In its latest effort to settle the ongoing controversy over contraceptive coverage, the Obama administration today proposed new measures to ensure that female employees of religious nonprofits and some “closed held” companies have free access to birth control regardless of employer objections.
The Associated Press reports that the revised policy would allow faith-affiliated charities, colleges and hospitals to notify the Department of Health and Human Services, rather than their insurer or third-party administrator, that they object to birth control on religious grounds. Likewise, for-profits with strongly-held religious beliefs could directly request an exception in a similar manner.
Ultimately, the “fix” just adds a bureaucracy buffer to the process, as the HHS in turn notifies the group’s insurer or TPA of its need to provide contraceptive coverage on behalf of the employer. In other words, the government serves as a neutral go-between in hopes of quelling moral disapproval (though employers still have the option of notifying a third party directly).
Over 50 religious nonprofit organizations have filed cases challenging the requirement that they opt out of coverage by filling out a form to their insurer or TPA stating their objection. Such an action, they say, would still go against their beliefs by making them “complicit” in providing something they consider sinful. So while these proposals do attempt to address the legal challenges, the crux of their objections still remains – if slightly redirected.
Opinion as to whether or not men should get tested for prostate cancer has seen a sizable shift of late. The general thinking that men age 50 and over should have an annual prostate-specific antigen (PSA) screening has given way to a more cautious approach, due in large part to research findings that suggest testing may offer more risks than rewards.
A recent European study determined that midlife PSA screenings do reduce a man’s risk of dying of the disease by 21% – which sounds significant until you take into account that a middle-aged man’s risk of dying of prostate cancer without screening is only about 3%. And getting regular screenings only lower the risk to 2.4%.
Such numbers led the study authors to advise against widespread screening, and instead focus on high-risk patients. Additionally, scientists should work to identify nonaggressive cancers so men will not be unnecessarily treated for the disease.
In The New York Times, Doctor of Internal Medicine Barak Gaster, MD explains why the decision to have a PSA test is a tricky one:
“Unlike cancer of the breast or the lung or the colon, which tends to kill people within five or 10 years, prostate cancer is usually slow growing. Men tend to die with it rather than of it. In fact, many live with it for 30 years or more and never even know they have it.
“That said, 3% of men do die of prostate cancer. So if we had an easy, safe treatment for prostate cancer, it would make sense to screen everyone and treat all the cancers we found. But the main treatments for prostate cancer carry a high risk of causing urinary incontinence and erectile dysfunction.
“As a result, when a man decides to be screened for prostate cancer, there’s a high risk he will sustain permanent harms from treating a cancer that he never would have known he had. And that risk is probably much higher than the chance that he will live longer because he was screened.”
MedBen follows current American Cancer Society guidelines which recommend that not every man be tested for prostate cancer, even those who are 50 and older. Rather, men should learn more about the disease and speak to their family doctor about the risk and possible benefits of testing.
Employers that offer tax-free individual major medical coverage through cafeteria plans may leave themselves open to significant adverse tax consequences, cautions a bulletin from the Employers Council on Flexible Compensation, a health care industry association.
Last year, the Departments of Treasury and Labor issued guidance that affects employers’ ability to pay for individual market (IM) policies, such as major medical coverage that is subject to the Affordable Care Act (ACA), through a cafeteria plan. IRS Notice 2013-54 stresses that pre-tax funding of IMs in this manner, whether through employer payment or reimbursement, would violate the law, resulting in the imposition of an excise tax against the employer of $100 per employee per day.
Despite this guidance, some benefits managers have told their clients that because the cafeteria plan is not a group health plan subject to the ACA, employers can make pre-tax payments of IM coverage premiums without risking a penalty. But this line of thinking runs counter to the IRS Notice, which states that any arrangement that pays or reimburses an employee’s IM policy premiums on a pre-tax basis would be an “employer payment plan,” which the agency clearly indicates is a “group health plan” subject to the ACA. And that means the employer would face a steep penalty for violating the law.
While the ACA is hardly lacking in regulations requiring clarification, MedBen reads this particular language as unambiguous – which is why we’re strongly advising our clients against funding IM policies through cafeteria plans. Clients that have any questions regarding this guidance are welcome to contact Director of Administrative Services Sharon A. Mills at email@example.com.
Health care prices nationwide have recently risen faster than general inflation, following an extended period of historically slow growth. But at MedBen, we’re committed to saving our clients money regardless of price trends.
According to a new Price Brief from the Altarum Institute, the health care price index in June 2014 rose 1.7% above June 2013. The 12-month moving average of 1.3% is near the all-time low for the institute’s data (1.2%), but it has now risen for four straight months, the first increasing trend since January 2012.
On its face, these increases are pretty small… but the fact that the health care prices are again growing faster than the gross domestic product suggests that bigger jumps are possible in the coming months. And with millions of newly insured Americans accessing health care, there’s a good chance the price of health care goods and services will reflect the added demand.
Health care prices are driven largely by market forces and government regulation. But that’s not to say that employers can’t take measures to control how such price fluctuations affect their own bottom line… and one of the best ways to do that is by partnering with a benefits management specialist that puts its clients’ best interests first.
Whatever the current economic client may be, MedBen works with employer groups to develop benefit solutions that save them money. Our unique claims process delivers the highest level of benefits at the best cost. Our pharmacy program brings more savings, and our WellLiving disease management and worksite wellness program promotes cost efficiency through a healthier workforce.
MedBen’s priority is to find clients quality health care backed up with verifiable savings. To learn more about how we can help your business save money, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Diabetes is an ongoing epidemic in this country, and the future forecast doesn’t look much brighter. But a heightened focus on worksite wellness can help to improve the numbers.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that approximately two out of every five Americans will develop type 2 diabetes at some point during their adult lives. WebMD reports that from 1985 to 2011, the lifetime risk of type 2 diabetes for the average 20-year-old American man jumped from nearly 21% to 40%, and from 27% to almost 40% for women.
“We weren’t necessarily surprised that it increased, but we didn’t expect it to increase this much,” said lead study author Edward Gregg, chief of the epidemiology and statistics branch in the division of diabetes translation at the CDC. “Forty percent is a humbling number.”
Part of the increase can be attributed to genetics and longer lifespans. But the growing obesity rate in this country is also a contributing factor.
Most diabetics have type 2 diabetes, which is among the most controllable chronic conditions. Even after an individual develops the condition, practicing proper wellness can actually reverse it to the point where medication is no longer required.
At MedBen, we help employers help employees reduce their type 2 diabetes risk through our recently upgraded WellLiving program. By encouraging timely preventive care and lifestyle changes, WellLiving plan members significantly lower their odds of developing a chronic condition. And with our one-on-one RN counseling, members already at risk can take the right steps to combat obesity and diabetes.
As Gregg observes, “If prevention efforts take hold, then the equation for lifetime risk will change pretty quickly.”
For additional information about MedBen WellLiving, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
The IRS has made a minor adjustment to what constitutes group plan member affordability under the Affordable Care Act, Employee Benefit News reports. For plan years beginning in 2015, Revenue Procedure 2014-37 sets the new limit at 9.56% of employee income… a slight increase from the current 9.5%.
The health care reform law requires that large employers provide affordable coverage beginning in 2015 or potentially face penalties. The “percentage of income” criteria only instructs employers to take into account employee salary, even if an employee has family coverage under the group health plan.
The adjustment reflects the rate of recent premium growth over income growth for the preceding calendar year.
Keith R. McMurdy of the legal firm Fox Rothschild notes that while this change is small, “it does serve as a reminder to employers that the definition of ‘affordable’ can change. So a key component of building a solid ACA compliance plan includes checking to see if the various limits and percentages have changed prior to a plan year.”
Awareness of ACA changes is indeed critical for employers looking to fines and other avoidable expenses, which is why the MedBen Compliance Team helps clients to stay on top of the latest developments. Clients who have any questions about affordable coverage under their plan are welcome to contact Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
Hoping to squeeze in a weekend getaway or even an extended vacation before the summer ends? By practicing the same healthy habits on the road that you do back in the “real world,” you’re likely to have a better time on your adventure.
Before you depart, schedule an appointment with your family physician to ensure that your immunizations are up to date, especially if you plan to travel abroad. And if you take prescription medications, be certain that you have enough on hand for the length of your trip.
Once you’ve reached your destination, do your best to stick to your regular exercise regimen. That’s not to say, however, that you can’t stir things up a bit: Instead of, say, simply opting for the treadmill in the hotel fitness area, enjoy a jog on the beach or take a brisk walk around the neighborhood to check out the scenery.
As for diet… well, while you’ll certainly want to sample some of the local cuisine, don’t use your vacation as an excuse to leave smart eating habits at home. So if you treat yourself to a high-calorie lunch, balance it with a salad for dinner. Along the same lines, don’t go overboard with the alcohol consumption – moderation remains the key, regardless of where your travels take you!
For such a seemingly innocuous drug, aspirin has been endlessly analyzed and scrutinized, and alternately praised and criticized. And now comes the latest piece of evidence to add to the debate.
According to AFP, researchers reviewed 200 clinical trials and other studies that explored aspirin’s anti-cancer effects, and found that taking a 75-100 mg dose aspirin daily for 10 years could cut bowel cancer cases by around 35% and deaths by 40%. Additionally, rates of esophageal and stomach cancers were cut by 30% and deaths from these cancers by 35-50%.
“Our study shows that if everyone aged between 50-65 started taking aspirin daily for at least 10 years, there would be a 9% reduction in the number of cancers, strokes and heart attacks overall in men and around 7% in women,” said Jack Cuzick, a professor at the Centre for Cancer Prevention at Queen Mary University of London, in a press release.
“The total number of deaths from any cause would also be lower, by about 4% over a 20-year period. The benefits of aspirin use would be most visible in the reduction in deaths due to cancer.”
The authors noted, however, that there is a trade-off to long-term use of aspirin – a higher risk of peptic ulcers and bleeding in the digestive tract, which in a small number of elderly people could prove life-threatening.
Whatever healing qualities scientists and consumers ascribe to aspirin, it is still a drug with potential side effects and must be treated as such. That’s why when regularly taking aspirin or any over-the-counter drug, it’s vital to discuss its usage with a primary care physician. Indeed, one of the greatest advantages of annual wellness exams from your family doctor is it allows him or her to track your medicine usage and advise you of a drug’s possible risks as well as benefits.
MedBen Worksite Wellness promotes a “physician-first” approach to personal health that keeps the family doctor involved in medication decisions. Plus, members have access to an online information Rx database containing information regarding thousands of brand name and generic drugs. For more information about the benefits of wellness in the workplace, contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
A “final” Affordable Care Act rule issued earlier this year has been tweaked a bit, Business Insurance reports. The Department of Health and Human Services announced that rather than requiring employers to pay the Transitional Reinsurance Fee in two installments, they will have the option of making a single payment.
Regulations released in March required that group health plans pay the 2014 assessment of $63 per participant in two installments – a $52.50 payment due January 15, 2015, and an additional $10.50 payment due November 15, 2015. But negative feedback from some employers led the HHS to reconsider the rule, adding a single payment option due January 15, 2015.
“We are thankful that HHS has changed its policy to allow one consolidated payment. Many companies prefer the efficiencies of a one-payment approach,” said Gretchen Young, senior vice president for health care with the ERISA Industry Committee in Washington.
The reinsurance tax was implemented under the ACA to cover high-cost cases in the individual market. Payments are to be made annually over a three-year period. The 2015 fee is $44 per plan participant; HHS has yet to propose the 2016 fee.
MedBen offers a variety of Transitional Reinsurance Fee services to its clients, from free eligibility data to more detailed reports. Clients that would like to receive more information (including costs) may contact their Group Service Representative.
And this time we really, really mean it…
The Department of Health and Human services have formally set a October 1, 2015, compliance date for conversion to ICD-10 diagnostic and procedure codes, Modern Healthcare reports. Originally scheduled to roll out later this year, the conversion was delayed in March following the passage of a Medicare “doc fix” bill.
“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner in a news release.
“For patients under the care of multiple providers, ICD-10 can help promote care coordination.”
Some providers, vendors and claims administrators say that even with the delay, they’ll have trouble meeting the October 2015 deadline, citing “challenges with software upgrades, workflow modification and staff training.” At MedBen, however, we say: Bring it on.
MedBen was already on schedule to meet the original October 2014 date… so suffice to say we’ll be well ahead of the curve by the time the formal switch takes place. In the interim, we’ll be able to accept the new codes early from provider “trading” partners who also have the system in place, based on the availability of pilot programs. When October 2015 rolls around, we’ll be ready!
MedBen clients with questions regarding ICD-10 readiness may contact Vice President of Information Systems Rose McEntire at firstname.lastname@example.org.
Last year, 70% of the self-funding proposal requests to MedBen originated from fully-insured employers… a number we expect to rise in 2014.
The Affordable Care Act has caused a dramatic shift in the cost and the demands of heath care coverage – and it’s especially true for employers that offer traditional health insurance. So it comes as little surprise that fully-insured groups are increasingly exploring the advantages of self-funding.
Businesses with as few as 25 employees can successfully self-fund their health care plan with MedBen. And you’re currently fully-insured, we can help you make a smooth transition.
MedBen Self-funded Solutions offer better service and savings:
Above all, MedBen puts the customer first. We listen to your concerns and respond with better self-funded solutions.
If your company is ready to benefit from the flexibility and savings potential of self-funding, MedBen can help. To learn more, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
Even though the employer mandate has been delayed and faces opposition from a Republican-led House of Representatives, the Obama administration is pressing forward in its efforts to make “play or pay” a reality. Toward that end, the IRS has released drafts of the forms that employers will be required to complete in order to comply with Affordable Care Act rules.
These unofficial drafts, used to certify coverage offered by an employer to its employees, include: Form 1094-B (“Transmittal of Health Coverage Information Returns”); Form 1094-C (“Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns”); Form 1095-A (“Health Insurance Marketplace Statement”); Form 1095-B (“Health Coverage”); Form 1095-C (“Employer-Provided Health Insurance Offer and Coverage”); Form 8962 (“Premium Tax Credit”) and Form 8965 (“Health Coverage Exemptions”).
In general, plans must file Form 1095-B and provide copies to their enrolled employees using the 1094-B transmittal Form. Additionally, large employers must file Form 1095-C and provide copies to their employees using transmittal Form 1095-B.
The other three forms are for use in conjunction with Exchange coverage. Form 1095-A is a notice provided from an Exchange to those who enrolled in coverage through the Exchange. Individuals getting a subsidy from an Exchange must file Form 8962 while those seeking an exemption from the individual mandate will claim such on Form 8965.
FRED’s Café is officially open for business!
On July 23, MedBen Benefit Configuration Specialist SueMarie Beaumont unveiled the sign that “bears” the name of the benefit management company’s new in-house convenience store. Located in MedBen’s break area, this innovative self-serve market offers hundreds of fresh food and beverage selections, and uses touch-screen technology to enable employees to pay for items with a dedicated key card.
Beaumont was the winner of a companywide contest to name the market. The MedBen executive team chose her submission out of more than 40 entries, and awarded her with additional credit on her key card to make market purchases. “FRED” is name of MedBen’s blue bear mascot, a likeness of which adorns the sign.
FRED’s Café offers employees greater selection and convenience than standard vending machines can provide. But introducing the concept wasn’t simply about that, says MedBen Chairman & CEO Doug Freeman. Rather, the company hopes to use the market as a means to encourage wellness, by offering lower prices on healthier items.
“We’ve offered subsidies on a smaller scale in the past, but with FRED’s Cafe we’ve vastly expanded the program,” said Freeman. “In addition to fruit and bottled water, we’re covering part of the cost for salads, sandwiches, yogurt and even some snacks… if it’s healthy, chances are good that MedBen is subsidizing it.”
Two separate – and opposing – federal appellate court rulings issued yesterday regarding subsidies available to individuals enrolled in health insurance exchanges could have long-term implications for another major provision of the Affordable Care Act, reports Andrea Davis of Employee Benefit News:
“Employers, meanwhile, are still waiting on the Internal Revenue Service to finalize employer reporting rules and forms for the ACA’s pay-or-play mandate, set to kick in next year. ‘If this drags on into the fall, where there is some uncertainty as to which exchanges do or do not trigger a penalty, combined with the delay in the employer reporting forms, I could easily see the government saying: ‘Let’s hold off another year [with the employer mandate] until this all gets settled,’’ says Paul Hamburger, co-chair of Proskauer’s employee benefits, executive compensation and ERISA litigation practice center in Washington, D.C.
“’It’s a fundamental decision the government needs to make – whether the employer mandate applies or doesn’t apply,’ says Brian Pinheiro, chair of the employee benefits and executive compensation group with law firm Ballard Spahr. ‘I don’t think there’s anything for employers to do, other than wait and see what everybody agrees the law is. If the D.C. Circuit opinion holds, then the employers that are in states that have federal exchanges basically don’t have any employer mandate – there’s no pay or play rules for [those] employers, which is huge.’”
July 31st is not only the anniversary of the creation of the federal Department of Health, Education and Welfare, it is also the date that the Department’s successor – Health and Human Services – set as the PCORI Fee filing date under the Affordable Care Act.
No later than July 31, 2014, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee. All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans – including employees, retirees, spouses and dependents. Self-funded plans subject to the requirements include self-funded medical benefit plans, including most non-ERISA self-funded plans and retiree-only plans. Other self-funded plans subject to the fee include self-funded HRAs and FSAs which are not integrated with a plan sponsor’s self-funded major-medical plan. Dental-only, vision-only, EAP, disease management, and wellness plans are exempt.
All plan sponsors must use the IRS Form 720 dated April, 2014 to record and remit the amount due. Those plan sponsors paying for the first time owe $1.00 per covered life; those paying for the second time owe $2.00 per covered life.
If you’re a MedBen client who needs more information about how to count covered lives under your plan or how to prepare and remit your payment, don’t hesitate to contact Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
By the way, if you’re interested in learning a little more about how your PCORI fees will be used, read this blog post from the Institute’s Executive Director.
On July 17, 2014, the Tri-Agencies (United States Departments of Labor, Health and Human Services and the Treasury) released a Frequently Asked Question notice pertaining to the recent U.S. Supreme Court ruling in Burwell vs. Hobby Lobby. As you recall, the Supreme Court ruled that Hobby Lobby, as a closely-held company, was allowed to pick and choose which contraceptive coverage its employee health benefit plan covered based on its deeply-rooted religious beliefs.
The FAQ released by the Tri-Agencies is probably only the first of its interpretive guidance on this issue. It provides only an inference that closely-held companies may select which contraceptive coverages they cover under the preventive services mandate of the Affordable Care Act. Rather, the guidance is a reminder to ERISA plans about how plan changes which reduce benefits coverage must be handled under ERISA. In fact, the FAQ doesn’t mention religious beliefs at all or how those might be tied to gaining an exemption from the contraceptive mandate. You can read the FAQ and the Tri-Agencies’ answer at the Department of Labor website.
As always, MedBen clients who have any questions regarding the ACA or its requirements should feel free to contact Vice President of Compliance Caroline Fraker at email@example.com.
A company that offers a worksite wellness program expects more for its efforts than the warm feeling that comes from doing its part to help plan members stay healthy. Understandably, it wants to see a tangible (read: monetary) return on its investment. But how does an employer go about quantifying the cost savings?
With MedBen Worksite Wellness, clients get actionable reporting that not only demonstrates the overall progress of their program, but shows in pure dollars-and-cents whether or not the plan is benefiting the business financially as well. We measure the success of our programs based on multiple criteria, including:
These reporting factors are tracked using Verisk Sightlines, an advanced data analytics platform that helps clients make informed health care decisions. This secure online service enables users to personally scrub claims and mine member data, so clients can identify trends and see exactly where their health care dollars are going – and why.
To learn more about how MedBen can help your business implement a worksite wellness program that improves member health and saves you money, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The extensive media coverage of the recent Supreme Court ruling on contraceptive coverage – not to mention, the resultant political outcry – has somewhat overshadowed the reality that the decision affects only a small percentage of businesses. And for those majority of employers that are still legally obligated to cover the cost of birth control for their female plan members, many believe the added expense is worth it, according to one expert.
“There are so many incentives for companies to cover contraception,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and policy organization that focuses on reproductive health, in an interview with NPR. He observes that insurers and self-funded employers benefit from the cost savings inherent in paying for birth control in full, as the coverage cost is much less than maternity and delivery.
Even before the passage of the Affordable Care Act, 85% of companies with more than 200 workers – and 63% of employers overall – provided birth control coverage, according to the Kaiser Family Foundation’s 2010 annual employer health benefits survey. The health care reform law did prohibit employers from choosing which specific contraceptive methods they would cover, however.
As the Washington Post notes in a Q&A, “FDA-approved methods of birth control are considered preventive care, and the health law requires nearly all health plans sold on the individual and group markets to cover preventive care without any out-of-pocket cost to consumers. The Supreme Court decision didn’t change that.”
A new report suggests that women who get their annual wellness examinations from their family doctors receive a broader range of services, compared to those who get preventive tests from their obstetrician/gynecologists (OB/GYNs).
“I think [primary care providers] and OB/GYNs can play an important role in clinical preventive services,” said study co-author Dr. Mona Saraiya of the Centers for Disease Control and Prevention. “I think it’s important to be aware where there might be deficits.”
According to Reuters Health, the analysis of medical records from between 2007 and 2010 found that women who saw OB/GYNs were more likely to get screened for cervical and breast cancers, Chlamydia and osteoporosis, compared to those who went to primary care doctors. But those who went to primary care doctors were more likely to get screened for colon cancer, high cholesterol and diabetes and to be counseled about diet, exercise and obesity.
The researchers write that “women of reproductive age who see OB/GYNs only for preventive care may not be receiving the full spectrum of recommended screening and counseling.”
Under Affordable Care Act rules, health care plans must cover the costs of recommended wellness tests, but not necessarily the cost of the office visit itself. However, many plans will cover the full cost of a woman’s annual exams at both her primary care physician and her OB/GYN.
Females who prefer to receive specific well woman tests from multiple doctors should review their summary plan document or speak to their plan administrator to determine how the exams are covered. MedBen clients are welcome to also contact a MedBen Customer Service Representative at (800) 686-8425 or visit MedBen Access.
The Supreme Court made its ruling about employers and birth control coverage last week, but that hardly means the matter has been put to rest.
The New York Times reports that two Senate Democrats have introduced legislation to override the Supreme Court decision. The bill, written with input from the Obama administration, would require for-profit corporations like Hobby Lobby Stores to provide and pay for contraceptive coverage, along with other preventive health services, under the Affordable Care Act.
The bill states that an employer “shall not deny coverage of a specific health care item or service” where coverage is required under any provision of federal law. However, it does preserve the earlier exemption for churches and non-profit religious organizations that object to the coverage mandate.
House Democrats are also expected to draft a bill, but it would stand little chance of passage in the Republican-run House.
The Supreme Court ruling has also prompted a response from a trade group representing third party administrators.
According to Business Insurance, the Self-Insurance Institute of America wrote a letter Monday to the U.S. Health and Human Services, Treasury and Labor departments stating that the accommodation for religiously inclined for-profit employers places an additional financial burden on TPAs. Under ACA rules, TPAs must cover contraceptives on behalf on their self-funded groups that have religious objections to the requirement.
And even some employers that ostensively benefit from the high court’s decision don’t think it goes far enough. In two separate set court cases, 50 for-profit and 59 non-profit groups are challenging the very existence of the contraceptive coverage requirements.
According to MedCity News, most of the entities involved in the lawsuits charge that the birth control mandate violates their rights under the Religious Freedom Restoration Act. While most would not have to provide such coverage, the process by which they can opt out, which involves filling out a form and sending it to their insurance company or TPA, still goes against their religious beliefs by making them “complicit” in providing something they consider sinful.
Suffice to say, we haven’t heard the last of this story…