Yearly Archives: 2015

  • Overpromising leads to overregulation…which was not “fine” with the carriers

    December 9, 2015

    Due to “unacceptable inaccuracies” in their directories, Blue Shield was hit with a fine of $350,000 and Anthem $250,000. In addition, Blue Shield had to reimburse $38 million to enrollees “who incurred out of network costs” due to inadequate information about the status of their providers. No wonder doctors were confused when patients asked about the lists…

  • 2016 Annual Limits Card Back by Popular Demand | Petaluma Benefits Broker

    December 7, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

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    Many employee benefit limits are automatically adjusted each year for inflation (this is often referred to as an “indexed” limit). UBA offers a quick reference chart showing the 2016 cost of living adjustments for health and Section 125 plans, qualified plans, Social Security/Medicare withholding, compensation amounts and more. This at-a-glance resource is a valuable desk tool for employers and HR practitioners.

    Here’s a snapshot of the 2016 health plan limits; be sure to request the complete chart from a UBA Partner.

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  • What if they made a recommendation and nobody cared? New mammogram standards

    December 4, 2015

    The American Cancer Society has made new recommendations on the required timing and frequency of mammograms. The new guidelines say that women with an average risk of breast cancer should begin getting annual mammograms at age 45 (was 40), and also that women age 55 and above should cut back to every other year (was every year). Marin doctors disagree…

  • Can Employers Access Current or Prospective Employee Social Media Accounts? | California Employee Benefits Specialist

    December 3, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    SocialMediaWe’ve become a very connected society, but that doesn’t mean we want to share everything with everybody. Take, for example, your social media site (e.g., Facebook, Twitter, LinkedIn, etc.). Typically, you have a select network of individuals with whom you want to connect and share your life, thoughts, and opinions. But what happens when a current or prospective employer wants access to your social media account either as a “friend” or by demanding your login and password information?

    In an article on the website of Employee Benefit News titled, “Can employers access an employee’s social media account?,” it outlines how the law is changing in some states and when there’s an exception to request social media access. Some states do not allow an employer to ask an employee to either friend them or give them access to their social media accounts. In addition, there are states that prohibit a company from asking an employee to log in to their social media site while a company representative is present and watching. Furthermore, the laws in some states also have language in them forbidding retaliation against an employee who does not provide his or her social media access. Not all states have laws pertaining to employee rights with social media, but with those that do the law often varies. If a company has employees in multiple states, it needs to be especially careful, which is why it’s always best to consult with an attorney. This blog entry, as well as the website article, should not be taken as legal advice.

    Granted, sometimes an employer has legitimate reasons to want to see what an employee is posting. Examples of these would include when an employee is speaking negatively about the company, using social media to bully or harass another employee, or posting company information that’s proprietary and confidential. Regardless, the employer will need to be careful and consult an attorney before attempting to request or otherwise access an employee’s social media account. Because of these reasons, there are often exceptions built into a state law that allow for internal investigations, violations of company policy, or illegal activities.

    An important point to note is that many of these laws allow companies to review any information that’s publicly available. So if a company is doing a simple Internet search of your name during the hiring process and certain information or photos happen to turn up on a public website, then all that is fair game.

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  • When the C-Suite Gets Seriously Sick | CA Benefits Broker

    December 1, 2015

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    By Bill Olson
    Chief Marketing Officer at United Benefit Advisors

    CSuiteSomeone in the C-Suite of a company gets sick. I’m not talking about a cold or flu; I’m talking about a major, possibly even terminal, illness. Depending on the level of severity, what can the human resources department do to help communicate this information properly to the company’s employees?

    There will always be privacy concerns, but there are also requirements with the Securities and Exchange Commission (SEC) that mandate publicly traded companies to disclose information that may impact an investor’s decision to buy or sell stock. A serious illness could be interpreted as something that needs to be reported to the SEC. Other than that, how much information should a C-Suite executive share with HR, when should he or she share it, and should they discuss any plans for a successor – either temporary or permanent? On the HR side, how much of this should they release to the rest of the company?

    Based on an article on Human Resource Executive Online titled, “Disclosing Illness in the C-Suite,” when handled correctly, the disclosure of an executive’s illness can do more than satisfy SEC compliance. It can reassure employees and investors that the company has a plan going forward, it can address important questions, and it can stop the almost certain spread of false rumors.

    Sharing information today is common and rapid, which makes hiding a major illness next to impossible. Rather than letting the company’s rumor mill disclose the information in a way that could be harmful to the executive and his or her family, detrimental to the company, and potentially completely false, it’s better to have it come directly from a company representative. Current examples include Goldman Sachs CEO and Chairman Lloyd Blankfein, who sent a memo to employees and the SEC just one day after his lymphoma diagnosis. Contrast this with Apple CEO Steve Jobs who withheld his cancer diagnosis for an entire year. The latter example is cited as a textbook case of how not to handle this. The “doom and gloom” speculation of what was happening to Jobs was rampant both internally at Apple and with investors.

    This type of speculation almost always leads to decreased employee morale and productivity, which is why HR should communicate information as quickly as possible. That being said, it’s up to the C-Suite executive to determine how much information he or she wants to divulge. The role of HR is to communicate how this is going to impact the company’s daily operations, whether someone will be temporarily assuming those responsibilities, and if the company has a succession plan in place if the executive is not able to return to work.

    Because this type of news can disrupt the operations of a company, HR should continually provide updates and put them in a positive light. As it states in the article, you can’t draft this type of plan, especially a plan of succession, after a critical illness diagnosis is announced. This is something that must be thought of ahead of time in order to avoid the turbulent aspect it can produce. Regardless of this, HR also needs to emphasize the seriousness of the issue and that it must be handled with respect, sensitivity, and professionalism.

    Hopefully, an HR department will never have to deal with this unfortunate experience. Striking a balance between the C-Suite executive’s privacy and everyone else’s need to know may be one of the most difficult things an HR department can face. This is why planning ahead can often provide that level of confidence during this time of corporate instability.

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  • How to Reduce Fullness | Petaluma Employee Benefits

    November 27, 2015

    By Serena Styles
    www.livestrong.com

    apple and tapeWhen you eat a large meal, there is about a 20 minute span between when your stomach is full and when your brain recognizes that fact. For 20 minutes, you can continue eating and not realize the feeling of fullness in your stomach. This can result in severe overeating with uncomfortable after effects. Although you cannot take back your indulgence, a few simple remedies help reduce fullness so you can fell better as soon as possible.

    Step 1

    Lie down and place something warm on your stomach for about 10 minutes directly following the meal. A warm water bottle or a heating pad that does not place too much pressure is best. This aids your stomach in digesting the food and often calms the initial discomfort of fullness.

    Step 2

    Take a walk. Although a feeling of fullness creates the desire to continue lying down for hours, gentle exercise helps relax your stomach and ease discomfort. Walking also gives your metabolism a boost, encouraging your body to start using some of the food you ate. Walk slowly and do not push yourself; allow your stroll to be leisurely. Walks as short as five minutes often do the trick, but lengths upward of 20 minutes do no harm to your body.

    Step 3

    Drink a glass of water to aid in digestion. One 8-ounce glass is plenty; drink it slowly so you do not increase the intensity of your fullness feeling. Some individuals find greater relief from drinking carbonated water, or water with 1 teaspoon of baking soda mixed in. However, no scientific research definitively supports this claim. In addition, many individuals enjoy a drop of peppermint extract in their water or opt for peppermint tea instead. The peppermint is reputed to settle a full stomach.

    Step 4

    Engage in light stretching to relax your abdominal muscles and relieve discomfort. Reaching your hands over your head and bending back slightly from a standing position elongates your stomach. In addition, trunk twists stretch your obliques, the muscles alongside your stomach, aiding in further relief. Stretch for two to five minutes and never push your muscles to the point of pain.

    Step 5

    Take an over-the-counter antacid medication to lessen the chance of discomfort later. One dose reduces bloating that commonly follows uncomfortable fullness. Follow the package instructions and take only as much as necessary to relieve your symptoms.

    Step 6

    Consume fiber-rich foods such as legumes, oat bran, berries, whole grains, green vegetables, nuts and potatoes. The fiber helps regulate your digestive system, keeping things moving after overeating. Continue eating fibrous foods for about two days after the fullness feeling; if your system gets backed up, you will experience a second bout of discomfort.

    Tips

    Avoid overeating in the future by drinking at least two 8-ounce glasses of water 10 to 15 minutes before your meal. This triggers your mind to know when you are full earlier in your meal. In addition, chew your food slowly and try to be the last one to finish eating at the table. This ensures you give your body enough time to let you know when your stomach is full.

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  • Ways to increase Employee Participation in a Wellness Program | Petaluma Benefits Broker

    November 24, 2015

    Finding different ways to increase employee participation in a wellness program is challenging. Without a majority participation rate, your wellness goals are probably not going to accomplish your ideal employee health target. Please review this short video highlighting some of the strategies that you could implement in your wellness program.

  • UBA Health Plan Survey: Plans Popular with Employers Aren’t Always Tops with Employees | California Employee Benefits

    November 19, 2015

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    The UBA Health Plan Survey tracks plans offered by region as well as enrollment by region. From a prevalence perspective, preferred provider organization (PPO) plans are most prevalent in the Central U.S., though they generally dominate nationwide, except in the Northeast where consumer-directed health plans (CDHPs) are most prevalent.

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    From an enrollment perspective, PPO plans have the greatest enrollment in the Central U.S. The Southeast and Northeast saw the biggest increase in PPO enrollment (7% and 8% respectively) this year. Enrollment in health maintenance organizations (HMOs) is down across most of the country, but is on the rise in the Central and Western U.S. Point of service (POS) plan enrollment has stayed virtually flat from last year. CDHP enrollment is highest in the Northeast U.S. at 29.2%, an increase of 11.5% over 2014. But the Southeast saw nearly a 23% increase in CDHP enrollment from 2014. Conversely, the North Central U.S. saw a 23.5% decrease in CDHP enrollment.

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    Sometimes, plans offered by employers are also equally desired by employees; in other words, what is offered most is also what employees opt to enroll in the most. For example, CDHPs and PPO plans are the most prevalent plans in the Northeast and also the top two plans employees enroll in. But it is interesting to note that those employees flip the order of their preference, favoring PPO plans more than CDHPs, while CDHPs are most popular among employers. Employers and employees in the Southeast, North Central and Central states mostly see eye-to-eye when prioritizing PPO plans, followed by CDHP plans as a distant second. In the West, employees enroll in PPO plans at a far greater rate than the prevalence rate of these plans among employers.

    This information can be very helpful when choosing your plan offerings. Download the free 2016 Health Plan Survey Executive Summary for additional information on health plan cost trends across the U.S., including employer contributions and costs for employees.

    To benchmark your plan against others in your region, industry or size bracket, contact a UBA Partner near you to run a custom benchmarking report.

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  • New codes cause headaches – what was wrong with ICD9? Is the new ICD10 better?

    November 18, 2015

    Logistical nightmares. Carrier non cooperation. Electronic Medical Records. What else can we throw at doctors to make them wish they never wend to med school? A new code book.   As one article put it, “the codes cover everything from parrot bites to getting sucked into a jet engine.” The cost to change systems and adapt to the new ICD10 code book is estimated to be over $3 billion. For example, there are 25 codes just for diabetes. So if your doctor is asking more questions, and there are delays in your insurance payment…you can thank the newest and best method for reporting.

  • CMS Provides Clarity on PACE Act Implications for States | California Benefits Broker

    November 17, 2015

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    By Danielle Capilla
    Chief Compliance Officer at United Benefit Advisors

    CMSClarityThe Providing Affordable Coverage for Employees (PACE) Act amended the Patient Protection and Affordable Care Act (ACA) and redefined small employers as those with 50 or fewer employees; it also gives states the option to expand the definition to include employers with up to 100 employees (or, practically speaking, those with 51 to 100 employees, also called “mid-size employers”). Prior to the ACA, all states defined small employers as those with 1 to 50 or 2 to 50 employees; however, many have passed legislation redefining the group size up to 100 employees beginning in 2016. States are now in the process of determining what they define as “small employer.”

    The Centers for Medicare & Medicaid Services (CMS), in response to the PACE Act, issued an FAQ on the impact of the PACE Act on small group expansion. CMS clarified that states that choose to expand the definition up to 100 employees beginning January 1, 2016, were required to notify CMS of the decision by October 1, 2015. States with other effective dates should notify CMS of the decisions as soon as is practical. A state’s definition is legally binding on health insurance issuers.

    Regarding rate filings by the carriers, the FAQ stated that states with a state-based Small Business Health Options Program (SHOP) that do not rely on the federal platform have the discretion, consistent with state law and regulations, to allow resubmission of small group coverage rate filings, including changes to rates for the first quarter of 2016. Technical constraints will prohibit carriers to change rate filings for the first quarter in states that utilize a federally-facilitated (FF) SHOP or a state-based SHOP using the federal platform. Rates may be adjusted effective April 1, 2016.

    On November 1, 2015, the beginning of open enrollment for 2016 coverage, all FF-SHOP eligibility screens on HealthCare.gov will ask employers if they have 1 to 50 employees for purposes of SHOP eligibility. CMS is working to update these screens as quickly as possible in applicable states.

    The PACE Act will not affect counting methodologies used by SHOPs in relation to employer shared responsibility, medical loss ratio (MLR) calculations, risk adjustment or risk corridors. The definition of a small employer for purposes of MLR, risk corridors, and risk adjustment will follow the state definition. Reporting for those programs during a transition in the state definition of small employer in the applicable reporting year should align with the policy issued to the employer, regardless of actual employer size.

    For more information on the PACE Act, download UBA’s ACA Advisor, “PACE Act Passes House, Senate.

    For comprehensive benchmarking information on health care costs among employers with 51 to 100 employees—including the rate outlook now that PACE has passed and community rating may be avoided for these groups—download UBA’s 2015 Health Plan Survey Executive Summary.

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