from CCH,Inc. and GBS

The U.S. Department of Health and Human Services has unveiled an innovative new on-line tool that will help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage. Called for by the Affordable Care Act, HealthCare.gov is the first website to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool.

“HealthCare.gov helps consumers take control of their health care and make the choices that are right for them, by putting the power of information at their fingertips,” said HHS Secretary Kathleen Sebelius. “For too long, the insurance market has been confusing and hard to navigate. HealthCare.gov makes it easy for consumers and small businesses to compare health insurance plans in both the public and the private sector and find other important health care information.”

HealthCare.gov is the first central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans. Consumers can receive information about options specific to their life situation and local community.

In addition, the website will be a one-stop-shop for information about the implementation of the Affordable Care Act as well as other health care resources. The website will connect consumers to quality rankings for local health care providers as well as preventive services.

“This website is unlike any government website you have ever seen or used before,” said HHS Chief Technology Officer Todd Park. “It was developed with significant consumer input and is remarkably easy to navigate. This is despite the sheer volume of content it offers consumers: billions of health care choices through the insurance finder and more than 500 pages of new content, all of which is designed to grow with ongoing consumer feedback and as our health care system improves.”

As the health care market transforms, so will HealthCare.gov. In October, 2010, price estimates for health insurance plans will be available online. In the weeks and months ahead, new information on preventing disease and illness and improving the quality of health care for all Americans will also be posted. The website also includes a series of opportunities where users can indicate whether pages were helpful to them and we will continue to seek user feedback to grow and strengthen the site.

“People need to see what choices are offered, what options cost, and how coverage works in practice,” said Karen Pollitz, Deputy Director for Consumer Support, Office of Consumer Information and Insurance Oversight. “Today HealthCare.gov takes an important first step in that direction. In the coming months and years, we will add pricing and plan performance information so that consumers can see and understand and make meaningful choices about their health coverage.”

SOURCE: HHS press release, July 1, 2010.

from HRBenefitsAlert

Wellness programs come in all shapes and sizes. But regardless of plan design there are five common components that set the successful programs apart from the rest.

At their core, wellness programs require constant monitoring and periodic adjustments. The programs that get mediocre results are the ones that are left to run on autopilot. That’s why it’s crucial to:

1. Know thine enemy. You have to know what’s driving your biggest claim costs on your healthcare plan – both among employees and their dependents.
2. Create realistic expectations. With wellness, what an employer gets will almost always depend on how much it spends, how well it plans and how well it sustains communications with participants and the vendor.
3. Maintain strong communications. The wellness initiatives that achieve the greatest success are those which are communicated aggressively from the get go and are sustained. Repetition is your friend when doing employee education.
4. Integrate wellness with other benefits. Real-life experience has shown that you should consider your employee assistance programs (EAPs) an extension of the wellness program. You should also consider issues like absenteeism, disability and worker’s compensation to be pieces of the wellness puzzle.
5. Practice what you preach. The key to ensuring employee buy-in is for management to lead the program by setting a positive example. If senior managers are unwilling to participate and address their own health issues, don’t expect many employees to take the program seriously.

From AJG

The Patient Protection and Affordable Care Act (“PPACA”), as amended by the Health Care &
Education Reconciliation Act of 2010, introduced several changes to employer payroll practices.
One important change impacts employee W-2s and takes effect next year.

W-2 Reporting Must Include Value of Health Care Coverage for Tax Years Beginning
After December 31, 2010.

Beginning with the 2011 tax year, employers must report the value of employer-sponsored health
care coverage on employee Form W-2s. Employers will not be required to provide a specific
breakdown of the various types of coverage, but must only report an aggregate cost. For
example, if an employee enrolls in medical, dental, and prescription drug coverage, the employer
only has to report one lump sum value, not a value for each individual benefit.

Note: This is only a reporting requirement. The employee’s gross income is not increased by the
value of the employer-sponsored health care coverage. In other words, the employee is not taxed
on the value of this coverage as part of his or her regular earnings.

This new reporting requirement from Healthcare Reform includes the value of both the employer
and employee contributions as calculated under the COBRA cost of coverage rules contained in
Section 4980B of the Internal Revenue Code.

How is the Value Calculated?

For fully insured plans, the COBRA cost of coverage is generally the premium paid to the
insurer. For self-funded plans, the COBRA cost of coverage is usually based upon a reasonable
actuarial estimate of future costs. Either way, the cost of coverage includes both the employee
and the employer portions, regardless of how that cost may be divided between the employee and
the employer (e.g., employee pays 20% of the cost of coverage, and the employer pays 80% for
active employees).

What’s included?

Employers should include the value, based upon the COBRA cost of coverage rules, of the
following:

• Medical coverage (including health reimbursement arrangements)
• Executive physical benefits
• Prescription drug coverage
• On-site clinics
• Medicare supplemental policies
• EAPs (except for referral only programs)
• Health Care FSA – employer contributions only (e.g., “seed” or match)
• Dental and vision, unless stand-alone plans (i.e., employee may elect only dental or only vision and is not required to also enroll in medical coverage)

What’s Not Included?

Employers should not include the value of the following:

• Long Term Care, accident, or disability income benefits
• Specific disease, indemnity, etc. coverage if not excludable from employee’s gross income
• Specified illness or disease policies such as cancer policies where the full premium is paid by the employee on an after-tax basis
• Hospital (or other) Indemnity insurance policies where the full premium is paid by the employee on an after-tax basis
• Archer MSA or HSA contributions of the employee or the employee’s spouse
• Salary reduction contributions to a Health FSA

Employer Action Steps

• Alert payroll as soon as possible
• Discuss changes with outside payroll vendor, if applicable
• Implement necessary changes to payroll system
• Consider implementing a monthly report on employee paystubs to reflect both cumulative and monthly health care coverage values in case employee terminates midyear and requests a W-2

Guidance has been issued with regard to the new health care reform coverage for children up to age 26.  The Employee Benefits Security Administration (EBSA) has issued a fact sheet, a series of questions and answers, and an interim final regulation about the new requirements. Basically, the health care reform act signed by President Obama will allow children to remain on their parents’ health coverage up to age 26. This provision is effective for plan or policy years beginning on or after September 23, 2010. Plans and issuers must give children who qualify an opportunity to enroll that continues for at least 30 days, regardless of whether the plan or coverage offers an open enrollment period. This enrollment opportunity and a written notice must be provided not later than the first day of the first plan or policy year beginning on or after September 23, 2010.

from MHA

Under the Patient Protection and Affordable Care Act (PPACA), both fully-insured and self-funded group plans that provide dependent coverage must provide coverage until age 26 for dependent children regardless of student or marital status. The new requirement is effective for plan years beginning on or after Sept. 23, 2010. This meant that many children, especially those graduating school this summer, would lose eligibility under their plan’s current eligibility definition and would have a gap in coverage before being permitted to re-enroll under the new PPACA definition of eligible dependent. To resolve this issue, many insurance carriers including Humana, Blue Cross Blue Shield, United Healthcare and Wellpoint have all issued statements indicating that they will work with employers to continue coverage for any dependent children currently enrolled in the plan until age 26, regardless of the plan’s next renewal date.

• Humana
• Blue Cross Blue Shield
• UnitedHealthcare
• Wellpoint

by MetLife

The findings from the 8th Annual Study of Employee Benefits Trends point to the apparent resilience of workplace benefits in this recession, and reveal that, as employers and employees continue to deal with the effects of the economic downturn, they are focused on the long term. Most employers have not reneged on their benefits commitments and employees continue to depend on their workplace benefits for protection and stability.

However, this year’s Study also reveals a benefits landscape that has been altered as a result of the recession experience. Employees must deal with the financial risks that were exposed when their 401(k) balances precipitously declined and their jobs became uncertain. Employers must seek ways to maintain a competitive advantage for their benefits programs in the context of greater focus on employee productivity and cost control.

Despite these challenges, employers and employees appear to be working toward a common goal: Securing financial health & wellness. Through employer-sponsored wellness programs, automatic enrollment features for retirement savings plans, voluntary benefits and protection products, employers are taking steps to help their employees act on their best intentions.

This year’s Study provides new insights that can help employers identify opportunities to realize the full potential of their benefits programs and to maximize the return on their benefits investment.

Key Highlights from the Study.

Employers Say That:

1. The importance of controlling costs has increased and is now their most important
   benefits objective.
2. The focus on employee retention is somewhat reduced, but is still the second most
   important objective despite the weak job market.
3. Employee productivity remains the third most important objective, but the steady
   increase in importance since 2007 continues.
4. Programs that help foster employee health & wellness and financial security are
   effective in improving employee productivity.
5. Active employer engagement in their qualified retirement plans is increasing and is
   necessary to help employees realize adequate income in retirement. There is emerging
   interest in automatic enrollment, automatic escalation and default annuitization in larger
   companies to help employees act on their intentions to save.
6. They have not increased their focus on providing financial advice, guidance and
   retirement education, despite employee interest, perhaps reflecting the economic
   pressures of the last year.
7. Voluntary benefits can cost-effectively enhance a benefits program, yet few are increasing
   the number offered or prioritizing this as a strategy.

Employees Say That They:

1. Intend to delay retirement. A full 59% of employees now plan to work past age 65.
2. Did not cut back on their benefits participation in the workplace, despite tight budgets.
   They value benefits as part of their financial safety net, and the workplace is the primary
   source for obtaining those benefits.
3. Are more satisfied with their benefits than at any time since 2007, before the recession,
   and they accept that they may need to pay more to get more in the new economy.
4. Feel hopeful about their short-term financial outlook, but still have significant concerns
   about their personal financial situations and admit that those concerns affect their
   workplace productivity.
5. View wellness programs as very worthwhile and connect successful participation to
   better health and productivity.
6. Remain very interested in having their employers provide financial advice, guidance and
   retirement education as they seek ways to realize predictable income for retirement.
7. Are more cautious, and have an increasing appetite for investment options that offer
   more safety than the potential of high returns, at least for now.

Full study can be found here: http://www.metlife.com/assets/institutional/services/insights-and-tools/ebts/Employee-Benefits-Trends-Study.pdf

by The Associated Press

Here are some of the features of the legislation.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 94 percent of eligible non-elderly Americans would have coverage, compared with 83 percent today.

COST: $938 billion over 10 years, according to the Congressional Budget Office.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine, which takes effect in 2014. There is an exemption for low-income people.

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.

MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016.

If the Senate approves a package of changes this week, a special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity would be eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.

TAXES: To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent. If the Senate follows through, it would impose a 40 percent tax on high-cost insurance plans above the threshold of $10,200 for individuals and $27,500 for families. The tax would go into effect in 2018.

PRESCRIPTION DRUGS: Gradually closes the “doughnut hole” coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare’s catastrophic coverage kicks in.

EMPLOYER RESPONSIBILITY: Employers are hit with a fee if the government subsidizes their workers’ coverage. The $2,000-per-employee fee would be assessed on the company’s entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement.

SUBSIDIES: The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.

GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.

ABORTION: The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

GOP HEALTH CARE SUMMIT IDEAS: Following a bipartisan health care summit last month, Obama announced he was open to incorporating several Republican ideas into his legislation. But two of the principle ones — hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives — did not make it into the legislation. The legislation incorporates only one, an increase in payments to primary care physicians under Medicaid, an idea mentioned by Sen. Charles Grassley, R-Iowa.

President Obama, on Dec. 19, 2009, signed the Fiscal Year 2010 Defense Appropriations Act which includes amendments to the federal American Recovery and Reinvestment Act of 2009 that provided health care premium assistance for certain individuals. ARRA revised the federal Consolidated Omnibus Budget Reconciliation Act of 1985 to require employers with COBRA-covered group health plans to pay 65 percent of health care premiums for up to nine months for assistance eligible individuals who lose health care coverage due to employees’ involuntary employment termination between Sept. 1, 2008, and Dec. 31, 2009. The new law expands the duration of the 65 percent premium assistance from nine to 15 months, and extends premium assistance to individuals who lose health care coverage due to employees’ involuntary employment termination between Sept. 1, 2008, and Feb. 28, 2010.

From MHA

The Equal Employment Opportunity Commission (EEOC) issued an informal letter regarding an employer that required a health risk assessment as a condition of eligibility for reimbursement under the employer’s health reimbursement arrangement (HRA). If an employee did not complete the assessment, the employee was not eligible for reimbursements under the HRA. The Americans with Disabilities Act (ADA) permits a wellness plan to ask disability-related questions only if the plan is voluntary and individuals are not penalized for nonparticipation. The EEOC stated that the assessment would violate the ADA because it asked disability-related questions and penalized individuals for not completing the assessment. The EEOC has not taken a formal stand on this issue, but this informal letter is in line with previous EEOC informal letters prohibiting a plan from basing enrollment in a group health plan on completion of a health risk assessment.

Click here for more information

From Employee Benefit News

Employer and employees have a new resource that can be used to help battle obesity in the workforce. Earlier this year, the Centers for Disease Control and Prevention unveiled LEANworks!, a web site full of free resources for employers to develop wellness programs to address obesity. The site, www.cdc.gov/LEANWorks, includes research reports, case studies, ROI information, and an obesity calculator. It features how -to information about assessing the needs of the workforce, developing an effective program, setting goals, budgeting, and strategies for implementing and promoting the program.