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PPACA Status of Grandfathered Plans

12/11/2013

 

It’s really happening!  Not just to individuals, but since October, we’re speaking to more and more companies whose plans have been canceled because they do not meet PPACA requirements.  They are then forced to scramble to find replacement plans in time to meet the new law’s deadlines.
While many Americans and members of Congress seem shocked by this news, the broker community knew this was coming.
While many Americans and members of Congress seem shocked by this news, the broker community knew this was coming.

Those who escaped this round of plan cancellations either have plans that already meet the PPACA guidelines or they are enrolled in policies that were in effect and haven’t changed since the PPACA was signed on March 23, 2010 – and they are both in an individual market minority.

We’re just waiting for the rest of America to figure out that cancellations will hit most small group plans in 2014, too.  The effects will be staggered since reform requirements are effective on the plan anniversary rather than on the calendar year.

Constituents whose policies were canceled put pressure on Congress, and in November, H.R. 3350, the Keep Your Health Plan Act of 20131, which already has 88 co-sponsors, was introduced by House Energy and Commerce Committee Chairman Fred Upton (R-MI).  Insurance companies who said their plans need to be canceled because they do not meet PPACA’s requirements would be authorized by this bill to keep offering these plans, essentially voiding the law’s individual market reform requirements for the time being.
We’re just waiting for the rest of America to figure out that cancellations will hit most small group plans in 2014, too.
The Senate joined in, with Democrats Mary Landrieu (LA) and Joe Manchin (WV) introducing similar legistation (S.1642)1.  While the text of the bill has not yet been released, according to NAHU (National Association of Health Underwriters)1, the bill would essentially overturn the PPACA requirements for all plans, allowing the consumer to retain or purchase plans that are not compliant with PPACA .  So far, Mary Pryor of Arkansas, is the only other co-sponsor on the bill.  

Both bills do beg the question, if plans are not required to meet PPACA guidelines, even if in a delayed timeline -- then what's the point? Would the PPACA still maintain relevance having these requirements waived?  The plot continues to thicken.

A voting timeline on these two bills is still unknown.  Meanwhile, companies would do well to quickly seek expert advice on the status of their current plan to avoid being thrown into crisis management, if their plan in fact does not meet PPACA requirements.

In the long run, moving towards Consumer-Driven Health Care is a win for companies.  Don’t let the bumps in the road on the way there throw your company off course.
In the long run, moving towards Consumer-Driven Health Care is a win for companies.  Don’t let the bumps in the road on the way there throw your company off course.
1 NAHU "What's Going On With Grandfathered Plans," Health Insurance Underwriters Magazine, December 2013, p18

Achieving Employee Wellness Engagement

12/3/2013

 

Wellness Program?  Got it!
Employee Participation – Not So Much…
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if you’re like 63% of all employers, the most common corporate wellness challenge is employee engagement
You’ve put a lot of effort, time and money into offering a wellness program.  But if you’re like 63% of all employers, the most common corporate wellness challenge is employee engagement, according to Healthiest Employers1.  In fact, RAND2 finds on average only half of eligible employees participate in health risk assessments like biometric screenings and fewer than 20% of eligible employees participate in subsequent health interventions.

Just imagine.  If the vast majority of your employees engage in a healthy lifestyle, your health benefits become mostly about prevention and maintenance. Your health care costs become another manageable business expense.  

So what went wrong?  Ownership, investment.  YOU own the wellness program because you created it and your COMPANY invested in it – but what about your employees?  
Move from Top-Down to Employee-Driven Wellness Programs.
All the scuttle about the new Affordable Care Act and Consumer-Driven Health Care provides the perfect opportunity to not only hand the reins over to your employees with THEIR benefit decisions, but also in designing THEIR wellness program.

How can you reconfigure your existing wellness program to allow employees to personalize the activities to meet their individual priorities?  
...people tend toward activities that increase their feelings of personal fulfillment, empowerment and self-actualization...
The science of motivation offers up some helpful clues.  Research into cognitive evaluation theory (CET) and self-determination theory (SDT), models first constructed by Dr. Edward Deci and Dr. Richard Ryan at the University of Rochester3,sheds light on what motivates employees to make lifestyle changes that they can sustain.

Deci and Ryan found motivation to be the result of basic and universal socio-psychological needs:
  • autonomy or self-determination—the sense that we’re choosing our own path.
  • competency or self-efficacy—the sense that we’re capable of accomplishing what we set out to do.
  • relatedness—the sense that we’re part of a bigger community that respects and appreciates us.


From the CET/SDT perspective, people tend toward activities that increase their feelings of personal fulfillment, empowerment and self-actualization, rather than being passive or reactive, or simply products of their environment.  They will exert effort to learn and develop these rewarding activities.  Each person’s engagement reasons may be intrinsic – self-satisfying – or extrinsic – receiving recognition, and that recognition can be tangible—a payment—or intangible—a compliment.  

Successful corporate wellness programs enable a self-renewing cycle of increasingly deeper employee engagement by carefully selecting tools that empower employees to meet their personal motivational needs.  

Examples of effective tools include 3:

  • Motivational surveying that helps establish individual health priorities and next steps.
  • Game platforms that allow users to choose or self-design their own challenging activities, providing reward elements like badges, points, and leader boards.
  • A mix of tangible and intangible, financial and non-financial recognition, rewards and incentive programs.

Effective Tool Characteristics 3:

  • They nurture common psychological needs like self-determination, self-efficacy, self-esteem and approval by others. 
  • They recognize that employees are not exclusively “coin-operated” but in fact are motivated by multiple factors.
  • They help identify and target individual employee values associated with at least a tiny spark of positive, volitional motivation – the essential building blocks on which the rest of the house is built.
  • They provide flexibility and make it easy for employees to select or design activities or challenges meaningful to them, key motivational factors identified in Dr Abraham Maslow’s research.
  • They make it easy for employees to chain together small wins that build on existing competencies, an effective behavior change technique identified by Dr. B.J.Fogg.
  • They support interaction and feedback with the individual employee’s community of interest, tapping the group influences identified by Dr. Nicholas Christakis’ and Dr. James Fowler’s social network research.
  • They provide a mix of recognition, rewards and incentives that allow employees to select what’s meaningful to them and increase their sense that they’re part of a community that respects them.

Which tools are best for your employees?  Ask!  Starting this conversation with your employees is the first step in moving towards an employee-driven wellness initiative – and their full engagement, helping you realize the health care cost containment you seek.

1 Healthiest Employers, “How To Become A Healthiest Employer,” HR.com, March 2012. 
2 RAND, “Review of the U.S. Workplace Wellness Market,” 2012.
3 Employee Benefit News “Employee Engagement: The New Currency of Wellness,” Hubbub White Paper, 2013


Wellness = Health Care Cost Containment

12/2/2013

 
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Get a Jump on New Year’s Wellness Resolutions & Long-Term Health Care Costs – Start a Company 
Wellness Program
It’s tough.  Wrangling with the new Affordable Care Act makes it a challenge to figure out how to ride the wave of Health Care Reform without going under.  Don’t be afraid to tap into the expertise you need with a Health Care Reform Navigator, then make a year-end resolution to get that company wellness program up and running in time for New Year’s Resolutions.  

According to the 2013 Wellness and Benefits Administration Benchmarking Study conducted by SourceMedia, publishers of Employee Benefits News, an increasing number of companies see Wellness Programs as a cost-efficient way to realize long-term employee health care savings.  

Biometric testing with an incentive program attached emerged as the foundation of most wellness programs.  77% of large employers said they have biometric testing, such as stress levels, cholesterol levels, blood pressure, body-fat level, nutrition analysis, compared to 61% last year.

While the dollar value of wellness incentives continue to increase, the long-term benefits of reduced employee health care costs and increased production far outweigh the outlay.  More than half of large employers, 54%, are reporting that they spend more than $250 per employee annually on wellness incentives compared to 49% in 2012.

Health insurance premium adjustments are the most common incentive payment mechanism.  Most large employers, (64%, up from 59% in 2012), use premium discounts or surcharges to motivate employees to participate in the company wellness program.

Employee buy-in is key.  With all the discussion going on surrounding Health Care Reform, it is a good time to dovetail this topic with a Wellness Program that empowers employees to permanently transition to consumer-driven health care, and realize incentives to do so.

Your year-end resolution is to:

1)      Start a wellness program

2)      Get employees to participate

3)      Get employees to make participation a lifestyle

Change is tough – but something’s got to change to curb spiraling health care costs.  The hope is that once the dust settles on the Affordable Care Act, it will help.  Being a change agent in improving employee health long-term is an even bolder step in the right direction.  Imagine.  If the majority of your employees were healthy, you could get your focus back on being productive and doing business.

The study was commissioned by bswift and conducted online in March 2013 among 380 benefit decision makers at organizations that offer health benefits. Respondents were required to be employed at an organization with 50 or more employees and have responsibility in HR/benefits/insurance designing benefit plans and selecting benefit carriers. The respondents were divided into two groups: large employers with more than 500 benefit-eligible employees and smaller employers with 50 to 500 benefit-eligible employees. Data reported within this paper will primarily focus on large employers, unless otherwise specified.

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    Rylan Klaseen & Associates

    Serving Southern California:
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    316 W 2nd Street
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Rylan Klaseen & Associates          Tailored Benefits Delivery          Serving Southern California
316 W 2nd Street, Suite 500, Los Angeles, CA 90012 Cell 909-243-4886