifestyle

FEATURED RECIPE

Sweet & Spicy Pork Bowls

Mini challenge

Dog Days of Summer

The post 2024 August Health & Wellness Resources: Reimagine Wellness appeared first on GBS Benefits.

Compliance Monthly Update: June 2024

GBS Benefits — Mon, 15 Jul 2024 16:34:13 +0000

Compliance Monthly Update: June 2024

Reminder that PCORI fee and filing is due by July 31.

The annual ACA Patient-Centered Outcomes Research Institute (PCORI) filing and fee on insurers and sponsors of self-funded medical plans (including HRAs) is coming up. The filing and payment due July 31, 2024, is required for policy and plan years that ended during the 2023 calendar year. For plan years that ended January 1, 2023 – September 30, 2023, the fee is $3.00 per covered life. For plan years that ended October 1, 2023 – December 31, 2023
(including calendar year plans that ended December 31, 2023), the fee is $3.22 per covered life. The PCORI fee is reported and paid using IRS Form 720. See the Form 720 Instructions for more information and instructions on reporting and paying the fee. As a reminder:

Insurers report and pay the fee for fully insured group medical plans.
For self-funded plans, the plan sponsor (e.g., the employer) reports and pays the fee.
An employer that sponsors an HRA along with a fully insured medical plan must pay the PCORI fee based on the number of employees (dependents are not included in this count) participating in the HRA, while the insurer pays the PCORI fee on the individuals (including dependents) covered under the insured plan.
Where an employer maintains an HRA along with a self-funded medical plan and both have the same plan year, the employer pays a single PCORI fee. Each person covered by both plans is only counted once. If the HRA covers anyone who is not also covered under the self-funded medical plan, the sponsor counts those individuals using the one life per participant rule.

Updated Change Healthcare Cybersecurity Incident FAQs.

On May 31, HHS updated their Change Healthcare Cybersecurity Incident FAQs and issued a press release to make clear that:

Covered entities impacted by the Change Healthcare breach may delegate to Change Healthcare the tasks of providing the required HIPAA breach notifications on their behalf.
Only one entity—which could be the covered entity itself or Change Healthcare—needs to complete breach notifications to impacted individuals, HHS, and where applicable the media.
If covered entities work with Change Healthcare to perform the required breach notifications in a manner consistent with the HITECH Act and HIPAA Breach Notification Rule, they would not have additional HIPAA breach notification obligations.

Supreme Court dismisses case challenging FDA approval of abortion medication.

On June 13, the US Supreme Court issued a ruling preserving the FDA approval and availability of mifepristone (known as the abortion pill). The Court unanimously dismissed the case on procedural grounds holding that the plaintiffs (anti-abortion doctors and medical groups) did not have standing to sue. Because the Court’s decision did not address the underlying merits of the case, this issue could be before the Court again at some point.

IRS issues FAQs and sample plan document for educational assistance programs.

On June 17, the IRS issued FAQs addressing educational assistance programs (EAPs) and also provided a sample document that employers can use as a template plan document for their own program. As a reminder, an EAP established under IRS Code Section 127 allows employers to provide employees with tax-free qualified educational assistance benefits—including payments for tuition, fees, books, supplies, and equipment. Since March 27, 2020, they also include payments by an employer for an employee’s principal or interest payments on qualified education loans, but this change is temporary and set to expire at the end of 2025 (unless extended by Congress). Employees may exclude from their gross income up to
$5,250 in qualified educational assistance benefits per year. Employers are not required to report these benefits on employee’s Form W-2, and amounts paid under these programs generally are deductible by the employer as business expenses. An EAP must be established in a written plan document and are subject to nondiscrimination testing requirements that prohibit discrimination in favor of highly compensated employees.

Court invalidates part of HIPAA online tracking technologies guidance.

On June 20, a federal court issued a ruling vacating part of an HHS bulletin regarding the HIPAA obligations of covered entities and business associates when using online tracking technologies. Tracking technologies (such as pixels, cookies, and web beacons) are scripts or codes that collect and analyze information about users as they interact with a website or app. The HHS bulletin was issued in 2023 to address potential impermissible disclosures of protected health information (PHI) when tracking technologies are used. At issue in this case was HHS’ broad interpretation of PHI to include a user’s IP address when the user visits a public facing, unauthenticated webpage with information about specific health conditions or healthcare providers (“Proscribed Combination”). The court found the HHS bulletin unlawfully expanded the definition of PHI to include data that could not reasonably identify an individual or their health condition without knowing the user’s subjective intent for the visit, and therefore, the Proscribed Combination related guidance cannot be enforced and is to be removed from the bulletin. The bulletin now includes a note about this decision and a statement that “HHS is evaluating its next steps.”

Fifth Circuit limits prior Braidwood ACA preventive care ruling—leaving preventive care mandate requirements intact (at least for now).

On June 21, a three-judge panel at the Fifth Circuit issued a mixed ruling on the validity of the ACA preventive health services mandate. The Fifth Circuit upheld a lower-court ruling that preventive-care mandates for ACA health plans are unconstitutional, but the court said the ruling should apply only to the plaintiffs.

As background, the ACA requires health plans to cover preventive care with no cost-sharing for participants, and the ACA empowers three agencies—the U.S Preventive Services Task Force (PSTF), the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practices (ACIP)—to determine what kinds of preventive care fall within each category of mandatory coverage by issuing guidelines or recommendations.
In March of 2023, a district court ruled in the Braidwood case that the ACA requirement to provide preventive care as recommended by the PSTF is unconstitutional and issued a nationwide injunction that prohibited the federal government from enforcing the ACA preventive care mandate. However, that district court ruling was stayed pending the outcome of the appeal.
The Fifth Circuit has now affirmed that the PSTF’s members have not been validly appointed under the Constitution because they were not nominated by the President and confirmed by the Senate. The court explained that this appointment process is necessary due to the level of power exercised by the PSTF in making recommendations on preventive services required to be covered under the ACA. Under this ruling, HHS is enjoined from enforcing PSTF recommendations, but only as to the Braidwood plaintiffs. The court reversed the trial court’s decision to vacate all agency actions taken to enforce the preventive care mandates and to universally block the agencies from enforcing the mandates with a nationwide injunction. The court withheld judgment and remanded the case back to the trial court to determine if the members of HRSA and ACIP were also unconstitutionally appointed.
So, although the Fifth Circuit has ruled that some aspects of the ACA preventive service requirements are unconstitutional, those requirements still apply to group health plans nationwide (except for the plaintiffs who brought this lawsuit). Therefore, the preventive services requirement remains intact for now.
Plan sponsors should monitor this litigation as it proceeds and be on the lookout for regulatory guidance that may be released addressing this ruling. The issues regarding the HRSA and ACIP will be presented to the district court. The government may also seek rehearing by the full Fifth Circuit to consider the constitutional issue, or the government may seek Supreme Court review of the issue.

Supreme Court overturns Chevron deference and opens door to increased legal challenges to federal regulations.

On June 28, the US Supreme Court overturned long standing precedent under which courts afforded deference to federal regulation agencies’ interpretation of a statute administered by the agency if the statute was silent or ambiguous regarding the applicable issue (initially set forth in the 1984 Chevron Supreme Court ruling). The overturning of Chevron fundamentally alters the landscape of administrative law. And while the specific impacts are still unclear, it will affect the world of employee benefits.

The Supreme Court held that Chevron deference conflicts with the Administrative Procedure Act (APA), which establishes procedures for agency action. And the APA’s judicial review provisions require courts to apply their own judgment in deciding questions of law, and do not provide for any deference on legal matters. Note that the APA does provide for judicial deference to agencies on factual matters (but not questions of law).
In overruling Chevron, the Supreme Court is now instructing courts to exercise their independent judgment in interpreting the law, and consequently, courts may not defer to an agency interpretation of the law simply because the statute is ambiguous. However, the Supreme Court noted that the holdings of prior cases that relied on Chevron deference remain lawful and may not be overturned solely because they relied on Chevron.
This decision should have far-ranging impacts on essentially all federal rulemaking, including regulations impacting group health plans. There is expected to be an increase in challenges to agency guidance, with regulatory provisions more likely to be limited or overturned entirely, which likely will create a period of uncertainty as new judicial precedents are established. The decision may also impact how Congress drafts future legislation and how agencies approach rulemaking.

State/Local Compliance Update: June 2024

Colorado

Colorado enacts law regulating the use of AI systems. Governor Polis has signed Senate Bill 24-205, “Concerning Consumer Protections in Interactions with Artificial Intelligence Systems,” making Colorado the first state to enact a broad regulatory framework for the development and use of artificial intelligence (AI) systems. The law takes effect February 1, 2026, and generally focuses on “high-risk” AI systems, which are defined as any AI system that, when deployed, makes, or is a substantial factor in making, a consequential decision. A “consequential decision” means a decision that has a material legal or similarly significant effect on the provision or denial to any consumer of, or the cost or terms of, among other services, health care services. The new law generally will require developers of “high-risk” AI systems and the businesses that use them to take extensive measures to avoid algorithmic discrimination—a use of AI that results in “unlawful differential treatment or impact” based on a protected classification such as age, race, sex or religion. Colorado employers that use AI, or are considering using AI, should consider what, if any, steps they may have to take to ensure that the necessary AI governance programs and risk management policies and processes are in place when the new law takes effect in 2026.

District of Columbia (DC)

Increase to 2025 payroll tax for Universal Paid Family Leave Program. On June 12, the DC City Council passed the 2025 fiscal year budget which includes a 0.49% increase (from 0.26% to 0.75%) to the mandatory employer payroll tax to support the Universal Paid Family Leave Program. Previously, the program mandated that payroll taxes paid by employers cover the cost of providing paid family leave to employees working DC. Now, under the changes made by the Council, a portion of the money collected from employers to fund the program is no longer being allocated directly to financing the benefits granted by the program. That is, rather than depositing this increase into the Universal Paid Leave Fund for future program expenses, the Council’s revised budget would redirect this money into the District’s General Fund to be spent on other, unrelated programs. This would mark the first time since the passage of the Universal Paid Leave law in 2016 that program payroll taxes would be used for purposes other than paid leave.

Maine

Proposed rules issued for Maine’s Paid Family and Medical Leave Program. The Maine DOL released proposed rules governing the Maine Paid Family and Medical Leave Program. The proposed rules provide greater detail as to how Maine plans to implement and enforce the new program that provides Maine employees up to 12 weeks of family and medical leave benefits over a one-year period. Employees can begin receiving paid leave benefits on May 1, 2026, and employer contributions to the plan funding those benefits begins on January 1, 2025.

Michigan

BCBS of Michigan dropping coverage of GLP-1 weight loss drugs. Blue Cross Blue Shield of Michigan has announced that their large group, fully-insured plans will no longer cover GLP-1 drugs (e.g., Ozempic and Wegovy) to treat obesity beginning in 2025. The insurer cited concerns over safety, effectiveness, and cost as the reasons for the decision.

Minnesota

Minnesota amends Earned Sick and Safe Time Act and Paid Family Leave Law. Governor Walz has signed legislation amending the Minnesota Earned Sick and Safe Time (ESST) Act that went into effect January 1, 2024. Some of the changes include increased potential penalties, clarification of the rate of pay for ESST, an amended definition of “employee,” and amended reasons for use of ESST. The legislation also amended the Minnesota Paid Family Leave (PFL) Law that goes into effect January 1, 2026. The PFL changes include amended definitions, clarifications on minimum increments of leave, small employer assistance grants, and a reduced small employer premium rate.

The post Compliance Monthly Update: June 2024 appeared first on GBS Benefits.

U.S. Supreme Court Overrules Chevron Deference

GBS Benefits — Mon, 01 Jul 2024 20:50:41 +0000

GBS COMPLIANCE

U.S. Supreme Court Overrules Chevron Deference

On June 28, 2024, the U.S. Supreme Court issued a decision in Loper Bright Enterprises v. Raimondo and Relentless Inc. v. Department of Commerce. The Court overruled its 1984 decision in Chevron, U.S.A. Inc. v. Natural Resources Defense Council Inc., which held that courts should defer to federal agencies to interpret ambiguities and gaps in the laws that the agencies implement (known as Chevron deference).

Background

Congress has the authority to pass laws that govern employers, and federal agencies have the authority to enforce those laws. To fill in any gaps or to remedy any ambiguities, federal agencies may issue more detailed guidance on how the laws should be interpreted and applied. For example, agencies may publish informal guidance, issue opinions or publish formal regulations. Under the doctrine of Chevron deference, courts are directed to defer to such agency guidance where the statute is ambiguous and the agency’s interpretation is reasonable.

In Loper and Relentless, the plaintiffs argued that Chevron should be overruled. The plaintiffs contended that courts should have the authority to interpret ambiguous laws and should have no obligation to adhere to federal agency guidance.

Highlights

On June 28, 2024, the Supreme Court overturned Chevron deference, a doctrine that requires courts to defer to federal agencies when interpreting legal ambiguities.
In its opinion, the Supreme Court stated that “[c]ourts must exercise their independent judgment in deciding whether an agency has acted within its statutory authority.”

Supreme Court Ruling

The Supreme Court overruled Chevron deference in a 6-3 decision. In its opinion, the Supreme Court held that the Administrative Procedure Act requires courts to exercise their independent judgment in interpreting the law, and consequently, “courts may not defer to an agency interpretation of the law simply because the statute is ambiguous.” However, the Supreme Court noted that the holdings of prior cases that relied on Chevron deference remain lawful and may not be overturned solely because they relied on Chevron.

Impact on Employers

Chevron deference has had a meaningful influence on the interpretation and enforcement of employment laws. Federal employment agencies, including the U.S. Equal Employment Opportunity Commission, the Occupational Health and Safety Administration, the U.S. Department of Labor (DOL) and the National Labor Relations Board, have relied on Chevron deference in issuing and defending agency interpretations.

In light of the Supreme Court’s ruling, federal agencies will not be able to rely on Chevron deference in existing litigation, including lawsuits that have been filed to challenge the DOL’s independent contractor and overtime rules, and may be subject to additional legal challenges regarding existing rules. Federal agencies may also issue fewer regulations and take more moderate positions in the regulations they issue, and they may face greater difficulty in addressing policy issues.

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Health Insurance Guide for Small Business Owners

GBS Benefits — Wed, 26 Jun 2024 21:22:03 +0000

Health Insurance Guide for Small Business Owners

Welcome to our health insurance guide for small business owners interested in providing their employees with health insurance options. In this article, we’ll cover the health insurance basics and walk you through key terms and concepts so you can work better toward the perfect health plan for your small business.

Understanding Health Insurance

Understanding health insurance is crucial to make informed decisions that benefit your business and employees. Health insurance helps manage healthcare costs by sharing the financial risk between the insurer and the insured. It can also assist in covering medical expenses like prescriptions, hospital stays, or doctor visits.

By providing your employees with effective health insurance plans, you’re helping them avoid shouldering the entire cost themselves.

Why Health Insurance Is Important for Small Businesses

A small business health insurance plan helps support your load-bearing employees. Your employees hold the company together on a much greater level than large companies. Caring for their health not only helps to keep them fit for work but also shows your employees that you care about their well-being.

Types of Health Insurance Plans

Choosing the right insurance place for your business can feel overwhelming with so many options available. Let’s break down the main types of health insurance plans so it’s easier to decide which is best for your employees and budget.

Health Maintenance Organization (HMO)

HMOs are business health insurance plans that limit coverage to doctors who are employed by the HMO or contracted specifically for the company. HMOs generally have lower monthly premiums than other plans on this list. However, they are limited in flexibility as all physicians covered by the business health insurance are in the same network.

Preferred Provider Organization (PPO)

Similar to an HMO plan, PPO coverage involves contracting with a network of medical professionals known as preferred providers. However, these two options diverge because PPOs offer coverage for when employees see professionals outside of the contracted network at a higher price.

PPOs are more affordable than many business health insurance plans, though they charge a higher monthly premium than HMOs. PPOs provide more flexibility to your employees but will come at a higher cost.

Exclusive Provider Organization (EPO)

EPOs are the local option for business health insurance. Exclusive Provider Organizations offer a local network of medical professionals and hospitals for employees and are generally more affordable than a PPO plan but costlier than an HMO.

Be aware that due to the local nature of EPOs, medical care may not be covered if you choose to get care outside your plan’s network, though this can change in the event of an emergency.

High-Deductible Health Plans (HDHP)

HDHPs are business health insurance plans with a higher deductible for employees to pay before the insurance company pays its share, but the monthly premium is usually lower for HDHPs.
HDHPs are HSA-eligible plans which can be combined with HSAs for tax-free health savings for medical purposes.

HRAs

HRAs aren’t business health insurance plans in the traditional sense.

Health insurance plans contribute directly to a network or health insurance provider, while HRAs are employer-funded group health plans where the employer contributes money for medical expenses throughout the year.

In this plan, the employee will use the funds from the HRA to contribute to medical expenses or even to pay for their own health insurance plan.

Rules for Offering Health Insurance to Employees

It is important to understand the rules for offering health insurance to employees.

Affordable Care Act (ACA) Requirements

The Affordable Care Act (ACA) was enacted in the United States to protect small businesses and their employees from overly expensive or otherwise unreasonable health insurance plans and policies.

As a small business owner, you are responsible for following ACA guidelines when offering health insurance to your employees.

Rules you should be aware of for your business health insurance plan:

All businesses are required to report information about employees to the IRS, even if they don’t offer insurance to their employees.
A 90-day waiting period in which you must offer health insurance to every full-time employee. The 90-day period begins on that employee’s date of hire.
The Summary of Benefits and Coverage is information about the plans offered, which must be disclosed to each employee.

State-Specific Regulations

Business health insurance laws are regulated at the state level and may vary based on your location. It is important to be aware of your state’s health insurance regulations. Need help? GBS Benefits has experts who are prepared to answer questions and provide resources, simply reach out!

Health Insurance Employer Contribution Rules

Certain regulations are in place to ensure fair treatment and consideration are offered to employees who qualify for business health insurance plans by the employer. In this section, we’ll guide you through a few rules you should follow for your company plans.

Percentage Contributions

Employers are typically responsible for contributing at least 50% of the monthly premium for their business health insurance plans, though this varies by state. Check your state regulations for your monthly contribution requirement.

Fixed Amount Contributions

Though less commonly used, defined contribution plans and other similar business health insurance plans allow employers to make fixed-amount contributions. The employer contributes a specific dollar amount per month rather than a percentage of the monthly premium. Employers must still cover around 50% of health care expenses (depending on state laws) for each full-time employee, so be mindful of that regulation.

Do Employers Have to Offer Health Insurance?

Have you ever wondered, “Do employers have to offer health insurance,” or “Do I have to offer health insurance to all employees?” This section of the health insurance guide will show you the requirements for offering health insurance and the consequences of neglecting to provide a business health insurance plan.

Employee Thresholds

According to the most recent ACA employer mandate, all employers with 50 or more full-time employees must offer business health insurance options to their employees.

You should still consider offering a health insurance plan for your employees before reaching that threshold, as providing health insurance to your employees shouldn’t be done out of obligation.

Penalties for Not Offering Insurance

Under the Affordable Care Act (ACA), employers must offer coverage to at least 95% of their full-time employees and dependents.

Other regulations, such as offering no “affordable” coverage options or not paying the minimum cost of covered services, can also result in penalties.

The typical penalty for failing to meet ACA regulations is around $2,880/year for each full-time employee, minus the first 30 employees.

Strategies for Managing Health Insurance Costs

We know you want to give your employees the best without breaking the bank. To help you do that, we’ve compiled some useful strategies for finding the best health insurance plan while staying on budget.

Shopping Around for Plans

When shopping for different insurance plans, many variables can make your decision challenging. Consider the following factors to find the proper business health insurance plan for your employees.

Number of full-time employees
Unique needs of your workforce (are your employees more likely to need health coverage?)
Monthly premiums

Juggling these different factors can be challenging, so professional assistance can help take the guesswork out of the equation. Discover how the experts at GBS Benefits can find the perfect fit for your business health insurance needs.

Wellness Programs

Many medical expenses that would require aid from health insurance can be prevented or avoided by healthy lifestyles.

Company wellness programs can greatly increase your employees’ physical and mental well-being, and GBS Benefits provides monthly health and wellness resources for your wellness programs.

Health Reimbursement Arrangements (HRAs)

Earlier in this health insurance guide, we briefly discussed HRAs and the differences between these arrangements and other health insurance plans. Simply put, an HRA is a group health plan allowing employers to contribute to a fund that employees can draw from for eligible medical expenses.

HRA contributions are up to the employer but can be significantly more affordable overall as you won’t need to pay monthly premiums for each employee’s health insurance plan.

Enhance Your Company's Employee Benefits with GBS Benefits

Employers have many factors to consider when choosing a business health insurance plan, which is why some of the most common types of are being displayed in this health insurance guide. Also included are some of the major regulations you should look out for in your contributions.

GBS Benefits has a team of experienced professionals capable of tailoring the perfect benefits packages for your company’s needs. Utilize our expertise to compile the perfect benefit package, complete with an ideal health insurance plan for your company.

Reach out for a consultation to learn more and discover your perfect health insurance plan!

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2024 July Health & Wellness Resources: Enjoy Summer Safely

GBS Benefits — Wed, 26 Jun 2024 16:14:44 +0000

Enjoy Summer Safely

July is UV Safety Awareness Month, a great time to learn about UV radiation. Review the resources below to learn about the effects UV radiation exposure as well as ways to protect yourself and prevent sunburns sun damage and skin cancer.

Take a minute to watch a quick video explaining this month's healthy habit and download the resources below.

QR CODE FLYER

Print & Share with Your Employees

CALENDAR

Enjoy Summer Safely

ASK THE EXPERT

Elise Garrick, CHES, NASM CPT

Enjoy Summer Safely

Boletin informativo

Disfruta del Verano de
Forma Segura

Flyer

ABCDE's of Skin Cancer

FEATURED RECIPE

Honey Lime Chicken

wildcard challenge

Safe Sun Fun

SEASONAL FLYER

Star-Spangled Workout

The post 2024 July Health & Wellness Resources: Enjoy Summer Safely appeared first on GBS Benefits.

GBS Benefits

Suicide Prevention & Awareness Mini-Series

Suicide Prevention Basics

Presented by Molly SignorettyGBS Population Health Consultant

Safe & Effective Messaging for Suicide Prevention

Presented by Alyssa Mitchell Utah Department of Health & Human Services

Firearm Safety & Suicide Prevention

Presented by Kristy Jones Intermountain Health Community Health Initiatives Director

Equipping Your Workplace: Tools & Resources for Suicide Prevention

Presented by Catherine Van Tassell GBS Behavioral Health Director

2024 October Health & Wellness Resources: Embrace Diversity

Embrace Diversity

Take a minute to watch a quick video explaining this month's healthy habit and download the resources below.

QR CODE FLYER

CALENDAR

ASK THE EXPERT

NEWSLETTER

Boletin informativo

Flyer

FEATURED RECIPE

SEASONAL FLYER

Compliance Monthly Update: August 2024

Compliance Monthly Update: August 2024

Fiduciary breach lawsuit filed against Wells Fargo.

Updated model CHIP Notice released.

Fifth Circuit affirms vacation of portions of surprise billing regulations.

HHS increases civil monetary penalties for HIPAA, MSP, and SBC noncompliance.

State/Local Compliance Update: July 2024

Medicare Part D Creditable Coverage

Medicare Part D Creditable Coverage

Creditable Coverage Disclosure Requirements

1) Employers must disclose to CMS whether the plan is creditable or non-creditable.

2) Employers must provide the Medicare Part D Notice of Creditable (or Non-Creditable) Coverage to all Medicare-eligible individuals who are enrolled or seeking to enroll in the employer’s group health plan.

Impact of Non-Creditable Coverage on Medicare Eligible Employees

INTENT

PENALTIES

Recent Changes to the Process of Determining Whether Coverage is Creditable or Non-Creditable

Before the Inflation Reduction Act (IRA)

Changes due to the Inflation Reduction Act (IRA)

DRAFT INSTRUCTIONS

FINAL INSTRUCTIONS

What this Means for Employers

Next Steps

DOWNLOAD NOW

Employee Communication Template

September 2024

8 Tips for Effective 2025 Open Enrollment Communication

8 Tips for Effective 2025 Open Enrollment Communication

Communicating With Employees

Effective Communication is An Integral Part of Open Enrollment

Consider these eight open enrollment communication tips:

Summary

This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.

© 2024 Zywave, Inc. All rights reserved.

Strategies for Identifying and Resolving Gaps in Benefits Offerings

Strategies for Identifying and Resolving Gaps in Benefits Offerings

Well-rounded benefits packages often translate to: enhanced employee well-being, boosted retention rates, and a positive work culture.

Employer Considerations

Review existing benefits.

Analyze employee demographics and specific needs.

Gather employee feedback.

Benchmark against industry standards.

Explore emerging trends and employee preferences.

Prioritize benefits based on budget and resources.

Communicate changes effectively.

Monitor and reassess.

Summary

This Benefits Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.

© 2023 Zywave, Inc. All rights reserved.

Preparing for the 2024 Election

Preparing for the 2024 Election

Workplace Conduct

Voting Leave

Employee Voting Initiatives

Common employee voting initiatives include:

Summary

This HR Insights is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.

© 2024 Zywave, Inc. All rights reserved.

2024 September Health & Wellness Resources: Celebrate Healthy Aging

Celebrate Healthy Aging

Presented by Molly Signoretty
GBS Population Health Consultant

Presented by Alyssa Mitchell
Utah Department of Health & Human Services

Presented by Kristy Jones
Intermountain Health Community Health Initiatives Director

Presented by Catherine Van Tassell
GBS Behavioral Health Director

Masterclass: Affordable
Care Act