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  11:21:00 pm, by MedBen5   , 341 words,  
Categories: American Health Care Act

MedBen University Season Rolls out with Roundtables

MedBen University

MedBen University (MBU) will soon be in session! Our educational seminar series will offer attendees actionable information on a range of health benefits management topics, from utilization trends to new cost-reducing benefit solutions.

MBU will kick off its 17th season with a series of benefits management roundtables. These special sessions use data from MedBen's business blocks as a starting point for a discussion of medical and pharmacy claim trends, showing where your health care dollars are going and helping you spot opportunities to lower costs. We'll also look at new and emerging coverage strategies, including a unique cost-reducing prescription benefits solution.

All three events will be held at the C. Arthur Morrow Conference Center, 1821 W. Main Street, Newark, Ohio (located next to the MedBen home office). Invitations will be mailed soon, so keep an eye out for yours!

16th Annual Hospital Roundtable
Because of a hospital's position as a care provider, benefit planning poses particular challenges and opportunities for plan administrators. Attendees will learn ways to use this industry advantage to their best benefit, and what performance indicators to watch in order to best manage costs.

12th Annual Municipality Roundtable
City and county governments, school systems and other public sector employers also face unique health care cost control issues. Attendees will learn cost reduction strategies that municipalities can apply to their coverage, and ways that they can make more informed planning decisions.

2nd Annual Employer Roundtable
While no two businesses are alike, there are actions that every employer can take to maximize the effectiveness of their self-funded plan. This session will highlight strategies that have proven successful to MedBen clients as well as new approaches to benefits management that promise to reduce plan costs even further.

Even if you've attended previous MBUs, you'll still get plenty of useful and timely information about health care planning. Our team of benefit management professionals will be happy to answer your questions... and yes, a continental breakfast and lunch will be provided at every session.

We hope to see you at an MBU event in 2018!

  11:14:00 pm, by MedBen5   , 238 words,  
Categories: American Health Care Act

Treatment Advances, Regular Screenings Reduce Breast Cancer Mortality

pink ribbon

A focus on preventive care and breakthroughs in screening and treatment reduced breast cancer deaths by 49% in 2012, compared with a 37% reduction in 2000, a new study finds.

"Advances in screening and treatment are saving lives," said lead researcher Sylvia Plevritis, a professor of radiology and biomedical data science at the Stanford University School of Medicine. "Here's an example that all this investment in research and discovery has had a real benefit. This has translated into making a difference."

The reduction in breast cancer deaths has also coincided with the rise in employer wellness programs like MedBen WellLiving. From its inception, WellLiving has emphasized the importance of regular cancer screenings based on age and gender... and we're pleased to assist employers in their efforts to help employees achieve better health and realize a higher quality of life. WellLiving recommends that women start getting mammograms at age 40 every two years until their physician decides not to order the screening.

Encouraging preventive care in the workplace offers physical and financial benefits alike. Not only do non-invasive (stage 0) and early stage (I and II) breast cancers have a better prognosis than cancer in its later stages (III and IV), which could possibly even save a life, early stage detection can save a health plan hundreds of thousands of dollars in treatment costs.

Learn how you can make a real difference by contacting MedBen Vice President of Sales & Marketing Brian Fargus at


  06:45:00 pm, by MedBen5   , 255 words,  
Categories: News, Health Care Reform, Taxes, IRS

Delayed Again . . . Cadillac Tax Postponed Until 2022

IRS Building

While things have been relatively quiet on the Affordable Care Act front, in recent weeks employers were starting to wonder if they needed to implement strategies to manage costs under the controversial Cadillac Tax which was set to become effective in 2020.

This week’s short-term budget bill put those concerns to rest for a couple more years. The bill that passed out of Congress and was signed by President Trump on January 22 included another delay of the Cadillac Tax – now postponed until 2022.

The biggest problem with planning for the Cadillac Tax is that there are still no implementing regulations. That means that there is no definitive guidance for plan sponsors who want to determine how this tax might affect them. In its current form, the Cadillac tax would assess a 40% penalty on health plans in excess of certain thresholds. Those thresholds, set in 2014 at $10,200 for single coverage or $27,500 for family coverage, increase each year thereafter by statute.

One important fact to remember is that, for Cadillac Tax purposes, the value of a health care plan is determined not just by what the plan offers, but by the overall costs of the plan, which is calculated using the same methodology as used in determining a plan’s annual COBRA rates. So simply removing a benefit here and there will not significantly affect the coverage cost in relation to the threshold amount if the overall plan costs are not affected.

For more information about the Cadillac Tax, contact Vice President of Compliance Caroline Compliance Caroline Fraker at 800-851-0907 or


  05:12:00 pm, by MedBen5   , 187 words,  
Categories: Announcements, Cost savings, Third party administration, Claims management

MedBen Claims Surveillance Continues to Save Clients Money

magnified dollar

MedBen's claims surveillance system, which screens and selects claims for specialist review, saved clients, on average, an additional 38% per selected claim in 2017... savings produced after network discounts are applied, but before claims are paid.

Our advanced surveillance technique takes claims processing to another level. This system works in tandem with our in-house processing, using physician-managed algorithms to find claims that may not meet medical necessity or appropriateness standards. If a claim is flagged, board-certified medical specialists further review the claim (with the client's approval) to find possible resolutions.

In dollars and cents, this added layer of claims analysis saved clients an average of $7.57 per employee per month (PEPM) in 2017. Furthermore, looking at the PEPM amounts from 2013 to 2016 reveals a five-year average client savings of $10.09 PEPM.

It should be noted that these savings come on top of savings derived from plan provisions, network discounts, and medical management. Taken together, these cost controls and other claim management strategies help MedBen clients remain under national plan spending trends.

Learn more about claims surveillance and other MedBen saving solutions by contacting Vice President of Sales & Marketing Brian Fargus at

  05:09:00 pm, by MedBen5   , 345 words,  
Categories: News, Wellness, Compliance

Judge Vacates EEOC Wellness Program Rules


“When you’re finished changing, you’re finished.”

Ben Franklin’s words ring true for those still struggling with the EEOC’s workplace wellness incentive rules. The EEOC’s May 2016 final rules outline how employers are permitted to offer wellness program incentives to employees and when those programs are considered voluntary. The rules were complex and often difficult to reconcile with the less complicated HIPAA wellness rules (which were in effect at the time and remain in effect today). However, in December 2017, a Washington D.C. Federal Judge vacated the EEOC rules in response to a lawsuit brought by the AARP (AARP v. EEOC, D.D.C. 1:16-cv-02113).

Judge John Bates’ ruling sides with the AARP, which has argued that the EEOC's wellness incentive rules (permitting health plans to include incentive penalties of up to 30% of the cost of coverage) are not a sufficient remedy for categorizing the wellness programs as voluntary.

But before running out to change your wellness program you should know two things about the Judge’s order. First, the Judge vacated the current EEOC wellness program rules – but not until January 1, 2019. The Judge reasoned that employers wouldn’t have sufficient time to re-design their plans for 2018 (“on they fly” as described by the Judge). Second, the Judge ordered the EEOC back to the drawing board, requiring that the Agency propose new rules by August 31, 2018. The EEOC must provide a reasoned explanation for considering workplace wellness programs voluntary even if those programs apply penalties.

What does this mean for your wellness program? It means that everything stays the same until it changes. That could be in the Fall of 2018 or in January 2019. Either way, it is important to note that none of this means making changes now and that any future changes may be ones we haven’t even imagined yet. So like Ben says, we’re not finished changing until we’re finished!

In the meantime, if you have any questions about the EEOC’s wellness program rules, the HIPAA wellness program rules, or any other aspect of wellness program design, feel free to contact MedBen Vice President of Compliance Caroline Fraker at 800-851-0907 or


  02:55:00 pm, by MedBen5   , 221 words,  
Categories: Dental, Research, Preventive care

Benefits of Dental Care Go Well Beyond Clean Teeth

dental chair

Dental checkups do much more than giving your teeth a good cleaning. Through twice-yearly exams, a dentist can monitor the condition of the teeth and gums to spot subtle changes that may need attention.

But that's only the half of it. Research shows that people who get their teeth professionally cleaned on a regular basis reduce their risk of heart attack and stroke.

Nor do the benefits end there: Many dentists also use these routine visits to check for signs of cancers of the lips, tongue, and cheek, in addition to other oral cancers, says Todd Coy, DMD, Director of Cleveland Clinic’s Department of Dentistry.

“Evaluation of the oral cavity, including the soft tissues, is part of my exam when patients are in the office for a checkup,” he says. “There are very few downsides to more frequent screening.”

In the first quarter of 2018, MedBen will be rolling out an enhanced version of its dental plan. MedBen PreceDent will offer lower costs through network care, as well as such value-added enhancements as dental implants and periodontal scaling. And of course, preventive care (which includes those twice-yearly exams) is covered in full.

If you'd like to get more information about how MedBen PreceDent promotes dental care that goes beyond the obvious, contact Vice President of Sales & Marketing Brian Fargus at


  06:11:00 pm, by MedBen5   , 233 words,  
Categories: Announcements, News, Wellness, MedBen Employees

MedBen Takes an "Encompassing" Approach to Employee Health

MedBen is taking its company wellness efforts to another level, offering employees tips and tools for living a better life, while earning them extra vacation time in the process.

In 2017, MedBen introduced "enCompass," a complement to our internal WellLiving program. Through enCompass, we bring together six distinct components that contribute to one's personal wellbeing – physical, intellectual, financial, social, occupational, and emotional. Each of these components offered a unique set of activities, from workout classes and nutritional seminars to software training and stress management sessions.

By participating in enCompass presentations and activities, MedBen employees earned points that could be used toward extra vacation time. Those who achieved this goal represent over 10% of our employee population. In total, nearly one-third of our employees participated in the program in 2017.

enCompass reward winners

MedBen employees who earned a full day vacation include: Caroline Fraker, Sheri Gutridge, Tammy Jones, Erin Kelly, Brenda McLean, Tiffany Ricket, Stacey Spring and Kay Williams.
Half-day vacation earners include: Robin Becker, Ashlyn Degler, Cindy Dittoe, Janice Harris, Abbie Hughes, Lindsay Kirk, Becky McCune and Jackie Turner.

In 2018, MedBen will continue to promote the total wellbeing of its employees, in mind as well as body, with expanded enCompass programming. Congratulations to every MedBen employee who earned time off or participated in enCompass!

MedBen can work with WellLiving clients to offer similar activities and incentives to expand their wellness program. For more information, contact your Group Health Representative.


  08:10:00 pm, by MedBen5   , 348 words,  
Categories: Wellness, Heart, Diabetes, Preventive care

Crushing Goals and Excess Weight


More than 50% of Americans make a resolution each year, yet only 8% are successful at achieving them. Among the top resolutions made each year are getting organized, saving money, and – at the top of the list – weight loss. By a happy coincidence, January is also Healthy Weight Awareness Month!

According to CDC, roughly 70% of America adults were classified as overweight or obese in 2014. Having excessive weight can pose a serious threat to one’s health, including an increased risk of heart disease, type 2 diabetes, joint problems, and other chronic conditions.

There are three key factors that play into weight: behavior, environment, and genetics. Unfortunately, there isn’t much we can do about genetics, but we can change our behaviors. Having a healthier and moderated diet, physical exercise of at least 30 minutes most days of the week, and setting goals to keep you on track are great ways to help subside excess weight – and they can give you an emotional boost as well!

Environment has a big impact on behavior as it sometimes deters physical activity. Someone that lives in a community without sidewalks is less likely to be physically active. However, keep in mind that malls and outdoor parks, offer great (and free) spaces to walk.

As always, MedBen WellLiving suggests consulting your physician before making any drastic lifestyle changes... even if they are for the better.

Full story »


  08:56:00 pm, by MedBen5   , 259 words,  
Categories: News, IRS

IRS Extends 1095 Form Distribution Period

IRS Building

Happy New Year from the IRS!

On December 27, 2017, the Internal Revenue Service gave employers sponsoring health plans a New Year’s gift. Again this year, the IRS has offered plan sponsors a 30-day automatic extension for the distribution of both 2017 IRS Forms 1095-B and 2017 IRS Forms 1095-C (as applicable) to their employees. Please note that no similar extension is available for filing the forms with the IRS.

The IRS has provided guidance (in IRS Notice 2018-06) and set the new distribution and existing filing deadlines, as follows:

  • March 2, 2018 – Deadline for distribution of IRS Form 1095-B (Health Coverage) or IRS Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) to employees.
  • February 28, 2018 – Deadline for paper filing of IRS Forms 1094-B/1095-B or 1094-C/1095-C with the IRS. (Note: An employer can only file paper copies if it distributes fewer than 250 1095s on or before March 2, 2018.)
  • April 2, 2018 – Deadline for electronic filing of IRS Forms 1094-C/1095-C with IRS. (Note: Employers that distribute 250 or more Form 1095-Cs must file electronically.)

To recap, the Affordable Care Act (ACA) and its supporting regulations require that all employers offering health benefits to their employees report certain health coverage information to those employees as well as to the IRS. And just like last year, employer’s sponsoring health plans must collect, aggregate and distribute this information via Form 1095.

The forms and codes are pretty much the same as they were on last year’s forms. But as always, MedBen clients who have any questions about preparing or distributing these forms are welcome to contact MedBen Vice President of Compliance Caroline Fraker at 800-851-0907 or


A Note from Our Chairman and President

Doug Freeman and Kurt Harden

To our customers, consultants, and brokers:

Welcome to 2018! For MedBen, the coming year carries a special significance, as we will celebrate our 80th anniversary in May. As with any benchmark anniversary, it gives us a chance to look back at how we’ve grown, and what we’ve learned along the way.

Reflecting on our company’s past, it’s hard to believe that for almost 50 years, MedBen served primarily as a hospital services association, covering hospital room and board, but not physician services. Flash-forward to 1987 and our transition to a mutual life insurer, and it’s remarkable to see how our business has changed in a comparatively short time… both in size (from 25 employees in 1987 to over 140 today) and scope, as we today offer a variety of benefit management services, from third party administration to pharmacy benefits management to worksite wellness to Medicare value-based payment analytics.

MedBen’s growth has coincided with the rising popularity of self-funding. Nearly 70% of U.S. employees are currently covered under employer-funded plans… and with good reason, as we have seen first-hand the flexibility and cost savings this approach offers. So much so, in fact, that our TPA clients – once a small portion of our customers – now make up our biggest block of business.

But regardless of these changes, what has remained constant are the relationships we’ve developed with all of you over the decades. And it’s these connections that make our jobs so fulfilling. It’s our continual goal to find better ways to serve you and earn your business – if we ever come up short, please call us at the numbers below. Rest assured that the trust you place in us is never taken for granted.

On behalf of the entire MedBen staff, we offer you our thanks and very best wishes for a healthy and prosperous 2018!


Doug Freeman
Chairman & CEO
(740) 522-7339

Kurt Harden
President & COO
(740) 522-7345

A quick reminder: MedBen will be closed on Monday, January 1 and reopen on Tuesday, January 2 at 8:00 a.m. EST. Should you have a claims or benefits question, please visit MedBen Access. Our online customer service center is available 24/7 for your convenience!

  10:05:00 pm, by MedBen5   , 377 words,  
Categories: Prescription, Cost savings

The “Cost Plus” Approach to Rx Benefits


A recent New York Times story identifies a fundamental problem in the pricing of medicines in our health care system today: It is difficult to determine what “cost” is for a medicine.

What a given pharmacy actually pays to stock a medicine in the pharmacy to sell may change from one order to the next based on a variety of factors. This is complicated by the fact that the amount a pharmacy is allowed to charge or what the pharmacy is paid for a medicine is determined by a contract between the pharmacy benefits manager (PBM) that manages the network of pharmacies (ex. Express Scripts, CVS/Caremark, Optum, etc.) and the pharmacy (Walgreens in the NYT article).

In the article’s example, the Walgreens pharmacy was allowed to charge $0.93 per pill for the cholesterol drug rosuvastatin – the network agreement between the PBM and Walgreens. In contrast, online Rx discounter Blink Health charged $0.51 per pill. But while Blink’s price was better, it was also able to secure a sizeable gross profit on this prescription. The data that follows is important in this determination.

AAWP – Average of Average Wholesale Price
AWAC – Average of Wholesale Acquisition Cost
ACA FUL – Affordable Care Act Federal Upper Limit
NADAC – National Average Daily Acquisition Cost

The NADAC price, in this case, is the price that matters and why Blink could sell at such a low cost and still make money. But how do employer health plans take advantage of this pricing approach for their plan members? We have the answer to the problem.

MedBen is launching a new Rx program that bypasses the industry standard of “AWP less discount and MAC pricing for generics” approach to drug pricing in favor of a “Cost Plus” basis of pricing.

The MedBen Rx program model will pay the pharmacy the average cost of the drug based on a proprietary national retail pharmacy survey (like NADAC, above) plus a dispensing fee that reflects the pharmacy services in filling a prescription. This method of pricing will provide MedBen groups with a pricing methodology that eliminates the “margin manipulation” that is possible in the current PBM AWP discount approach to pricing.

For more information on this money-saving pharmacy program, contact MedBen Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or


  09:50:00 pm, by MedBen5   , 212 words,  
Categories: Wellness, Reporting, Diabetes, Hypertension, Cholesterol

Nearly One-Third of Adverse Health Tied to Chronic Conditions


Hypertension, diabetes, and high cholesterol are among the chronic conditions responsible for 30% of adverse health nationally, according to a recent report from Moody’s Analytics... conditions that can be better controlled through a focus on preventive care through worksite wellness.

The report also suggests that these conditions can be significantly impacted by a person's environment, upbringing, and other social determinants. But here, too, is where a wellness program like MedBen WellLiving can have a positive effect: Offering the same program participation incentives to all plan members – coupled with other trade secrets– improves the likelihood that a higher proportion of the employee population will get regular wellness exams and screenings regardless of individual differences.

Additionally, WellLiving emphasizes "family doctor first." By establishing and maintaining a physician-patient relationship, the family doctor is better positioned to detect an increased risk of hypertension, diabetes, and high cholesterol. All of these in addition to other conditions the report cites as primary contributors to adverse health, such as depression and substance abuse.

Better health and lower health care costs begins with a wellness program that promotes preventive care and condition management for all employees, and MedBen WellLiving was designed with those goals in mind. Get more information by contacting Vice President of Sales & Marketing Brian Fargus at


  04:01:00 pm, by MedBen5   , 357 words,  
Categories: Wellness

The Most Wonderful or Stressful Time of Year?

ugly sweater

Though known as “the most wonderful time of the year,” a study by Greenberg Quinlan Rosner Research found that people are more likely to feel increased stress during the holiday season. This could be due to increased financial burdens, pressures of gift buying, finding time to attend or host events, and seasonal depression.

When you’re in a stressful situation, your hypothalamus, a tiny region at the base of your brain, sets off an alarm system. Through a combination of nerve and hormonal signals, this system prompts a release of hormones, including adrenaline and cortisol. This causes your heartbeat and breathing to speed up and your muscles to tense.

The body can usually recuperate quickly from a single stressful situation. However, it’s when the condition becomes chronic that it poses a serious health threat, leading to heart conditions, depression, and rapid aging.

Knowing what causes your stress is the first step in fighting it. Then, do what you can to reduce it, or eliminate it completely. No, we’re not saying that you should cancel the holidays, but we are suggesting that you take it easy (see tips on how to manage holiday stress below) and be aware of signs such as fatigue or insomnia, irritability, or just a constant feeling of worry that indicate you may be dealing with stress. Be sure to see your family physician for any evidence of chronic stress.

Full story »


  11:23:00 pm, by MedBen5   , 273 words,  
Categories: Announcements, News, MedBen Employees

MedBen Employees Participate in Families Helping Families Program

Exchanging gifts with friends and family is fun, but sharing with those less fortunate is the true meaning of the holiday season... and once again, the MedBen staff has embraced the spirit of giving.

For 18 years and counting, MedBen has participated in the Licking County (Ohio) Families Helping Families program. Our employees worked together to raise funds and purchase presents, to ensure that the underprivileged children of our community enjoy a special holiday memory.

Families Helping Families

Licking County Job & Family Services (LCJFS), in conjunction with the Salvation Army, has coordinated the Families Helping Families program for four decades. Families Helping Families calls on individuals and groups to donate presents to brighten the holiday season for members of Licking County. Every year, approximately 600 children and 75 elderly community members receive a variety of gifts from anonymous donors.

This year, MedBen employees shopped for 16 children (from lists provided through LCJFS as well as House of New Hope, which helps foster children) ranging in age from seven months to 12 years old. Each child received clothing in addition to toys that were on their “wish list.”

MedBen has proudly partnered with multiple charities and non-profit organizations over the years. In addition to Families Helping Families, we've provided ongoing support to United Way, Food Pantry Network, A Call to College, Big Brothers/Big Sisters, the Midland Theatre and the Licking County Community Health Clinic, to name a few.

MedBen has called Licking Country home since 1938, and we've pleased to be able to assist the people of our community.

Individuals and groups who are interested in contributing to a future Families Helping Families drive are encouraged to contact LCJFS’ Jamie Spangler at 740-670-8736.

  11:14:00 pm, by MedBen5   , 228 words,  
Categories: Announcements, News, MedBen Employees

We're Home For The Holidays, But Still Open Online


Happy holidays from your friends at MedBen!

Our home office will be closed on Christmas Day, and will reopen at 8:00 a.m. Tuesday, December 26. We will close again on Monday, January 1 and reopen at 8:00 a.m. on Tuesday, January 2, 2018.

While we hope health matters don't interrupt your holiday enjoyment, should you have a question that needs a fast answer, we encourage you to visit us online. MedBen offers a variety of helpful services 24/7!

The MedBen Access website acts as your one-stop service center. Be it an inquiry about the status of a claim, the remaining balance in your FSA, or the cost of a prescription drug, MedBen Access has the information you need 365 days a year!

If you don’t already have MedBen Access bookmarked in your browser, the easiest route there is through the home page. Just click on “MedBen Access” (located on the top right corner of the page), type in your user name and password, and you’re in!

Also keep in mind that offers resources frequently requested by customers, such as a list of FSA-eligible expenses and instructions for reading EOBs. Just select the “Plan Sponsors” or “Plan Members” button on the home page, depending on your specific needs.

Oh, and if you haven't done so already, don't wait any longer to schedule your yearly wellness exam!

Best wishes for your continued health and happiness in 2018!


  04:00:00 pm, by MedBen5   , 256 words,  
Categories: Announcements, News, Privacy, Third party administration, Compliance, MedBen Employees

Fraker to Serve as SPBA Secretary/Treasurer

Caroline Fraker

MedBen Vice President of Compliance & Chief Privacy Officer Caroline Fraker will serve as Board Secretary/Treasurer of the Society of Professional Benefit Administrators (SPBA) for the 2018 year. Fraker joined the board in 2015.

As Secretary/Treasurer, Fraker will keep the minutes of the Board meetings, serve as custodian of certain SPBA records, and ensure that SPBA financial management policies are fulfilled in accordance with Board policy.

Fraker was a member of SPBA well before she was invited to join the Board, going back to when she started at MedBen in 1992. The organization performs an instructive role for third party administrators (TPAs) providing benefit services to private and public groups alike, she said.

“SPBA provides education and support to TPAs, and educates lawmakers on the finer points of health benefits," Fraker noted. "Not in any sort of lobbying capacity, but strictly to ensure they have the information they need to make informed legislative decisions.”

Formed in 1975, SPBA strives to advance the goals of benefits administrators as well as to provide advice that helps members better serve their clients and their clients’ plans. SPBA Board members meet monthly via conference call to discuss issues of importance to the Society’s members and their customers. Board members also host twice-yearly conferences open to all SPBA members, which are preceded by Board-only meetings.

A 30-plus year veteran of employee benefits, Fraker assists MedBen clients with regulatory compliance, contractual and risk management issues. In addition to her SPBA responsibilities, she also serves on the Government Affairs Committee of the Licking County Chamber of Commerce.


  11:18:00 pm, by MedBen5   , 232 words,  
Categories: Cost savings, Third party administration, Self-funding

Flexibility Adds to Self-funding Appeal

MedBen building

With all the uncertainly in the fully-insured market nowadays, it's little wonder that the popularity of self-funding continues to grow. Today, nearly 70% of U.S. employees are covered under employer-funded plans, as more businesses are seeing for themselves the flexibility (and savings) these plans offer.

In its State of the TPA Industry & Forecast for 2018, the Society of Professional Benefit Administrators (an organization on which MedBen Vice President of Compliance Caroline Fraker serves as a board member) projects that "employers will continue to move to self-funding for the ability to design and fully customize health plans that fit their specific work populations."

It is that flexibility, coupled with greater regulatory freedom, that makes self-funding an appealing alternative to groups looking for ways to control health care costs. And when you consider that employers pay only for their actual plan expenses, the choice becomes even more obvious.

In short, self-funding provides multiple avenues for saving employers money... and MedBen is an expert in working with groups to create health plans that take full advantage of these benefits. We help fully-insured groups make a smooth transition to self-funding, and help self-funded groups find additional saving opportunities.

With nearly 80 years of experience in benefits management, MedBen knows the important distinctions that make every group unique. Learn more about our self-funded solutions by visiting or contacting Vice President of Sales & Marketing Brian Fargus at

  11:03:00 pm, by MedBen5   , 479 words,  
Categories: Health Care Reform, IRS

“Cash in Lieu of Benefits” Considerations


With many employers updating benefit packages effective January 1st, it is easy to overlook certain basic benefit options. Offering cash in lieu of benefits is a growing trend among employers, especially those considered Applicable Large Employers (ALE) under the Affordable Care Act (ACA). While it is still permissible to offer a cash incentive to employees who opt out of the employer’s group health plan, there are several important things to understand and consider before implementing or renewing such a program.

  • First, remember that any cash benefit provided to an employee will always be taxable. This rule applies no matter what type of cash option arrangement the employer implements. (Note that benefits provided through a Section 125 plan are subject to different rules.)
  • The “cash in lieu” amount must be counted in the affordability calculation determination under the ACA if the opt-out arrangement is deemed “unconditional” by the IRS. An “unconditional” opt-out arrangement is one in which payment is made to the employee based solely on the employee declining the employer’s offer of group health coverage. In this case, the employer must report the opt-out payment in addition to the standard employee contribution amount as that employee’s cost on line 15 of Form 1095-C.
  • If the offer of cash in lieu of enrollment is “conditional,” the amount does not need to be included in the ACA affordability calculation. The IRS defines a “conditional” opt-out amount as a payment made to the employee only if the employee satisfies a specific condition – generally, the requirement to show evidence that the employee is covered under another health plan or other insurance coverage.
  • The cash option cannot be provided by the employer to enable the employee to buy an individual policy either on or off of the Marketplace (Exchange).
  • The cash option must be offered to all eligible employees (or employees who are eligible as a specific class of employees) in the underlying group health plan. Other IRS rules prohibit an employer from applying the cash option to highly compensated employees only or just those with high claims.

Full story »


  08:11:00 pm, by MedBen5   , 256 words,  
Categories: News, Wellness, Cancer, Research, Preventive care

Nearly Half of Cancer Cases Preventable, Study Finds

cancer definition

A new study suggests that nearly half of cancer cases in the U.S. can be attributed to unhealthy habits – habits that could be changed through a focus on wellness and maintaining a doctor-patient relationship.

The American Cancer Society study found that 45% of cancer deaths and 42% of diagnosed cancer cases can be attributed to what the authors call “modifiable” risk factors, such as smoking, poor diet, excess alcohol intake, and prolonged sun exposure.

Cancer rates have dropped in recent decades, due in large part to a drop in cigarette smoking. Even so, the ACS notes that smoking is still responsible for 30% of cancer deaths... and a nationwide spike in obesity has negatively impacted the overall decline.

A wellness program like MedBen WellLiving can play a crucial role in reducing cancer rates. Promoting preventive care through age- and gender-appropriate screenings greatly improves the chance a cancer can be detected and treated successfully. Moreover, the cost difference between treating an early cancer vs. a cancer in its advanced stages can be substantial.

Equally important, WellLiving encourages regular wellness exams with a family doctor. A sustained relationship allows the physician to serve as a mentor, providing advice and a gentle nudge in the right direction should the patient find themselves on a course that could lead to cancer down the road.

We have it in our power to reduce our risk of developing cancer... and MedBen WellLiving can be a valuable ally in the fight. Find our more by contacting Vice President of Sales & Marketing Brian Fargus at


  04:48:00 pm, by MedBen5   , 513 words,  
Categories: News, Health Care Reform, IRS

Coming Soon: 2015 Employer Shared Responsibility Penalty Notices

IRS building

What does the IRS do while it awaits the outcome of tax reform? It works on identifying employers that are not complying with the Affordable Care Act’s (ACA’s) employer shared responsibility mandate.

In April, a Treasury Inspector General for Tax Administration (TIGTA) audit revealed that the IRS’ processes to ensure that applicable employers are compliant with the information reporting requirements mandated by the ACA were falling short. Well. that’s all changed.

The IRS has announced that they have begun issuing letters to inform applicable large employers (ALEs) of their potential liability for an Employer Shared Responsibility Payment (ESRP) in late 2017. The IRS determination of whether an employee may be liable for an ESR Payment is based on 2015 calendar year data reported to the IRS on Forms 1094-C and 1095-C during the first quarter of 2016.

IRS “Letter 226J” will notify employers that the IRS believes the employer owes money under the ACA’s Employer Mandate provisions for calendar year 2015. Two forms are included with the letter.

The first form, Form 14764 (Employer Shared Responsibility Payment Response), must be used to respond to the IRS’ inquiries. The other, Form 14765 (Employee Premium Tax Credit (PTC) Listing), lists each full-time employee that was allowed a PTC on his or her tax return for one or more months in 2015 and did not have an affordability safe harbor or other relief reported on such employee’s Form 1095-C. If an employer disagrees with all or a portion of the proposed ESRP, Form 14765 must be returned with the response marked to show corrections to Line 14 and/or 16 codes, as necessary.

Full story »

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