Since its inception, the Employee Retirement Income Security Act of 1974 (or ERISA), as amended, has required employers and plan administrators to provide certain information and documentation to group health plan participants and beneficiaries. These documents include such things as Summary Plan Descriptions (SPDs), Summaries of Benefits and Coverage (SBCs), Summaries of Material Modifications (SMMs) and Summary Annual Reports (SARs) – as well as information and notices like open enrollment materials, QMCSO notices, COBRA notices, and the new Section 1557 Notices (if applicable).
In 2012, the United States Department of Labor (DOL) issued regulations providing guidance to employers and plan administrators about how they could make these required document and information distributions electronically. With the increase in technology infiltrating the employee benefits field, including the group health plan arena, MedBen thought it was good idea to review the Electronic Distribution rules.
The MedBen Compliance Department has put together a summary of the ERISA Electronic Distribution regulations, which is available for download from MedBen.com. If you are interested in starting to provide documents and information to your plan participants electronically, now is the time to review the rules. Or if you are already providing documentation and information electronically, it is always a good idea to check your compliance. Either way, if you have any questions about these rules, feel free to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
It’s easy to lose sight of a healthy diet… especially at this time of year. The average person consumes more than 3,000 calories on ONE Thanksgiving meal (and 7,000 total on Christmas Day) where the USDA recommends (depending on demographics) individuals consume between 1,300 – 3,000 calories per day.
While it’s too late to modify your eating habits for Thanksgiving, there’s still time to be conscious of your consumption for December festivities. So what can you do to stay healthy this winter season? Being cautious in the kitchen and staying active are two great answers. (They’re also good ways to make sure your annual wellness results aren’t skewed if you’re planning to get that within the next month or so).
Skip items like dark turkey (especially if it still has the skin) and go for the ham with just 140 calories per three-ounce serving, or a piece of fudge for dessert versus a brownie that contains 112 calories per two-inch square. Be careful, though, as choosing an item with added glaze or toppings could undo your healthy choice. In addition, eat smaller portions and wait 5-10 minutes before getting a second helping to ensure you don’t pass “full” status.
Finally, make sure to stay active! It’s easier to skip walks or stay at your home when the cold air surrounds you. But going to the gym or bundling up and taking a brisk walk has the same benefits it did in the summertime. And what’s so bad about a holiday walk?
The Naughty List of Foods
The list has been checked twice. Here’s some foods you should avoid this winter.
The MedBen team wishes you and yours a happy holiday season!
Our home office will be open regular hours (8:00 a.m. to 5:00 p.m. EST, with customer service available until 6:30 p.m. EST) on Friday, December 23. We will be closed on Monday, December 26 and will reopen at 8:00 a.m. EST on Tuesday, December 27.
MedBen will also observe regular office hours on Friday, December 30. We'll be closed on Monday, January 2, 2017 and reopen at 8:00 a.m. EST on Tuesday, January 3.
A few year-end reminders:
When we're closed, take advantage of MedBen online services. Plan members and plan administrators alike can visit the MedBen Access site 24/7 to view claims and benefits information and perform many other client services. MedBen.com also offers a variety of useful features, including downloadable forms and applications, provider directory links, and 2017 prescription formularies.
Remember the FSA "use it or lose it" rule. If your health plan offers a flexible spending account (FSA) option that requires remaining funds to be used by December 31, remind plan members that they can view a list of IRS-eligible expenses at MedBen.com should they need to make last-minute purchases. The site also offers FSA reimbursement requests and substantiation forms, as well as similar documents for health reimbursement arrangement (HRA) members.
FSA and HRA members can check their current balances through MedBen Access by selecting the “FSA/HRA Online Inquiry” under the “My Plan” section.
Check your wellness compliance. As a year comes to a close, it's a good time to double-check if you've up to date on recommended wellness exams and screenings. For MedBen WellLiving members, MedBen Access features an easy-to-use page that displays current wellness compliance status. If you're overdue for a checkup, please schedule it soon!
Once again, enjoy the holidays, be safe... and have a healthy and prosperous 2017!
A sound body is critical to good health, but a sound mind can be no less important, suggests a study which analyzed how an optimistic outlook affects a person's physical well-being.
Using what The New York Times describes as a "well-validated questionnaire," researchers rated 70,000 women on their level of optimism and collected information about their health and behavioral characteristics. Comparing the two sets of data, they found significant associations between increasing levels of optimism and decreasing risks of death from cancer, heart disease, stroke, respiratory disease and infections.
Particularly strong were the associations for cardiovascular disease, as women in the quarter with the highest optimism scores had a nearly 40% lower risk for heart disease and stroke than those in the lowest quarter, even taking into account other health factors.
The MedBen WellLiving program subscribes to the idea that wellness works best when an individual is fully invested with the goals for better health. That's one of the reasons why, rather than offering onsite wellness, we encourage members to maintain a professional relationship with a family doctor of their choosing.
Through our primary care program, members have the opportunity to discuss concerns with a doctor who is well-acquainted with their health history and can provide informed guidance. This, in turn, increases the likelihood that the patient will heed the advice ‒ and hopefully promotes a positive attitude about his or her long-term health.
Learn more about all the ways MedBen WellLiving can benefit your workplace by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
While the recent election has created much uncertainty about the future of the Affordable Care Act (ACA), there's a strong likelihood that a number of its individual provisions will survive in one form or another ‒ among them, the push to switch from a fee-for-service provider payment model to one centered around value-based care.
Kevin Kennedy of ECG Management Consultants suggests 10 reasons why value-based care will continue to thrive in the Trump Administration. You can read the entire list at the ECG website, but we'll highlight a few of his thoughts below:
We need to get costs under control, and the same fee-for-service model isn’t going to get us there. According to the Department of Health & Human Services, healthcare spending could climb to $3.35 trillion by the end of 2016. That equates to $10,345 for every American, which dwarfs the per capita healthcare spending of every other industrialized nation.
Many employers have already made up their minds about value-based care. In an effort to keep their employees healthier and curb premium costs, employers are increasingly collaborating with health insurers and medical service providers to design value-based reimbursement arrangements.
Healthcare consumers want value. As in other industries, consumers want to know that there is value in the services they are purchasing, be that in the form of cost, quality, convenience, experience, or a combination. Consumerism is not a partisan issue.
Kennedy also mentions that "... innovation has been unleashed on the healthcare industry" ‒ and here's where MedBen Analytics comes in. We provide an innovative platform with which hospitals can best capitalize from bundled payments for value-based care.
MedBen Analytics' advanced reporting system takes raw claims data and converts it into actionable reports. Using the insights offered, providers can see where opportunities for improvement lie. And while the initial focus for our platform is on Medicare payments, its cost-saving applications have the potential to benefit the private sector as well.
Hospitals and providers interested in a demonstration of the MedBen Analytics system or additional information are welcome to contact MedBen President and COO at 888-633-2364 or firstname.lastname@example.org.
For the 17th consecutive year, MedBen is pleased to take part in the Families Helping Families program. Our employees have once again joined together to raise funds and purchase presents, to ensure that the less privileged children of Licking County (Ohio) share in the giving spirit of the holiday season.
"For nearly 80 years, we've been proud to be a part of Licking County, and have benefitted greatly from working here," said MedBen Chairman & CEO Doug Freeman. "Families Helping Families is just one way we try to give back to the community, and our people really enjoy buying gifts for the kids."
Spearheaded by Licking County Job and Family Services (LCJFS) and coordinated by the Salvation Army, Families Helping Families provides gifts anonymously to more than 600 children in Licking County. Area businesses, churches, schools, clubs, families, and other groups all contribute to the program, which brightens the holidays for many elderly citizens as well.
This year, MedBen employees "adopted" 17 children ranging in age from 2 months old to 12 years, from lists provided through LCJFS as well as House of New Hope, which helps foster children. Each child receives clothing in addition to toys and other items that were on their wish list. MedBen contributes extra funds on top of the employee donations to buy additional gifts.
Families Helping Families is among the many charities and non-profit organizations MedBen has partnered with over the years. We've also been honored to support United Way, Food Pantry Network, Licking County Community Health Clinic, A Call to College, Big Brothers/Big Sisters, and the Midland Theatre, to name just a few.
Individuals and groups who are interested in donating to Families Helping Families are encouraged to contact Jamie Spangler or Misty Edwards at (740) 670-8714 or LCFHF@jfs.ohio.gov.
Heart disease is the leading cause of death among Americans under the age of 80, followed by cancer, stroke, and asthma, according to new Centers for Disease Control and Prevention (CDC) data. But there's good news, too ‒ between 2010 and 2014, the CDC saw notable declines in deaths from cancer, heart disease and stroke.
These declines happen to coincide with a growing effort to better personal health: Over two-thirds of U.S. employers currently offer some form of worksite wellness. MedBen WellLiving has also grown during that period, and is using its experience to put in place wellness programs with a proven record of success.
By controlling the chronic conditions that lead to disease, we significantly reduce the odds of developing the disease in the first place. A study published by JACC found that patients without hypertension, obesity, or diabetes had much lower risks of incident heart failure than patients with these risk factors, and lived an average of 3 to 15 years longer.
WellLiving acts as a proper complement to diet, exercise and other healthy habits. By tracking health changes through annual wellness exams and regular screening, individuals reduce the risk of developing chronic conditions while improving energy and productivity.
Through MedBen WellLiving, employers benefit from a healthier workplace and long-term savings on medical costs. Learn more about how it can work for your group by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
The increasing popularity of specialty drugs has brought new challenges to health plan management. However, MedBen has closely followed their growth, and works with clients to develop strategies that balance their medicinal advantages with realistic cost considerations.
Back in 1990 ‒ roughly the same time MedBen launched its third party administration services ‒ there were just 10 specialty drugs on the market. Today, there are around 300 available, with a projected 700 more in various stages of development. Since 2010, half of all FDA approvals are for specialty drugs.
But those numbers don't tell the real story. While specialty drugs make up only 1% of all prescriptions, in 2014 they comprised 32% of total drug spending. That same year, spending on specialty drugs rose over 30%, compared to 6% for traditional medications.
When determining whether to cover a specialty drug, self-funded groups must consider its benefits (i.e., the potential to replace more expensive and prolonged medical treatment) along with its drawbacks (high cost, no assurance of effectiveness). MedBen, working in conjunction with our pharmacy advisor, offers clients recommendations on coverage levels as well as alternative medications and therapeutic options.
By providing educated guidance on the costliest drugs, last year MedBen limited average client trend on per-member pharmacy spending to just 4.1%, compared to 12.2% nationally. Learn more about how we can do the same for your group by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
9.3%. 29.1 million. Both representations of the number of Americans who have been diagnosed with diabetes. The 7th leading cause of death in the United States, the American Diabetes Association states that an additional 86 million Americans are at risk of developing the disease.
Generally, people with diabetes either have a total lack of insulin (type 1 diabetes) or they have too little insulin or cannot use it effectively (type 2 diabetes). Type 1 diabetes accounts for 5% of diabetic diagnosis while type 2 diabetes accounts for the remaining cases in the U.S. at 95%.
Type 1 diabetes has no known prevention. Risk factors for developing type 2 diabetes include obesity, having a family history of diabetes, and having diabetes while pregnant (gestational diabetes). Many people with type 2 diabetes can control their blood glucose (sugar) with lifestyle changes such as healthier eating and being active. Others may require oral medications or insulin injections.
As with caring for other chronic conditions, it is essential that you monitor the status, including regular visits to see your family physician. Even if you are not diagnosed with diabetes and live a healthy life, visiting your family physician at least once a year for an annual wellness visit is a good idea. In doing so, your physician could detect any early onsets of the condition and help guide you through a prevention or management plan, tailored to you.
The presidential election of Donald Trump, coupled with the Republican majority in both houses of Congress, has suddenly put the future of the Affordable Care Act into serious doubt. For the short term, however, it's business as usual... and MedBen is helping clients to prepare for health care reform in 2017.
As a timely reminder of what the ACA has in store for employers next year, the MedBen Compliance team has compiled a summary of its various costs, fees and potential penalties. You can download "2017 By the Numbers" from the MedBen website.
But what will become of the ACA after 2017? For all the talk of "repeal and replace" during the election, it's still a more likely scenario that less successful elements of the ACA are scrapped or changed (i.e., marketplace insurance out, individual health savings accounts in), while more popular provisions, like dependent coverage to age 26 and no pre-existing condition limitations, remain. Indeed, President-elect Trump has already indicated that he would likely keep these rules in place.
Most of the post-election chatter on ACA changes has focused on what will happen to the 20 million Americans who have purchased coverage through the marketplaces; there's been comparatively little talk about the rules directly affecting employers, such as health coverage data reporting and PCORI fees. Again, there's a strong probability that at least some of these provisions will stay put or get tweaked... though at this point it's all pure speculation.
One employer-related element that seems almost certain to be scrapped or revamped is the Cadillac tax. Already delayed until 2020 and unpopular with Republicans and Democrats alike, this penalty on benefit-rich health plans was pretty much doomed regardless of which party took the White House.
Whatever the future of health care reform may be, MedBen Compliance is always ready to assist clients with their ACA questions and concerns. Simply contact Vice President of Compliance Caroline Fraker at 800-851-0907 or email@example.com.
Is there anything a dental checkup can't do? In addition to ensuring the continued health of your teeth (and often getting a free toothbrush in the bargain), dentist visits may even help to keep your lungs clean.
HealthDay News reports that a new study suggests that regular dental cleanings could lower your risk of pneumonia by reducing levels of bacteria that cause the lung infection. The review of over 26,000 medical records found that people who never saw a dentist were 86%t more likely to get bacterial pneumonia compared to people who got dental checkups twice a year.
While "clean lungs" may sound comparatively trivial to things like healthy teeth and gums, the study does serve to show that the advantages of dental care go beyond the obvious ‒ and why dental coverage offers a value-added benefit to your group health care plan.
In addition to promoting preventive care through regular exams, MedBen Dental allows businesses to provide employees with restorative services at reasonable prices. And because frequent cleanings could actually reduce the risk of heart attack and stroke, a good dental plan complements a company's wellness program.
Dental care is among the least expensive benefits that employers can offer, and one of the most popular. Whether as a stand-alone service or part of a total health benefits package, MedBen Dental offers valuable care at an affordable cost. Learn more about its advantages by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
On Friday, November 18, 2016, the Internal Revenue Service released Notice 2016-70, effectively extending the due date for furnishing IRS Forms 1095-B and 1095-C to individuals offered and/or covered under employer-provided health plans. The extended deadline for distribution of these forms to employees and covered individuals is now March 2, 2017. The Notice also extends good-faith transition relief from penalties to the 2016 information reporting requirements. The Notice can be found at the MedBen website.
According to the Notice, the Treasury Department has determined that there is no similar need for an extension of time to file the Forms with the IRS which means that a plan sponsor's 1094-B (and accompanying 1095-Bs) or 1094-C (and accompanying 1095-Cs) are still due on February 28, 2017 (if filing via paper) or March 31, 2017 (if filing electronically).
The Notice extends transition relief from penalties under sections 6721 and 6722 to reporting entities that can show that they have made good-faith efforts to comply with the information-reporting requirements under sections 6055 and 6056 (both for furnishing to individuals and for filing with the Service) for incorrect or incomplete information reported on the return or statement. This relief applies to missing and inaccurate taxpayer identification numbers and date of birth, as well as other information required on the return or statement. No relief is provided in the case of reporting entities that do not make a good-faith effort to comply with the regulations or that fail to file an information return or furnish a statement by the due dates.
MedBen clients who have questions regarding the deadline extension are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or email@example.com.
Happy Thanksgiving from the staff of MedBen! We hope that you and your family have a fun, safe, and relaxing holiday.
To observe the holiday, MedBen will be closed on Thursday, November 24 and Friday, November 25. We will reopen at 8:00 a.m. on Monday, November 28.
Our hope is that health care concerns are the furthest thing from your mind this holiday, but should you be in need of information about your plan, our online service is always open and ready to help. Just go to the MedBen.com home page, click on the “MedBen Access” link, and log in.
MedBen Access offers claims and benefit information, and more. Plan members can see their accumulated deductibles and out-of-pocket costs, read up on medications and compare drug costs, and send questions to MedBen Customer Service (which will be answered by the next business day). Additionally, FSA and HRA plan members can review their account payments and balances, and WellLiving members can check their compliance with wellness exams and screenings.
Plan administrators can also take advantage of MedBen Access' various features, such as enrolling new members, adding or changing dependents, requesting ID cards, and notifying MedBen of COBRA events. The site offer drop-down convenience that makes navigation easy.
Again, our best wishes to you and yours for a great Thanksgiving holiday!
Earlier this year, Health and Human Services (HHS) and the Office of Civil Rights (OCR) published a final rule implementing Section 1557 of the Patient Protection and Affordable Care Act (ACA). This rule prohibits discrimination on the basis of race, color, national origin, sex (gender), age, or disability, for any health program or activity, any part of which receives federal funding or assistance from HHS.
HHS put out guidance on how employers can determine whether or not they are subject to the new Section 1557 rules. These rules are complex, and even more complicated is making a determination as to whether or not your organization and your health plan must comply. Making the rules more complicated is the fact that only HHS has put out guidance about how to determine if an organization is subject to the rules based on HHS-provided federal assistance.
The MedBen Compliance Department has put together a downloadable summary on the rules, including how to determine if the law applies to you and what changes you need to make if it does. For more information or if you have questions, please contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
Formulary updates for prescription plans administered by Pharmacy Data Management, Inc. (PDMI) are now available at MedBen.com – simply click on “Plan Sponsors” (for employers) or “Plan Members” (for insureds) and select “Prescription Formularies” from the “Form” drop-down menu.
The new formularies become effective January 1, 2017. As always, plan administrators with questions about the formularies can contact their Group Service Representative, while plan members can call MedBen Customer Service at (800) 686-8425.
Groups use either the Focus formulary or the Outcomes formulary. Focus offers the most cost-effective drug options, while Outcomes offers broader choice while still delivering significant cost savings. If you're not sure what type of formulary you use, check with your plan administrator or log on to MedBen Access.
Should you still need a 2016 formulary, they will remain available on the MedBen website until the end of the year.
The tax-free benefits of flexible spending accounts (FSAs) helps plan members to save money on their health care spending... but using FSAs to their maximum advantage requires a bit of prior planning.
Many FSA members are currently deciding how much of their salary they want to place into their account. To determine the proper contribution amount, the best strategy is to consider health-related purchases over the past several years and use that as a starting point. MedBen clients can review their recent spending activity by logging into MedBen Access and clicking on “FSA/HRA Online Inquiry” under the “My Plan” section.
In 2017, the FSA contribution limit will be $2,600, though employers do have the option of setting a lower amount. If you're certain that you'll spend the set limit on qualified medical expenses, you can maximize the value of your FSA by making the full allowed contribution. Otherwise, consider your standard annual costs ‒ dental expenses, vision exams and materials, recurring prescriptions, and so forth ‒ and use them as your contribution baseline. Funds will be taken from your paychecks throughout the year, but the full contribution amount will be available for use on January 1.
When planning, it's critical to remember that a "use it or lose it" rule applies to FSAs. While some employers will offer a 2-1/2 month grace period to use up your remaining funds or let you roll up to $500 into the next year, ultimately any unused funds must be spent or forfeited. FSA members unsure about their group's policy should check with their plan administrator or call the MedBen Flexible Spending Unit at (800) 297-1829.
The shift from fully-insured group health plans to self-funded coverage continues, with more and more businesses realizing its savings potential. And not just large companies, either... as benefit managers like MedBen offer solutions to minimize risk, even smaller businesses are successfully making the transition.
According to Benefits Pro, a recent study by the Employee Benefit Research Institute found that between 2013 and 2015, the percentage of mid-sized companies offering at least one self-insured health plan increased from 25% to 30%. Among small businesses, the percentage jumped from 13.3% to 14.2%.
Meanwhile, self-funded businesses may soon benefit from lower rate increases. Willis Towers Watson’s Marketplace Realities report forecasts 2017 cost growth of just 4-5% for self-funded plans, compared to 7-8% for fully-insured plans.
But cost savings is just one reason more businesses are making the switch to self-funding. Plan control, access to analytic information, and the ability to design wellness initiatives have all increased self-funded appeal. MedBen helps clients of all sizes take advantage of these and other benefits.
If your business has 25 covered lives or more, you can gain from the cost-saving potential of self-funding while getting maximum use out the design and regulatory freedoms it offers. Contact MedBen Vice President of Sales & Marketing Brian Fargus to learn more.
MedBen continues to maintain high standards of quality, says the latest independent audit of the company's ISO 9001 compliance.
According to the auditing firm SAI Global, MedBen's management system, which was put in place to ensure process consistency across the company, is being followed and utilized. Additionally, MedBen management provides "appropriate input and support" to ensure that the established ISO standards are met.
"The recommendation from this audit is that your certification continues," the audit report reads.
The audit, conducted on October 20, reviewed MedBen processes in performance monitoring and measurement, management responsibility and review, and product realization. In these and other areas, the staff has implemented and improved on the company's quality management system.
Having ISO standards only works when every employee is invested in following them, noted MedBen Chairman & CEO Doug Freeman. "It takes a companywide effort to maintain quality and consistency, and I'm pleased that these audits repeatedly show that everyone here has bought in to the idea," he said.
MedBen achieved ISO 9001 Certification in 2005, and undergoes semi-annual follow-up audits to ensure continued quality performance. In 2017, the company will undergo an extensive multi-day review in order to receive recertification.
Back in May, MedBen highlighted new wellness rules from the Equal Employment Opportunity Commission (EEOC) regarding the use of incentives to promote participation in corporate wellness programs. These rules, which go into effect on or after January 1, 2017, place a limit on how much financial incentive employers can offer to their employees to encourage healthier habits.
To give more detail about the EEOC rules and how it will affect their wellness plans, the MedBen Compliance team has put together a summary document containing additional information. The document was recently e-mailed to our clients by their Group Service Representatives, but in case you missed it, it is also available for download from the MedBen website.
As was noted in the earlier article, the EEOC rules provide guidance to ensure that wellness programs comply with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). The ADA prohibits employers from making disability-based inquiries or requiring medical exams for employment or benefit purposes, while GINA restricts employers from requesting, requiring or purchasing genetic information which includes information about an employee's or family member's disease state or medical history.
Common to both ADA and GINA rules is a set limit on wellness incentives that employees can offer to employees and their spouses ‒ no more than 30% of the total cost of self-only coverage. It's important to note, however, that this amount must take into account both financial and in-kind incentives, such as time-off awards, prizes, and any other item of value.
MedBen is currently assisting WellLiving clients that need to make changes and working with them to ensure that their wellness programs are compliant with the new rules, but all clients with questions regarding the final EEOC rules are welcome to contact Caroline Fraker at 800-851-0907 or email@example.com.
When discussing hypertension, we tend to focus on its physical effects, such as its link to heart disease, stroke and diabetes. But doctors warn that high blood pressure may affect your mental capacity as well.
According to HealthDay News, a new scientific statement from the American Heart Association warns that having high blood pressure may increase one's risk of dementia. Statement author Dr. Costantino Iadecola said that hypertension is "the worst possible thing for the brain," as damage to its blood vessels leads to hardening of the arteries and an inability to control blood flow critical to normal brain operations.
While high blood pressure is a pervasive condition (about 1 in every 3 American adults have it), it's also treatable through such basic lifestyle changes as a healthier diet and regular exercise, as well as prescribed medication. Equally useful for individuals is having access to a proven worksite wellness program for advice and motivation.
Through MedBen WellLiving, plan members have a two-pronged approach to controlling high blood pressure and other chronic conditions: primary prevention that promotes annual wellness exams and building a doctor-patient relationship, which allows earlier detection and treatment; and specialty care that identifies high-risk members and offers individualized coaching from registered nurses.
For the employer, WellLiving provides regular reports, one of which includes their population’s compliance with various wellness categories and nurse coaching calls.
Effective preventive care addresses the body and mind alike, and helps employers promote a healthier workplace, which in turn leads to increased productivity and reduced absenteeism. Learn more about the benefits of MedBen WellLiving by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.