Yearly Archives: 2021

  • Are Your Healthcare Benefits Contributing to the Labor Shortage?

    December 27, 2021

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    Employ­ee ben­e­fits are a major bar­gain­ing chip for com­pa­nies look­ing to attract tal­ent. The prob­lem is health­care costs are sky­rock­et­ing, and it’s dif­fi­cult for employ­ers to offer the same lev­el of cov­er­age. High­er costs are either result­ing in less cov­er­age or small­er wages for employees.

    Find out what’s hap­pen­ing with health­care and recruit­ment, and get tips on what com­pa­nies can do to stay competitive:

    The Rising Costs of Healthcare

    It’s no secret that health­care costs have been increas­ing for years. Accord­ing to the research, it will con­tin­ue to increase. One study from the Peter­son Cen­ter on Health­care and the Kaiser Fam­i­ly Foun­da­tion (KFF) found that $3.8 trillion—or $11,582 per per­son— was spent on health­care in 2019. By 2028, indi­vid­ual Amer­i­cans will be spend­ing around $18,000 on healthcare.

    While the issue is com­plex, experts agree that the major fac­tors in this spike include an aging pop­u­la­tion, a rise in chron­ic dis­ease, and high­er prices for med­ical ser­vices and drugs. Costs are ris­ing so rapid­ly that insur­ers are increas­ing deductibles, not cov­er­ing cer­tain ser­vices, or apply­ing caps. As a result, health­care pack­ages are play­ing a larg­er role when cho­sen can­di­dates are decid­ing whether to accept a new job.

    How Important Are Competitive Healthcare Packages?

    As health­care costs con­tin­ue to rise, a new debate has emerged. Should employ­ers or employ­ees take more respon­si­bil­i­ty for cov­er­ing healthcare?

    One of two things are hap­pen­ing with work­place health­care. Either employ­ees are leav­ing their cur­rent posi­tion for a job with bet­ter health­care cov­er­age or their annu­al salary increas­es are being eat­en up by high­er health­care pre­mi­ums being passed on to employees.

    A recent sur­vey found that 42% of employ­ees are think­ing about leav­ing their cur­rent posi­tion because of inad­e­quate benefits.

    “The ris­ing price of health care costs fam­i­lies thou­sands of dol­lars a year in fore­gone wages, out-of-pock­et costs, and increased tax­es,” said Josh Bivens, research direc­tor at the Eco­nom­ic Pol­i­cy Insti­tute, in an inter­view with Mar­ket­Watch.

    He said the effect may not be appar­ent, but it’s one of the main rea­sons wages have remained stag­nant. If you spot a num­ber of para­dox­es here, then you aren’t alone. Low­er salaries won’t attract top tal­ent, and pass­ing on the costs of health­care to cur­rent employ­ees won’t retain them. This quandary for employ­ers is com­pound­ed by the cur­rent labor short­age, which is often referred to as the Great Resignation.

    What Can Companies Do?

    It’s clear that health­care is impor­tant to job can­di­dates. To attract new tal­ent, com­pa­nies should rev­o­lu­tion­ize the way they treat well­ness in the workplace.

    Pro­mot­ing health and well­ness ini­tia­tives not only improves employ­ee morale and decreas­es absen­teeism, but a health­i­er work­force is less like­ly to use their insur­ance. This may even­tu­al­ly equate to low­er premiums.

    Anoth­er easy way to curb costs is by com­mu­ni­cat­ing with employ­ees about what plans are avail­able. Health insur­ance is often a com­plex top­ic, and some employ­ees may acci­den­tal­ly choose the wrong plan because they don’t under­stand the difference.

    Proac­tive­ly high­light­ing avail­able ser­vices can assist employ­ees before a med­ical issue spins out of con­trol. Men­tal health ser­vices are an exam­ple of this. Let­ting employ­ees know about Employ­ee Assis­tance Pro­grams or low-cost tele­health options could offer help before a more seri­ous inter­ven­tion is needed.

    There are many options avail­able for com­pa­nies to make their ben­e­fit pack­ages more com­pet­i­tive to attract top tal­ent. Some com­pa­nies are con­sid­er­ing Health Sav­ings Accounts or HSAs that help employ­ees pay med­ical bills while enrolled in cheap­er, high deductible plans.

    Direct Pri­ma­ry Care is anoth­er tech­nique being used by com­pa­nies to con­trol costs. DPC allows employ­ees to pay fixed month­ly, quar­ter­ly, or annu­al fees to cov­er pri­ma­ry care, con­sul­ta­tions, care coor­di­na­tion, and com­pre­hen­sive care man­age­ment. Not only does DPC result in cost-sav­ings, but it fos­ters a bet­ter rela­tion­ship between patient and doctor.

    Leveraging Your Benefits

    Even though health­care costs con­tin­ue to rise, it’s pos­si­ble for com­pa­nies to con­trol costs by pro­mot­ing well­ness ini­tia­tives and help­ing employ­ees select the best ben­e­fit pack­age for their needs.

    Being proac­tive with health­care and mak­ing smart finan­cial deci­sions can keep health­care prices rea­son­able, and ensure that com­pa­nies will be able to attract talent.

    By Mcken­zie Cassidy

    Orginal­ly post­ed on HR Exchange Network

  • IRS Announces 2022 Retirement Plan Contribution Limits

    December 21, 2021

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    On Novem­ber 4, 2021, the Inter­nal Rev­enue Ser­vice (IRS) released Notice 2021–61 announc­ing cost-of-liv­ing adjust­ments affect­ing dol­lar lim­its for pen­sion plans and oth­er retire­ment-relat­ed items for tax year 2022. Many pen­sion plan lim­its will change next year because the increase in the cost-of-liv­ing index met the statu­to­ry thresh­olds that trig­ger their adjust­ment. Oth­er items, how­ev­er, will not increase for 2022. Here is a sum­ma­ry of the lim­its for 2022.

    For 401(k), 403(b), and most 457 plans and the fed­er­al government’s Thrift Sav­ings Plans:

    • The elec­tive defer­ral (con­tri­bu­tion) lim­it increas­es from $19,500 for 2021 to $20,500 for 2022.
    • The catch-up con­tri­bu­tion lim­it for employ­ees aged 50 and over who par­tic­i­pate in these plans will stay the same at $6,500 for 2022.

    For indi­vid­ual retire­ment arrange­ments (IRAs):

    • The lim­it on annu­al con­tri­bu­tions will not change for 2022. It remains $6,000.
    • The addi­tion­al catch-up con­tri­bu­tion lim­it for indi­vid­u­als aged 50 and over is not sub­ject to an annu­al cost-of-liv­ing adjust­ment so it remains $1,000 for 2022.

    For sim­pli­fied employ­ee pen­sion (SEP) IRAs and individual/solo 401(k) plans:

    • Elec­tive defer­rals increase to $61,000 for 2022, based on an annu­al com­pen­sa­tion lim­it of $305,000 (up from the 2021 amounts of $58,000 and $290,000).
    • The min­i­mum com­pen­sa­tion that may be required for par­tic­i­pa­tion in a SEP remains unchanged at $650.

    For sav­ings incen­tive match plan for employ­ees (SIMPLE) IRAs:

    • The con­tri­bu­tion lim­it on SIMPLE IRA retire­ment accounts increas­es from $13,500 for 2021 to $14,000 for 2022.
    • The SIMPLE catch-up lim­it remains unchanged at $3,000 for 2022.

    For defined ben­e­fit plans:

    • The basic lim­i­ta­tion on the annu­al ben­e­fits under a defined ben­e­fit plan increas­es from $230,000 for 2021 to $245,000 for 2022.

    Oth­er items:

    • The thresh­old for deter­min­ing “high­ly com­pen­sat­ed employ­ees” increas­es from $130,000 for 2021 to $135, 000 for 2022.
    • The thresh­old for offi­cers who are “key employ­ees” in a top-heavy plan increas­es from $185,000 for 2021 to $200,000 for 2022.
    • In a sep­a­rate announce­ment, the Social Secu­ri­ty Admin­is­tra­tion stat­ed that the 2022 tax­able wage base will increase to$147,000, an increase of $4,200 from the 2021 tax­able wage base of $142,800. Thus, the max­i­mum Social Secu­ri­ty tax lia­bil­i­ty will increase for both employ­ees and employers.

    The IRS announce­ment is need­ed infor­ma­tion for employ­ers that spon­sor 401(k) plans and oth­er types of retire­ment and sav­ings plans. For those inter­est­ed in health and wel­fare plans, the IRS will release a sep­a­rate announce­ment on the 2022 ben­e­fit lim­its for health flex­i­ble spend­ing accounts (HFSAs) and tran­sit ben­e­fit pro­grams which we’ll cov­er sep­a­rate­ly on this blog.

    By Kath­leen A. Berg­er, CEBS

    Orig­i­nal­ly post­ed on Min­er­al

  • How Health Insurance Can Win the War for Talent

    December 13, 2021

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    The COVID-19 pan­dem­ic shined a spot­light on the impor­tance of employ­er-pro­vid­ed health ben­e­fits. Not only have employ­ees been request­ing an expan­sion of their ben­e­fits for months, but report after report has indi­cat­ed that com­pre­hen­sive plans that also cov­er men­tal health or include paid parental leave, for exam­ple, are the key to get­ting peo­ple back to work. But are employ­ers listening?

    The 2021 Employ­ee Ben­e­fits Trends Study from MetLife start­ed col­lect­ing data on what com­pa­nies planned to do about ben­e­fits going for­ward. It found that 80% of the sur­veyed employ­ers agreed that ben­e­fits play a huge role in employ­ee resilience and well-being.

    Most com­pa­nies have seen the writ­ing on the wall and they’re ready to do what’s need­ed to get work­ers back and ensure they stay hap­py, healthy, and productive.

    What Techniques Are Companies Implementing?

    For some com­pa­nies, com­mu­ni­ca­tions have grown mud­dled by the remote envi­ron­ment. Oth­ers may have rec­og­nized they weren’t explain­ing ben­e­fits enough pre-COVID and decid­ed it was time to make a change.

    Accord­ing to the study, 80% of the employ­ers sur­veyed are increas­ing their ben­e­fits com­mu­ni­ca­tions. Most Amer­i­cans select the wrong type of insur­ance for their indi­vid­ual needs, which results in more bills and a prof­it loss for their employer.

    One study cit­ed by CNBC found that only 4% of Amer­i­cans could cor­rect­ly iden­ti­fy the terms deductible, co-pay, coin­sur­ance, and out-of-pock­et max­i­mum. Increas­ing the com­mu­ni­ca­tions about ben­e­fits will help employ­ees bet­ter under­stand what’s avail­able and how to pick the right plan for them. It should decrease out-of-pock­et costs and elim­i­nate the stress of prov­ing to the insur­ance com­pa­ny that cer­tain treat­ments are needed.

    It’s also impor­tant to con­sid­er that employ­ees are 177% more like­ly to be “holis­ti­cal­ly well” when they receive clear com­mu­ni­ca­tions on a reg­u­lar basis.

    Hav­ing a strong com­mu­ni­ca­tion strat­e­gy is more impor­tant than ever as employ­ers are deal­ing with more remote and hybrid employ­ees. The nature of these work modes requires clear expec­ta­tions and reg­u­lar follow-up.

    Besides edu­cat­ing employ­ees on the plans avail­able, 75% of com­pa­nies also said they intend­ed to offer more cus­tomiza­tion of ben­e­fits. Not every­one needs to be cov­ered for the same things. There’s no rea­son to force every­one to get a “one-size-fits-all” plan.

    How Employers Feel About Health Benefits Expansion

    Health insur­ance isn’t cheap and most com­pa­nies would rather focus on cut­ting costs than adding new ben­e­fits. But there are cre­ative ways to help employees.

    For instance, 74% of employ­ers are offer­ing more added-val­ue ser­vices. These may include telemed­i­cine, med­ical bill-sav­ing assis­tance, employ­ment assis­tance pro­grams, and even iden­ti­ty theft pro­tec­tion. Some offer perk ben­e­fits like com­muter spend­ing accounts, cafe­te­ria food plans, or employ­ee dis­counts at local businesses.

    Over­all, employ­ers are strong­ly con­sid­er­ing more vol­un­tary ben­e­fits for employ­ees. Accord­ing to the MetLife study, 66% of employ­ers are expand­ing the range of “employ­ee paid” or vol­un­tary benefits.

    These vol­un­tary ben­e­fits aug­ment what cov­er­age is cur­rent­ly avail­able, but they also sup­port the finan­cial well-being of employ­ees, cut com­pa­ny insur­ance costs, and bet­ter retain cur­rent employees.

    At this moment in time, the big con­cern among employ­ers is reten­tion. Research indi­cates that 78% of employ­ees will decide to stay with a com­pa­ny because of its ben­e­fits program.

    Shifting Attitudes Toward Health Insurance

    Ben­e­fits have always been a key part of com­pet­i­tive job offers, yet how employ­ers view them is shift­ing. More employ­ers believe they have a respon­si­bil­i­ty for the health of their employ­ees. Accord­ing to the study, they see a direct cor­re­la­tion between employ­ee health and productivity.

    The Great Res­ig­na­tion has shown com­pa­nies that a high­er salary isn’t always enough to keep employ­ees on the job. They also need ben­e­fit options to pro­tect their men­tal and phys­i­cal well-being.

    By Mcken­zie Cassidy

    Orig­i­nal­ly post­ed on HR Exchange Network

  • IRS Announces 2022 Limits for Health FSAs and Transit Benefits

    December 8, 2021

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    Today, the Inter­nal Rev­enue Ser­vice (IRS) announced annu­al infla­tion adjust­ments for more than 50 tax pro­vi­sions, includ­ing an increase in vol­un­tary employ­ee con­tri­bu­tions to employ­er-spon­sored health­care flex­i­ble spend­ing arrange­ments (HFSAs) to $2,850 for plan years begin­ning in 2022, up from the 2021 lim­it of $2,750.

    For HFSAs that include a car­ry­over pro­vi­sion, up to $570 may be car­ried over from the 2022 plan year to the next plan year. Note that HFSAs had the option of allow­ing an unlim­it­ed car­ry­over for the 2021 plan year due to fed­er­al COVID-19 relief pro­vi­sions. For unused HFSA funds at the end of the 2022 plan year, how­ev­er, the plan can­not allow more than $570 to be car­ried over for use in the fol­low­ing year.

    The IRS also announced an increase in the 2022 month­ly lim­its for qual­i­fied trans­porta­tion fringe ben­e­fits under Code § 132(f). For trans­porta­tion in a com­muter high­way vehi­cle and mass tran­sit pass­es, the lim­it will be $280 (up from $270 this year). The sep­a­rate month­ly lim­it for qual­i­fied park­ing also will increase to $280.

    Details of this announce­ment can be found in Rev­enue Pro­ce­dure 2021–45.

    By Kath­leen A. Berg­er, CEBS

    Orig­i­nal­ly post­ed on Min­er­al

  • Tips for Managing the Holiday Blues

    December 1, 2021

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    “Chil­dren laugh­ing, peo­ple pass­ing, meet­ing smile after smile” stirs hap­py mem­o­ries of singing Christ­mas car­ols for some, but for oth­ers, the hol­i­days can be the most stress­ful and loneli­est time of the year.  The hol­i­days often present a dizzy­ing array of demands — shop­ping, bak­ing, and enter­tain­ing to name a few.  For those deal­ing with men­tal health con­di­tions like depres­sion or or anx­i­ety, the hol­i­days can be even harder.

    Hol­i­day depres­sion can be mis­in­ter­pret­ed as being noth­ing more than the win­ter blues.  So, when it comes to the hol­i­days, peo­ple are more focused on their phys­i­cal health issues instead of their men­tal health issues. They are more inter­est­ed in los­ing weight than tak­ing care of their men­tal health.  Being unaware that there is a prob­lem can make hol­i­day depres­sion evolve into major depres­sion.  Coun­sel­ing and med­ica­tion are good avenues to seek if you are liv­ing with symp­toms of depression.

    Here are 9 tips that you can use to help you with hol­i­day depression:

    1. Be real­is­tic – Hol­i­days change just as peo­ple change. Kids grow old­er, peo­ple move, and new peo­ple will become a part of your life.  Focus on those con­nec­tions, new tra­di­tions and remem­ber past hol­i­days with fond­ness while still enjoy­ing the one right in front of you.
    2. Sched­ule Some Down-Time – Even 15–20 min­utes a day to enjoy some qui­et time, take a bath, lis­ten to music or read a book can do won­ders for your stress lev­els. Plus, it’s ok to say no: you don’t have to attend every par­ty or fam­i­ly event.
    3. Don’t Iso­late Your­self – Look for ways that you can enjoy social con­nec­tions, even if you aren’t able to go home for the hol­i­days. If you are feel­ing lone­ly, ask a friend to come over for a heart to heart or vol­un­teer for some­thing that inter­ests you.
    4. Drink Only in Mod­er­a­tion – Alco­hol is a depres­sant and can exac­er­bate neg­a­tive feelings.
    5. Exer­cise Reg­u­lar­ly – While hit­ting the gym can be tough when you are stressed and busy, try going for a short walk. Did you know that exer­cise can help relieve symp­toms of depression?
    6. Focus on the Pos­i­tives – Today is a gift. That is why it’s called the present! Being pos­i­tive and prac­tic­ing grat­i­tude has a strong pos­i­tive impact on psy­cho­log­i­cal well-being. It increas­es self-esteem, enhances pos­i­tive emo­tions and makes us more optimistic.
    7. Keep Expec­ta­tions Man­age­able – Try to set real­is­tic goals for your­self and your fam­i­ly. Pace your­self.  Orga­nize your time and make a list and pri­or­i­tize the impor­tant activities.
    8. Let Peo­ple Close to You Know What’s Going On – Don’t try to hide your hol­i­day depres­sion from your friends and fam­i­ly. Hid­ing your prob­lem can make your men­tal health worse.  Instead, be hon­est with them and let them know what you are going through and make sure you let them know that you don’t expect them to make it better.
    9. Seek Pro­fes­sion­al Help if You Need It – You may find your­self feel­ing per­sis­tent­ly sad or anx­ious, unable to sleep, unable to face rou­tine chores or irri­ta­ble and hope­less despite your best efforts. If these feel­ings last for a while, talk to your doc­tor or a men­tal health professional.

    Avoid beat­ing your­self up if you are not full of the “joy of the sea­son.”  With some plan­ning, self-care and social con­nec­tions, it’s pos­si­ble to tack­le depres­sion around the hol­i­days and still enjoy the sea­son.  Be gen­tle with your­self, have real­is­tic expec­ta­tions, and don’t aban­don your healthy habits just because it’s the hol­i­day sea­son.  By active­ly work­ing to man­age your men­tal health, you will be able to make the best of the holidays!

    If you are expe­ri­enc­ing these symp­toms over a peri­od of sev­er­al weeks, you may be depressed. Talk­ing with a men­tal health pro­fes­sion­al or tak­ing a men­tal health screen­ing test can help you under­stand how well you are cop­ing with recent events. Seek help.

     

  • Biden-Harris Administration Issues Third Rule To Implement No Surprises Act

    November 29, 2021

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    WASHINGTON – The Biden-Har­ris admin­is­tra­tion – through the depart­ments of Labor, Health and Human Ser­vices, Trea­sury and the Office of Per­son­nel Man­age­ment – today issued an inter­im final rule with com­ment peri­od to con­tin­ue imple­men­ta­tion of the No Sur­pris­es Act, a con­sumer pro­tec­tion law that helps curb the prac­tice known as “sur­prise billing” for med­ical care.

    The inter­im final rule details the fed­er­al arbi­tra­tion process – or the inde­pen­dent dis­pute res­o­lu­tion process as it’s also known – that providers, facil­i­ties or providers of air ambu­lance ser­vices, and health plans or issuers will use to deter­mine final pay­ment beyond allow­able patient cost-shar­ing for cer­tain out-of-net­work health­care ser­vices in sit­u­a­tions where the No Sur­pris­es Act pro­hibits sur­prise billing. The rule also requires that cer­tain providers and facil­i­ties pro­vide a good faith esti­mate of the charges to unin­sured (or self-pay) indi­vid­u­als so they can know what costs to expect when seek­ing healthcare.

    Today’s rule is the third in a series that the depart­ments are using to imple­ment the No Sur­pris­es Act, a pri­or­i­ty for Pres­i­dent Biden. In July, the Pres­i­dent direct­ed HHS to pri­or­i­tize and imple­ment this law as part of the Exec­u­tive Order on Pro­mot­ing Com­pe­ti­tion in the Amer­i­can Econ­o­my. In the same month, the depart­ments issued an inter­im final rule on con­sumer pro­tec­tions against sur­prise billing. In ear­ly Sep­tem­ber, they issued a pro­posed rule to help col­lect data on the air ambu­lance provider indus­try. The two inter­im final rules take effect on Jan. 1, 2022, and ban sur­prise billing for emer­gency ser­vices and ancil­lary care at in-net­work facil­i­ties, and lim­it high out-of-net­work cost shar­ing for emer­gency and non-emer­gency ser­vices, such that it can­not be high­er than if such ser­vices were pro­vid­ed in-network.

    “Fear of sur­prise billing should nev­er be a bar­ri­er to receiv­ing med­ical care,” said U.S. Sec­re­tary of Labor Mar­ty Walsh. “At the Depart­ment of Labor, we are com­mit­ted to empow­er­ing all work­ers and their fam­i­lies, includ­ing by help­ing to make sure they receive the health­care ben­e­fits they are legal­ly enti­tled to. Today’s rule­mak­ing is anoth­er step by the Biden-Har­ris admin­is­tra­tion that will help pro­tect Amer­i­cans from sur­prise billing that can dis­cour­age need­ed med­ical care or lead to finan­cial peril.”

    “No one should have to go bank­rupt over a sur­prise med­ical bill,” said U.S. Sec­re­tary of Health and Human Ser­vices Xavier Becer­ra. “Today’s rule helps ensure that Amer­i­cans get a bet­ter deal from a more com­pet­i­tive health­care sys­tem. We are build­ing on our ongo­ing efforts to deliv­er on Pres­i­dent Biden’s Com­pe­ti­tion Exec­u­tive Order by pro­mot­ing trans­par­ent out-of-net­work costs, expos­ing inflat­ed health care costs and tak­ing con­sumers out of the mid­dle ulti­mate­ly to help low­er their bills.”

    To pro­tect patients from sur­prise bills and remove them from the mid­dle of pay­ment dis­putes between out-of-net­work providers, facil­i­ties, or providers of air ambu­lance ser­vices and health plans or issuers, on July 1, 2021, the depart­ments and OPM issued an inter­im final rule with com­ment peri­od. The inter­im final rule states that, begin­ning in 2022, patients will only be required to pay cost shar­ing based on in-net­work rates for cer­tain out-of-net­work emer­gency ser­vices, out-of-net­work non-emer­gency ser­vices at in-net­work facil­i­ties and out-of-net­work air ambu­lance services.

    Today’s rule builds on this work and details how the total pay­ment to an out-of-net­work provider or facil­i­ty will be deter­mined. In some cas­es – based on the law – state law or appli­ca­tion of a state All-Pay­er Mod­el Agree­ment will deter­mine this amount. Where nei­ther applies, the rule sets forth the fed­er­al process that will apply for deter­min­ing the amount. When a pay­ment dis­pute for items/services that fall under sur­prise billing pro­tec­tions occur, either a provider, facil­i­ty, or air ambu­lance provider or plan/issuer may ini­ti­ate a 30-day open nego­ti­a­tion peri­od. If open nego­ti­a­tion fails, either par­ty may ini­ti­ate the fed­er­al inde­pen­dent dis­pute res­o­lu­tion process. This rule details how this process ini­ti­ates, what is eli­gi­ble for this process and how inde­pen­dent dis­pute res­o­lu­tion enti­ties should con­sid­er fac­tors when deter­min­ing a pay­ment amount.

    The depart­ments will cer­ti­fy inde­pen­dent dis­pute res­o­lu­tion enti­ties on a rolling basis. Enti­ties seek­ing cer­ti­fi­ca­tion by Jan. 1, 2022 should sub­mit their appli­ca­tion by Nov. 1, 2021. Learn more about the cer­ti­fi­ca­tion process or apply to be a cer­ti­fied inde­pen­dent dis­pute res­o­lu­tion entity.

    In added con­sumer pro­tec­tions, today’s rule out­lines key require­ments relat­ed to unin­sured (or self-pay) indi­vid­u­als (self-pay indi­vid­u­als are indi­vid­u­als who have cov­er­age but do not choose to have their care billed to their health plan or issuer). When indi­vid­u­als sched­ule an item or ser­vice with cer­tain providers and facil­i­ties, those providers and facil­i­ties will be required to inquire about the individual’s health cov­er­age sta­tus, and if the indi­vid­ual wants their care billed to their health plan or issuer.

    The provider or facil­i­ty must pro­vide a good faith esti­mate of expect­ed charges for the care they are sched­ul­ing for indi­vid­u­als deemed unin­sured (or self-pay). An unin­sured (or self-pay) indi­vid­ual may also request a good faith esti­mate, with­out sched­ul­ing an item or ser­vices. The rule also estab­lish­es a process for unin­sured (or self-pay) indi­vid­u­als to ini­ti­ate a pay­ment dis­pute res­o­lu­tion process if they are ulti­mate­ly billed sub­stan­tial­ly in excess of the good faith esti­mate they received.

    To find fact sheets on today’s rule, visit:

    Require­ments Relat­ed to Sur­prise Billing Part II IFR with com­ment period.
    What you Need to Know about the Biden-Har­ris Admin­is­tra­tion’s Actions to Pre­vent Sur­prise Billing

    Orig­i­nal­ly post­ed on U.S. Depart­ment of Labor

  • Understanding Alzheimer’s Disease

    November 22, 2021

    Tags: ,

    Many of us have heard of Alzheimer’s dis­ease but may not know much more than it is a dis­ease that caus­es mem­o­ry loss.  Experts sug­gest that more than 6 mil­lion Amer­i­cans, most of them age 65 or old­er, may have demen­tia caused by Alzheimer’s.  This dis­ease is cur­rent­ly ranked as the sixth lead­ing cause of death in the Unit­ed States, but recent esti­mates indi­cate the dis­or­der may rank third, just behind heart dis­ease and can­cer as a cause of death for old­er people.

    Alzheimer’s dis­ease is a pro­gres­sive brain dis­or­der that slow­ly destroys mem­o­ry and think­ing skills, and even­tu­al­ly, the abil­i­ty to car­ry out the sim­plest tasks. Changes in the brain may begin a decade or more before symp­toms appear. Dur­ing this very ear­ly stage of Alzheimer’s, tox­ic changes are tak­ing place in the brain.  Pre­vi­ous­ly healthy neu­rons stop func­tion­ing, lose con­nec­tions with oth­er neu­rons, and die.

    Signs and symp­toms of Alzheimer’s disease

    Mem­o­ry prob­lems are typ­i­cal­ly one of the first signs of cog­ni­tive impair­ment relat­ed to Alzheimer’s. Alzheimer’s dis­ease pro­gress­es in sev­er­al stages: ear­ly, mild (some­times called mild cog­ni­tive impair­ment), mod­er­ate, and severe.

    In the Ear­ly stage, a per­son begins to expe­ri­ence mem­o­ry loss and oth­er cog­ni­tive dif­fi­cul­ties, though the symp­toms appear grad­ual to the per­son and their family.

    Dur­ing the Mild Cog­ni­tive Impair­ment(MCI), stage dam­age occurs in areas of the brain that con­trol lan­guage, rea­son­ing, sen­so­ry pro­cess­ing, and con­scious thought. Con­di­tions such as dia­betes, depres­sion, and stroke may increase a person’s risk for MCI.

    Some of the signs of MCI include:

    • Los­ing things often
    • For­get­ting to go to events or appointments
    • Hav­ing more trou­ble com­ing up with words than oth­er peo­ple of the same age

    MCI can be man­aged by see­ing a doc­tor or spe­cial­ist every 6 to 12 months.  A doc­tor can help track any changes in mem­o­ry and think­ing skills over time.  Peo­ple with MCI might also con­sid­er par­tic­i­pat­ing in clin­i­cal tri­als or studies.

    The Mod­er­ate stage of Alzheimer’s dis­ease requires more inten­sive super­vi­sion and care becomes necessary.

    Symp­toms may include:

    • Increased mem­o­ry loss and confusion
    • Inabil­i­ty to learn new things
    • Dif­fi­cul­ty with speech and prob­lems read­ing, writ­ing and work­ing with numbers
    • Dif­fi­cul­ty orga­niz­ing thoughts and log­i­cal thinking
    • Short­ed atten­tion span
    • Prob­lems cop­ing with new situations
    • Dif­fi­cul­ty car­ry­ing out mul­ti­step tasks, such as get­ting dressed
    • Prob­lems rec­og­niz­ing fam­i­ly and friends
    • Hal­lu­ci­na­tions, delu­sions, and paranoia
    • Impul­sive behavior
    • Inap­pro­pri­ate out­bursts of anger
    • Rest­less­ness, agi­ta­tion, anx­i­ety, wan­der­ing in the late after­noon or evening
    • Repet­i­tive state­ments or movement

    Peo­ple with Severe Alzheimer’s can­not com­mu­ni­cate and are com­plete­ly depen­dent on oth­ers for care.  The per­son may also be in the bed most or all the time as the body shuts down.

    Symp­toms often include:

    • Inabil­i­ty to communicate
    • Weight loss
    • Seizures
    • Skin infec­tions
    • Dif­fi­cul­ty swallowing
    • Groan­ing, moan­ing, or grunting
    • Increased sleep­ing
    • Loss of bow­el and blad­der control

    How is Alzheimer’s dis­ease treated?

    Cur­rent­ly, there is no cure for Alzheimer’s, though there are med­i­cines that can help treat the symp­toms of the dis­ease.  Most med­i­cines work best for peo­ple in the ear­ly or mid­dle stages of Alzheimer’s. Researchers are explor­ing oth­er drug ther­a­pies and oth­er inter­ven­tions to delay or pre­vent the dis­ease as well as treat its symp­toms.  Some of those include phys­i­cal activ­i­ty, diet, cog­ni­tive train­ing, and a com­bi­na­tion of these.

    Alzheimer’s is com­plex and it is there­fore unlike­ly that any one drug or oth­er inter­ven­tion will suc­cess­ful­ly treat it in all peo­ple liv­ing with the dis­ease.  It is impor­tant to talk to your doc­tor if you expe­ri­ence any signs or symp­toms of the dis­ease so that appro­pri­ate med­ical tests can be con­duct­ed.  This will not only give you peace of mind but will help you and your fam­i­ly pre­pare for the future.

    The jour­ney typ­i­cal­ly lasts for years and for most of that time, peo­ple liv­ing with Alzheimer’s can still enjoy the same things they always have.  Instead of focus­ing on what is lost, focus on what remains.  Peo­ple still enjoy beau­ty and feel emo­tions long after los­ing the abil­i­ty to store short-term mem­o­ries. Rec­og­nize each moment as an oppor­tu­ni­ty to help your loved one expe­ri­ence the joys of life.

  • California Paid Leave begs leave to make changes and leave alone other parts | by Jordan Shields, Partner

    November 18, 2021

    Tags: ,

    There will be no changes in the cal­cu­la­tions used for Paid Fam­i­ly Leave or State Dis­abil­i­ty for the year 2022, but there are changes being pro­posed in 2023.  There was an increase in ben­e­fit pro­posed, but it was vetoed by Gov­er­nor New­som.  In 2023, employ­ees earn­ing more than $1,749 in their high­est earn­ing quar­ter in the base peri­od will receive 55% of those earn­ings divid­ed by 13, up to the week­ly maximum.

  • The Root Cause of the Great Resignation Is Not What You Think

    November 17, 2021

    Tags: ,

    The­o­ries abound about why work­ers are leav­ing their jobs in record num­bers in 2021 and thus cre­at­ing what pun­dits are call­ing the Great Res­ig­na­tion. The U.S. Bureau of Labor Sta­tis­tics report­ed that 4.3 mil­lion Amer­i­cans quit their jobs in August. These res­ig­na­tions con­tin­ue to be high­er in food ser­vice, retail, and education.

    One pop­u­lar opin­ion was that peo­ple quit unex­pect­ed­ly and did not look for a new job because of the gen­er­ous unem­ploy­ment ben­e­fits insti­tut­ed dur­ing the pan­dem­ic. The claim was that the job mar­ket would return back to nor­mal once those ben­e­fits were phased out.

    Even though the ben­e­fits end­ed over Labor Day week­end, there has been no sig­nif­i­cant recov­ery in employ­ment. Twen­ty states actu­al­ly stopped the ben­e­fits over the sum­mer and have seen no improve­ment since then either.

    So what’s real­ly behind this trend? Accord­ing to econ­o­mists and labor mar­ket experts, Amer­i­can work­ers are soul-searching.The Great Res­ig­na­tion is a philo­soph­i­cal reset of work expectations.

    What Workers Really Want

    Heather Long, an eco­nom­ics cor­re­spon­dent from the Wash­ing­ton Post, spoke with CBS News recent­ly to dis­cuss her report­ing on the Great Resignation.

    She said some work­ers are still con­cerned about COVID-19, yet that fear may be wan­ing with the increase of vac­ci­na­tions cou­pled with decreased infec­tions. Many oth­ers sim­ply want to change what they’re doing with their lives.

    Low­er wage work­ers are protest­ing over sub­stan­dard pay and harsh work con­di­tions, but even mid-lev­el work­ers who earned high­er salaries and bet­ter ben­e­fits are leav­ing to open their own busi­ness­es or pur­sue their passions.

    Long said that the two biggest pri­or­i­ties for Amer­i­cans are find­ing some­thing dif­fer­ent or more ful­fill­ing, and work­ing for an employ­er that val­ues both men­tal health and work-life balance.

    What does this mean for companies?

    Offer­ing high­er salaries to job can­di­dates may seem like an obvi­ous fix to the prob­lem, but be pre­pared for the nee­dle to bare­ly move as a result. And it’s clear from the last few months that unem­ploy­ment ben­e­fits weren’t hold­ing work­ers back either.

    “The ear­ly evi­dence cer­tain­ly sug­gests that the unem­ploy­ment ben­e­fits were not the main rea­son hold­ing peo­ple back from going and seek­ing work again,” said Long.

    Instead, the Great Res­ig­na­tion has proven to be more about per­son­al val­ues and less about economics.

    The Great Reassessment of Work in America

    In her inter­view, Long described what’s hap­pen­ing as a” great reassess­ment of work in Amer­i­ca,” and one of the “biggest shake­ups of the labor mar­ket since World War II.”

    It takes a sig­nif­i­cant or trau­mat­ic event like a pan­dem­ic or world war to get peo­ple ques­tion­ing their lives and how work fits into it. So much about the work­force changed in the mid-1900s. Amer­i­cans were still reel­ing from The Great Depres­sion only a few years before the war that caused unem­ploy­ment rates to sky­rock­et to 25%.

    The start of the war actu­al­ly got things mov­ing again. Fac­to­ries were estab­lished to pro­duce weapons and sup­plies. More Amer­i­cans, includ­ing women who were pre­vi­ous­ly expect­ed to be stay-at-home wives and moth­ers, went to work to sup­port the effort. A major­i­ty of the work­force became per­ma­nent­ly indus­tri­al­ized in that decade.

    The Amer­i­can work­force was nev­er the same after World War II, and many experts are point­ing to a sim­i­lar shift today in 2021.

    Advice for HR Professionals and Companies

    Know­ing the root caus­es of “The Great Res­ig­na­tion” will help HR depart­ments and com­pa­nies tru­ly solve this labor cri­sis. Mon­ey is impor­tant. Every­one needs to pay their bills, and it would be nice to have a few extra dol­lars to take an extra vaca­tion or buy a more expen­sive car. But don’t make the mis­take of think­ing it’s all salary that will bring back workers.

    Even if some employ­ees return for a high­er salary, it will only keep them engaged in the short-term. When they even­tu­al­ly quit again because of burnout, com­pa­nies will be back to square one.

    Younger work­ers from the Mil­len­ni­al and Gen‑Z gen­er­a­tions are lead­ing this trend. Besides the mon­ey, they want to feel safe and well-com­pen­sat­ed. They want to be treat­ed with decen­cy by employ­ers, who care about their men­tal health and per­son­al downtime.

    by Mcken­zie Cassidy

    Orig­i­nal­ly post­ed on HR Exchange Network

  • What’s my incentive…or not…to get vaccinated and show up for work? | by Jordan Shields, Partner

    November 12, 2021

    Tags: ,

    Well, the agen­cies final­ly saw things com­ing after they came, and have issued joint guid­ance about what to do with unvac­ci­nat­ed employ­ees.  The Depart­ments of Labor, Trea­sure and Health/Human Ser­vices have declared the following:

    1)  HIPAA gen­er­al­ly pro­hibits a group health plan from dis­crim­i­nat­ing among sim­i­lar­ly sit­u­at­ed indi­vid­u­als based on a health fac­tor, which is how this is being described. “Well­ness” pro­grams, which allow an incen­tive or dis­in­cen­tive, are “par­tic­i­pa­to­ry” (open-end­ed with no reward based on health fac­tors, sta­tus or enroll­ment) and “con­tin­gent” (rewards based on par­tic­i­pa­tion).  For the lat­ter, the incen­tive lim­it is 30% of the premium.

    The agen­cies have deemed vac­cine pre­mi­um incen­tive pro­grams as “activ­i­ty only” say­ing that receipt of a vac­cine is a health fac­tor that trig­gers the 30% lim­i­ta­tion, and sub­ject to sev­er­al conditions:

                   a) Pro­gram is rea­son­ably designed to pro­mote health or pre­vent disease

                   b) A rea­son­able alter­na­tive must be pro­vid­ed for those for whom it is unrea­son­ably dif­fi­cult due to a med­ical con­di­tion or if it is med­ical­ly inad­vis­able to obtain a COVID 19 vaccine

                   c) The reward must not exceed 30% of the total cost of employ­ee only coverage

    2)  Con­di­tion­ing eli­gi­bil­i­ty for ben­e­fits or cov­er­age for oth­er­wise cov­ered items or ser­vices is NOT per­mis­si­ble under HIPAA

    3)  If the incen­tive is a pre­mi­um dis­count, the dis­count is treat­ed as not earned and there­fore afford­abil­i­ty is based on the assumed increased pre­mi­um cost for the par­tic­i­pant, for ACA dis­crim­i­na­tion test­ing purposes.

    The EEOC issued FAQs in May say­ing that the ADA (Amer­i­cans with Dis­abil­i­ties Act) well­ness rules do not apply where the employ­er mere­ly requests proof of vac­ci­na­tion BUT an employ­er must still pro­vide a rea­son­able accom­mo­da­tion to an employ­ee who can­not get the vac­cine due to a disability

    For GINA, the EEOC said that an incen­tive for a fam­i­ly mem­ber get­ting vac­ci­nat­ed is gen­er­al­ly per­mis­si­ble and no incen­tive lim­its apply, as long as the fam­i­ly mem­ber gets the vac­cine from a third par­ty and not the employ­er or its agent.

     

  • Four Misunderstood Terms in the Americans with Disabilities Act

    November 8, 2021

    Tags: , ,

    The Amer­i­cans with Dis­abil­i­ties Act (ADA) applies to employ­ers with 15 or more employ­ees. Despite its broad cov­er­age, there’s a lot of con­fu­sion about what the law requires and what its terms entail. A big rea­son for this con­fu­sion is the lan­guage of the law itself; the ADA speaks of neb­u­lous con­cepts like undue hard­ship and rea­son­able accom­mo­da­tion. Words like undue and rea­son­able are by their nature open to some inter­pre­ta­tion, which is not exact­ly a com­fort to employers.

    For­tu­nate­ly, employ­ers can feel con­fi­dent in their appli­ca­tion of the law by review­ing and under­stand­ing its most impor­tant con­cepts. In this arti­cle, we’re going to define and ana­lyze the terms dis­abil­i­ty, undue hard­ship, rea­son­able accom­mo­da­tion, and inter­ac­tive process. These are the big four terms that serve as the foun­da­tion of your respon­si­bil­i­ties as an employ­er under the ADA.

    Disability

    Let’s start with the term dis­abil­i­ty. Under the ADA, a per­son with a dis­abil­i­ty is some­one who:

    • Has a phys­i­cal or men­tal impair­ment that sub­stan­tial­ly lim­its one or more major life activities;
    • Has a record of such an impair­ment; or
    • Is regard­ed as hav­ing such an impairment.

    Major life activ­i­ties include car­ing for one­self, per­form­ing man­u­al tasks, see­ing, hear­ing, eat­ing, sleep­ing, walk­ing, stand­ing, lift­ing, bend­ing, speak­ing, breath­ing, learn­ing, read­ing, con­cen­trat­ing, think­ing, com­mu­ni­cat­ing, and work­ing. A major life activ­i­ty also includes the oper­a­tion of a major bod­i­ly func­tion, such as diges­tive, cir­cu­la­to­ry, and repro­duc­tive functions.

    Although deter­min­ing whether an impair­ment meets the def­i­n­i­tion of dis­abil­i­ty is an indi­vid­u­al­ized assess­ment, some con­di­tions “vir­tu­al­ly always qual­i­fy.” For exam­ple, accord­ing to the EEOC, deaf­ness sub­stan­tial­ly lim­its hear­ing; HIV sub­stan­tial­ly lim­its immune func­tion; and bipo­lar dis­or­der sub­stan­tial­ly lim­its brain func­tion. Oth­er con­di­tions may vary from case to case in whether they sub­stan­tial­ly lim­it a major life activity.

    It’s impor­tant to note that the def­i­n­i­tion of dis­abil­i­ty is broad. After the ADA was orig­i­nal­ly passed, the courts inter­pret­ed the def­i­n­i­tion very nar­row­ly, and Con­gress respond­ed by amend­ing the ADA in 2008 so that more dis­abil­i­ties are cov­ered. If an employ­ee asks for an accom­mo­da­tion because of a phys­i­cal or men­tal con­di­tion, it often won’t be hard for them to show that the con­di­tion sub­stan­tial­ly lim­its a major life activity.

    Reasonable Accommodation

    Employ­ers often encounter the ADA when an appli­cant or employ­ee asks for a rea­son­able accom­mo­da­tion. A rea­son­able accom­mo­da­tion is a change to the work­place or the job appli­ca­tion process so that peo­ple with dis­abil­i­ties can per­form the essen­tial func­tions of their job, access employ­ment ben­e­fits, or be con­sid­ered for a job they’re qual­i­fied for. The intent of rea­son­able accom­mo­da­tions is to remove work­place bar­ri­ers for peo­ple with disabilities—barriers that don’t pre­vent peo­ple with­out dis­abil­i­ties from per­form­ing the work or apply­ing for the job. But don’t focus too much on the word rea­son­able; in the con­text of dis­abil­i­ty accom­mo­da­tions, rea­son­able means fea­si­ble or plausible.

    Com­mon types of accom­mo­da­tions include mod­i­fy­ing work sched­ules, alter­ing the way job duties are done, re-assign­ing a non-essen­tial job duty (like ask­ing the recep­tion­ist to stack the month­ly 100-lb paper deliv­ery in the stor­age room), grant­i­ng addi­tion­al breaks, pro­vid­ing acces­si­ble park­ing, and pro­vid­ing mate­ri­als in alter­na­tive for­mats (e.g., Braille, large print). Anoth­er type of accom­mo­da­tion is a tem­po­rary leave of absence. Although a bit coun­ter­in­tu­itive (because the employ­ee isn’t work­ing while on leave), the the­o­ry with a leave as an accom­mo­da­tion is that the time off will enable to employ­ee to per­form the essen­tial func­tions of their job when they return.

    Not every request­ed accom­mo­da­tion is required, how­ev­er. For one, employ­ers don’t have to remove an essen­tial job func­tion (e.g., the recep­tion­ist can still be expect­ed to answer the phone). Employ­ers also aren’t required to pro­vide items for per­son­al use, like wheel­chairs or hear­ing aids. And, as we turn to next, an accom­mo­da­tion doesn’t have to be pro­vid­ed if it caus­es an undue hardship.

    Undue Hardship

    Under the ADA, an employ­er is not required to pro­vide rea­son­able accom­mo­da­tions to employ­ees or appli­cants with dis­abil­i­ties if doing so cre­ates an undue hard­ship on the orga­ni­za­tion. The basic def­i­n­i­tion of undue hard­ship is an action that cre­ates a sig­nif­i­cant dif­fi­cul­ty or expense. Gen­er­al­ly, this is a high stan­dard to meet.

    The cost of an accom­mo­da­tion could be an undue hard­ship on the employ­er, but so could an accommodation’s dura­tion or dis­rup­tion. An accom­mo­da­tion that would fun­da­men­tal­ly alter the nature or oper­a­tion of the busi­ness would be an undue hard­ship even if the cost was neg­li­gi­ble. But if cost alone is the basis for claim­ing undue hard­ship, employ­ers should remem­ber that the stan­dard is a sig­nif­i­cant expense.

    Undue hard­ship is deter­mined on a case-by-case basis, con­sid­er­ing the fol­low­ing factors:

    • The nature and net cost of the accom­mo­da­tion, includ­ing the avail­abil­i­ty of tax cred­its and deduc­tions, as well as out­side funding;
    • The over­all finan­cial resources of the facil­i­ty pro­vid­ing the accom­mo­da­tion, the num­ber of employ­ees at the facil­i­ty, and the effect of the accom­mo­da­tion on expens­es and resources;
    • The employer’s over­all finan­cial resources, size, num­ber of employ­ees, and the num­ber, type, and loca­tion of its facilities;
    • The type of oper­a­tion of the employ­er, includ­ing the com­po­si­tion, struc­ture, and func­tions of the work­force, and the geo­graph­ic sep­a­rate­ness and admin­is­tra­tive or fis­cal rela­tion­ship of the facil­i­ty pro­vid­ing the accom­mo­da­tion; and
    • The impact of the accom­mo­da­tion on the oper­a­tion of the facil­i­ty, includ­ing the impact on the abil­i­ty of oth­er employ­ees to per­form their duties and the impact on the facility’s abil­i­ty to con­duct business.

    An employ­er can’t claim undue hard­ship based on employ­ee or cus­tomer fears or prej­u­dices toward the dis­abil­i­ty. An undue hard­ship also can’t be based on the pos­si­bil­i­ty that an accom­mo­da­tion could reduce employ­ee morale.

    Interactive Process

    The inter­ac­tive process is an ongo­ing con­ver­sa­tion between the employ­er and employ­ee to explore poten­tial accom­mo­da­tions so that the employ­ee can per­form their essen­tial job func­tions or access the ben­e­fits or priv­i­leges of their job.

    Basi­cal­ly, the inter­ac­tive process starts with brain­storm­ing. The employee—and in some cas­es their med­ical provider—is often the best source for accom­mo­da­tion options. How­ev­er, the employ­er should do some research too, for exam­ple, by search­ing for the dis­abil­i­ty or func­tion­al lim­i­ta­tion on the Job Accom­mo­da­tion Net­work web­site.

    Next, the employ­er choos­es an accom­mo­da­tion from all the options. Employ­ers should give con­sid­er­a­tion to which accom­mo­da­tion the employ­ee prefers, but, at bot­tom, what­ev­er accom­mo­da­tion they choose must be effec­tive. If it’s not clear ini­tial­ly, the employ­er can imple­ment an accom­mo­da­tion for a tri­al peri­od to deter­mine whether it’s effec­tive. If that accom­mo­da­tion doesn’t work, employ­ers should then try a dif­fer­ent accom­mo­da­tion. In addi­tion, cir­cum­stances may change over time, so the best prac­tice is to keep an open dia­logue with the employ­ee to see if fur­ther adjust­ments are need­ed through­out the employ­ment relationship.

    By Megan LeMire

    Orig­i­nal­ly post­ed on Min­er­al

  • Pending Items – just a few things from the Biden package that may or may not go through | by Jordan Shields, Partner

    November 5, 2021

    Tags:

    Some of the items list­ed below have been float­ed in alter­nate pro­pos­als, which are now ram­pant in Con­gress as the Democ­rats seek to get some­thing passed.

    1. Increase the cor­po­rate tax rate to 28% (pre­vi­ous­ly had been 35%, then reduced under the Trump admin­is­tra­tion to 21%), begin­ning in 2022
    2. Medicare sup­ple­men­tal tax of .9% (cur­rent­ly imposed on those with AGI in excess of $200,000 ($250,000 if mar­ried) will now be imposed on self-employ­ment income where the AGI is in excess of $400,000 – begin­ning in 2022
    3. Sen­ate Finance Chair Ron Wyden has pro­posed phas­ing out the Qual­i­fied Busi­ness Income deduc­tion under IRC 199A and the deductibil­i­ty lim­its which per­tain to spec­i­fied ser­vice trade or businesses
    4. Return to a top mar­gin­al income tax rate of 39.6%, which is what pre­ced­ed the Trump Admin­is­tra­tion change to 37%. The “Green Book” which car­ries some pro­pos­als, is also dis­cussing nar­row­ing the range on the 35% tax bracket.
    5. Long term cap­i­tal gains may be taxed at the top mar­gin­al ordi­nary rate for gains and div­i­dends that exceed $1 mil­lion of a taxpayer’s AGI
    6. Dis­turbing­ly, some pro­pos­als have the Long Term Cap­i­tal gains tax change retroac­tive to some time in 2021
    7. Lim­it on 1031 exchanges for real prop­er­ty to $500,000 of gain per tax­pay­er ($1M if mar­ried) per year
    8. Some are push­ing to repeal the Trump administration’s lim­it on the deductibil­i­ty on State and Local income tax­es, but it is not real­is­tic to assume this will go through
    9. Changes in estate tax too numer­ous to men­tion or sort through – but something

    The oth­er issue is whether these will apply in 2021 or 2022

  • 10 Surprising Things You Can Buy With Your Leftover FSA Money

    November 2, 2021

    Tags: ,

    The end of the year is draw­ing near which may mean you have some extra mon­ey to spend.

    No, you didn’t read that wrong.  Many Amer­i­cans have mon­ey in their Flex­i­ble Sav­ings Accounts (FSAs) that they need to use up before the end of the year. FSAs pro­vide the ben­e­fit of putting pre-tax mon­ey aside which opti­mizes your mon­ey.  Your FSA is set up through your employ­er and everyone’s rules are a lit­tle dif­fer­ent.  How­ev­er, most plans run Jan­u­ary 1 – Decem­ber 31.  Some com­pa­nies allow their employ­ees to roll over a set amount into the new year.  Check­ing with your HR depart­ment will help you max­i­mize your hard-earned money.

    Typ­i­cal­ly, FSA mon­ey has to be used by the end of the year but the COVID-19 relief bill gets you one more year to spend.  That means you have until Decem­ber 31, 2021 to spend FSA mon­ey ear­marked for last year.  The exten­sion also applies for your 2021 FSA mon­ey – the cred­it will be avail­able until the end of 2022.

    All funds remain­ing in the account at the end of the grace peri­od are for­feit­ed accord­ing to the “use-it-or-lose-it” rule, which requires all remain­ing funds in an FSA to be for­feit­ed at the end of the plan year.

    If you have FSA mon­ey to spend, we’ve com­piled a list of some ways to use up your hard-earned FSA dol­lars that you may not have thought possible:

    Fill Your Med­i­cine Cabinet

    You can once again pur­chase over the counter med­ica­tion with FSA mon­ey thanks to the CARES  Act.  You can stock up on first aid kits or oth­er items that don’t require a pre­scrip­tion such as:

    • Ban­dages
    • Heat­ing pads
    • Con­tra­cep­tives
    • Fer­til­i­ty and Preg­nan­cy Tests
    • Sleep aids such as Mela­tonin or a sleep mask
    • Motion sick­ness medication
    • Headache med­i­cine
    • Antacids or heart­burn medication
    • Men­stru­al products
    • Con­tact Solution
    • Aller­gy medication
    • Acne creams and cleansers

    Alter­na­tive Therapies 

    Under IRS law, cer­tain alter­na­tive ther­a­pies are eli­gi­ble for reim­burse­ment. Acupunc­ture and chi­ro­prac­tic care, alter­na­tive med­i­c­i­nal treat­ments, and herbal sup­ple­ments are a great way to use up your funds for the year and get a lit­tle cash back when you most need it.

    Den­tal

    Den­tal ben­e­fits often work dif­fer­ent­ly than med­ical cov­er­age. Accord­ing to the Amer­i­can Den­tal Asso­ci­a­tion, this ben­e­fit is often capped annu­al­ly – gen­er­al­ly between $1,000 and $2,000. If you have unused funds remain­ing in your FSA, now may be the time to sched­ule a last-minute appoint­ment with your den­tist, espe­cial­ly if you might need seri­ous work down the road. This way, you can use up the funds remain­ing in your account by year-end and reduce your out-of-pock­et expense next year.

    Pre­scrip­tion Refills 

    Refill­ing your pre­scrip­tion med­ica­tions at year end are a great way to use up your funds in your med­ical FSA. Take inven­to­ry of your pre­scrip­tion drugs, toss out expired ones, and make that call for a refill to your doc­tor or pharmacy.

    Med­ical Equip­ment and Supplies 

    Med­ical equip­ment and sup­plies are eli­gi­ble for reim­burse­ment under a med­ical FSA. Walk­ing aids like canes, walk­ers and crutch­es, blood pres­sure mon­i­tors, ther­mome­ters, and joint braces are just a few.  Please note that some will require a note or pre­scrip­tion from your doctor.

    Mileage and Oth­er Health­care-Relat­ed Extras 

    Trav­el­ing to and from any med­ical facil­i­ty for appoint­ments or treat­ment for your­self or a depen­dent are eli­gi­ble for reim­burse­ment under your FSA. This not only includes trav­el­ing by your own vehi­cle, but also by bus, train, plane, ambu­lance ser­vice and includes park­ing fees and tolls.  How­ev­er, trans­porta­tion expens­es are not eli­gi­ble with a Depen­dent Care Flex­i­ble Spend­ing Account (DCFSA).

    Fam­i­ly Planning

    You can put your FSA dol­lars to work if you are a new or soon-to-be mom on prod­ucts such as preg­nan­cy tests, fer­til­i­ty mon­i­tors, pre­na­tal vit­a­mins and breast­feed­ing sup­plies.  On the flip side, con­doms and oth­er con­tra­cep­tives are also FSA eligible.

    Nico­tine Ces­sa­tion Products

    If you are try­ing to quit smok­ing, you can use your FSA funds toward nico­tine gum, patch­es, lozenges, inhalers and nasal sprays.

    Depen­dent Care 

    If you have opt­ed to con­tribute to a DCFSA, you can get reim­bursed for day care, preschool, sum­mer camps and non-employ­er spon­sored before and after school pro­grams. In addi­tion, funds con­tributed to this type of FSA can be used for elder­ly day­care if you’re cov­er­ing more than 50% your parent’s main­te­nance costs.

    Ances­try Kits with Health Reports

    Inter­est­ed in learn­ing about your her­itage and how your DNA can affect your health?  You are in luck! Ances­try kits like 23andMe that include health reports are typ­i­cal­ly con­sid­ered FSA eli­gi­ble to be reim­bursed approx­i­mate­ly 50%.

    Peo­ple often don’t use their FSA out of fear that they need to save it for lat­er.  How­ev­er, every year $400–500 mil­lion in FSA funds is for­feit­ed.  Lost cash is nev­er a good thing.  If you still have left­over funds, con­sid­er going to the FSA Store where you can find hun­dreds of eli­gi­ble items and pay for them with your account dol­lars with­out ever leav­ing your house.

    This list is not an exhaus­tive list of ways to spend your FSA mon­ey.  Check with your HR depart­ment and insur­ance agent if you have ques­tions about qual­i­fied expenses.

     

  • Spam and Phishing

    October 27, 2021

    Tags: , , ,

    Malicious Email

    A mali­cious email can look just like it comes from a finan­cial insti­tu­tion, an e‑commerce site, a gov­ern­ment agency or any oth­er ser­vice or business.

    It often urges you to act quick­ly, because your account has been com­pro­mised, your order can­not be ful­filled or there is anoth­er urgent mat­ter to address.

    If you are unsure whether an email request is legit­i­mate, try to ver­i­fy it with these steps:

    • Con­tact the com­pa­ny direct­ly – using infor­ma­tion pro­vid­ed on an account state­ment, on the company’s offi­cial web­site or on the back of a cred­it card.
    • Search for the com­pa­ny online – but not with infor­ma­tion pro­vid­ed in the email.

    Spam

    Spam is the elec­tron­ic equiv­a­lent of junk mail. The term refers to unso­licit­ed, bulk – and often unwant­ed – email. Here are ways to reduce spam:

    • Enable fil­ters on your email pro­grams: Most inter­net ser­vice providers (ISPs) and email providers offer spam fil­ters; how­ev­er, depend­ing on the lev­el you set, you may end up block­ing emails you want. It’s a good idea to occa­sion­al­ly check your junk fold­er to ensure the fil­ters are work­ing properly.
    • Report spam: Most email clients offer ways to mark an email as spam or report instances of spam. Report­ing spam will also help to pre­vent the mes­sages from being direct­ly deliv­ered to your inbox.
    • Own your online pres­ence: Con­sid­er hid­ing your email address from online pro­files and social net­work­ing sites or only allow­ing cer­tain peo­ple to view your per­son­al information. 

    Phishing

    Phish­ing attacks use email or mali­cious web­sites (click­ing on a link) to col­lect per­son­al and finan­cial infor­ma­tion or infect your machine with mal­ware and viruses.

    Spear Phishing

    Spear phish­ing involves high­ly spe­cial­ized attacks against spe­cif­ic tar­gets or small groups of tar­gets to col­lect infor­ma­tion or gain access to sys­tems. For exam­ple, a cyber­crim­i­nal may launch a spear phish­ing attack against a busi­ness to gain cre­den­tials to access a list of cus­tomers. From that attack, they may launch a phish­ing attack against the cus­tomers of the busi­ness. Since they have gained access to the net­work, the email they send may look even more authen­tic and because the recip­i­ent is already cus­tomer of the busi­ness, the email may more eas­i­ly make it through fil­ters and the recip­i­ent maybe more like­ly to open the email.

    The cyber­crim­i­nal can use even more devi­ous social engi­neer­ing efforts such as indi­cat­ing there is an impor­tant tech­ni­cal update or new low­er pric­ing to lure people.

    Spam & Phishing on Social Networks

    Spam, phish­ing and oth­er scams aren’t lim­it­ed to just email. They’re also preva­lent on social net­work­ing sites. The same rules apply on social net­works: When in doubt, throw it out. This rule applies to links in online ads, sta­tus updates, tweets and oth­er posts. Here are ways to report spam and phish­ing on major social networks:

    Tips for Avoiding Being a Victim

    • Don’t reveal per­son­al or finan­cial infor­ma­tion in an email, and do not respond to email solic­i­ta­tions for this infor­ma­tion. This includes fol­low­ing links sent in email.
    • Before send­ing or enter­ing sen­si­tive infor­ma­tion online, check the secu­ri­ty of the web­site.
    • Pay atten­tion to the website’s URL. Mali­cious web­sites may look iden­ti­cal to a legit­i­mate site, but the URL may use a vari­a­tion in spelling or a dif­fer­ent domain (e.g., .com ver­sus .net).
    • If you are unsure whether an email request is legit­i­mate, try to ver­i­fy it by con­tact­ing the com­pa­ny direct­ly. Con­tact the com­pa­ny using infor­ma­tion pro­vid­ed on an account state­ment, not infor­ma­tion pro­vid­ed in an email. Check out the Anti-Phish­ing Work­ing Group (APWG) to learn about known phish­ing attacks and/or report phishing.
    • Keep a clean machine. Keep all soft­ware on inter­net-con­nect­ed devices – includ­ing PCs, smart­phones and tablets – up to date to reduce risk of infec­tion from malware.

    What to Do if You Are a Victim

    • Report it to the appro­pri­ate peo­ple with­in the orga­ni­za­tion, includ­ing net­work admin­is­tra­tors. They can be alert for any sus­pi­cious or unusu­al activity.
    • If you believe your finan­cial accounts may be com­pro­mised, con­tact your finan­cial insti­tu­tion imme­di­ate­ly and close the account(s).
    • Watch for any unau­tho­rized charges to your account.
    • Con­sid­er report­ing the attack to your local police depart­ment, and file a report with the Fed­er­al Trade Com­mis­sion or the Inter­net Crime Com­plaint Cen­ter.

    Protect Yourself With These STOP. THINK. CONNECT.™ Tips

    • When in doubt, throw it out: Links in email, tweets, posts and online adver­tis­ing are often how cyber­crim­i­nals try to com­pro­mise your infor­ma­tion. If it looks sus­pi­cious, even if you know the source, it’s best to delete or – if appro­pri­ate – mark it as junk.
    • Think before you act: Be wary of com­mu­ni­ca­tions that implores you to act imme­di­ate­ly, offers some­thing that sounds too good to be true or asks for per­son­al information.
    • Make your passphrase a sen­tence: A strong passphrase is a sen­tence that is at least 12 char­ac­ters long. Focus on pos­i­tive sen­tences or phras­es that you like to think about and are easy to remem­ber (for exam­ple, “I love coun­try music.”). On many sites, you can even use spaces!
    • Unique account, unique passphrase: Hav­ing sep­a­rate passphras­es for every account helps to thwart cyber­crim­i­nals. At a min­i­mum, sep­a­rate your work and per­son­al accounts and make sure that your crit­i­cal accounts have the strongest passphrases.
    • Lock down your login: For­ti­fy your online accounts by enabling the strongest authen­ti­ca­tion tools avail­able, such as bio­met­rics, secu­ri­ty keys or a unique one-time code through an app on your mobile device. Your user­names and passphras­es are not enough to pro­tect key accounts like email, bank­ing and social media.

    Additional Resources

    Orig­i­nal­ly post­ed on Stay Safe Online

  • The ABC’s of Medicare

    October 20, 2021

    Tags: ,

    Try­ing to fig­ure out Medicare can be one of the most frus­trat­ing aspects of retire­ment.  Even the savvi­est of retirees strug­gle with fig­ur­ing out when to enroll and which parts to enroll in – there’s Part A, Part B, Part C, Part D, Medi­gap plans and so on. And, what in the world is a donut hole, anyway?

    What is Medicare?

    Medicare is the gov­ern­ment health care pro­gram for peo­ple 65 and over as well as some younger peo­ple with dis­abil­i­ties.  Medicare’s cov­er­age plays an impor­tant role in con­tain­ing med­ical costs as you age. Medicare is a dif­fer­ent pro­gram than Med­ic­aid, which offers health and oth­er ser­vices to eli­gi­ble low-income peo­ple of all ages.

    Types of Medicare

    • Part A cov­ers inpa­tient hos­pi­tal stays, skilled nurs­ing facil­i­ty stays, some home health vis­its, and hos­pice care. Gen­er­al­ly, you don’t have to pay pre­mi­ums if you or your spouse paid Medicare tax­es for at least 10 years.
    • Part B cov­ers doc­tor vis­its and oth­er med­ical­ly nec­es­sary ser­vices and sup­plies. That includes pre­ven­tive ser­vices or health care to pre­vent ill­ness, as well as ambu­lance ser­vices, durable med­ical equip­ment and men­tal health cov­er­age. Part B comes with a month­ly price tag – the stan­dard pre­mi­um was $148.50 in 2021.
    • Part C or Medicare Advan­tage is a type of health plan offered by pri­vate insur­ance com­pa­nies that pro­vides the ben­e­fits of Part A and Part B and often Part D as well. These bun­dles plans may have addi­tion­al cov­er­age such as vision, hear­ing, den­tal care and may even include perks such as gym mem­ber­ships or trans­porta­tion to doctor’s appoint­ments. Medicare Advan­tage plans have an annu­al lim­it on out-of-pock­et costs.  Medicare Advan­tage plans are typ­i­cal­ly HMOs or PPOs.
    • Part D is the pre­scrip­tion drug ben­e­fit that cov­ers most out­pa­tient pre­scrip­tion drugs. It is a sep­a­rate plan pro­vid­ed by pri­vate Medicare approved com­pa­nies, and you must pay a month­ly pre­mi­um.  Unless you have cred­itable drug cov­er­age and will have a Spe­cial Enroll­ment Peri­od, you should enroll in Part D when you first get Medicare. If you delay enroll­ment, you may face gaps in cov­er­age and enroll­ment penal­ties.  Most plans with Medicare pre­scrip­tion drug cov­er­age (Part D) have a cov­er­age gap (called a “donut hole”).  That means that after you and your drug plan have spent a cer­tain  amount of mon­ey for cov­ered drugs, you have to pay all costs out-of-pock­et for your pre­scrip­tions up to a year­ly lim­it.  Once you have spent up to the year­ly lim­it, your cov­er­age gap ends and your drug plan helps pay for cov­ered drugs again.
    • Medi­gap or Medicare Sup­ple­ment Insur­ance is an addi­tion­al health insur­ance pol­i­cy you can buy from a pri­vate insur­er to help pay some of the costs not cov­ered by Medicare Part A and Part B, includ­ing deductibles, coin­sur­ance and health care if you trav­el out­side the U.S. Medi­gap poli­cies do not cov­er pre­scrip­tion drugs, den­tal, vision, hear­ing aids, pri­vate nurs­ing care or long-term care. There are 10 types of Medi­gap plans avail­able in most states.

    When to Sign Up for Medicare

    For most peo­ple, sign­ing up for Medicare occurs dur­ing a 7 month ini­tial enroll­ment period(IEP).   The IEP starts 3 months before you turn age 65 and con­tin­ues for 3 months after your birth­day. You may be eli­gi­ble soon­er if you have a dis­abil­i­ty, End-Stage Renal Dis­ease (ESRD), or ALS (also called Lou Gehrig’s disease).

    Dur­ing the IEP, you can sign up for Medicare Part A.  Even if you are still work­ing after you turn 65, you should con­sid­er sign­ing up for Part A now.  If you’ve worked and paid Medicare tax­es, it comes at no cost to you and cov­ers hos­pi­tal services.

    You can join, switch, or drop a Medicare Health Plan or a Medicare Advan­tage Plan (Part C) with or with­out drug cov­er­age dur­ing these times:

    • Ini­tial Enroll­ment Peri­od — When you first become eli­gi­ble for Medicare, you can join a plan.
    • Open Enroll­ment Peri­od — From Octo­ber 15 – Decem­ber 7 each year, you can join, switch, or drop a plan.
    • Medicare Advan­tage Open Enroll­ment Peri­od — From Jan­u­ary 1 – March 31 each year, if you’re enrolled in a Medicare Advan­tage Plan, you can switch to a dif­fer­ent Medicare Advan­tage Plan or switch to Orig­i­nal Medicare (and join a sep­a­rate Medicare drug plan) once dur­ing this time.

    Let’s be hon­est, no one gets too excit­ed about enrolling in Medicare, but the more you know, the eas­i­er it is.  Being pre­pared for life’s unex­pect­ed twist and turns and keep­ing up with your health care is more impor­tant than ever.  By under­stand­ing the ABC’s of Medicare, you are empow­er­ing your­self for your future!

    Oth­er Help­ful Resources Include:

    Under­stand­ing Medicare’s Options: Parts A, B, C and D

    What is Medicare?

    An Overview of Medicare

  • Think Before You Click

    October 6, 2021

    Tags: , ,

    If you are con­cerned about your cyber secu­ri­ty – and you should be – it’s essen­tial to know the biggest threats to you right now.  So, what is cyber secu­ri­ty any­way?  And how can you pro­tect yourself?

    Cyber secu­ri­ty is the prac­tice of defend­ing com­put­ers, servers, mobile devices, elec­tron­ic sys­tems, net­works, and data from mali­cious attacks. Glob­al cyber threat con­tin­ues to increase at a rapid pace.  Most, but not all, cyber­crime is com­mit­ted by hack­ers who want to make mon­ey.  As the result of the COVID-19 pan­dem­ic, Cyber­crime, which includes every­thing from embez­zle­ment to data hack­ing and destruc­tion, is up 600%.

    Types of Cyber Threats:

    Mal­ware, short for “mali­cious soft­ware”, refers to any intru­sive soft­ware devel­oped by cyber­crim­i­nals or hack­ers to steal data and dam­age com­put­ers and com­put­er sys­tems.  Mal­ware is often acti­vat­ed when a user clicks on a mali­cious link or attach­ment, which leads to installing dan­ger­ous soft­ware.  There are sev­er­al types of malware:

    • Virus: A self-repli­cat­ing pro­gram that attach­es itself to clean files and spreads through­out a com­put­er sys­tem, infect­ing files with mali­cious code.
    • Tro­jans: A type of mal­ware that con­ceals its true con­tent to fool a user into think­ing it’s a harm­less file. Cyber­crim­i­nals trick users into upload­ing Tro­jans onto their com­put­er where they can col­lect data or cause damage.
    • Worms: Mali­cious soft­ware that spreads copies of itself from com­put­er to com­put­er with­in a net­work. Worms exploit vul­ner­a­bil­i­ties in your secu­ri­ty soft­ware to steal sen­si­tive infor­ma­tion and cor­rupt files. A worm is dif­fer­ent from a virus, how­ev­er, because a worm can oper­ate on its own while a virus needs a host computer.
    • Spy­ware: A pro­gram that secret­ly records what a user does, so that cyber­crim­i­nals can make use of this infor­ma­tion. Spy­ware is often used to steal per­son­al or finan­cial information.
    • Ran­somware: Mali­cious soft­ware which locks down a user’s files and data with the threat of eras­ing it unless a ran­som is paid.
    • Adware: Unwant­ed soft­ware that dis­plays adver­tise­ments on your screen. Adware col­lects per­son­al infor­ma­tion from you to serve you with per­son­al­ized ads. While adware is not always dan­ger­ous, it can redi­rect your brows­er to unsafe sites and can even con­tain Tro­jans and spyware.
    • Rootk­its: Mali­cious soft­ware that is extreme­ly dif­fi­cult to spot and also very hard to remove. A rootk­it allows some­one to main­tain con­trol over a com­put­er with­out the com­put­er own­er know­ing about it.  Once a rootk­it has been installed, noth­ing on your com­put­er is secure.

    Where does mal­ware come from?

    The most com­mon sources of mal­ware are mali­cious web­sites, email attach­ments, and shared networks.

    • Phish­ing: E‑mails that appear to be from a legit­i­mate com­pa­ny ask­ing for sen­si­tive infor­ma­tion. Phish­ing attacks are often used to trick peo­ple into hand­ing over per­son­al infor­ma­tion or cred­it card data.
    • Shared Net­works: A mal­ware infect­ed com­put­er on your shared net­work can spread mal­ware onto all devices on the network.
    • Mali­cious Web­sites: Some web­sites may install mal­ware onto your com­put­er – usu­al­ly through adver­tise­ments on pop­u­lar sites (malver­tis­ing) or mali­cious links.

    How to Pre­vent Mal­ware – 7 Things You Should Start Doing Now:

    1. Install Anti-virus Soft­ware: Anti-virus soft­ware will scan your com­put­er to detect and clean the mal­ware and pro­vide enhanced pro­tec­tion against new­ly cre­at­ed viruses.
    2. Reg­u­lar­ly Update Soft­ware: Keep your soft­ware updat­ed to stop attack­ers gain­ing access to your com­put­er through vul­ner­a­bil­i­ties in out­dat­ed systems.
    3. Install a Fire­wall: A fire­wall blocks all unau­tho­rized access to or from a pri­vate com­put­er network.
    4. Use Secure Authen­ti­ca­tion Meth­ods: Use strong pass­words with at least 8 char­ac­ters, includ­ing an upper­case let­ter, a low­er­case let­ter, and a num­ber or sym­bol. You should also enable mul­ti-fac­tor authen­ti­ca­tion, such as a secu­ri­ty ques­tion in addi­tion to a password.
    5. Don’t Open Emails From Unknown Sources: Hack­ers often send emails with links that are sure to send mal­ware your way and hack into your impor­tant infor­ma­tion. It is bet­ter to delete the email than to suf­fer the con­se­quences of open­ing it.
    6. Avoid Using Unse­cure WiFi Net­works in Pub­lic Places: On an unse­cure net­work, a cyber­crim­i­nal can inter­cept com­mu­ni­ca­tion between two indi­vid­u­als to steal data.
    7. Main­tain Reg­u­lar Back­ups of Your Data: Back­ups do not secure your net­work from attacks but they help when you face a mal­ware attack.

    Jeh John­son, for­mer U.S. Sec­re­tary of Home­land Secu­ri­ty, stat­ed “Cyber­at­tacks of all man­ner and from mul­ti­ple sources are going to get worse before they get bet­ter.  In this realm and at this moment, those on offense have the upper hand.  Whether it’s cyber-crim­i­nals, hack­tivists, or nation-state actors, those on offense are inge­nious, tena­cious, agile, and get­ting bet­ter all the time.  Those on defense strug­gle to keep up.”

    It is imper­a­tive that you pro­tect your­self and your fam­i­ly from cyber­crim­i­nals.  With tech­nol­o­gy increas­ing, crim­i­nals don’t have to rob stores or banks, nor do they have to be out­side to com­mit a crime — they have every­thing they need on their lap.  Their weapons are no longer guns, they attack with a com­put­er mouse and passwords.

  • Big News! Arrow Benefits Group Announces New Partnership with Aita and Associates, Inc. Expanding Local Ties with Community.

    September 29, 2021

    Tags: , ,

    Aita con­tin­ues to serve clients unit­ed with Arrow.

    Arrow Ben­e­fits Group announces its part­ner­ship with Aita and Asso­ciates, Inc., a high­ly respect­ed insur­ance firm head­quar­tered in Sebastopol, Ca. for over 35 years. This con­sol­i­da­tion allows the Aita team to build on its rep­u­ta­tion of com­mit­ment to local com­mu­ni­ty, per­son­al atten­tion to clients, and advo­ca­cy excel­lence in the ben­e­fits insur­ance indus­try. The union serves to fur­ther strength­en ABG’s assets and ties to the local com­mu­ni­ty.  Says com­pa­ny co-own­er Bob Aita, “We have always been intense­ly client focused, and this part­ner­ship — and the cul­ture and autonomous lead­er­ship at Arrow Ben­e­fits — will allow our team to con­tin­ue their efforts in that same man­ner. For us, it also means we’ll have access to addi­tion­al excep­tion­al top resources to serve our clients. ABG’s lev­el of integri­ty, respect for team mem­bers and how and where they per­form their respon­si­bil­i­ties, along with a real under­stand­ing and accep­tance of how Aita does busi­ness, allows our lega­cy of excel­lence to be con­tin­ued as part of Arrow.”

    The Aita team of experts each bring to the accord a wide breadth of expe­ri­ence and ded­i­ca­tion to high­ly hands-on per­son­al­ized ser­vice, guid­ance for ben­e­fits, and an inti­mate knowl­edge of the Ben­e­fits, HR, and Com­pli­ance worlds. They will con­tin­ue this high lev­el of ser­vice and con­sul­ta­tion. The com­bi­na­tion of these two long-term indus­try lead­ers and both their shared con­nec­tions with well-respect­ed agen­cies and long-term rela­tion­ships with car­ri­ers is a win­ning com­bi­na­tion. With ABG’s devel­oped resources, the Aita team will con­tin­ue to deliv­er the same lev­el of ser­vice to exist­ing clients while also free­ing up time to prospect for and mar­ket to prospec­tive clients.

    The tal­ent­ed Aita team con­tin­ues to include:

    • Bob Aita, Co-own­er/Se­nior Ben­e­fits Con­sul­tant — Con­tact: [email protected] & 707–981-5414 x 251
    • Jes­si­ca Dominik, Senior Account Man­ag­er – Con­tact: [email protected] & 707–981-5415 x 252
    • Lin­da Rivera, Senior Account Man­ag­er, Com­pli­ance Offi­cer and H.R. Con­sul­tant – Con­tact: [email protected] & 707–981-5417 x 254
    • Stephanie Pav­los, Account Man­ag­er – Con­tact: [email protected] & 707–981-5416 x 253

    “We are excit­ed about bring­ing the Aita team into Arrow Ben­e­fits Group,” says Joe Gen­ovese, CEO & Man­ag­ing Prin­ci­pal. “Their long-stand­ing rep­u­ta­tion for excep­tion­al ser­vice, high lev­el of exper­tise, and a per­son­al touch that goes well beyond sim­ply serv­ing the client is a great com­pli­ment to the increas­ing capa­bil­i­ties at ABG. We are extreme­ly proud to wel­come the A&A team.”

    Arrow & Aita Con­tin­u­ing to Sup­port Local Including:

     

     

  • Employer Medicare Part D Notices Are Due Before October 15, 2021

    September 29, 2021

    Tags: ,

    Are you an employ­er that offers or pro­vides group health cov­er­age to your work­ers? Does your health plan cov­er out­pa­tient pre­scrip­tion drugs — either as a med­ical claim or through a card sys­tem? If so, be sure to dis­trib­ute your plan’s Medicare Part D notice before Octo­ber 15.

    Purpose

    Medicare began offer­ing “Part D” plans — option­al pre­scrip­tion drug ben­e­fit plans sold by pri­vate insur­ance com­pa­nies and HMOs — to Medicare ben­e­fi­cia­ries many years ago. Peo­ple may enroll in a Part D plan when they first become eli­gi­ble for Medicare.

    If they wait too long, a late enroll­ment penal­ty amount is per­ma­nent­ly added to the Part D plan pre­mi­um cost when they do enroll. There is an excep­tion, though, for indi­vid­u­als who are cov­ered under an employer’s group health plan that pro­vides cred­itable cov­er­age. (“Cred­itable” means that the group plan’s drug ben­e­fits are actu­ar­i­al­ly equiv­a­lent or bet­ter than the ben­e­fits required in a Part D plan.) In that case, the indi­vid­ual can delay enrolling for a Part D plan while he or she remains cov­ered under the employer’s cred­itable plan. Medicare will waive the late enroll­ment pre­mi­um penal­ty for indi­vid­u­als who enroll in a Part D plan after their ini­tial eli­gi­bil­i­ty date if they were cov­ered by an employer’s cred­itable plan. To avoid the late enroll­ment penal­ty, there can­not be a gap longer than 62 days between the cred­itable group plan and the Part D plan.

    To help Medicare-eli­gi­ble plan par­tic­i­pants make informed deci­sions about whether and when to enroll in a Part D drug plan, they need to know if their employer’s group health plan pro­vides cred­itable or non­cred­itable pre­scrip­tion drug cov­er­age. That is the pur­pose of the fed­er­al require­ment for employ­ers to pro­vide an annu­al notice (Employer’s Medicare Part D Notice) to all Medicare-eli­gi­ble employ­ees and spouses.

    Employer Requirements

    Fed­er­al law requires all employ­ers that offer group health cov­er­age includ­ing any out­pa­tient pre­scrip­tion drug ben­e­fits to pro­vide an annu­al notice to plan participants.

    The notice require­ment applies regard­less of the employer’s size or whether the group plan is insured or self-funded:

    • Deter­mine whether your group health plan’s pre­scrip­tion drug cov­er­age is cred­itable or non­cred­itable for the upcom­ing year (2022). If your plan is insured, the carrier/HMO will con­firm cred­itable or non­cred­itable sta­tus. Keep a copy of the writ­ten con­fir­ma­tion for your records. For self-fund­ed plans, the plan actu­ary will deter­mine the plan’s sta­tus using guid­ance pro­vid­ed by the Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS).
    • Dis­trib­ute a Notice of Cred­itable Cov­er­age or a Notice of Non­cred­itable Cov­er­age, as applic­a­ble, to all group health plan par­tic­i­pants who are or may become eli­gi­ble for Medicare in the next year. “Par­tic­i­pants” include cov­ered employ­ees and retirees (and spous­es) and COBRA enrollees. Employ­ers often do not know whether a par­tic­u­lar par­tic­i­pant may be eli­gi­ble for Medicare due to age or dis­abil­i­ty. For con­ve­nience, many employ­ers decide to dis­trib­ute their notice to all par­tic­i­pants regard­less of Medicare status.
    • Notices must be dis­trib­uted at least annu­al­ly before Octo­ber 15. Medicare holds its Part D enroll­ment peri­od each year from Octo­ber 15 to Decem­ber 7, which is why it is impor­tant for group health plan par­tic­i­pants to receive their employer’s notice before Octo­ber 15.
    • Notices also may be required after Octo­ber 15 for new enrollees and/or if the plan’s cred­itable ver­sus non­cred­itable sta­tus changes.

    Prepar­ing the Notice(s)

    Mod­el notices are avail­able on the CMS web­site. Start with the mod­el notice and then fill in the blanks and vari­able items as need­ed for each group health plan. There are two ver­sions: Notice of Cred­itable Cov­er­age or Notice of Non­cred­itable Cov­er­age and each is avail­able in Eng­lish and Spanish:

    Employ­ers who offer mul­ti­ple group health plan options, such as PPOs, HDH­Ps, and HMOs, may use one notice if all options are cred­itable (or all are non­cred­itable). In this case, it is advis­able to list the names of the var­i­ous plan options so it is clear for the read­er. Con­verse­ly, employ­ers that offer a cred­itable plan and a non­cred­itable plan, such as a cred­itable HMO and a non­cred­itable HDHP, will need to pre­pare sep­a­rate notices for the dif­fer­ent plan participants.

    Dis­trib­ut­ing the Notice(s)

    You may dis­trib­ute the notice by first-class mail to the employee’s home or work address. A sep­a­rate notice for the employee’s spouse or fam­i­ly mem­bers is not required unless the employ­er has infor­ma­tion that they live at dif­fer­ent addresses.

    The notice is intend­ed to be a stand-alone doc­u­ment. It may be dis­trib­uted at the same time as oth­er plan mate­ri­als, but it should be a sep­a­rate doc­u­ment. If the notice is incor­po­rat­ed with oth­er mate­r­i­al (such as sta­pled items or in a book­let for­mat), the notice must appear in 14-point font, be bold­ed, off­set, or boxed, and placed on the first page. Alter­na­tive­ly, in this case, you can put a ref­er­ence (in 14-point font, either bold­ed, off­set, or boxed) on the first page telling the read­er where to find the notice with­in the mate­r­i­al. Here is sug­gest­ed text from the CMS for the first page:

    “If you (and/or your depen­dents) have Medicare or will become eli­gi­ble for Medicare in the next 12 months, a fed­er­al law gives you more choic­es about your pre­scrip­tion drug cov­er­age. Please see page XX for more details.”

    Email dis­tri­b­u­tion is allowed but only for employ­ees who have reg­u­lar access to email as an inte­gral part of their job duties. Employ­ees also must have access to a print­er, be noti­fied that a hard copy of the notice is avail­able at no cost upon request, and be informed that they are respon­si­ble for shar­ing the notice with any Medicare-eli­gi­ble fam­i­ly mem­bers who are enrolled in the employer’s group plan.

    CMS Dis­clo­sure Requirement

    Sep­a­rate from the par­tic­i­pant notice require­ment, employ­ers also must dis­close to the CMS whether their group health plan pro­vides cred­itable or non­cred­itable cov­er­age. To sub­mit your plan’s dis­clo­sure, use the CMS online tool and fol­low the prompts. The process usu­al­ly takes only 5 or 10 min­utes to com­plete. It is due with 60 days after the start of the plan year; for instance, for cal­en­dar year plans that will be March 1, 2022. If the plan’s pre­scrip­tion drug cov­er­age ends or its sta­tus as cred­itable or non­cred­itable changes, sub­mit a new dis­clo­sure with­in 30 days of the change.

    By Kath­leen A. Berger

    Orig­i­nal­ly post­ed on Min­er­al

  • They had it all figured out – until they didn’t | by Jordan Shields, Partner

    September 24, 2021

    Tags:

    First the com­bi­na­tion of Berk­shire Hath­away, Ama­zon and Citibank – we can’t even remem­ber the name it came and went so fast.  Then Google Health was formed, sup­port­ing over 500 employ­ees to trans­form the way health care is deliv­ered.  Apple fol­lowed suit.  And now…the first guys are gone, Google just announced it was pulling the plug, and Apple said it has scaled back a spe­cif­ic health team focused on its inter­nal health app.

    So wait, is it real­ly that hard, and why is it that the great tech com­pa­nies couldn’t solve the prob­lem of admin­is­tra­tive waste, health care deliv­ery effi­cien­cy and all the oth­er items the fed­er­al gov­ern­ment said they can solve just by expand­ing Medicare?  Huh?

  • Life Insurance: Putting a Price on Peace of Mind

    September 22, 2021

    Tags: ,

    Life insur­ance pro­vides finan­cial pro­tec­tion for your loved ones when you die.  Essen­tial­ly, in exchange for your pre­mi­um pay­ments, the insur­ance com­pa­ny will pay a lump sum known as a death ben­e­fit to your ben­e­fi­cia­ries after your death. While this mon­ey can nev­er replace you, it can help your loved one(s) live the kind of life you hoped to provide.

    Life insur­ance cov­er­age offers afford­able finan­cial pro­tec­tion and invalu­able peace of mind.  You can choose a legal enti­ty, orga­ni­za­tion or any­one to be your life insur­ance ben­e­fi­cia­ry.  You can name mul­ti­ple ben­e­fi­cia­ries and decide what per­cent­age they each will receive when you die.  Com­mon choic­es include:

    • Your spouse
    • Fam­i­ly members
    • Friends
    • A trust
    • Char­i­ta­ble organizations

    You can cus­tomize your pol­i­cy to fit your family’s needs by choos­ing the type of pol­i­cy you buy, the num­ber of years you want it to last and your cov­er­age amount.  If you die while your life insur­ance pol­i­cy is active, your ben­e­fi­cia­ries can file a claim and the death ben­e­fit will be paid out to them.

    There are two pri­ma­ry types of life insur­ance: term and per­ma­nent life. Per­ma­nent life insur­ance such as whole life insur­ance or uni­ver­sal life insur­ance can pro­vide life­time cov­er­age, while term life insur­ance pro­vides basic pro­tec­tion for a set peri­od of time.

    Term life Insurance:

    • Term life insur­ance guar­an­tees pay­ment of a stat­ed death ben­e­fit to the insured’s ben­e­fi­cia­ries if the insured per­son dies dur­ing a spec­i­fied term.
    • These poli­cies have no val­ue oth­er than the guar­an­teed death ben­e­fit and fea­ture no sav­ings com­po­nent as found in a whole life insur­ance product.
    • Term life pre­mi­ums are based on a person’s age, health, and life expectancy.
    • Sim­plest and most afford­able type of life insurance.

    Whole Life Insurance:

    • Whole life insur­ance lasts for a policyholder’s life­time, as opposed to term life insur­ance, which is for a spe­cif­ic num­ber of years.
    • Whole life insur­ance is paid out to a ben­e­fi­cia­ry or ben­e­fi­cia­ries upon the policyholder’s death, pro­vid­ed that the pre­mi­um pay­ments were maintained.
    • Whole life insur­ance pays a death ben­e­fit, but also has a sav­ings com­po­nent in which cash can build up.
    • The sav­ings com­po­nent can be invest­ed; addi­tion­al­ly, the pol­i­cy­hold­er can access the cash while alive, by either with­draw­ing or bor­row­ing against it, when needed.

    Uni­ver­sal Life Insurance:

    • Uni­ver­sal life (UL) insur­ance is a form of per­ma­nent life insur­ance with an invest­ment sav­ings ele­ment plus low premiums.
    • The price tag on uni­ver­sal life (UL) insur­ance is the min­i­mum amount of a pre­mi­um pay­ment required to keep the policy.
    • Ben­e­fi­cia­ries only receive the death benefit.
    • Unlike term life insur­ance, a UL insur­ance pol­i­cy can accu­mu­late cash value.

    How Do I Choose What is Right for Me?

    It can be con­fus­ing to choose the right type of life insur­ance.  When you com­pare some of the biggest dif­fer­ences in life insur­ance, it is eas­i­er to choose.

    The biggest dif­fer­ence in term life vs. whole life or uni­ver­sal life insur­ance is cov­er­age length.  Term life insur­ance is good for peo­ple who want a finan­cial safe­ty net for a spe­cif­ic num­ber of work­ing years, such as the years of pay­ing off a mort­gage.  Dif­fer­ent term lengths are avail­able such as 10, 15, 20 or 30 years.  Term life insur­ance is much cheap­er than whole life but if you out­live your term, there won’t be a life insur­ance pay­out. Term life is a sim­ple, inex­pen­sive way for you to proac­tive­ly take care of your loved ones so they don’t have to wor­ry when you’re gone.

    Whole and uni­ver­sal life insur­ance give you cov­er­age for the dura­tion of your life. It also includes a cash val­ue com­po­nent. The biggest dif­fer­ence between whole life insur­ance and uni­ver­sal life insur­ance is the cost. Whole life insur­ance is gen­er­al­ly the most expen­sive way to buy per­ma­nent life insur­ance because of the guar­an­tees with­in the pol­i­cy: pre­mi­ums are guar­an­teed not to change, the death ben­e­fit is guar­an­teed and cash val­ue has a min­i­mum guar­an­teed rate of return. Whole life insur­ance is good for peo­ple who like pre­dictabil­i­ty and want life­long cov­er­age to build cash val­ue.  Your ben­e­fi­cia­ry will get a guar­an­teed life insur­ance pay­out as long as you’ve paid the pre­mi­ums to keep the pol­i­cy cur­rent. This type of pol­i­cy tends to cost more in the ear­ly years to sup­port the guar­an­tees it pro­vides.  But, as the cost of liv­ing goes up in the years ahead, your whole life insur­ance pre­mi­um will remain iden­ti­cal every month and will nev­er cost more.

    Uni­ver­sal life insur­ance often offers more flex­i­bil­i­ty than a whole life insur­ance pol­i­cy.  These poli­cies offer life­long cov­er­age, pro­vide flex­i­bil­i­ty when it comes to pay­ing pre­mi­ums and choic­es for how the policy’s cash val­ue is invest­ed. A stan­dard uni­ver­sal life insur­ance policy’s cash val­ue grows accord­ing to the per­for­mance of the insurer’s port­fo­lio and can be used to pay pre­mi­ums.  With a uni­ver­sal life insur­ance pol­i­cy, the cash val­ue will build depend­ing on the pol­i­cy type.  If you want to build tax-deferred sav­ings and don’t expect to tap into the funds for a long time, uni­ver­sal life may be a suit­able option for you.

    No one wants to talk about it, but we have to. You need life insur­ance. When you’re gone, those you love will be griev­ing. This is unavoid­able. Leav­ing them to strug­gle finan­cial­ly, how­ev­er, is avoid­able.  Talk­ing to a pro­fes­sion­al when you choose your life insur­ance plan can help you to find ways to afford the right kind of coverage.

    Check out these great resources to bet­ter edu­cate your­self on choos­ing life insurance:

    Term vs. Whole Life Insur­ance: How to Choose

    Life Insur­ance Basics

    8 Smart Steps for Buy­ing Life Insurance

  • The Great Resignation: How Companies Can Cope With The Mass Exodus

    September 13, 2021

    Tags: ,

    Amer­i­can com­pa­nies are at a seri­ous cross­roads right now because of an unex­pect­ed con­se­quence of COVID-19 known as the “Great Res­ig­na­tion.”

    CNBC report­ed ear­li­er this sum­mer that four mil­lion peo­ple had quit their jobs. This would be shock­ing under nor­mal cir­cum­stances, yet these peo­ple quit sta­ble jobs in the mid­dle of a glob­al pandemic.

    The major­i­ty of these res­ig­na­tions occurred in retail, pro­fes­sion­al ser­vices, trans­porta­tion, ware­hous­ing, and util­i­ties. And in terms of geog­ra­phy, work­ers were more like­ly to quit in the South­ern, Mid­west­ern, or West­ern regions of the Unit­ed States.

    What caused this to hap­pen? Ana­lysts say it’s been in the works for years, and COVID-19 sim­ply gave dis­sat­is­fied work­ers a moment to reflect on their situations.

    Peo­ple have repri­or­i­tized their lives as a result of COVID-19, putting more of their time and effort into per­son­al expe­ri­ences and fam­i­ly time.

    Oth­er employ­ees took advan­tage of the quar­an­tine to leave low-wage jobs or com­pa­nies they believed were tak­ing advan­tage of them. Remote work has also flour­ished over the past two years.

    Employ­ers are now pan­ick­ing about how to bring these peo­ple back, or at the very least, find suit­able replace­ments. This blog will cov­er some of the changes com­pa­nies should make to sur­vive the “Great Resignation.”

    Change How You Treat Employees

    Data from a 2019 sur­vey of 11 mil­lion work­ers nar­rowed down three rea­sons for the “Great Res­ig­na­tion,” each relat­ed to how com­pa­nies treat­ed their employ­ees and their work environment.

    A lack of work­place com­mu­ni­ca­tion frus­trat­ed enough employ­ees to con­sid­er leav­ing their posi­tion. They seek more trans­paren­cy in a new job, as well as a sense of belonging.

    Oth­er respon­dents said they were con­cerned about the man­ag­er-employ­ee rela­tion­ship. Specif­i­cal­ly, they said man­agers need­ed to acknowl­edge their work more and serve as reli­able inter­me­di­aries between them and the organization.

    Many frus­trat­ed employ­ees also said they were leav­ing tox­ic envi­ron­ments that held them and the com­pa­ny back from reach­ing its full poten­tial. They want­ed com­pa­ny lead­er­ship to address the issues and offer more flex­i­bil­i­ty with remote or hybrid options.

    Morale Does Matter— And It’s Your Responsibility

    A large share of res­ig­na­tions this year came from work­ers on edge in their tox­ic work­places or con­tin­u­al­ly feel­ing burnt out with­out any relief. Work­ing from home dur­ing the quar­an­tine gave them time to think about what they real­ly want­ed in their career.

    What is a tox­ic work­place exact­ly? It’s a com­pa­ny that puts mon­ey or suc­cess over the needs of its employ­ees. Prof­its are impor­tant in busi­ness but noth­ing is sus­tain­able if employ­ees aren’t in a healthy mind frame.

    Here are some com­mon signs of a tox­ic workplace:

    ● Employ­ees are over­worked and underpaid
    ● Man­age­ment rules with fear and they aren’t con­cerned with staff well-being
    ● Ver­bal abuse or sex­u­al harass­ment in the office
    ● Employ­ees aren’t rec­og­nized for good work and made to feel guilty for not tak­ing on new projects
    ● Zero account­abil­i­ty companywide

    Healthy work envi­ron­ments and employ­ee morale start at the top. It’s impor­tant for com­pa­ny lead­er­ship to estab­lish and main­tain a pos­i­tive cul­ture for everyone.

    Oth­er­wise, employ­ees will be mis­er­able, pro­duc­tiv­i­ty will plum­met, and there will be high turnover rates.

    Stay Competitive With Salaries & Benefits

    Although mon­ey isn’t the pri­ma­ry fac­tor behind the “Great Res­ig­na­tion,” enhanc­ing salary and ben­e­fits could entice some employ­ees back.

    Work­ers now have more options and pow­er in their job search­es than ever before. There is a sur­plus of tal­ent. If you want to recruit the best, you’ll need to be will­ing to pay for them.

    In fact, a labor mar­ket sur­vey dis­cov­ered the low­est wage work­ers with­out a col­lege degree are will­ing to accept in 2021 is $61,483. That’s a $10,000 increase from the year before.

    Prospec­tive employ­ees are also think­ing more about their health ben­e­fits after liv­ing near­ly two years with COVID-19. They want bet­ter pre­ven­ta­tive care, enhanced rela­tion­ships with pri­ma­ry care providers, and men­tal health coverage.

    Their focus is on pre­vent­ing dis­ease and ensur­ing that insur­ance plans will cov­er any seri­ous ill­ness­es that do emerge.

    Men­tal health ser­vices are at the cen­ter of this trend. Around 60% of employ­ees report­ed feel­ing more stress and anx­i­ety dur­ing the pan­dem­ic, and ther­a­py appoint­ments have sky­rock­et­ed in 2021.

    Rethinking Business As Usual

    The “Great Res­ig­na­tion” is not hit­ting every indus­try or busi­ness the same, but those who want to weath­er the storm will need to eval­u­ate how they treat employ­ees and what kind of work cul­ture they want to promote.

    They can start by tak­ing an “employ­ee-cen­tric” approach to deci­sion-mak­ing and tak­ing full respon­si­bil­i­ty for employ­ee morale.

    And while salary shouldn’t be the only rea­son some­one takes a job, there is a grow­ing expec­ta­tion among younger work­ers for high­er salaries and bet­ter health­care benefits.

    By Mcken­zie Cassidy

    Orig­i­nal­ly post­ed on HR Exchange Network

  • Vaccine or Not – But Now it Might Cost You – Delta Air Lines, Ironically, Pushes the First Variant | by Jordan Shields, Partner

    September 10, 2021

    Tags: ,

    Com­pa­nies have been cajol­ing and com­pen­sat­ing employ­ees to get the COVID vac­cine, but now Delta is fight­ing the Delta with a new delta – if employ­ees do not get the vac­cine, they will now pay $200 per month for their health insur­ance.  This is to off­set the addi­tion­al costs to the Delta med­ical plan due to COVID cas­es.  While Delta does have 75% of their employ­ees vac­ci­nat­ed, their goals, as with oth­er com­pa­nies look­ing for full com­pli­ance, are for 100%.

  • Open Enrollment: Looking Backward to Plan Forward

    September 7, 2021

    Tags: , ,

    When the autumn leaves fall and the weath­er turns cool­er, we know it’s time to start think­ing of open enroll­ment. Open enroll­ment sea­son can be a con­fus­ing time. As you begin your research into which plan to choose or even how much to con­tribute to your Health Sav­ings Account (HSA), con­sid­er eval­u­at­ing how you used your health plan last year. Look­ing back­ward can help you plan for­ward to make the most of your health care dol­lars for the com­ing year.  Here’s what you need to know about your work­place ben­e­fits to max­i­mize them:

    1).  Know the Open Enroll­ment Dates

    It is up to you to make sure you take advan­tage of the open enroll­ment peri­od. Be sure you know when your com­pa­ny has open enroll­ment because it can be your only time to adjust ben­e­fits for the com­ing year.

    2).  Eval­u­ate Your Cur­rent Benefits

    Before open enroll­ment starts, review the ben­e­fits you cur­rent­ly are receiv­ing. Your pay stub can be an excel­lent resource to find this infor­ma­tion; you should be able to find the ben­e­fits you are pay­ing for under the deduc­tions or with­drawals sec­tion.  Stan­dard deduc­tions might include med­ical insur­ance, den­tal insur­ance, 401(k) con­tri­bu­tions, life insur­ance, vision insur­ance, long- term dis­abil­i­ty insur­ance, health sav­ings account or flex­i­ble spend­ing account con­tri­bu­tions, and acci­den­tal death and dis­mem­ber­ment insur­ance.  Review those deduc­tions to make sure you know what you’re pay­ing for and whether you actu­al­ly used the benefits.

    3).  Ask These Ques­tions to Decide What Ben­e­fits You Need

    Everyone’s sit­u­a­tion is dif­fer­ent, but most employ­ees should have at least med­ical, den­tal and vision insur­ance and make con­tri­bu­tions to a 401(k) or sim­i­lar work­place retire­ment sav­ings account.

    When eval­u­at­ing your ben­e­fits pack­age, con­sid­er what your needs will be or what life changes you can expect for the com­ing year:

    • Do you have a med­ical con­di­tion that requires ongo­ing care such as dia­betes or heart disease?
    • Are you try­ing to get preg­nant or are expect­ing a baby?
    • Are you get­ting mar­ried (or divorced)?
    • Is your child turn­ing 26 and can no longer be cov­ered under your health insurance?
    • Does your sig­nif­i­cant oth­er have cov­er­age, or will you need to include your part­ner in your health coverage?
    • Are you on track for retire­ment, or do you need to save more? Don’t for­get to take advan­tage of your com­pa­ny match in your retire­ment account. This is free mon­ey for the future.

    All of these are essen­tial ques­tions to ask your­self dur­ing the open enroll­ment sea­son because they can make a dif­fer­ence in what ben­e­fits you choose to elect.  As you browse the dif­fer­ent options, ana­lyze the type of treat­ment and the amount of treat­ment you have received in the past. You can­not fore­see every expense but focus­ing on the trends will help you make a sound decision.

    4). Com­pare Out-of-Pock­et Cost

    Much like health net­works, out-of-pock­et costs are cru­cial when choos­ing the right plan for you and your fam­i­ly. Most health ben­e­fits sum­maries should high­light the amount you will pay in out-of-pock­et expens­es, includ­ing the pock­et limit.

    Your goal in com­par­ing out-of-pock­et costs is to nar­row down the plans that pay a high­er per­cent­age of your med­ical expens­es and offer high­er month­ly pre­mi­ums. These types of plans are suit­able for you if:

    • You need emer­gency care frequently
    • You are plan­ning to have surgery soon
    • You often see a pri­ma­ry care physician
    • You have a pre-exist­ing con­di­tion or have been diag­nosed with a chron­ic dis­ease like can­cer or diabetes
    • Your house­hold income is suf­fi­cient to cov­er the month­ly premiums

    5).  Do the Math

    Peo­ple focus on the month­ly pre­mi­um, but you also need to look at the deductible. For instance, if you have a choice between a low­er sil­ver plan pre­mi­um of $345 a month for a plan with a $5,500 deductible, and a high­er gold plan pre­mi­um at $465 a month with a $1,750 deductible, you’re bet­ter off with the sec­ond plan if you antic­i­pate need­ing more than $1,500 in med­ical care. With the sec­ond plan, your total annu­al cost for the pre­mi­um and deductible comes to $7,330, a $2,310 sav­ings over the low­er pre­mi­um plan.

    6).  Look at Out-of-Pock­et Costs

    The deductible is just one out-of-pock­et expense; you also have copay­ments and coin­sur­ance. The three togeth­er are your max­i­mum out-of-pock­et costs. Under the Afford­able Care Act, the max­i­mum out-of-pock­et lim­it is $8,550 for a sin­gle per­son and $17,100 for a fam­i­ly policy.

    7).  Uti­lize Tax-Free Benefits

    Flex­i­ble spend­ing accounts (FSAs), health sav­ings accounts (HSAs), and depen­dent care spend­ing accounts pro­vide won­der­ful tax advan­tages because con­tri­bu­tions are made with before-tax income.  They can be used to pay for deductibles, pre­scrip­tions and health-relat­ed costs that are not cov­ered by your insur­ance (braces, eye­glass­es, etc.). At the end of the year, you lose any mon­ey left over in your FSA so it’s impor­tant to plan care­ful­ly and not put more mon­ey in your FSA that you think you’ll spend.  How­ev­er, with an HSA, funds roll over from year to year which makes it a great way to save for future med­ical costs.

    8).  Review the Provider List

    Most health plans today have “in-net­work” providers. If you see those doc­tors and vis­it those hos­pi­tals, you pay less out of pock­et than if you go out­side the net­work. So, if you want to keep your own doc­tor and go to a cer­tain hos­pi­tal, make sure they’re on the provider list.

    When it comes to choos­ing the best work­place ben­e­fits plan for you, edu­ca­tion is your most sig­nif­i­cant defense against mak­ing sub­stan­tial finan­cial mis­takes, includ­ing not tak­ing full advan­tage of your employer’s ben­e­fits.  If you have ques­tions about any of the ben­e­fits offered, ask your HR depart­ment for help or clar­i­fi­ca­tion.  And remem­ber, look­ing back­ward on your past habits and expens­es can be an impor­tant tool to help you plan for­ward for next year.

  • What’s in Store for Wal Mart – They Want More of Your Money Through Health Care| by Jordan Shields, Partner

    September 3, 2021

    Tags: ,

    Wal­mart unveiled its first health cen­ter in 2019, offer­ing a vari­ety of ser­vices that include pri­ma­ry care, lab, X‑Ray, EKG, coun­sel­ing, den­tal, opti­cal, hear­ing and com­mu­ni­ty health.  All pric­ing is low (nat­u­ral­ly) and trans­par­ent (unnat­u­ral­ly).  Wal­mart is now expand­ing their mod­el across sev­er­al sites, with a lot more to go (giv­en that they have 5,000 stores nationwide).

    Wal­mart is not lim­it­ing its efforts to in store ser­vices.  They also just announced their acqui­si­tion of MeMD, a leader in tele­health (also known as vir­tu­al health).

    Final­ly, don’t for­get that Wal­mart, as with a few oth­er major phar­ma­cy retail­ers, pro­vide a large list of $4 drugs.

  • Does Enrolling in Medicare Trigger an Offer of COBRA?

    September 1, 2021

    Tags: ,

    Enrolling in Medicare does not cause COBRA to start. Under the fed­er­al rules, COBRA must be offered to per­sons enrolled in the employer’s health plan only if they lose cov­er­age because of cer­tain spe­cif­ic events. Ter­mi­na­tion of employ­ment is an exam­ple of a COBRA qual­i­fy­ing event. Becom­ing eli­gi­ble for Medicare, or enrolling in Medicare, is not a COBRA qual­i­fy­ing event.

    On the oth­er hand, if some­one is already on COBRA due to a pri­or event, and then they enroll in Medicare, COBRA will end. Ear­ly ter­mi­na­tion of COBRA due to Medicare enroll­ment only affects that per­son. If oth­er fam­i­ly mem­bers also are on COBRA, they may con­tin­ue for the remain­der of the COBRA peri­od assum­ing their pre­mi­ums are paid when due and they do not enroll in Medicare or anoth­er group health plan.

    Let’s look at anoth­er sce­nario: An employ­ee enrolls in Medicare while con­tin­u­ing as an active employ­ee cov­ered under the employer’s health plan. Then the employ­ee leaves the com­pa­ny. This will trig­ger a COBRA offer since loss of cov­er­age due to ter­mi­na­tion of employ­ment is a COBRA qual­i­fy­ing event. Can the for­mer employ­ee elect COBRA despite being enrolled in Medicare? Yes, because they were already enrolled in Medicare before they elect­ed COBRA. They prob­a­bly will choose not to elect COBRA due to the cost, and since Medicare will be the pri­ma­ry claims pay­er, but they have the choice.

    There is one oth­er rule about COBRA and Medicare that can be con­fus­ing. As we said, the employ­ee who enrolled in Medicare while still work­ing and cov­ered under the employer’s plan lat­er had a COBRA event. When loss of cov­er­age is due to ter­mi­na­tion of employ­ment, the COBRA con­tin­u­a­tion peri­od is 18 months. Due to a spe­cial pro­vi­sion in the COBRA rules, the max­i­mum COBRA peri­od for the spouse or child (if also enrolled in the employer’s health plan when the COBRA event occurred) might be longer than 18 months. If the employ­ee had first enrolled in Medicare no more than 18 months before the COBRA event, the max­i­mum peri­od for the spouse and chil­dren is 36 months count­ing from the employee’s Medicare enrollment.

    For instance, let’s call the active employ­ee Mary and say she enrolled in Medicare in Jan­u­ary 2021 and then lost her group cov­er­age when she ter­mi­nat­ed employ­ment in May 2021. So, she enrolled in Medicare few­er than 18 months before her COBRA event. Her max­i­mum COBRA peri­od will be 18 months count­ing from May 2021, but COBRA for her spouse and chil­dren (if enrolled) could run for up to 36 months count­ing from Jan­u­ary 2021.

    Last­ly, employ­ers some­times ask whether they can auto­mat­i­cal­ly ter­mi­nate an employee’s (or spouse’s) group health cov­er­age at age 65. Due to the fed­er­al Medicare as Sec­ondary Pay­er (MSP) rules, employ­ers with 20 or more work­ers can­not take into account anyone’s poten­tial Medicare sta­tus in admin­is­ter­ing the group health plan. An employ­er with few­er than 20 work­ers also may be pro­hib­it­ed from bas­ing health plan eli­gi­bil­i­ty on the employee’s age due to the fed­er­al Age Dis­crim­i­na­tion in Employ­ment Act (ADEA). We rec­om­mend employ­ers review these mat­ters with legal counsel.

    By Kath­leen A. Berg­er, CEBS

    Orig­i­nal­ly post­ed on Min­er­al

  • How to Use Early Open Enrollment for Employee Retention

    August 25, 2021

    Tags: ,

    Amid the eco­nom­ic pan­ic last year, work­ers were unwill­ing to sac­ri­fice job secu­ri­ty for a new work envi­ron­ment.  Many work­ers felt it was fool­ish to re-enter the job mar­ket dur­ing a shut down.  How­ev­er, in 2021, employ­ers have expe­ri­enced high turnover rates and experts are now pre­dict­ing a “turnover tsuna­mi” in vol­un­tary depar­tures and res­ig­na­tions.  Cur­rent pro­jec­tions esti­mate that 3.3 mil­lion Amer­i­cans will leave their jobs by Decem­ber in search of new ones.

    Turnover is expen­sive: the process­es of recruit­ing, hir­ing, on-board­ing and train­ing cost exten­sive time but is also a con­sid­er­able invest­ment. When an employ­ee leaves, the com­pa­ny not only los­es a valu­able resource but also has to re-dis­trib­ute duties to oth­er team mem­bers in the inter­im of find­ing a replace­ment.  The team mem­bers who absorb the addi­tion­al respon­si­bil­i­ties reach their own tol­er­ance thresholds.

    Employ­ers are always look­ing for ways to sweet­en the attain and retain tal­ent­ed employ­ees.  For any job offer, salary will remain a cru­cial aspect but ben­e­fits also play an impor­tant role in over­all employ­ee com­pen­sa­tion. This year more than ever, employ­ers have a unique oppor­tu­ni­ty to show employ­ees how val­ued they are and may con­vince those who are seek­ing a new job to remain through their ben­e­fits.  So, what are some of the top ben­e­fits employ­ees are look­ing for right now?

    • Health Insur­ance

    This sta­ple ben­e­fit is of the utmost impor­tance to job can­di­dates and typ­i­cal­ly includes cov­er­age for their fam­i­lies.  In fact, 46% of U.S. adults said health insur­ance was the either the decid­ing fac­tor or a pos­i­tive influ­ence in choos­ing their cur­rent job.  And 56% said that employ­er-spon­sored health cov­er­age is a key fac­tor in decid­ing to stay in their cur­rent job.

    • Retire­ment

    The most com­mon type of retire­ment ben­e­fits is the 401(k) plan.  This allows employ­ees to deduct a cer­tain per­cent­age of each pay­check to put towards retire­ment sav­ings.  Some busi­ness­es choose to match the employee’s deduc­tion or up to a cer­tain percentage.

    • Dis­abil­i­ty

    Employ­ers can offer short ‑term dis­abil­i­ty (STD) or long-term dis­abil­i­ty (LTD) insur­ance to their employ­ees.  If an insured employ­ee is injured or has a lengthy ill­ness, the ben­e­fit pays them dur­ing the peri­od of time they are unable to work.  STD pays a por­tion of an employee’s salary if tem­porar­i­ly become sick or are unable to work.  LTD pay­ments are paid to employ­ees who have a per­ma­nent ill­ness or injury pre­vent­ing them from per­form­ing their duties.

    • Life Insur­ance

    Life insur­ance and acci­den­tal death & dis­mem­ber­ment insur­ance (AD&D) are impor­tant as employ­ees look to the future and want reas­sur­ance in pro­tect­ing their families.

    Employ­ers should also con­sid­er some perks that have become increas­ing­ly sought after.  Perks are some­thing that is in addi­tion to the employee’s salary and ben­e­fits pack­age that may sway an employ­ee to val­ue one employ­er over anoth­er.  Some of the most val­ued perks in 2021 are:

    • Men­tal Health Resources

    Well­be­ing and men­tal health pro­vi­sions have tak­en on a new sig­nif­i­cance in the last 12 months.  Employ­ers can offer an Employ­ee Assis­tance Pro­gram (EAP) which helps employ­ees to solve prob­lems – whether those relate to finances or oth­er non-work stress­es. But employ­ers are also offer­ing more com­pre­hen­sive men­tal health ser­vices such as coun­sel­ing or ther­a­py.  48% of employ­ees indi­cat­ed they had expe­ri­enced high lev­els of stress over the last year and are look­ing for sup­port for stress, burnout, and oth­er men­tal health issues.

    • Flexibility/Remote Work Options

    Remote work and flex­i­bil­i­ty have always been pop­u­lar among employ­ees but their impor­tance soared in light of the pan­dem­ic.  Flex­i­bil­i­ty has been a key fac­tor in pro­vid­ing for employ­ees who have had changes in their life such as car­ing for a chron­i­cal­ly ill loved one or those who sud­den­ly had vir­tu­al school for their chil­dren.  In fact, 76% of work­ers said they would be more will­ing to stay with their cur­rent employ­er if they could work flex­i­ble hours.

    • Paid Time Off

    This past year has served as a reminder that employee’s lives don’t just revolve around work.  With pets and chil­dren crash­ing our Zoom calls, and oth­er respon­si­bil­i­ties – includ­ing elder­care and child­care – on many worker’s minds, it’s evi­dent that employ­ees have oth­er respon­si­bil­i­ties and pri­or­i­ties that dis­tract us from work.  Dur­ing the pan­dem­ic, one in four women con­sid­ered leav­ing the work­force or scaled back their work role because of added fam­i­ly care­giv­ing pressures.

    Many employ­ees don’t under­stand the ben­e­fits they chose dur­ing open enroll­ment — which means some employ­ees may be look­ing for a new job for ben­e­fits or perks they already have!  Now more than ever, it is crit­i­cal for employ­ers to start com­mu­ni­cat­ing ear­ly about open enroll­ment.  Get­ting the word out about open enroll­ment and avail­able ben­e­fits will help employ­ees weigh the advan­tages of guar­an­teed perks and ben­e­fits with search­ing for a new job.  Giv­ing employ­ees more time to under­stand their ben­e­fits is cru­cial to employ­ee reten­tion and contentment.

     

  • Requirements Related to Surprise Billing; Part I Interim Final Rule with Comment Period

    August 16, 2021

    Tags: , ,

    On July 1, 2021, the Depart­ment of Health and Human Ser­vices (HHS), the Depart­ment of Labor, and the Depart­ment of the Trea­sury (col­lec­tive­ly, the Depart­ments), along with the Office of Per­son­nel Man­age­ment (OPM) released an inter­im final rule with com­ment peri­od (IFC), enti­tled “Require­ments Relat­ed to Sur­prise Billing; Part I.” This rule relat­ed to Title I (the No Sur­pris­es Act) of Divi­sion BB of the Con­sol­i­dat­ed Appro­pri­a­tions Act, 2021 estab­lish­es new pro­tec­tions from sur­prise billing and exces­sive cost-shar­ing for con­sumers receiv­ing health care items and ser­vices. This IFC imple­ments many of the law’s require­ments for group health plans, health insur­ance issuers, car­ri­ers under the Fed­er­al Employ­ees Health Ben­e­fits (FEHB) Pro­gram, health care providers and facil­i­ties, and air ambu­lance ser­vice providers.

    Back­ground – Sur­prise Billing & the Need for Greater Protections

    Most group health plans and health insur­ance issuers that offer group or indi­vid­ual health insur­ance cov­er­age have a net­work of providers and health care facil­i­ties (in-net­work providers) that agree to accept a spe­cif­ic pay­ment amount for their ser­vices. Providers and facil­i­ties that are not part of a plan’s or issuer’s net­work (out-of-net­work providers) usu­al­ly charge high­er amounts than the con­tract­ed rates the plans and issuers pay to in-net­work providers.

    When a per­son with health insur­ance cov­er­age gets care from an out-of-net­work provider, their health plan or issuer usu­al­ly does not cov­er the entire out-of-net­work cost, leav­ing the per­son with high­er costs than if they had been seen by an in-net­work provider. In many cas­es, the out-of-net­work provider may bill the indi­vid­ual for the dif­fer­ence between the billed charge and the amount paid by their plan or insur­ance, unless pro­hib­it­ed by state law. This is known as “bal­ance billing.”

    A “bal­ance bill” may come as a sur­prise for many peo­ple. A sur­prise med­ical bill is an unex­pect­ed bill from a health care provider or facil­i­ty. This can hap­pen when a per­son with health insur­ance unknow­ing­ly gets med­ical care from a provider or facil­i­ty out­side their health plan’s net­work. Sur­prise billing hap­pens in both emer­gency and non-emer­gency care.

    In an emer­gency, an indi­vid­ual usu­al­ly goes (or is tak­en) to the near­est emer­gency depart­ment. Even if they go to an in-net­work hos­pi­tal for emer­gency care, they might get care from out-of-net­work providers at that facility.

    For non-emer­gency care, an indi­vid­ual might choose an in-net­work facil­i­ty or an in-net­work provider, but not know that a provider involved in their care (for exam­ple, an anes­the­si­ol­o­gist or radi­ol­o­gist) is an out-of-net­work provider. In both emer­gency and non-emer­gency cir­cum­stances, the per­son might not be able to choose the provider or ensure that all of their care is from a par­tic­i­pat­ing provider. In addi­tion to get­ting a bill for their cost-shar­ing amount (like co-pay­ments, co-insur­ances, and any applic­a­ble deductibles), which tends to be high­er for these out-of-net­work ser­vices, the indi­vid­ual might also get a bal­ance bill from the out-of-net­work provider or facil­i­ty. This is espe­cial­ly com­mon in the con­text of air ambu­lance ser­vices, for which indi­vid­u­als gen­er­al­ly do not have the abil­i­ty to choose an air ambu­lance provider and have lit­tle or no con­trol over whether the provider is in-net­work with their plan or coverage.

    When indi­vid­u­als do not have an oppor­tu­ni­ty to select in-net­work providers, their health care costs go up over­all. Sur­prise billing is often used as lever­age by providers to get high­er in-net­work pay­ments, which result in high­er pre­mi­ums, high­er cost shar­ing for con­sumers, and increased health care spend­ing over­all.[1] Stud­ies have shown that sur­prise bills can be high.

    • A recent study found that pay­ments made to providers by peo­ple who got a sur­prise bill for emer­gency care were more than 10 times high­er than those made by oth­er indi­vid­u­als for the same care.
    • Out-of-net­work cost shar­ing and sur­prise bills usu­al­ly do not count toward a person’s deductible and max­i­mum out-of-pock­et lim­it. Indi­vid­u­als with sur­prise bills may have to spend more out-of-pock­et because they have to pay their out-of-net­work cost shar­ing and sur­prise billing amounts regard­less of whether they have met their deductible and max­i­mum out-of-pock­et lim­its. Nine per­cent of indi­vid­u­als who got sur­prise bills paid more than $400 to providers, which may result in finan­cial dis­tress for con­sumers, giv­en recent find­ings that show 40% of Amer­i­cans strug­gle to find $400 to pay for an unex­pect­ed bill.[2][3],
    • Stud­ies have shown that in the peri­od from 2010–2016, more than 39% of emer­gency depart­ment vis­its to in-net­work hos­pi­tals result­ed in an out-of-net­work bill, increas­ing to 42.8% in 2016. Dur­ing the same peri­od, the aver­age amount of a sur­prise med­ical bill also increased from $220 to $628.[4]
    • Although some states have enact­ed laws to reduce or elim­i­nate bal­ance billing, these efforts have cre­at­ed a patch­work of con­sumer pro­tec­tions.[5] Even in a state that has enact­ed pro­tec­tions, they typ­i­cal­ly only apply to indi­vid­u­als enrolled in health insur­ance cov­er­age, as fed­er­al law gen­er­al­ly pre­empts state laws that reg­u­late self-insured group health plans spon­sored by pri­vate employ­ers. In addi­tion, states have lim­it­ed pow­er to address sur­prise bills that involve an out-of-state provider.

    Sum­ma­ry of IFC

    This IFC pro­tects indi­vid­u­als from sur­prise med­ical bills for emer­gency ser­vices, air ambu­lance ser­vices pro­vid­ed by out-of-net­work providers, and non-emer­gency ser­vices pro­vid­ed by out-of-net­work providers at in-net­work facil­i­ties in cer­tain circumstances.

    If a plan or cov­er­age pro­vides or cov­ers any ben­e­fits for emer­gency ser­vices, this IFC requires emer­gency ser­vices to be covered:

    • With­out any pri­or autho­riza­tion (i.e., approval beforehand).
    • Regard­less of whether the provider is an in-net­work provider or an in-net­work emer­gency facility.
    • Regard­less of any oth­er term or con­di­tion of the plan or cov­er­age oth­er than the exclu­sion or coor­di­na­tion of ben­e­fits, or a per­mit­ted affil­i­a­tion or wait­ing period.

    Emer­gency ser­vices include cer­tain ser­vices in an emer­gency depart­ment of a hos­pi­tal or an inde­pen­dent free­stand­ing emer­gency depart­ment, as well as post-sta­bi­liza­tion ser­vices in cer­tain instances.

    This IFC also lim­its cost shar­ing for out-of-net­work ser­vices sub­ject to these pro­tec­tions to no high­er than in-net­work lev­els, requires such cost shar­ing to count toward any in-net­work deductibles and out-of-pock­et max­i­mums, and pro­hibits bal­ance billing. These lim­i­ta­tions apply to out-of-net­work emer­gency ser­vices, air ambu­lance ser­vices fur­nished by out-of-net­work providers, and cer­tain non-emer­gency ser­vices fur­nished by out-of-net­work providers at cer­tain in-net­work facil­i­ties, includ­ing hos­pi­tals and ambu­la­to­ry sur­gi­cal centers.

    Cost-Shar­ing Amounts:

    This IFC spec­i­fies that con­sumer cost-shar­ing amounts for emer­gency ser­vices pro­vid­ed by out-of-net­work emer­gency facil­i­ties and out-of-net­work providers, and cer­tain non-emer­gency ser­vices fur­nished by out-of-net­work providers at cer­tain in-net­work facil­i­ties, must be cal­cu­lat­ed based on one of the fol­low­ing amounts:

    • An amount deter­mined by an applic­a­ble All-Pay­er Mod­el Agree­ment under sec­tion 1115A of the Social Secu­ri­ty Act.
    • If there is no such applic­a­ble All-Pay­er Mod­el Agree­ment, an amount deter­mined under a spec­i­fied state law.
    • If nei­ther of the above apply, the less­er amount of either the billed charge or the qual­i­fy­ing pay­ment amount, which is gen­er­al­ly the plan’s or issuer’s medi­an con­tract­ed rate.

    Sim­i­lar­ly, cost-shar­ing amounts for air ambu­lance ser­vices pro­vid­ed by out-of-net­work providers must be cal­cu­lat­ed using the less­er of the billed charge or the plan’s or issuer’s qual­i­fy­ing pay­ment amount, and the cost shar­ing require­ment must be the same as if ser­vices were pro­vid­ed by an in-net­work air ambu­lance provider.

    Bal­ance Billing:

    Under this IFC, sur­prise billing for items and ser­vices cov­ered by the rule gen­er­al­ly is not allowed.

    Deter­min­ing Out-of-Net­work Rates:

    Under this IFC, the total amount to be paid to the provider or facil­i­ty, includ­ing any cost shar­ing, is based on:

    • An amount deter­mined by an applic­a­ble All-Pay­er Mod­el Agree­ment under sec­tion 1115A of the Social Secu­ri­ty Act.
    • If there is no such applic­a­ble All-Pay­er Mod­el Agree­ment, an amount deter­mined by a spec­i­fied state law.
    • If there is no such applic­a­ble All-Pay­er Mod­el Agree­ment or spec­i­fied state law, an amount agreed upon by the plan or issuer and the provider or facility.
    • If none of the three con­di­tions above apply, an amount deter­mined by an inde­pen­dent dis­pute res­o­lu­tion (IDR) entity.

    The Depart­ments intend to issue reg­u­la­tions soon regard­ing IDR enti­ties and the IDR process.

    In lim­it­ed cas­es, a provider or facil­i­ty can pro­vide notice to a per­son regard­ing poten­tial out-of-net­work care, and obtain the individual’s con­sent for that out-of-net­work care and extra costs. How­ev­er, this excep­tion does not apply in cer­tain sit­u­a­tions when sur­prise bills are like­ly to hap­pen, like for spec­i­fied ancil­lary ser­vices con­nect­ed to non-emer­gency care, such as anes­the­si­ol­o­gy or radi­ol­o­gy ser­vices pro­vid­ed at an in-net­work health­care facility.

    Notice to Consumers:

    This IFC requires cer­tain health care providers and facil­i­ties to make pub­licly avail­able, post on a pub­lic web­site, and pro­vide to indi­vid­u­als a one-page notice about:

    • The require­ments and pro­hi­bi­tions applic­a­ble to the provider or facil­i­ty under Pub­lic Health Ser­vice Act sec­tions 2799B‑1 and 2799B‑2 and their imple­ment­ing regulations.
    • Any applic­a­ble state bal­ance billing lim­i­ta­tions or prohibitions.
    • How to con­tact appro­pri­ate state and fed­er­al agen­cies if some­one believes the provider or facil­i­ty has vio­lat­ed the require­ments described in the notice.

    Applic­a­bil­i­ty Date & Com­ment Period

    The reg­u­la­tions are gen­er­al­ly applic­a­ble to group health plans and health insur­ance issuers for plan and pol­i­cy years begin­ning on or after Jan­u­ary 1, 2022. The HHS-only reg­u­la­tions that apply to health care providers, facil­i­ties, and providers of air ambu­lance ser­vices are applic­a­ble begin­ning on Jan­u­ary 1, 2022. The OPM-only reg­u­la­tions that apply to car­ri­ers under the FEHB Pro­gram are applic­a­ble to con­tract years begin­ning on or after Jan­u­ary 1, 2022. Writ­ten com­ments must be received by 5 p.m. 60 days after dis­play in the Fed­er­al Reg­is­ter to be considered.

    Vis­it https://www.cms.gov/files/document/cms-9909-ifc-surprise-billing-disclaimer-50.pdf to read more about the inter­im final rule.

    Orig­i­nal­ly post­ed on CMS.gov

    [1] Coop­er, Z. et al., Sur­prise! Out-of-Net­work Billing for Emer­gency Care in the Unit­ed States, NBER Work­ing Paper 23623, 20173623; Duffy, E. et al., Poli­cies to Address Sur­prise Billing Can Affect Health Insur­ance Pre­mi­ums. The Amer­i­can Jour­nal of Man­aged Care 26.9 (2020): 401–404; and Brown E.C.F., et al., The Unfin­ished Busi­ness of Air Ambu­lance Bills, Health Affairs Blog (March 26, 2021), doi: 10.1377/hblog20210323.911379, avail­able at https://www.healthaffairs.org/do/10.1377/hblog20210323.911379/full/.

    [2]Biener, A. et al., Emer­gency Physi­cians Recov­er a High­er Share of Charges from Out-of-net­work Care than from In-net­work Care, Health Affairs 40.4 (2021): 622–628.

    [3]Board of Gov­er­nors of the U.S. Fed­er­al Reserve Sys­tem. Report on the Eco­nom­ic Well­be­ing of U.S. House­holds in 2018. (May 2019). Avail­able at https://www.federalreserve.gov/publications/files/2018-report-economic-well-being-us-households-201905.pdf.

    [4] Sun, E.C., et al. “Assess­ment of Out-of-Net­work Billing for Pri­vate­ly Insured Patients Receiv­ing Care in In-net­work Hos­pi­tals.” JAMA Inter­nal Med­i­cine, 179.11 (2019): 1543–1550. Doi:10.1001/jamainternmed.2019.3451.

    [5] States that have enact­ed bal­ance billing pro­tec­tions include Ari­zona, Col­orado, Delaware, Indi­ana, Iowa, Maine, Mass­a­chu­setts, Min­neso­ta, Mis­sis­sip­pi, Mis­souri, New Mex­i­co, North Car­oli­na, Penn­syl­va­nia, Rhode Island, Texas, Ver­mont, and Washington.

  • EEO‑1 Data Collection

    August 11, 2021

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    The EEO‑1 Com­po­nent 1 report is a manda­to­ry annu­al data col­lec­tion that requires all pri­vate sec­tor employ­ers with 100 or more employ­ees, and fed­er­al con­trac­tors with 50 or more employ­ees meet­ing cer­tain cri­te­ria, to sub­mit demo­graph­ic work­force data, includ­ing data by race/ethnicity, sex and job cat­e­gories.  The fil­ing by eli­gi­ble employ­ers of the EEO‑1 Com­po­nent 1 Report is required under sec­tion 709© of Title VII of the Civ­il Rights Act of 1964, as amend­ed, 42 U.S.C. § 2000e‑8©, and 29 CFR 1602.7-.14 and 41 CFR 60–1.7(a).  Employ­ers can find addi­tion­al eli­gi­bil­i­ty infor­ma­tion at https://eeocdata.org/eeo1.

    Update: New Fil­ing Dead­line for 2019 and 2020 EEO‑1 Com­po­nent 1 Data Collection

    The dead­line to sub­mit and cer­ti­fy 2019 and 2020 EEO‑1 Com­po­nent 1 data HAS BEEN CHANGED.  The new fil­ing dead­line is NOW Mon­day, August 23, 2021. After delay­ing the open­ing of the 2019 EEO‑1 Com­po­nent 1 data col­lec­tion because of the COVID-19 pub­lic health emer­gency, the EEOC announced the open­ing of the 2019 and 2020 EEO‑1 Com­po­nent 1 data col­lec­tion on April 26, 2021.  Fil­ers should vis­it https://EEOCdata.org/eeo1 for addi­tion­al information.

    Fil­ers should vis­it the new­ly launched EEO‑1 Com­po­nent 1 web­site at https://EEOCdata.org/eeo1 for the lat­est fil­ing updates and addi­tion­al infor­ma­tion.  By vis­it­ing the Fil­er Sup­port Cen­ter locat­ed at https://EEOCdata.org/eeo1/support, fil­ers can request assis­tance as well as find help­ful resources, includ­ing fact sheets and FAQs.

    Eli­gi­ble employ­ers that have not received a 2019 and 2020 EEO‑1 Com­po­nent 1 noti­fi­ca­tion let­ter via U.S. mail should con­tact the EEOC’s Fil­er Sup­port Team at [email protected] for assis­tance.  Employ­ers that have received the noti­fi­ca­tion let­ter, may now cre­ate user accounts using the “Com­pa­ny ID” and “Pass­code” pro­vid­ed in the noti­fi­ca­tion letter.

    Once a user account is cre­at­ed, there are two dif­fer­ent ways to file the 2019 and 2020 EEO‑1 Com­po­nent 1 Report(s):

    1. ONLINE FORM (avail­able begin­ning Mon­day, April 26, 2021)
      Fil­ers may enter their data into a secure data entry form via the EEO‑1 Com­po­nent 1 Online Fil­ing Sys­tem at https://EEOCdata.org/eeo1/signin.
    2. DATA FILE UPLOAD (avail­able begin­ning Wednes­day, May 26, 2021)
      Fil­ers may upload data files through the EEO‑1 Com­po­nent 1 Online Fil­ing Sys­tem. The for­mat of the uploaded data file(s) must fol­low the file layout(s) set forth in the EEOC-approved spec­i­fi­ca­tions avail­able begin­ning Wednes­day, May 26, 2021 at https://EEOCdata.org/eeo1.

    Orig­i­nal­ly post­ed on EEOC.gov

  • Wellness Programs Work Except When They Don’t — Latest Study Results| by Jordan Shields, Partner

    August 5, 2021

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    “Health and Eco­nom­ic Out­comes Up to Three Years After a Work­place Well­ness Pro­gram:  A Ran­dom­ized Con­trolled Tri­al” was recent­ly pub­lished – it’s impres­sive if for no oth­er rea­son than the title.  This was pub­lished in Health Affairs, a lead­ing aca­d­e­m­ic jour­nal for health coverage.

    Bot­tom line – build­ing on pre­vi­ous­ly released results from study years one and two, the year three data again showed lit­tle evi­dence of improve­ments in employ­ees’ health at work­sites that offer typ­i­cal well­ness pro­grams includ­ing health risk assessments.

    BUT – while there may not be any deter­minable ROI, the study con­cedes that well­ness pro­grams are at least pop­u­lar so…

  • The Public Option is Back — We Hadn’t Seen It Since the Advent of the ACA| by Jordan Shields, Partner

    August 2, 2021

    Neva­da is gam­bling on the suc­cess of a pub­lic pri­vate part­ner­ship, where the state gov­ern­ment will now com­pete with insur­ance car­ri­ers while using those same insur­ance car­ri­ers to pro­vide a more afford­able health care option for state cit­i­zens.   They fol­low in the foot­steps of Col­orado and Wash­ing­ton, both of which just passed sim­i­lar leg­is­la­tion.  Illi­nois, New Mex­i­co and Ore­gon are con­sid­er­ing the same.

    The Neva­da law requires some insur­ers to bid to offer plans start­ing in 2026, with the goal to have these plans priced 5% less than oth­er pop­u­lar plans, and 15% less over four years.  The enforce­ment mech­a­nism has not yet been estab­lished.  The law is intend­ed to achieve low­er costs by pay­ing doc­tors, hos­pi­tals and oth­er providers less than what they are cur­rent­ly being reim­bursed by insur­ers.  This may end up resem­bling some of the “skin­ny net­works” which have already become noto­ri­ous in Cal­i­for­nia and oth­er states.  Not exact­ly a solu­tion, but a start…and we may see more of the same with­in the halls of Con­gress, as the pub­lic option may return there as a com­pro­mise mea­sure to ward of Medicare for All.

  • Exploring Benefits Lingo

    August 2, 2021

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    We all know how con­fus­ing and com­plex ben­e­fits and health­care terms can be- the dif­fer­ence between deductible and co-insur­ance is a com­mon ques­tion for many and there are plen­ty of oth­ers like it.  When you are com­fort­able and con­fi­dent in how your plan works, you can make an informed deci­sion on HOW to use and take advan­tage of your benefits!

    We have cre­at­ed a list and expla­na­tion of the most com­mon terms to help you under­stand and bet­ter uti­lize your health benefits:

    • Co-pay­ment:  An amount you pay as your share of the cost for a med­ical ser­vice or item, like a doc­tor’s vis­it.  Co-pays are most com­mon for emer­gency room, urgent care and pre­scrip­tion drugs. In some cas­es, you may be respon­si­ble for pay­ing a co-pay as well as a per­cent­age of the remain­ing charges.
    • Co-insur­ance:  Your share of the cost for a cov­ered health care ser­vice, usu­al­ly cal­cu­lat­ed as a per­cent­age (like 20%) of the allowed amount for the ser­vice. For exam­ple, if your plan has a 30% co-insur­ance rate, the car­ri­er will pay 70% of the allowed amount while you pay the balance.
    • Deductible: The amount you owe for cov­ered health care ser­vices before your health insur­ance or plan begins to pay.  For exam­ple, many plans require an indi­vid­ual to pay $1,000 in cumu­la­tive deductibles before they begin pay­ing out.
    • Depen­dent cov­er­age:  Health insur­ance cov­er­age extend­ed to the spouse and unmar­ried chil­dren up to age 26 who are total­ly or sub­stan­tial­ly reliant on their par­ents for sup­port, there­by defined as “depen­dent children”.
    • Expla­na­tion of Ben­e­fits (EOB): Every time you use your health insur­ance, your health plan sends you a record called an “expla­na­tion of ben­e­fits” (EOB) or “mem­ber health state­ment” that explains how much you owe. The EOB also shows the total cost of care, how much your plan paid and the amount an in-¬network doc­tor or oth­er health­care pro­fes­sion­al is allowed to charge a plan mem­ber (called the “allowed amount”).
    • In-Net­work Provider: A provider who has a con­tract with your health insur­er or plan to pro­vide ser­vices to you at a dis­count. In-Net­work Providers have con­tract­ed with the insur­ance car­ri­er to accept reduced fees for ser­vices pro­vid­ed to plan mem­bers. Using in-net­work providers will cost you less mon­ey. When con­tact­ing an In-Net­work Provider, remem­ber to ask, “are you a con­tract­ed provider with my plan?” Nev­er ask if a provider “takes” your insur­ance, as they will all take it. The key phrase is contracted.
    • Open Enroll­ment: A peri­od dur­ing which a health insur­ance com­pa­ny is required to accept appli­cants with­out regard to health history.
    • Out-of-Net­work Provider: A provider who doesn’t have a con­tract with your health insur­er or plan to pro­vide ser­vices to you at a pre-nego­ti­at­ed dis­count. You’ll pay more to see an out-of-net­work provider, some­times referred to as an out-of-net­work provider.
    • Out-of-Pock­et Max­i­mum: The lim­it or most you’ll pay out of your own pock­et for ser­vices dur­ing your insur­ance plan peri­od (usu­al­ly one year).
    • Pre­mi­um: The amount you pay for your health insur­ance or plan each month.
    • Qual­i­fy­ing Life Event (QLE): A change in your life that allows you to make changes to your ben­e­fits’ cov­er­age out­side of the annu­al open enroll­ment peri­od. These changes include a change in mar­i­tal sta­tus (mar­riage, divorce, death of spouse), a change in the num­ber of eli­gi­ble chil­dren (birth, adop­tion, death, aging-out), and a change in a fam­i­ly member’s ben­e­fits eli­gi­bil­i­ty under anoth­er plan (los­ing a job, Medicare or Med­ic­aid eli­gi­bil­i­ty, etc.)

    In addi­tion to under­stand­ing these com­mon terms, there are oth­er ways to uti­lize your ben­e­fits, save mon­ey and make an informed deci­sion based on your spe­cif­ic needs.

    • Flex­i­ble Spend­ing Account (FSA): Fund­ed through pre-tax pay­roll deduc­tions, an FSA is a cost-sav­ings tool that allows you to pay for qual­i­fied health­care-relat­ed expens­es with pre-tax dol­lars. Funds deposit­ed in an FSA must be spent in the same year in which they are set aside, or they are for­feit­ed. This rule is often referred to as “use it or lose it”.
    • Health Reim­burse­ment Account (HRA): An employ­er-fund­ed sav­ings plan that will reim­burse you for out-of-pock­et med­ical expens­es. Unlike an FSA, how­ev­er, you don’t “use it or lose it” – unused bal­ances will roll over and accu­mu­late over time, though the account can­not be “cashed-out.”
    • Health Sav­ings Account (HSA): A sav­ings prod­uct that serves as a sub­sti­tute for tra­di­tion­al health insur­ance. HSAs enable you to pay for cur­rent health costs. They also allow you to save for future med­ical and retiree health costs tax-free. Unlike an FSA, how­ev­er, you don’t “use it or lose it” – unused bal­ances will roll over and accu­mu­late over time and can be “cashed-out.”

    Under­stand­ing all of the terms and acronyms can feel like learn­ing a new lan­guage, so it’s help­ful to have a basic ref­er­ence chart.  With a good under­stand­ing of what some health­care “ben­e­fits lin­go” means, it will be eas­i­er to find a plan that meets your needs and bud­get. To explore more health­care terms, vis­it https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/common-health-benefit-terms-glossary.aspx

  • Another ACA Victory — the United States Supreme Court Refuses to Hear the Challenge| by Jordan Shields, Partner

    July 30, 2021

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    In CA vs. TX, a chal­lenge was made to whether or not the Afford­able Care Act was con­sti­tu­tion­al.  The Supreme Court isn’t say­ing it is or it isn’t, which means that they have said that, for now, it is, because they refused to hear the case.

  • IRS: Monthly Child Tax Credit payments begin

    July 28, 2021

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    WASHINGTON —TheIn­ter­nal Rev­enue Ser­vice and the Trea­sury Depart­ment announced today that mil­lions of Amer­i­can fam­i­lies have start­ed receiv­ing month­ly Child Tax Cred­it pay­ments as direct deposits begin post­ing in bank accounts and checks arrive in mailboxes.

    This first batch of advance month­ly pay­ments worth rough­ly $15 bil­lion reached about 35 mil­lion fam­i­lies today across the coun­try. About 86% were sent by direct deposit.

    The pay­ments will con­tin­ue each month. The IRS urged peo­ple who nor­mal­ly aren’t required to file a tax return to explore the tools avail­able on IRS.gov. These tools can help deter­mine eli­gi­bil­i­ty for the advance Child Tax Cred­it or help peo­ple file a sim­pli­fied tax return to sign up for these pay­ments as well as Eco­nom­ic Impact Pay­ments, and oth­er cred­its you may be eli­gi­ble to receive.

    Under the Amer­i­can Res­cue Plan, each pay­ment is up to $300 per month for each child under age 6 and up to $250 per month for each child ages 6 through 17. Nor­mal­ly, any­one who receives a pay­ment this month will also receive a pay­ment each month for the rest of 2021 unless they unen­roll. Besides the July 15 pay­ment, pay­ment dates are: Aug. 13, Sept. 15, Oct. 15, Nov. 15 and Dec. 15.

    Here are fur­ther details on these payments:

    • Fam­i­lies will see the direct deposit pay­ments in their accounts start­ing today, July 15. For those receiv­ing pay­ment by paper check, they should remem­ber to take into con­sid­er­a­tion the time it takes to receive it by mail.
    • Pay­ments went to eli­gi­ble fam­i­lies who filed 2019 or 2020 income tax returns.
    • Tax returns processed by June 28 are reflect­ed in these pay­ments. This includes peo­ple who don’t typ­i­cal­ly file a return, but dur­ing 2020 suc­cess­ful­ly reg­is­tered for Eco­nom­ic Impact Pay­ments using the IRS Non-Fil­ers tool or in 2021 suc­cess­ful­ly used the Non-fil­er Sign-up Tool for Advance CTC, also on IRS.gov.
    • Pay­ments are auto­mat­ic. Aside from fil­ing a tax return, includ­ing a sim­pli­fied return from the Non-Fil­er Sign-Up tool, fam­i­lies don’t have to do any­thing if they are eli­gi­ble to receive month­ly payments.

    Addi­tion­al infor­ma­tion is avail­able on a spe­cial Advance Child Tax Cred­it 2021 page, designed to pro­vide the most up-to-date infor­ma­tion about the cred­it and the advance payments.

    Orig­i­nal­ly post­ed on IRS.gov

  • It Could Happen Here — Things Move Down the Coast — Washington’s LTC Law| by Jordan Shields, Partner

    July 27, 2021

    The State of Wash­ing­ton has cre­at­ed a manda­to­ry long term care plan, fund­ed by employ­ees, and it takes effect Jan­u­ary 1, 2022.  Pay­ment is made through pay­roll tax deduc­tion.  The amount will be 58 cents for every $100 earned.

  • Let Every Community Create COVID Compliance — Sonoma County Ordinance| by Jordan Shields, Partner

    July 26, 2021

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    The Sono­ma Emer­gency Paid Sick Leave ordi­nance is not only in effect for 2021 but it is enact­ed retroac­tive­ly to Jan­u­ary 1, 2021.  It remains in effect through Sep­tem­ber 30, 2021.

    Essen­tial­ly, employ­ers are required to pro­vide 80 hours of paid leave for those work­ing 40 or more hours per week on a reg­u­lar basis (oth­er employ­ees worked as a pro­por­tion)  The amount may be off­set by what is already being pro­vid­ed employ­ees under the Cal­i­for­nia 2021 sup­ple­men­tal paid sick law.

    If an employ­ee has at least 80 hours of accrued paid sick leave or 1260 hours of paid sick leave, vaca­tion and paid time off, as of June 8, 2021, they have met the require­ment.  If by this date the employ­ee has few­er than these min­i­mums, employ­ers must make up the deficiency.

    From a prac­ti­cal stand­point, any employ­er with more than 25 employ­ees is already sub­ject to the Cal­i­for­nia law and this repli­cates it – those with few­er than 25 employ­ees will need to get up to speed on this law.

  • No Surprises Among the Prizes You Receive When You Get Medical Care| by Jordan Shields, Partner

    July 23, 2021

    Tags:

    The appro­pri­a­tions act passed ear­li­er this year con­tains a pro­vi­sion that expands the tra­di­tion­al Expla­na­tion of Ben­e­fits to what is now called an Advanced EOB.  Start­ing with plan years with a renew­al of Jan­u­ary 1, 2022, group health plans must pro­vide this on request.  This must contain

    1. Whether or not the provider or facil­i­ty is in net­work – if so, the con­tract­ed rate under the plan for the provider or service
    2. Good faith esti­mate of the cost of ser­vices to be pro­vid­ed, which includes the total cost of ser­vices, the amount of par­tic­i­pant cost shar­ing, the accrued amounts already met and the amount the plan is respon­si­ble for pay­ing (yes, just like EOBs are sup­posed to already)
    3. Dis­claimers that this is only an estimate

  • COBRA Subsidy Clarification| by Jordan Shields, Partner

    July 20, 2021

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    No the ini­tial infor­ma­tion was insuf­fi­cient, as with any hasti­ly con­trived rules.  For­tu­nate­ly, the IRS issued Notice 2021–31, which clar­i­fies in a brisk 86 ques­tions what every­one has been won­der­ing, but which most of us had sur­mised.  High­lights are:

    • The new Forms 941 (quar­ter­ly wage report, along with Sched­ule R) and 7200
    • The tax cred­it tak­en on the quar­ter­ly wage report is against the Medicare amount due
    • Employ­er may rely on indi­vid­ual attes­ta­tion that they are not eli­gi­ble for oth­er coverage
    • Avail­abil­i­ty of oth­er cov­er­age does not pre­clude exten­sion if they can­not yet enroll in it
    • Sec­ond qual­i­fy­ing events mere­ly con­tin­ue cov­er­age and thus the sub­sidy – no break
    • All basic cov­er­age is eli­gi­ble for a sub­sidy EXCEPT a health FSA (HRA IS included)
    • Retiree cov­er­age is includ­ed for pur­pos­es of the subsidy
    • Reduc­tion in hours is def­i­nite­ly seen as an invol­un­tary termination

    Most impor­tant­ly, the notice makes clear what con­sti­tutes Invol­un­tary Ter­mi­na­tion which, along with reduc­tion in hours, are the two qual­i­fy­ing events that allow for receipt of the subsidy:

    The Notice defines an invol­un­tary ter­mi­na­tion of employ­ment as a sev­er­ance from employ­ment due to the inde­pen­dent exer­cise of the employer’s uni­lat­er­al author­i­ty to ter­mi­nate the employ­ment, oth­er than due to the employee’s implic­it or explic­it request, where the employ­ee was will­ing and able to con­tin­ue per­form­ing ser­vices.  An employ­ee ini­ti­at­ed ter­mi­na­tion of employ­ment con­sti­tutes an invol­un­tary ter­mi­na­tion of employ­ment for pur­pos­es of the Sub­sidy if the ter­mi­na­tion of employ­ment con­sti­tutes a ter­mi­na­tion for a good reason.

    The notice is spe­cif­ic about some ter­mi­na­tion sce­nar­ios that qual­i­fy as invol­un­tary termination

    1. Non renew­al of an employee’s con­tract if the employ­ee was oth­er­wise will­ing to enter into a new con­tract or con­tin­ue employ­ment with­out a con­tract, assum­ing the employ­ee knows that the con­tract would only be for a lim­it­ed amount of time
    2. Par­tic­i­pa­tion in a win­dow pro­gram that meets appro­pri­ate Trea­sury requirements
    3. Employ­er ini­ti­at­ed action to end an individual’s employ­ment while the indi­vid­u­als is absent from work due to ill­ness or dis­abil­i­ty if, before the action, there is a rea­son­able expec­ta­tion that the employ­ee will return to work after the ill­ness or dis­abil­i­ty subsides.
    4. Invol­un­tary ter­mi­na­tion for cause, pro­vid­ed, how­ev­er, if the ter­mi­na­tion is due to gross mis­con­duct of the employ­ee, the loss of cov­er­age due to a ter­mi­na­tion of employ­ment for gross mis­con­duct will not result in an indi­vid­ual becom­ing eli­gi­ble for the subsidy

    The notice is equal­ly spe­cif­ic about what is NOT invol­un­tary ter­mi­na­tion – and thus employ­ees in these sit­u­a­tions are NOT eli­gi­ble for the subsidy

    1. An employ­ee ini­ti­at­ed ter­mi­na­tion of employ­ment due to the employee’s child being unable to attend school or child­care facil­i­ty due to COVID. If, how­ev­er, the employ­er main­tains the abil­i­ty to return to work so that the event is a tem­po­rary leave of absence, then the employ­ee could qual­i­fy for the pre­mi­um sub­sidy as a vol­un­tary reduc­tion in hours
    2. An employ­ee ini­ti­at­ed ter­mi­na­tion of employ­ment due to gen­er­al con­cerns about work­place safe­ty (unless employ­ee can demon­strate that the employer’s actions result­ed in a change to the employ­ment rela­tion­ship anal­o­gous to a con­struc­tive discharge)
    3. Ter­mi­na­tion due to gross mis­con­duct (note – be care­ful here, as the def­i­n­i­tion of what con­sti­tutes gross mis­con­duct is extreme­ly narrow)
    4. Retire­ment, unless the facts indi­cate that the employ­ee was will­ing to work and knew the employ­er was plan­ning on ter­mi­nat­ing the employee
    5. Death of the employee

  • PCORI Fee Continues as Part of How the Affordable Care Act Lives On — Due Soon| by Jordan Shields, Partner

    July 19, 2021

    Tags:

    The due date for fil­ing and pay­ing the Patient Cen­tered Out­come Research Insti­tute fee is August 2 this year.  For plan years that end­ed 1/1/20 through 9/30/20, the fee is $2.54 per cov­ered life.  For plan years 10/1/20 through 12/31/20 the fee is $2.66 per cov­ered life.

    The fee is for all self fund­ed med­ical and Health Reim­burse­ment Arrangements.

  • How to Stay on Track While on Vacation

    July 15, 2021

    Tags: ,


    Sum­mer is here and so many of us work hard to lose a few pounds before sum­mer vaca­tion but then get to our vaca­tions and ‘’want to live it up!’’ The prob­lem is that then we end up bloat­ed and unhap­py with those deci­sions.  Vaca­tion is sup­posed to be a time to relax and unwind and shouldn’t make you wor­ri­some or appre­hen­sive about your fit­ness goals.  Here are a few tips to stay on track with your goals while still being able to enjoy yourself:

    Make a Plan

    What are you look­ing for­ward to the most? Eat­ing at a cer­tain restau­rant? A cer­tain food in gen­er­al? Try to make good choic­es with your food and activ­i­ty all day so that you won’t feel guilty if you indulge in eat­ing your favorite burg­er. Allow your­self a splurge, enjoy it, but then move on and get back on track.

    Drink Water

    Drink­ing enough water may be the last thing you are think­ing about on vaca­tion but it is essen­tial for your health and to help you stay on track. Drink­ing water not only helps your body func­tion prop­er­ly but also helps you feel full before and dur­ing meals so you eat less.  Even the slight­est bit of dehy­dra­tion can cause you to believe you need food when, in real­i­ty, you just need some water.

    In addi­tion, water is a great choice to sub­sti­tute for alco­hol.  Drink­ing water is also a good way to slow down the amount of alco­hol you’re drink­ing and helps you to avoid hang­overs or get­ting the ‘’munchies’’ lat­er that night and the next day.

    Sched­ule in Movement

    Make a com­mit­ment to sched­ule in dai­ly move­ment.  The goal isn’t to make strength improve­ments or lose weight but rather to stay con­sis­tent to keep momen­tum. If you enjoy walk­ing, jog­ging, or bik­ing, it’s time to take go into the great out­doors to enjoy your new sur­round­ings. You can also engage in new oppor­tu­ni­ties to move your body in ways that aren’t avail­able to you at home, like:  surf­ing, swim­ming, rock climb­ing and pad­dle boarding.

    Don’t Skip Meals

    Whether you’re rush­ing to tourist sites or head­ing to the beach for the day, it’s easy to lose track of time and skip a meal.  But, skip­ping a meal can eas­i­ly lead to overeat­ing at your next meal.  Keep­ing your hunger in check is key so pack a few nutri­tious, pro­tein packed snacks when­ev­er you head out.

    Remem­ber Your Goals

    When you are strug­gling to turn down that sec­ond serv­ing of dessert, remem­ber why you want­ed to get healthy in the first place.  Is it to feel con­fi­dent? Get your cho­les­terol num­bers down? To be able to run and play with your kids? Find some­thing that you find moti­vat­ing and remind your­self sev­er­al times a day.

    Take a breath and enjoy life!

    Go danc­ing, bik­ing, swim­ming or go hik­ing! Vaca­tion is the time to slow down and enjoy the lit­tle moments.  This time away is impor­tant to your well­be­ing and men­tal health.

    Stay­ing on track on vaca­tion doesn’t have to mean per­fec­tion – it just means you have to strike a bal­ance. It is pos­si­ble to have a great time with­out sac­ri­fic­ing fun or sab­o­tag­ing all that hard work you put in before your trip.  Even with these tips, your diet progress may stall on vaca­tion (and that’s ok!).  As long as you’re not gain­ing weight, you’re still on track toward meet­ing your goals. Relax, enjoy your­self, and focus on mak­ing healthy choic­es when you can.

  • Exploring Heart Health

    July 12, 2021

    Tags: ,

    Heart­breaks are painful, but did you know that heart dis­ease is the lead­ing cause of death in the Unit­ed States, with more than 655,000 peo­ple dying from the con­di­tion each year. This equates to one in four deaths attrib­uted to this awful dis­ease. The most com­mon form of heart dis­ease is coro­nary artery dis­ease (CAD), which is what can cause heart attacks.

    CAD is caused when a sub­stance called plaque builds up in a person’s arter­ies. As the buildup grows, the open­ing of the arter­ies grad­u­al­ly clos­es until blood flow is blocked and the patient expe­ri­ences a heart attack. While these sta­tis­tics are sober­ing, there are sev­er­al ways we can pre­vent heart dis­ease. Know­ing the “why” about this dis­ease can aid in pre­ven­tion. First, let’s learn about the big three risk fac­tors of heart disease:

    High Blood Pressure

    High blood pres­sure (HBP) is the force of blood push­ing against blood ves­sel walls. This is what your nurse checks when she puts the blood pres­sure cuff on your arm and pumps air into it at your check-up. She is lis­ten­ing for the pres­sure when your heart beats and the pres­sure for when your heart is at rest between beats. High blood pres­sure usu­al­ly has no signs or symp­toms so it is very impor­tant to keep your annu­al phys­i­cal appoint­ments with your doc­tor and to fol­low her rec­om­men­da­tions if she diag­noses you with HBP.

    High Cho­les­terol

    High cho­les­terol is when you devel­op fat­ty deposits in your blood ves­sels. These deposits can lead to nar­row ves­sels and increase your chance of a heart attack. It is deter­mined through blood tests. While high cho­les­terol can be inher­it­ed, it can also be pre­vent­ed through med­ica­tion, diet and exercise.

    Smok­ing

    Smok­ers are four times more like­ly to devel­op heart dis­ease than non-smok­ers. The nico­tine in smoke reduces your blood flow, rais­es your blood pres­sure, and speeds up your heart. Quit­ting smok­ing will not reverse the dam­age done to your heart, but it great­ly reduces the dam­age going for­ward to your heart and arteries.

    In addi­tion to the three key risk fac­tors, it’s impor­tant to explore what we can do to pre­vent it. Pre­ven­tion behav­iors can take you from the dan­ger zone of heart dis­ease and put you on the path to a healthy heart.

    Heart Disease Prevention

    Healthy Diet

    Accord­ing to the Mayo Clin­ic, sim­ple tips to pre­vent heart dis­ease by diet include tips like these:  con­trol­ling por­tion size, eat­ing more veg­eta­bles and fruits, select­ing whole grains, lim­it­ing unhealthy fats, choos­ing low-fat pro­tein, reduc­ing sodi­um intake, and lim­it­ing treats.

    Healthy Weight

    Being over­weight increas­es your risk for heart dis­ease. One mea­sure used to deter­mine if your weight is in a healthy range is body mass index (BMI). If you know your weight and height, you can cal­cu­late your BMI at CDC’s Assess­ing Your Weight web­site. When in doubt, con­sult a physi­cian who can help in cal­cu­lat­ing whether your health is at risk due to weight.

    Phys­i­cal Activity

    Among the many ben­e­fits to get­ting enough phys­i­cal activ­i­ty can, it can help you main­tain a healthy weight and low­er your blood pres­sure, cho­les­terol, and sug­ar lev­els. From walk­ing, to swim­ming, to cycling, adding even mod­er­ate activ­i­ty to your rou­tine can have a great impact on your heart health. Just remem­ber, it’s always a good idea to check with your doc­tor before start­ing any new exer­cise regimen.

    Quit Smok­ing

    Smok­ing cig­a­rettes great­ly increas­es your risk for heart dis­ease. If you don’t smoke, don’t start. If you do smoke, quit­ting will low­er your risk for heart dis­ease. Your doc­tor can sug­gest ways to help you quit, and you can find many oth­er help­ful resources, includ­ing cre­at­ing a tai­lored plan to help you quit at SmokeFree.gov.

    Lim­it Alcohol

    There’s a good rea­son your doc­tor asks about rou­tine alco­hol con­sump­tion at each check-up. Drink­ing too much alco­hol can dras­ti­cal­ly raise blood pres­sure and binge drink­ing can increase heart rate. For heart health, the med­ical guide­lines state that men should have no more than two drinks per day, and women only one. Talk to your doc­tor if you aren’t sure whether or not you should drink alco­hol or how much you should drink for opti­mal heart health.

    Check out these great resources to bet­ter edu­cate your­self and oth­ers on heart health:

    Under­stand Your Risks to Pre­vent a Heart Attack

    Heart Health Information

    Strate­gies to Pre­vent Heart Disease

    Heart Health Tips

  • IRS Provides Guidance on Premium Assistance and Tax Credit for Continuation Health Coverage

    July 7, 2021

    Tags:

    WASHINGTON — The Inter­nal Rev­enue Ser­vice today pro­vid­ed guid­ance on tax breaks under the Amer­i­can Res­cue Plan Act of 2021 for con­tin­u­a­tion health cov­er­age under the Con­sol­i­dat­ed Omnibus Bud­get Rec­on­cil­i­a­tion Act of 1985 (COBRA).

    Notice 2021–31 PDF pro­vides guid­ance for employ­ers, plan admin­is­tra­tors, and health insur­ers regard­ing the new cred­it avail­able to them for pro­vid­ing con­tin­u­a­tion health cov­er­age to cer­tain indi­vid­u­als under COBRA.

    The Amer­i­can Res­cue Plan pro­vides a tem­po­rary 100% reduc­tion in the pre­mi­um that indi­vid­u­als would have to pay when they elect COBRA con­tin­u­a­tion health cov­er­age fol­low­ing a reduc­tion in hours or an invol­un­tary ter­mi­na­tion of employ­ment. The new law pro­vides a cor­re­spond­ing tax cred­it for the enti­ties that main­tain group health plans, such as employ­ers, mul­ti­em­ploy­er plans, and insur­ers. The 100% reduc­tion in the pre­mi­um and the cred­it are also avail­able with respect to con­tin­u­a­tion cov­er­age pro­vid­ed for those events under com­pa­ra­ble State laws, some­times referred to as “mini-COBRA.”

    Notice 2021–31 pro­vides infor­ma­tion regard­ing the cal­cu­la­tion of the cred­it, the eli­gi­bil­i­ty of indi­vid­u­als, the pre­mi­um assis­tance peri­od, and oth­er infor­ma­tion vital to employ­ers, plan admin­is­tra­tors, and insur­ers to under­stand the credit.

    COBRA pro­vides cer­tain for­mer employ­ees, retirees, spous­es, for­mer spous­es, and depen­dent chil­dren the right to tem­po­rary con­tin­u­a­tion of health cov­er­age at group rates. COBRA gen­er­al­ly cov­ers health plans main­tained by pri­vate-sec­tor employ­ers with 20 or more full and part-time employ­ees. It also cov­ers employ­ee orga­ni­za­tions or fed­er­al, state or local gov­ern­ments. State mini-COBRA laws often pro­vide sim­i­lar ben­e­fits for insured small employ­ers not sub­ject to Fed­er­al COBRA.

    The IRS will con­tin­ue to update infor­ma­tion relat­ed to health plans on IRS.gov.

    Orig­i­nal­ly post­ed on IRS.gov

     

  • Data Drop: D&I Appetite, Mental Health Struggles and the Expanding Gig Economy

    June 30, 2021

    Tags: , ,

    There are cer­tain issues that have tak­en cen­ter stage in the col­lec­tive con­scious when talk­ing about the work­place, the future of work and how the cur­rent work­force is far­ing under the cur­rent con­di­tions. Nat­u­ral­ly, as those things enter the col­lec­tive con­scious, researchers find them­selves ask­ing what exact­ly holds true and what can we learn from it?

    As usu­al, my inbox is full of the lat­est stud­ies and sur­veys being con­duct­ed by HR ven­dors, researchers and employ­ers of all sizes. In today’s data drop, we’re going to take a clos­er look at how employ­ees view diver­si­ty and inclu­sion efforts, what chal­lenges they’re fac­ing when it comes to men­tal health and the impact the gig econ­o­my is having.

    The D&I Appetite

    At this point, there should be lit­tle doubt around the impor­tance of D&I or DEI in your orga­ni­za­tion. It’s been well estab­lished the impact it has on the bot­tom line and employ­er brands, but if you need­ed more reas­sur­ance, the lat­est study from Boston Con­sult­ing Group should ham­mer it home.

    The study asked ques­tions of more than 200,000 employ­ees across 190 coun­tries and the results shouldn’t come as a sur­prise to any­one who’s been fol­low­ing sen­ti­ments around DEI over the last year. Results includ­ed the following:

    • More than half (51%) of U.S. respon­dents said they would exclude a com­pa­ny from their job search if its val­ues and stance on diver­si­ty and inclu­sion (D&I) didn’t match their own beliefs. This num­ber was even high­er among respon­dents 30 years and younger (56%).
    • D&I became more impor­tant over the last year across all age groups glob­al­ly. In the U.S., respon­dents 30 years and younger (72%) were most like­ly to agree with this state­ment com­pared to all U.S. respon­dents (63%) and all respon­dents glob­al­ly (69%).

    It’s a notable sen­ti­ment fol­low­ing the release of research by diver­si­ty plat­form Head­start as part of its “Dis­crim­i­na­tion in Amer­i­can Hir­ing” report. The find­ings show that 54% of those seek­ing a new job in the last two years felt they were fre­quent­ly dis­crim­i­nat­ed against. That num­ber rose to 66% for Black Amer­i­cans and 83% for those who iden­ti­fy as gen­der-diverse. Inter­est­ing­ly, how­ev­er, 30% of respon­dents who faced recruit­ment dis­crim­i­na­tion would con­sid­er reap­ply­ing for the same company.

    Mental Health Struggles

    In June of last year, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) released data which showed that 40% of Amer­i­cans were strug­gling with men­tal health. That num­ber hasn’t decreased as the pan­dem­ic has con­tin­ued and the months that fol­lowed includ­ed a hec­tic elec­tion and numer­ous oth­er crises.

    A more recent report from The Stan­dard, an Ore­gon based insur­ance com­pa­ny, showed that 55% of work­ers sur­veyed said that a men­tal health issue had affect­ed them more since the pan­dem­ic began. MetLife’s annu­al Employ­ee Ben­e­fits Trends Study backs this up, with 54% say­ing men­tal health has been their biggest con­cern dur­ing the pandemic.

    This won’t come as a sur­prise to HR teams that have been work­ing toward devel­op­ing men­tal health sup­port tools for their work­forces, but it should also be extend­ed to tal­ent teams as they con­sid­er their hir­ing processes.

    Among the unem­ployed, one in five are or have been treat­ed for depres­sion in the last year. Many suf­fer from sleep loss and high lev­els of stress that can impact their abil­i­ty to search and inter­view for a new job. Long term unem­ploy­ment can lead to seri­ous health issues such as obe­si­ty and oth­er con­di­tions relat­ed to stress and inac­tive lifestyle.

    Expanding Gig Economy

    Glob­al­ly the gig econ­o­my has seen a boom as lay­offs and needs for flex­i­ble sched­ul­ing have seen more peo­ple around the world adopt gig work than ever before. In the U.S., around 40% of Amer­i­cans are cur­rent­ly work­ing in gig or con­tract roles.

    Job boards are now see­ing a stark rise in con­tract job post­ings, with Resume-Library not­ing a 58% increase in the demand for handy­man roles month over month. While many think of rideshare dri­vers and free­lancer graph­ic artists when they think of gig work, the top five gig post­ings on the site now include the following:

    • Handy­man +58.3%
    • Mar­ket Researcher +50%
    • Pack­er +20.3%
    • Social Media +4.5%
    • Pho­tog­ra­ph­er +4.3%

    The U.S. is cur­rent­ly the fastest grow­ing free­lance mar­ket in the world, expe­ri­enc­ing a 78% growth in gig posi­tions over the last year, with the UK fol­low­ing behind at 59% and Brazil at 48%.

    By David Rice

    Orig­i­nal­ly post­ed on ThinkHR

  • Exploring In-Network and Out-of-Network Benefits

    June 16, 2021

    Tags: , ,

    You have sure­ly heard the terms “in-net­work” and “out-of-net­work” when refer­ring to doc­tors or care facil­i­ties and your insur­ance plan. It can be con­fus­ing and make you won­der why it mat­ters to you, as the con­sumer. Let’s explore these terms and find out more!

    What are Health Insur­ance Plan Networks?

    Health insur­ance plans cre­ate net­works of doc­tors and facil­i­ties with which they have con­tract­ed to accept nego­ti­at­ed rates for the ser­vices they pro­vide.  When you sub­scribe to a spe­cif­ic insur­ance plan, you can look up the list of these con­tract­ed providers to see which ones are “in-net­work.” Most plans have help­ful search tools online like “Find a Doc­tor” to save you time as you look for your spe­cif­ic doc­tor. You can also call the facil­i­ty or health­care provider and ask if they are con­sid­ered “in-net­work” or “out-of-net­work” for your par­tic­u­lar health insur­ance plan.

    Why Choose “In-net­work” Providers?

    When you make the choice to see an “in-net­work” health­care provider or vis­it an “in-net­work” facil­i­ty, you will typ­i­cal­ly pay less for the ser­vice (doc­tor vis­it, screen­ing, hos­pi­tal stay, etc.) than if you chose to use a provider out­side of the plan’s net­work. Your insur­ance plan has nego­ti­at­ed a dis­count­ed cost for the ser­vice and pass­es that sav­ings on to you, the sub­scriber. See the table below for an example.

    Addi­tion­al Ben­e­fit to “In-Net­work” Care

    Some health insur­ance plans allow you to vis­it “out-of-net­work” doc­tors and facil­i­ties with the under­stand­ing that you will pay more for these ser­vices since they are not in an agree­ment with one anoth­er. How­ev­er, you may not be able to apply these expens­es towards your annu­al deductible.  This means it may take you longer in the year, with more out-of-pock­et expens­es, to reach your deductible. Stay­ing “in-net­work” alle­vi­ates this delay and any added costs.

    Stay­ing with “in-net­work” providers tru­ly equals greater cost-sav­ings to the con­sumer. By doing a lit­tle research upfront to find the doc­tors and facil­i­ties in your plan net­work, you will end up with less out-of-pock­et expens­es for your health care each year. While the choice is ulti­mate­ly up to you on who you see for your care, look­ing with­in your plan net­work will reap you great benefits.

  • IRS Announces HSA Limits for 2022

    June 9, 2021

    Tags:

    On May 10, 2021, the Inter­nal Rev­enue Ser­vice (IRS) released Rev­enue Pro­ce­dure 2021–25 announc­ing the annu­al infla­tion-adjust­ed lim­its for health sav­ings accounts (HSAs) for cal­en­dar year 2022. An HSA is a tax-exempt sav­ings account that employ­ees can use to pay for qual­i­fied health expenses.

    To be eli­gi­ble for an HSA, an employee:

    • Must be cov­ered by a qual­i­fied high deductible health plan (HDHP);
    • Must not have any dis­qual­i­fy­ing health cov­er­age (called “imper­mis­si­ble non-HDHP coverage”);
    • Must not be enrolled in Medicare; and
    • May not be claimed as a depen­dent on some­one else’s tax return.

    The lim­its vary based on whether an indi­vid­ual has self-only or fam­i­ly cov­er­age under an HDHP. The lim­its are as follows:

    • 2022 HSA con­tri­bu­tion limit:
    • Sin­gle: $3,650 (an increase of $50 from 2021)
    • Fam­i­ly: $7,300 (an increase of $100 from 2021)
    • Catch-up con­tri­bu­tions for those age 55 and old­er remains at $1,000
    • 2022 HDHP min­i­mum deductible*
    • Sin­gle: $1,400 (no change from 2021)
    • Fam­i­ly: $2,800 (no change from 2021)
    • 2022 HDHP max­i­mum out-of-pock­et limit:
    • Sin­gle: $7,050 (an increase of $50 from 2021)
    • Fam­i­ly: $14,100** (an increase of $100 from 2021)

    *   The deductible does not apply to pre­ven­tive care ser­vices nor to ser­vices relat­ed to test­ing for COVID-19. An HDHP also may choose to waive the deductible for cov­er­age of COVID-19 treat­ment, and/or tele­health and oth­er remote care services.

    **   If the HDHP is a non-grand­fa­thered plan, a per-per­son lim­it of $8,700 also will apply due to the Afford­able Care Act’s cost-shar­ing pro­vi­sion for essen­tial health benefits.

    By Kathy Berger

    Orig­i­nal­ly post­ed on Mineral.com

  • Important Tips for Men’s Health

    June 2, 2021

    Tags: ,

    We have cer­tain­ly been focused on improv­ing our health this year. June is Men’s Health Month and pro­vides a great oppor­tu­ni­ty to focus on some sim­ple tips that men can fol­low to shore up their health. These five guide­lines will not only assist with a man’s phys­i­cal health, but also their men­tal health.

    Make Annu­al Appointments

    Men are noto­ri­ous­ly the punch­line for jokes about not going to the doc­tor until they are on their death bed. Let’s stop the jok­ing! Annu­al check-ups ensure you and your doc­tor are both aware of your health issues. Annu­al exams and blood tests can look at blood pres­sure, warn­ing signs of heart dis­ease, obe­si­ty, and cho­les­terol. Stay­ing on top of these health issues through reg­u­lar doctor’s vis­its can extend your life and improve your over­all health.

    Eat a Healthy Diet

    A healthy diet does not mean eat­ing just sal­ads. Look at MyPlate.gov to see what a healthy plate should look like for each meal. Cut down on sug­ar intake, make half your meal fruits and veg­eta­bles, and vary up your pro­tein rou­tine. Healthy food choic­es do more than assist with weight loss, they also decrease your risk for heart dis­ease, dia­betes, and stroke.

    Know Your Fam­i­ly History

    Does your fam­i­ly have a his­to­ry of can­cer? What about heart dis­ease? Men who know their family’s med­ical his­to­ry can share this infor­ma­tion with their doc­tor so that they can be bet­ter informed about pos­si­ble issues in the future. Know­ing that your fam­i­ly has cer­tain pro­cliv­i­ties to dis­ease, allows you to go on the offen­sive with your health. Write down your med­ical his­to­ry and that of your par­ents and close relatives.

    Get Your Sleep

    Adults need 7–9 hours of sleep each night. Accord­ing to the Sleep Foun­da­tion, “Sleep allows the brain and body to slow down and engage in process­es of recov­ery, pro­mot­ing bet­ter phys­i­cal and men­tal per­for­mance the next day and over the long-term.” Men should make sure they get enough sleep each night because poor sleep is also close­ly relat­ed to increased chances of obe­si­ty, heart dis­ease, dia­betes, and depres­sion. Sleep is an essen­tial part of a healthy lifestyle.

    Strength­en Your Rela­tion­ship Bonds

    Con­nect­ing with oth­ers has been proven to improve your over­all health and even extend your life. As we grow old­er, rela­tion­ships are hard­er to build as fam­i­lies are built, jobs change, and inter­ests evolve. We’ve all seen how iso­la­tion and social dis­tanc­ing neg­a­tive­ly affect our men­tal health this year. Sol­id rela­tion­ships allow you to have account­abil­i­ty with oth­ers about strug­gles you may have, give you a net­work of sup­port in a health cri­sis, and even improve your self-esteem. When you have good men­tal health, your phys­i­cal health will also be affect­ed. Men must work to cre­ate and main­tain rela­tion­ship bonds for the sake of their men­tal and phys­i­cal well-being.

    The men­tal and phys­i­cal health of the men in our lives can eas­i­ly be improved by fol­low­ing these sim­ple tips. From get­ting enough sleep to eat­ing a healthy diet, these guide­lines are cer­tain­ly a great way to kick-off a healthy rou­tine in your life.

  • FAQs About Cobra Premium Assistance Under The American Rescue Plan Act of 2021

    May 26, 2021

    April 07, 2021 

    Set out below are Fre­quent­ly Asked Ques­tions (FAQs) regard­ing imple­men­ta­tion of cer­tain pro­vi­sions of the Amer­i­can Res­cue Plan Act of 2021 (ARP), as it applies to the Con­sol­i­dat­ed Omnibus Bud­get Rec­on­cil­i­a­tion Act of 1985, com­mon­ly called COBRA. These FAQs have been pre­pared by the Depart­ment of Labor (DOL). Like pre­vi­ous­ly issued FAQs (avail­able at https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs), these FAQs answer ques­tions from stake­hold­ers to help indi­vid­u­als under­stand the law and ben­e­fit from it, as intend­ed. The Depart­ment of the Trea­sury and the Inter­nal Rev­enue Ser­vice (IRS) have reviewed these FAQs, and, con­cur in the appli­ca­tion of the laws under their juris­dic­tion as set forth in these FAQs.

    COBRA Con­tin­u­a­tion Coverage

    COBRA con­tin­u­a­tion cov­er­age pro­vides cer­tain group health plan con­tin­u­a­tion cov­er­age rights for par­tic­i­pants and ben­e­fi­cia­ries cov­ered by a group health plan. In gen­er­al, under COBRA, an indi­vid­ual who was cov­ered by a group health plan on the day before the occur­rence of a qual­i­fy­ing event (such as a ter­mi­na­tion of employ­ment or a reduc­tion in hours that caus­es loss of cov­er­age under the plan) may be able to elect COBRA con­tin­u­a­tion cov­er­age upon that qual­i­fy­ing event. [1]  Indi­vid­u­als with such a right are referred to as qual­i­fied ben­e­fi­cia­ries. Under COBRA, group health plans must pro­vide cov­ered employ­ees and their fam­i­lies with cer­tain notices explain­ing their COBRA rights.

    ARP COBRA Pre­mi­um Assistance 

    Sec­tion 9501 of the ARP pro­vides for COBRA pre­mi­um assis­tance to help Assis­tance Eli­gi­ble Indi­vid­u­als (as defined below in Q3) con­tin­ue their health ben­e­fits. The pre­mi­um assis­tance is also avail­able for con­tin­u­a­tion cov­er­age under cer­tain State laws. Assis­tance Eli­gi­ble Indi­vid­u­als are not required to pay their COBRA con­tin­u­a­tion cov­er­age pre­mi­ums. The pre­mi­um assis­tance applies to peri­ods of health cov­er­age on or after April 1, 2021 through Sep­tem­ber 30, 2021. An employ­er or plan to whom COBRA pre­mi­ums are payable is enti­tled to a tax cred­it for the amount of the pre­mi­um assistance.

    Gen­er­al Information 

    Q1: I have heard that the ARP includ­ed tem­po­rary COBRA pre­mi­um assis­tance to pay for health cov­er­age. I would like more information. 

    The ARP pro­vides tem­po­rary pre­mi­um assis­tance for COBRA con­tin­u­a­tion cov­er­age for Assis­tance Eli­gi­ble Indi­vid­u­als (see Q3 to deter­mine if you are eli­gi­ble). COBRA allows cer­tain peo­ple to extend employ­ment-based group health plan cov­er­age, if they would oth­er­wise lose the cov­er­age due to cer­tain life events such as loss of a job.

    Indi­vid­u­als may be eli­gi­ble for pre­mi­um assis­tance if they are eli­gi­ble for and elect COBRA con­tin­u­a­tion cov­er­age because of their own or a fam­i­ly member’s reduc­tion in hours or an invol­un­tary ter­mi­na­tion from employ­ment. This pre­mi­um assis­tance is avail­able for peri­ods of cov­er­age from April 1, 2021 through Sep­tem­ber 30, 2021. This pre­mi­um assis­tance is gen­er­al­ly avail­able for con­tin­u­a­tion cov­er­age under the Fed­er­al COBRA pro­vi­sions, as well as for group health insur­ance cov­er­age under com­pa­ra­ble state con­tin­u­a­tion cov­er­age (“mini-COBRA”) laws.

    If you were offered Fed­er­al COBRA con­tin­u­a­tion cov­er­age as a result of a reduc­tion in hours or an invol­un­tary ter­mi­na­tion of employ­ment, and you declined to take COBRA con­tin­u­a­tion cov­er­age at that time, or you elect­ed Fed­er­al COBRA con­tin­u­a­tion cov­er­age and lat­er dis­con­tin­ued it, you may have anoth­er oppor­tu­ni­ty to elect COBRA con­tin­u­a­tion cov­er­age and receive the pre­mi­um assis­tance, if the max­i­mum peri­od you would have been eli­gi­ble for COBRA con­tin­u­a­tion cov­er­age has not yet expired (if COBRA con­tin­u­a­tion cov­er­age had been elect­ed or not discontinued).

    Q2: Which plans does the pre­mi­um assis­tance apply to? 

    The COBRA pre­mi­um assis­tance pro­vi­sions apply to all group health plans spon­sored by pri­vate-sec­tor employ­ers or employ­ee orga­ni­za­tions (unions) sub­ject to the COBRA rules under the Employ­ee Retire­ment Income Secu­ri­ty Act of 1974 (ERISA). They also apply to plans spon­sored by State or local gov­ern­ments sub­ject to the con­tin­u­a­tion pro­vi­sions under the Pub­lic Health Ser­vice Act. The pre­mi­um assis­tance is also avail­able for group health insur­ance required under state mini-COBRA laws. Q3: How can I tell if I am eli­gi­ble to receive the COBRA pre­mi­um assis­tance? The ARP makes the pre­mi­um assis­tance avail­able for “Assis­tance Eli­gi­ble Indi­vid­u­als.” An Assis­tance Eli­gi­ble Indi­vid­ual is a COBRA qual­i­fied ben­e­fi­cia­ry who meets the fol­low­ing require­ments dur­ing the peri­od from April 1, 2021 through Sep­tem­ber 30, 2021:

    • Is eli­gi­ble for COBRA con­tin­u­a­tion cov­er­age by rea­son of a qual­i­fy­ing event that is a reduc­tion in hours (such as reduced hours due to change in a business’s hours of oper­a­tions, a change from full-time to part-time sta­tus, tak­ing of a tem­po­rary leave of absence, or an individual’s par­tic­i­pa­tion in a law­ful labor strike, as long as the indi­vid­ual remains an employ­ee at the time that hours are reduced) or an invol­un­tary ter­mi­na­tion of employ­ment (not includ­ing a vol­un­tary ter­mi­na­tion); and
    • Elects COBRA con­tin­u­a­tion coverage.

    How­ev­er, you are not eli­gi­ble for the pre­mi­um assis­tance if you are eli­gi­ble for oth­er group health cov­er­age, such as through a new employer’s plan or a spouse’s plan (not includ­ing except­ed ben­e­fits, a qual­i­fied small employ­er health reim­burse­ment arrange­ment (QSEHRA), or a health flex­i­ble spend­ing arrange­ment (FSA)), or if you are eli­gi­ble for Medicare. Note that if you have indi­vid­ual health insur­ance cov­er­age, like a plan through the Health Insur­ance Mar­ket­place®[2]  , or if you have Med­ic­aid, you may be eli­gi­ble for ARP pre­mi­um assis­tance. How­ev­er, if you elect to enroll in COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance, you will no longer be eli­gi­ble for a pre­mi­um tax cred­it, advance pay­ments of the pre­mi­um tax cred­it, or the health insur­ance tax cred­it for your health cov­er­age dur­ing that period.

    Note: If the employee’s ter­mi­na­tion of employ­ment was for gross mis­con­duct, the employ­ee and any depen­dents would not qual­i­fy for COBRA con­tin­u­a­tion cov­er­age or the pre­mi­um assistance.

    Q4: If I am eli­gi­ble for the pre­mi­um assis­tance, how long will it last? 

    Your pre­mi­um assis­tance can last from April 1, 2021 through Sep­tem­ber 30, 2021. How­ev­er, it will end ear­li­er if:

    • You become eli­gi­ble for anoth­er group health plan, such as a plan spon­sored by a new employ­er or a spouse’s employ­er (not includ­ing except­ed ben­e­fits, a QSEHRA, or a health FSA), or you become eli­gi­ble for Medicare**, or
    • You reach the end of your max­i­mum COBRA con­tin­u­a­tion cov­er­age period.

    If you con­tin­ue your COBRA con­tin­u­a­tion cov­er­age after the pre­mi­um assis­tance peri­od, you may have to pay the full amount of the pre­mi­um oth­er­wise due. Fail­ure to do so may result in your loss of COBRA con­tin­u­a­tion cov­er­age. Con­tact your plan admin­is­tra­tor, employ­er spon­sor­ing the plan, or health insur­ance issuer for more information.

    When your COBRA pre­mi­um assis­tance ends, you may be eli­gi­ble for Med­ic­aid or a spe­cial enroll­ment peri­od to enroll in cov­er­age through the Health Insur­ance Mar­ket­place® or to enroll in indi­vid­ual mar­ket health insur­ance cov­er­age out­side of the Mar­ket­place. A spe­cial enroll­ment peri­od is also avail­able when you reach the end of your max­i­mum COBRA cov­er­age peri­od. You may apply for and, if eli­gi­ble, enroll in Med­ic­aid cov­er­age at any time. For more infor­ma­tion, go to: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/.

    **Indi­vid­u­als receiv­ing the COBRA pre­mi­um assis­tance must noti­fy their plans if they become eli­gi­ble for cov­er­age under anoth­er group health plan (not includ­ing except­ed ben­e­fits, a QSEHRA, or a health FSA), or for Medicare. Fail­ure to do so can result in a tax penalty.

    Q5: Who is eli­gi­ble for an addi­tion­al elec­tion oppor­tu­ni­ty for COBRA con­tin­u­a­tion coverage? 

    A qual­i­fied ben­e­fi­cia­ry whose qual­i­fy­ing event was a reduc­tion in hours or an invol­un­tary ter­mi­na­tion of employ­ment pri­or to April 1, 2021 and who did not elect COBRA con­tin­u­a­tion cov­er­age when it was first offered pri­or to that date or who elect­ed COBRA con­tin­u­a­tion cov­er­age but is no longer enrolled (for exam­ple, an indi­vid­ual who dropped COBRA con­tin­u­a­tion cov­er­age because he or she was unable to con­tin­ue pay­ing the pre­mi­um) may have an addi­tion­al elec­tion oppor­tu­ni­ty at this time. Indi­vid­u­als eli­gi­ble for this addi­tion­al COBRA elec­tion peri­od must receive a notice of extend­ed COBRA elec­tion peri­od inform­ing them of this oppor­tu­ni­ty. This notice must be pro­vid­ed with­in 60 days of the first day of the first month begin­ning after the date of the enact­ment of the ARP (so, by May 31, 2021) and indi­vid­u­als have 60 days after the notice is pro­vid­ed to elect COBRA. How­ev­er, this addi­tion­al elec­tion peri­od does not extend the peri­od of COBRA con­tin­u­a­tion cov­er­age beyond the orig­i­nal max­i­mum peri­od (gen­er­al­ly 18 months from the employ­ee’s reduc­tion in hours or invol­un­tary ter­mi­na­tion). COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance elect­ed in this addi­tion­al elec­tion peri­od begins with the first peri­od of cov­er­age begin­ning on or after April 1, 2021. Indi­vid­u­als can begin their cov­er­age prospec­tive­ly from the date of their elec­tion, or, if an indi­vid­ual has a qual­i­fy­ing event on or before April 1st, choose to start their cov­er­age as of April 1st, even if the indi­vid­ual receives an elec­tion notice and makes such elec­tion at a lat­er date. In either case, please note that the pre­mi­um assis­tance is only avail­able for peri­ods of cov­er­age from April 1, 2021 through Sep­tem­ber 30,2021.

    Due to the COVID-19 Nation­al Emer­gency, the DOL, the Depart­ment of the Trea­sury, and the IRS issued a Notice of Exten­sion of Cer­tain Time­frames for Employ­ee Ben­e­fit Plans, Par­tic­i­pants, and Ben­e­fi­cia­ries Affect­ed by the COVID–19 Out­break (“Joint Notice”).[3]  This notice pro­vid­ed relief for cer­tain actions relat­ed to employ­ee ben­e­fit plans required or per­mit­ted under Title I of ERISA and the Code, includ­ing the 60-day ini­tial elec­tion peri­od for COBRA con­tin­u­a­tion cov­er­age. The DOL’s Employ­ee Ben­e­fits Secu­ri­ty Admin­is­tra­tion (EBSA) pro­vid­ed fur­ther guid­ance on this relief in EBSA Dis­as­ter Relief Notice 2021-01. [4]  This extend­ed dead­line relief pro­vid­ed in the Joint Notice and Notice 2021-01 does not apply, how­ev­er, to the 60-day notice or elec­tion peri­ods relat­ed to COBRA pre­mi­um assis­tance under the ARP.

    Q6: Does the ARP change any State pro­gram require­ments or time peri­ods for elec­tion of con­tin­u­a­tion coverage? 

    No. The ARP does not change any require­ment of a State con­tin­u­a­tion cov­er­age pro­gram. The ARP only allows Assis­tance Eli­gi­ble Indi­vid­u­als who elect con­tin­u­a­tion cov­er­age under State insur­ance law to receive pre­mi­um assis­tance from April 1, 2021 through Sep­tem­ber 30, 2021. It also allows Assis­tance Eli­gi­ble Indi­vid­u­als to switch to oth­er cov­er­age offered to sim­i­lar­ly sit­u­at­ed active employ­ees if the plan allows it, pro­vid­ed that the new cov­er­age is no more expen­sive than the pri­or cov­er­age. See Q15 and Q17 for more information.

    Pre­mi­ums

    Q7: How do I apply for the pre­mi­um assistance? 

    If you were cov­ered by an employ­ment-based group health plan on the last day of your employ­ment or a fam­i­ly member’s employ­ment (or the last day before your or your fam­i­ly member’s reduc­tion in hours caus­ing a loss of cov­er­age), the plan or issuer should pro­vide you and your ben­e­fi­cia­ries with a notice of your eli­gi­bil­i­ty to elect COBRA con­tin­u­a­tion cov­er­age and to receive the pre­mi­um assis­tance. The notice should include any forms nec­es­sary for enroll­ment, includ­ing forms to indi­cate that you are an Assis­tance Eli­gi­ble Indi­vid­ual and that you are not eli­gi­ble for anoth­er group health plan (this does not include except­ed ben­e­fits, a QSEHRA, or a health FSA), or eli­gi­ble for Medicare.

    If you believe you are (or may be, upon a COBRA elec­tion) an Assis­tance Eli­gi­ble Indi­vid­ual and have not received a notice from your employ­er, you may noti­fy your employ­er of your request for treat­ment as an Assis­tance Eli­gi­ble Indi­vid­ual (for exam­ple, using the “Request for Treat­ment as an Assis­tance Eli­gi­ble Indi­vid­ual Form” that is attached to the Sum­ma­ry of COBRA Pre­mi­um Assis­tance Pro­vi­sions under the Amer­i­can Res­cue Plan Act of 2021) for peri­ods of cov­er­age start­ing April 1, 2021. If you are an Assis­tance Eli­gi­ble Indi­vid­ual, the ARP pro­vides that you must be treat­ed, for pur­pos­es of COBRA, as hav­ing paid in full the amount of such pre­mi­um from April 1, 2021 through Sep­tem­ber 30, 2021. [5]  Accord­ing­ly, plans and issuers should not col­lect pre­mi­um pay­ments from Assis­tance Eli­gi­ble Indi­vid­u­als and sub­se­quent­ly require them to seek reim­burse­ment of the pre­mi­ums for peri­ods of cov­er­age begin­ning on or after April 1, 2021, and pre­ced­ing the date on which an employ­er sends an elec­tion notice, if an indi­vid­ual has made an appro­pri­ate request for such treat­ment. You should con­tact your plan or issuer direct­ly to ask about tak­ing advan­tage of the pre­mi­um assistance.

    Q8: How will the pre­mi­um assis­tance be pro­vid­ed to me? 

    You will not receive a pay­ment of the pre­mi­um assis­tance. Instead, Assis­tance Eli­gi­ble Indi­vid­u­als do not have to pay any of the COBRA pre­mi­um for the peri­od of cov­er­age from April 1, 2021 through Sep­tem­ber 30, 2021. The pre­mi­um is reim­bursed direct­ly to the employ­er, plan admin­is­tra­tor, or insur­ance com­pa­ny through a COBRA pre­mi­um assis­tance credit.

    Q9: Am I required to pay any admin­is­tra­tive fees? 

    If you are an Assis­tance Eli­gi­ble Indi­vid­ual, you will not need to pay any part of what you would oth­er­wise pay for your COBRA con­tin­u­a­tion cov­er­age, includ­ing any admin­is­tra­tion fee that would oth­er­wise be charged.

    Notices

    Q10: Does the ARP impose any new notice requirements? 

    Yes, plans and issuers are required to noti­fy qual­i­fied ben­e­fi­cia­ries regard­ing the pre­mi­um assis­tance and oth­er infor­ma­tion about their rights under the ARP, as follows:

    • A gen­er­al notice to all qual­i­fied ben­e­fi­cia­ries who have a qual­i­fy­ing event that is a reduc­tion in hours or an invol­un­tary ter­mi­na­tion of employ­ment from April 1, 2021 through Sep­tem­ber 30, 2021. This notice may be pro­vid­ed sep­a­rate­ly or with the COBRA elec­tion notice fol­low­ing a COBRA qual­i­fy­ing event.
    • A notice of the extend­ed COBRA elec­tion peri­od to any Assis­tance Eli­gi­ble Indi­vid­ual (or any indi­vid­ual who would be an Assis­tance Eli­gi­ble Indi­vid­ual if a COBRA con­tin­u­a­tion cov­er­age elec­tion were in effect) who had a qual­i­fy­ing event before April 1, 2021. This require­ment does not include those indi­vid­u­als whose max­i­mum COBRA con­tin­u­a­tion cov­er­age peri­od, if COBRA had been elect­ed or not dis­con­tin­ued, would have end­ed before April 1, 2021 (gen­er­al­ly, those with applic­a­ble qual­i­fy­ing events before Octo­ber 1, 2019). This notice must be pro­vid­ed with­in 60 days fol­low­ing April 1, 2021 (that is, by May 31, 2021).

    The ARP also requires that plans and issuers pro­vide indi­vid­u­als with a notice of expi­ra­tion of peri­ods of pre­mi­um assis­tance explain­ing that the pre­mi­um assis­tance for the indi­vid­ual will expire soon, the date of the expi­ra­tion, and that the indi­vid­ual may be eli­gi­ble for cov­er­age with­out any pre­mi­um assis­tance through COBRA con­tin­u­a­tion cov­er­age or cov­er­age under a group health plan. Cov­er­age may also be avail­able through Med­ic­aid or the Health Insur­ance Mar­ket­place®. This notice must be pro­vid­ed 15 — 45 days before the individual’s pre­mi­um assis­tance expires.

    Unless specif­i­cal­ly mod­i­fied by the ARP, the exist­ing require­ments for the man­ner and tim­ing of COBRA notices con­tin­ue to apply. Due to the COVID-19 Nation­al Emer­gency, DOL, the Depart­ment of the Trea­sury, and the IRS issued guid­ance extend­ing time­frames for cer­tain actions relat­ed to health cov­er­age under pri­vate-sec­tor employ­ment-based group health plans. [6] The exten­sions under the Joint Notice and EBSA Dis­as­ter Relief Notice 2021-01 do not apply, how­ev­er, to the notices or the elec­tion peri­ods relat­ed to COBRA pre­mi­um assi­tance avail­able under the ARP. There­fore, plans and issuers must pro­vide the notices accord­ing to the time­frames spec­i­fied in the ARP (out­lined above).

    DOL is com­mit­ted to ensur­ing that indi­vid­u­als receive the ben­e­fits to which they are enti­tled under the ARP. Employ­ers or mul­ti­em­ploy­er plans may also be sub­ject to an excise tax under the Inter­nal Rev­enue Code for fail­ing to sat­is­fy the COBRA con­tin­u­a­tion cov­er­age require­ments. This tax could be as much as $100 per qual­i­fied ben­e­fi­cia­ry, but not more than $200 per fam­i­ly, for each day that the tax­pay­er is in vio­la­tion of the COBRA rules.

    Q11: What infor­ma­tion must the notices include? 

    The notices must include the fol­low­ing information:

    • The forms nec­es­sary for estab­lish­ing eli­gi­bil­i­ty for the pre­mi­um assistance;
    • Con­tact infor­ma­tion for the plan admin­is­tra­tor or oth­er per­son main­tain­ing rel­e­vant infor­ma­tion in con­nec­tion with the pre­mi­um assistance;
    • A descrip­tion of the addi­tion­al elec­tion peri­od (if applic­a­ble to the individual);
    • A descrip­tion of the require­ment that the Assis­tance Eli­gi­ble Indi­vid­ual noti­fy the plan when he/she becomes eli­gi­ble for cov­er­age under anoth­er group health plan (not includ­ing except­ed ben­e­fits, a QSEHRA, or a health FSA), or eli­gi­ble for Medicare and the penal­ty for fail­ing to do so;
    • A descrip­tion of the right to receive the pre­mi­um assis­tance and the con­di­tions for enti­tle­ment; and
    • If offered by the employ­er, a descrip­tion of the option to enroll in a dif­fer­ent cov­er­age option avail­able under the plan

    Q12: Will there be mod­el notices? 

    Yes. DOL has devel­oped mod­el notices that are avail­able at https://www.dol.gov/cobra-subsidy.

    Indi­vid­ual Ques­tions For Employ­ees And Their Families 

    Q13: How much time do I have to enroll in COBRA con­tin­u­a­tion coverage? 

    In gen­er­al, indi­vid­u­als who are eli­gi­ble for COBRA con­tin­u­a­tion cov­er­age have 60 days after the date that they ini­tial­ly receive their COBRA elec­tion notice to elect COBRA con­tin­u­a­tion cov­er­age. Due to the COVID-19 Nation­al Emer­gency, DOL, the Depart­ment of the Trea­sury, and the IRS issued guid­ance extend­ing time­frames for cer­tain actions relat­ed to health cov­er­age under pri­vate-sec­tor employ­ment-based group health plans. The exten­sions under the the Joint Notice and EBSA Dis­as­ter Relief Notice 2021-01 do not apply, how­ev­er, to the notices or elec­tions relat­ed to COBRA pre­mi­um assis­tance avail­able under the ARP. Poten­tial Assis­tance Eli­gi­ble Indi­vid­u­als there­fore must elect COBRA con­tin­u­a­tion cov­er­age with­in 60 days of receipt of the rel­e­vant notice or for­feit their right to elect COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance. [7] Sim­il­iar­ly, plans and issuers must pro­vide the notices required under the ARP with­in the time­frame required by the ARP.

    Assis­tance Eli­gi­ble Indi­vid­u­als do not need to send any pay­ments for the COBRA con­tin­u­a­tion cov­er­age dur­ing the pre­mi­um assis­tance peri­od. For addi­tion­al infor­ma­tion about this guid­ance vis­it: https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-andcompliance/disaster-relief.

    Q14: I am an Assis­tance Eli­gi­ble Indi­vid­ual who has been enrolled in COBRA con­tin­u­a­tion cov­er­age since Decem­ber 2020. Will I receive a refund of the pre­mi­ums that I have already paid?

    No. The COBRA pre­mi­um assis­tance pro­vi­sions in the ARP apply only to pre­mi­ums for cov­er­age peri­ods from April 1, 2021 through Sep­tem­ber 30, 2021. If you were eli­gi­ble for pre­mi­um assis­tance, but paid in full for peri­ods of COBRA con­tin­u­a­tion cov­er­age begin­ning on or after April 1, 2021 through Sep­tem­ber 30, 2021, you should con­tact the plan admin­is­tra­tor or employ­er spon­sor­ing the plan to dis­cuss a cred­it against future pay­ments (or a refund in cer­tain circumstances).

    Q15: I am cur­rent­ly enrolled in COBRA con­tin­u­a­tion cov­er­age, but I would like to switch to a dif­fer­ent cov­er­age option offered by the same employ­er. Can I do this?

    Group health plans can choose to allow qual­i­fied ben­e­fi­cia­ries to enroll in cov­er­age that is dif­fer­ent from the cov­er­age they had at the time of the COBRA qual­i­fy­ing event. The ARP pro­vides that chang­ing cov­er­age will not cause an indi­vid­ual to be inel­i­gi­ble for the COBRA pre­mi­um assis­tance, pro­vid­ed that:

    • The COBRA pre­mi­um charged for the dif­fer­ent cov­er­age is the same or low­er than for the cov­er­age the indi­vid­ual had at the time of the qual­i­fy­ing event;
    • The dif­fer­ent cov­er­age is also offered to sim­i­lar­ly sit­u­at­ed active employ­ees; and
    • The dif­fer­ent cov­er­age is not lim­it­ed to only except­ed ben­e­fits, a QSEHRA, or a health FSA.

    If the plan per­mits indi­vid­u­als to change cov­er­age options, the plan must pro­vide the indi­vid­u­als with a notice of their oppor­tu­ni­ty to do so. Indi­vid­u­als have 90 days to elect to change their cov­er­age after the notice is provided.

    Q16: Only part of my fam­i­ly elect­ed COBRA con­tin­u­a­tion cov­er­age but all of us were eli­gi­ble. Can I enroll the oth­ers and take advan­tage of the pre­mi­um assistance? 

    Each COBRA qual­i­fied ben­e­fi­cia­ry may inde­pen­dent­ly elect COBRA con­tin­u­a­tion cov­er­age. If a fam­i­ly mem­ber did not elect COBRA con­tin­u­a­tion cov­er­age when first eli­gi­ble and that indi­vid­ual would be an Assis­tance Eli­gi­ble Indi­vid­ual, that indi­vid­ual has an addi­tion­al oppor­tu­ni­ty to enroll and qual­i­fy for the pre­mi­um assis­tance. How­ev­er, this extend­ed elec­tion peri­od does not extend the max­i­mum peri­od of COBRA con­tin­u­a­tion cov­er­age had COBRA con­tin­u­a­tion cov­er­age been orig­i­nal­ly elect­ed. See Q3 and Q5 above for more information.

    Q17: I received my COBRA elec­tion notice. Can I change my cov­er­age option from the one I had previously? 

    In gen­er­al, COBRA con­tin­u­a­tion cov­er­age pro­vides the same cov­er­age that the indi­vid­ual had at the time of the qual­i­fy­ing event. How­ev­er, under the ARP, a plan may offer Assis­tance Eli­gi­ble Indi­vid­u­als the option of choos­ing oth­er cov­er­age that is also offered to sim­i­lar­ly sit­u­at­ed active employ­ees and that does not have high­er pre­mi­ums than the cov­er­age the indi­vid­ual had at the time of the qual­i­fy­ing event. See Q15 for more information.

    Q18: I am cur­rent­ly enrolled in indi­vid­ual mar­ket health insur­ance cov­er­age, but I am poten­tial­ly an Assis­tance Eli­gi­ble Indi­vid­ual. Can I switch to COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assistance? 

    Yes, Poten­tial Assis­tance Eli­gi­ble Indi­vid­u­als can use the elec­tion peri­od to change from indi­vid­ual mar­ket health insur­ance cov­er­age (that they got either through a Health Insur­ance Mar­ket­place®, such as through HealthCare.gov, or out­side of the Mar­ket­place) to COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance. Addi­tion­al­ly, you may apply for and, if eli­gi­ble 9 enroll in Med­ic­aid at any time. If you elect to enroll in COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance, you will no longer be eli­gi­ble for a pre­mi­um tax cred­it, or advance pay­ments of the pre­mi­um tax cred­it, for Mar­ket­place cov­er­age you oth­er­wise would qual­i­fy for dur­ing this pre­mi­um assis­tance peri­od. You must con­tact the Mar­ket­place to let them know that you’ve enrolled in oth­er min­i­mum essen­tial cov­er­age or you may have to repay some or all of the advance pay­ments of the pre­mi­um tax cred­it made on your behalf dur­ing the peri­od you were enrolled in both COBRA con­tin­u­a­tion cov­er­age and Mar­ket­place cov­er­age. This repay­ment would be required when fil­ing your income tax return for 2021 (see addi­tion­al infor­ma­tion about con­tact­ing the Mar­ket­place below).

    Q19: Can I end my indi­vid­ual health insur­ance cov­er­age retroac­tive­ly if I can qual­i­fy for COBRA with pre­mi­um assis­tance start­ing on April 1? 

    Enrollees gen­er­al­ly are not per­mit­ted to ter­mi­nate cov­er­age pur­chased through a Mar­ket­place retroac­tive­ly. You must do so prospec­tive­ly. If you want to end cov­er­age that you got from a Health Insur­ance Mar­ket­place®, such as on HealthCare.gov, because you want to change to COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance, you must update your Mar­ket­place appli­ca­tion or call the Mar­ket­place to do so. If you enrolled in cov­er­age through HealthCare.gov, you can call 1–800-318‑2596 (TTY: 1–855-889‑4325). If your state has its own Mar­ket­place plat­form, find con­tact infor­ma­tion for your State Mar­ket­place here: https://www.healthcare.gov/marketplace-in-your-state/.

    If you want to end indi­vid­ual health insur­ance cov­er­age that you got out­side of a Mar­ket­place, such as direct­ly from an insur­ance com­pa­ny, you must con­tact the insur­ance com­pa­ny to do so.

    Q20: What should I con­sid­er when mak­ing a deci­sion whether to con­tin­ue with indi­vid­ual mar­ket health insur­ance cov­er­age or change to COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assistance? 

    You should con­sid­er the fac­tors you nor­mal­ly would when decid­ing on which health insur­ance cov­er­age is right for you and your fam­i­ly. For exam­ple, in addi­tion to pre­mi­um cost, you may want to com­pare cost-shar­ing require­ments such as plan deductibles and copays. You may also want to con­sid­er how much progress you have made toward your deductible and oth­er plan accu­mu­la­tors, and com­pare dif­fer­ent plans’ and cov­er­age options’ provider net­works and pre­scrip­tion drug for­mu­la­ries based on your family’s med­ical care needs. Note, how­ev­er, that if you are cur­rent­ly employed by the employ­er offer­ing the COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance, you may enroll in Mar­ket­place cov­er­age but are inel­i­gi­ble for a sub­sidy or a pre­mi­um tax cred­it for the Mar­ket­place cov­er­age for the peri­od you are offered the COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assistance.

    Q21: Can I qual­i­fy for a spe­cial enroll­ment peri­od (SEP) to enroll in indi­vid­ual mar­ket health insur­ance cov­er­age, such as through a Health Insur­ance Mar­ket­place®, when my COBRA pre­mi­um assis­tance ends on Sep­tem­ber 30? What about if my COBRA con­tin­u­a­tion cov­er­age ends soon­er than that?

    When your COBRA pre­mi­um assis­tance ends, you may be eli­gi­ble for a SEP to enroll in cov­er­age through a Health Insur­ance Mar­ket­place®, or to enroll in indi­vid­ual health insur­ance 10 cov­er­age out­side of the Mar­ket­place. You may also qual­i­fy for a SEP when you reach the end of your max­i­mum COBRA cov­er­age peri­od. For more infor­ma­tion about this SEP, see: https://www.healthcare.gov/unemployed/cobra-coverage/.

    For more infor­ma­tion about enrolling in Mar­ket­place cov­er­age, see: HealthCare.gov, or you can call 1–800-318‑2596 (TTY: 1–855-889‑4325). If your state has its own Mar­ket­place plat­form, find con­tact infor­ma­tion for your State Mar­ket­place here: https://www.healthcare.gov/marketplace-in-your-state/.

    You may apply for and, if eli­gi­ble, enroll in Med­ic­aid cov­er­age at any time. For more infor­ma­tion, go to: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/.

    More Infor­ma­tion

    Q21: How can I get more infor­ma­tion on my eli­gi­bil­i­ty for COBRA con­tin­u­a­tion cov­er­age or the pre­mi­um assis­tance, includ­ing help if my employ­er has denied my request for the pre­mi­um assistance? 

    For group health plans spon­sored by pri­vate-sec­tor employ­ers, guid­ance and oth­er infor­ma­tion is avail­able on the DOL web site at https://www.dol.gov/cobra-subsidy. You can also con­tact one of EBSA’s Ben­e­fits Advi­sors at askebsa.dol.gov or 1.866.444.3272. EBSA’s Ben­e­fits Advi­sors may also be able to assist if you feel that your plan or employ­er has improp­er­ly denied your request for treat­ment as an Assis­tance Eli­gi­ble Indi­vid­ual. Employ­ers and plans may be sub­ject to an excise tax under the Inter­nal Rev­enue Code for fail­ing to sat­is­fy the COBRA con­tin­u­a­tion cov­er­age requirements.This tax could be as much as $100 per qual­i­fied ben­e­fi­cia­ry, but not more than $200 per fam­i­ly, for each day that the plan or employ­er is in vio­la­tion of the COBRA rules. If you feel you may have been improp­er­ly denied pre­mi­um assis­tance, con­tact EBSA at askebsa.dol.gov or 1.866.444.3272. If you work for a state or local gov­ern­ment employ­er and have ques­tions regard­ing the pre­mi­um assis­tance, please con­tact the Cen­ters for Medicare & Med­ic­aid Ser­vices via email at [email protected] or call 410–786-1565.

    Orig­i­nal­ly post­ed on dol.gov

    __________________________

    [1]  For more infor­ma­tion on COBRA con­tin­u­a­tion cov­er­age require­ments applic­a­ble to pri­vate-sec­tor employ­ment based group health plans, see “An Employer’s Guide to Group Health Con­tin­u­a­tion Cov­er­age Under COBRA,” avail­able at https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/publications/anemployers-guide-to-group-health-continuation-coverage-under-cobra.pdf.

    [2]  Health Insur­ance Mar­ket­place® is a reg­is­tered ser­vice mark of the U.S. Depart­ment of Health & Human Services

    [3]  85 FR 26351 (May 4, 2020).

    [4]  Avail­able at https://www.dol.gov/sites/dolgov/files/ebsa/employers-and-advisers/plan-administration-andcompliance/disaster-relief/ebsa-disaster-relief-notice-2021–01.pdf.

    [5]  ARP sec­tion 9501(a)(1)(A).

    [6]  Notice of Exten­sion of Cer­tain Time­frames for Employ­ee Ben­e­fit Plans, Par­tic­i­pants, and Ben­e­fi­cia­ries Affect­ed by the COVID–19 Out­break (Joint Notice). 85 FR 26351 (May 4, 2020); EBSA Dis­as­ter Relief Notice 2021-01 (Feb. 26, 2021), avail­able at https://www.dol.gov/sites/dolgov/files/ebsa/employers-and-advisers/planadministration-and-compliance/disaster-relief/ebsa-disaster-relief-notice-2021–01.pdf. Note that the Depart­ments of Labor and the Trea­sury share juris­dic­tion for enforce­ment of the COBRA con­tin­u­a­tion provisions.

    [7]  Note, how­ev­er, that a poten­tial Assis­tance Eli­gi­ble Indi­vid­ual has the choice of elect­ing COBRA con­tin­u­a­tion cov­er­age begin­ning April 1, 2021 or after (or begin­ning prospec­tive­ly from the date of your qual­i­fy­ing event if your qual­i­fy­ing event is after April 1, 2021), or elect­ing COBRA con­tin­u­a­tion cov­er­age com­menc­ing from an ear­li­er qual­i­fy­ing event if the indi­vid­ual is eli­gi­ble to make that elec­tion, includ­ing under the extend­ed time frames pro­vid­ed under the Joint Notice and EBSA Notice 2021-01. The elec­tion peri­od for COBRA con­tin­u­a­tion cov­er­age with pre­mi­um assis­tance does not cut off the individual’s pre­ex­ist­ing right to elect COBRA con­tin­u­a­tion cov­er­age, includ­ing under the extend­ed time frames pro­vid­ed under the Joint Notice and EBSA Notice 2021-01. Note, that the pre­mi­um assis­tance is only avail­able for peri­ods from April 1, 2021 through Sep­tem­ber 30,2021

  • Top Strategies of Relationship Marketing

    May 19, 2021

    Tags: ,

    As a busi­ness, you are con­stant­ly man­ag­ing your sales funnel–from the first point of con­tact with a prospect to their pur­chase of your ser­vice.  But it doesn’t (and shouldn’t) stop there. Per­haps the most impor­tant part of your sales fun­nel is the fol­low-up post-sale. It’s in this time of fol­low-up that you build the ongo­ing rela­tion­ship that will lead to cus­tomer loy­al­ty and, hope­ful­ly, cus­tomer refer­rals. Rela­tion­ship mar­ket­ing is the key to cus­tomer sat­is­fac­tion and long-term com­pa­ny success.

    Rela­tion­ship Mar­ket­ing and the Bot­tom Line

    It makes sens­es that before we dive into strate­gies for rela­tion­ship mar­ket­ing, you under­stand WHY it’s impor­tant.  Gain­ing a new cus­tomer in a crowd­ed mar­ket is hard. Accord­ing to Invesp, “The prob­a­bil­i­ty of sell­ing to an exist­ing cus­tomer is 60–70%, while the prob­a­bil­i­ty of sell­ing to a new prospect is 5–20%.” Did you know how expen­sive it is to get that new sale? It’s 5–25 times more expen­sive to gain a new cus­tomer than to retain an exist­ing one. WOW! And while you are focus­ing on gain­ing that new client, you are like­ly not spend­ing the same amount of time nur­tur­ing the rela­tion­ships you have with your cur­rent ones. That lack of atten­tion can affect your bot­tom line. By just increas­ing cus­tomer reten­tion rates by 5%, you can increase prof­its by 25–95%!  Rela­tion­ship build­ing and rela­tion­ship mar­ket­ing must demand your atten­tion or you’ll see low­er prof­its because of the high­er cost of acquir­ing that hard-to-obtain new customer.

    Rela­tion­ship Mar­ket­ing Strategies

    Cul­ti­vat­ing your cur­rent rela­tion­ships can ensure cus­tomer loy­al­ty in the long-term. Here are some effec­tive rela­tion­ship mar­ket­ing strate­gies to build strong, last­ing con­nec­tions with your sat­is­fied clients.

    1. Spend the time and mon­ey on build­ing an excel­lent cus­tomer ser­vice depart­ment. When your client has a ser­vice issue, they do not want to get in an end­less loop of being passed off to the next com­put­er­ized voice, super­vi­sor, or depart­ment and end the call with their prob­lem unre­solved. Instead, you want to make sure that they feel heard, under­stood, and have had their prob­lem resolved at the first touch-point. One bad cus­tomer ser­vice inter­ac­tion can result in the loss of a repeat sale. One good cus­tomer ser­vice inter­ac­tion can result in a great review and referral.
    1. Cre­ate a cus­tomer loy­al­ty and/or refer­ral rewards program.
      Loy­al­ty pro­grams aren’t restrict­ed to a prod­uct punch card sys­tem. You can cre­ate a loy­al­ty pro­gram that rewards cur­rent cus­tomers with a dis­count on a new ser­vice or a reduced ser­vice fee for a cur­rent offer­ing. The same goes for refer­ral rewards. Encour­age refer­rals from your clients and give gift cards or send a thank you gift when they respond. Lack of cus­tomer loy­al­ty affects your bot­tom line. CallMiner’s Churn Index 2020 states, “US com­pa­nies lose $136.8 bil­lion per year due to avoid­able con­sumer switch­ing.”  It’s worth the time to build into these rela­tion­ships so that they result in long-term cus­tomers who don’t even think about leav­ing you.
    1. Ask for feed­back and ask for it regularly.
      Com­mu­ni­ca­tion is a two-way street. You can spend count­less hours send­ing emails and post­ing to social media accounts about all the things your com­pa­ny does, but if you nev­er ask your clients what they think about you, you’ll stay stag­nant and nev­er grow to be bet­ter. Open up the lines of com­mu­ni­ca­tion in your client rela­tion­ships. Don’t be afraid to hear where you are lacking—it’s a chance to fix a prob­lem and make a cus­tomer feel heard. When you get pos­i­tive feed­back, pub­lish it. It’s one thing to hear about why a com­pa­ny thinks they are the best, it’s anoth­er thing to hear why their client thinks they are.

    Rela­tion­ship mar­ket­ing is instru­men­tal in cre­at­ing a grow­ing, thriv­ing busi­ness. It builds cus­tomer sat­is­fac­tion, reten­tion, and elic­its ideas for improve­ment while also pro­duc­ing oppor­tu­ni­ties for you to shout the prais­es from long-term cus­tomers. Take the time to cul­ti­vate these rela­tion­ships and you’ll see your busi­ness is bet­ter for it.

  • Maybe your benefit program is not enough…a list of the 16 most popular employee perks | by Jordan Shields, Partner

    May 18, 2021

    Tags: ,

    Accord­ing to a recent study pub­lished by the Soci­ety for Human Resource Management

    98%                 Paid Vacation

    83%                 Men­tal Health Coverage

    68%                 Health­care and Flex­i­ble Spend­ing Accounts

    56%                 Health Sav­ings Account

    32%                 Long Term Care Insurance

    27%                 Paid Parental Leave

    19%                 IVF Cov­er­age and Infer­til­i­ty Treatments

    15%                 Pay­roll Advances

    15%                 Pet Insurance

  • It’s not national health…but it is slowly appearing…proposed lower Medicare age

    May 11, 2021

    Tags: ,

    After the infra­struc­ture bill, Pres­i­dent Biden and the Democ­rats are propos­ing that the qual­i­fy­ing age for Medicare not be raised, in accord with the increas­ing aver­age life expectan­cy and many work­ing past the “typ­i­cal” retire­ment age of 65; they are propos­ing the entry age go down to 60.

    The way is fair­ly clear in some respects, as Sen­a­tor Bernie Sanders is chair­man of the Sen­ate Bud­get Com­mit­tee.  Stay tuned.

  • Exploring Mental Health Benefits

    May 10, 2021

    Tags: ,

    The over­all well-being of an employ­ee has nev­er been more of a pri­or­i­ty for employ­ers as it is right now. From health care to vision care to men­tal health care, the entire­ty of the employee’s health is impor­tant to the health of the organization.

    Impor­tance of Men­tal Health Benefits

    Men­tal health and the cost of not treat­ing its issues has far-reach­ing effects from the indi­vid­ual to the glob­al world.

    • If left untreat­ed, an employee’s poor men­tal health could lead to work relat­ed acci­dents, absen­teeism, poor work­place pro­duc­tiv­i­ty, and even work­place violence.
    • Men­tal health costs make up about 8% of the US’s total health­care spending.
    • The Nation­al Insti­tute on Men­tal Health esti­mates that major men­tal ill­ness costs the US at least $193 bil­lion per year in lost earnings.
    • Glob­al­ly, depres­sion and anx­i­ety issues cost about $1 tril­lion a year.

    Types of Men­tal Health Benefits

    Men­tal health ben­e­fits can look dif­fer­ent for each orga­ni­za­tion. Uni­ver­sal­ly, busi­ness­es offer some sort of Employ­ee Assis­tance Pro­gram (EAP) to its mem­bers. EAPs include ser­vices that are typ­i­cal­ly deliv­ered online or by tele­phone. Ser­vices may include alco­hol and sub­stance abuse coun­sel­ing, legal aid, and health and well­ness coun­sel­ing. These ser­vices are offered to the employ­ee free of charge and are done anonymously.

    As an exten­sion of basic health care ben­e­fits, men­tal health ben­e­fits can also include one-on-one coun­sel­ing with a licensed coun­selor for a cer­tain num­ber of ses­sions.  Men­tal health ben­e­fits may also incor­po­rate well­ness pro­grams like relax­ation and med­i­ta­tion class­es, sleep tech­niques, and stress man­age­ment lessons. Check your health insur­ance ben­e­fits pack­age details as you may find men­tal health insur­ance cov­er­age includ­ed under the behav­ioral health section.

    Dur­ing open enroll­ment, when employ­ers present the employ­ees with the upcom­ing year’s health insur­ance plans, the employ­ee should also ask about men­tal health­care options. Just as you assess the dif­fer­ent health­care plans and what fits best for you and your fam­i­ly, you can also assess the costs and cov­er­age of men­tal health plans. Also, find out if your com­pa­ny offers a Flex­i­ble Spend­ing Account as you can use that pre-tax mon­ey to pay for out-of-pock­et men­tal health ser­vice costs.

    Now, more than ever, peo­ple are more aware of the ben­e­fits to good men­tal health and how it affects their over­all health and work per­for­mance.  Uti­lize the com­pa­ny spon­sored EAP offer­ings and inves­ti­gate the details of your health insur­ance plan to find out what men­tal health ser­vices are cov­ered. Your over­all health and well-being are impor­tant and so are you!

  • The Fundamentals of Performance Management

    May 5, 2021

    Tags: ,

    The right per­for­mance man­age­ment process for your orga­ni­za­tion depends in large part on what you want to accom­plish with it and what you’re will­ing to invest in it. Here are some prin­ci­ples to keep in mind when decid­ing on your pol­i­cy and per­form­ing assessments:

    • Per­for­mance reviews are often stress­ful and dif­fi­cult because the employ­ees don’t know how they’ll be eval­u­at­ed and they’re wor­ried they’ll be sur­prised with a bad review. But reviews, how­ev­er often they’re done, shouldn’t be a sur­prise. If you give employ­ees reg­u­lar feed­back on their per­for­mance and address poor per­for­mance when it hap­pens, then the review becomes more of a reminder and sum­ma­ry of what employ­ees are doing well and where they have oppor­tu­ni­ties to improve.
    • Set­ting clear per­for­mance expec­ta­tions and hold­ing employ­ees account­able to them improves effi­cien­cy and pro­duc­tiv­i­ty. It also improves morale. Con­ver­sa­tions with an under­per­form­ing employ­ee may be chal­leng­ing, but allow­ing poor per­for­mance to con­tin­ue unabat­ed can cause wide­spread frus­tra­tion and resent­ment from cowork­ers whose work is affect­ed by it. Ignor­ing poor per­for­mance only com­pounds the problem.
    • Employ­ees are more like­ly to take own­er­ship over their per­for­mance goals if they have a role in defin­ing those goals.
    • Con­nect­ing per­for­mance mea­sures to com­pa­ny objec­tives and val­ues can increase employ­ees’ sense of pur­pose and engage­ment by draw­ing a direct cor­re­la­tion between their indi­vid­ual work and per­for­mance and your col­lec­tive suc­cess as a company.
    • It’s help­ful to struc­ture per­for­mance eval­u­a­tion meet­ings and con­ver­sa­tions around the spe­cif­ic expec­ta­tions set in the job descrip­tion to ensure that the dis­cus­sion is direct­ly applic­a­ble to that employee’s par­tic­u­lar job duties.
    • Doc­u­ment­ing per­for­mance eval­u­a­tions can help you jus­ti­fy pay increas­es, decreas­es, or oth­er employ­ment deci­sions like ter­mi­na­tion that could be chal­lenged as dis­crim­i­na­to­ry. It’s safest to ter­mi­nate an employ­ee when you have doc­u­men­ta­tion that jus­ti­fies the legit­i­mate busi­ness rea­sons for the termination.

    By Kyle Cupp

    Orig­i­nal­ly post­ed on ThinkHR

  • When You’ve Been Fully Vaccinated

    April 28, 2021

    Tags:

    COVID-19 vac­cines are effec­tive at pro­tect­ing you from get­ting sick. Based on what we know about COVID-19 vac­cines, peo­ple who have been ful­ly vac­ci­nat­ed can start to do some things that they had stopped doing because of the pandemic.

    We’re still learn­ing how vac­cines will affect the spread of COVID-19. After you’ve been ful­ly vac­ci­nat­ed against COVID-19, you should keep tak­ing pre­cau­tions—like wear­ing a mask, stay­ing 6 feet apart from oth­ers, and avoid­ing crowds and poor­ly ven­ti­lat­ed spaces—in pub­lic places until we know more.

    These rec­om­men­da­tions can help you make deci­sions about dai­ly activ­i­ties after you are ful­ly vac­ci­nat­ed. They are not intend­ed for health­care set­tings.

    What You Can Start to Do

    If you’ve been ful­ly vaccinated:

    • You can gath­er indoors with ful­ly vac­ci­nat­ed peo­ple with­out wear­ing a mask or stay­ing 6 feet apart.
    • You can gath­er indoors with unvac­ci­nat­ed peo­ple of any age from one oth­er house­hold (for exam­ple, vis­it­ing with rel­a­tives who all live togeth­er) with­out masks or stay­ing 6 feet apart, unless any of those peo­ple or any­one they live with has an increased risk for severe ill­ness from COVID-19.
    • If you trav­el in the Unit­ed States, you do not need to get test­ed before or after trav­el or self-quar­an­tine after travel.
    • You need to pay close atten­tion to the sit­u­a­tion at your inter­na­tion­al des­ti­na­tion before trav­el­ing out­side the Unit­ed States. 
      • You do NOT need to get test­ed before leav­ing the Unit­ed States unless your des­ti­na­tion requires it.
      • You still need to show a neg­a­tive test result or doc­u­men­ta­tion of recov­ery from COVID-19 before board­ing a flight to the Unit­ed States.
      • You should still get test­ed 3–5 days after inter­na­tion­al travel.
      • You do NOT need to self-quar­an­tine after arriv­ing in the Unit­ed States.
    • If you’ve been around some­one who has COVID-19, you do not need to stay away from oth­ers or get test­ed unless you have symptoms. 
      • How­ev­er, if you live in a group set­ting (like a cor­rec­tion­al or deten­tion facil­i­ty or group home) and are around some­one who has COVID-19, you should still stay away from oth­ers for 14 days and get test­ed, even if you don’t have symptoms.

    What You Should Keep Doing

    For now, if you’ve been ful­ly vaccinated:

    • You should still take steps to pro­tect your­self and oth­ers in many sit­u­a­tions, like wear­ing a mask, stay­ing at least 6 feet apart from oth­ers, and avoid­ing crowds and poor­ly ven­ti­lat­ed spaces. Take these pre­cau­tions when­ev­er you are: 
    • You should still avoid medi­um or large-sized gath­er­ings.
    • If you trav­el, you should still take steps to pro­tect your­self and oth­ers. You will still be required to wear a mask on planes, bus­es, trains, and oth­er forms of pub­lic trans­porta­tion trav­el­ing into, with­in, or out of the Unit­ed States, and in U.S. trans­porta­tion hubs such as air­ports and sta­tions. Ful­ly vac­ci­nat­ed inter­na­tion­al trav­el­ers arriv­ing in the Unit­ed States are still required to get test­ed with­in 3 days of their flight (or show doc­u­men­ta­tion of recov­ery from COVID-19 in the past 3 months) and should still get test­ed 3–5 days after their trip.
    • You should still watch out for symp­toms of COVID-19, espe­cial­ly if you’ve been around some­one who is sick. If you have symp­toms of COVID-19, you should get test­ed and stay home and away from others.
    • You will still need to fol­low guid­ance at your workplace.

    What We Know and What We’re Still Learning

    • We know that COVID-19 vac­cines are effec­tive at pre­vent­ing COVID-19 dis­ease, espe­cial­ly severe ill­ness and death. 
      • We’re still learn­ing how effec­tive the vac­cines are against vari­ants of the virus that caus­es COVID-19. Ear­ly data show the vac­cines may work against some vari­ants but could be less effec­tive against others.
    • We know that oth­er pre­ven­tion steps help stop the spread of COVID-19, and that these steps are still impor­tant, even as vac­cines are being distributed. 
      • We’re still learn­ing how well COVID-19 vac­cines keep peo­ple from spread­ing the disease.
      • Ear­ly data show that the vac­cines may help keep peo­ple from spread­ing COVID-19, but we are learn­ing more as more peo­ple get vaccinated.
    • We’re still learn­ing how long COVID-19 vac­cines can pro­tect people.
    • As we know more, CDC will con­tin­ue to update our rec­om­men­da­tions for both vac­ci­nat­ed and unvac­ci­nat­ed people.

    Until we know more about those ques­tions, everyone—even peo­ple who’ve had their vaccines—should con­tin­ue tak­ing steps to pro­tect them­selves and oth­ers when recommended.

    Orig­i­nal­ly post­ed on CDC.gov

  • Exploring Vision Insurance

    April 19, 2021

    Tags: , ,

    Accord­ing to Web­MD, the eyes are the most high­ly devel­oped sen­so­ry organs in your body. They report that more of your brain is ded­i­cat­ed to the sense of sight than to all of the oth­er sens­es com­bined. So, it makes sense that you would do all that you can to pro­tect and care for these impor­tant organs. Vision insur­ance can be a great asset as you work keep your eyes healthy.

    What is vision insurance?

    Vision insur­ance is an insur­ance prod­uct used to reduce the costs of eye-relat­ed care, eye prod­ucts, and eye surg­eries. Group vision plans are typ­i­cal­ly pur­chased through employ­ers, asso­ci­a­tions, or gov­ern­ment pro­grams like Medicare or Med­ic­aid.  Some­times, vision plans are part of a val­ue-added ben­e­fit that is linked to the subscriber’s health insur­ance. Plan sub­scribers usu­al­ly receive free eye care, like annu­al eye exams, and a fixed dis­count on eye wear in exchange for a month­ly pre­mi­um. This type of cov­er­age is rec­om­mend­ed for peo­ple who need vision cor­rec­tion devices, who have a fam­i­ly his­to­ry of eye issues, or for those who have a high­er risk of eye dis­ease, like diabetics.

    What is a vision dis­count program?

    Dif­fer­ent from vision insur­ance, a vision dis­count pro­gram gives users dis­counts on eye exam ser­vices and prod­ucts. The month­ly pre­mi­um is low­er for dis­count pro­grams but does not gen­er­al­ly include free annu­al eye exams like vision insur­ance does. When the user buys into the dis­count pro­gram, they become a mem­ber of a large group for whom the pro­gram admin­is­tra­tors have nego­ti­at­ed low­er costs. Dis­count pro­grams are most use­ful for those with­out pre-exist­ing eye conditions.

    What are the ben­e­fits of hav­ing vision coverage?

    As men­tioned before, your eyes are the most com­plex sen­so­ry organ in your body. Because of this, they are impor­tant to keep healthy and in good work­ing con­di­tion. Vision cov­er­age allows the user to have annu­al eye exams. At these exams, the optometrist deter­mines if you need cor­rec­tive lens­es to improve your eye­sight by means of glass­es or con­tact lens­es. The doc­tor will also check for eye dis­eases. Exams can even detect hid­den med­ical con­di­tions like brain tumors, rheuma­toid arthri­tis, high blood pres­sure, or thy­roid dis­ease. If a med­ical con­di­tion is detect­ed, the optometrist will refer the patient to a med­ical doc­tor for fur­ther tests and treatment.

    Vision insur­ance and dis­count pro­grams play a huge part in keep­ing your eyes healthy. Through reg­u­lar eye exams, not only are your eyes eval­u­at­ed, but the health of the rest of your body is, too. By sched­ul­ing eye exams, you are also able to obtain cor­rec­tive eye wear that allow you to see clear­er and with­out eye strain. Healthy vision is a ben­e­fit you don’t want to lose!

  • Benefits of Remote Onboarding

    April 14, 2021

    Tags: ,

    Remote Onboard­ing Suc­cess Plan

    Remote work­places have become very com­mon­place in our world today. In fact, a PwC sur­vey of 669 CEOs, 78% agree that remote work is here for the long-term. As a result, remote onboard­ing has become part of the nor­mal Human Resources oper­a­tion in com­pa­nies. Let’s dive into what remote onboard­ing looks like and some ben­e­fits and chal­lenges of this new way of wel­com­ing employ­ees to the team.

    What is onboarding?

    Onboard­ing is the process of wel­com­ing new employ­ees to the com­pa­ny and intro­duc­ing them to the com­pa­ny cul­ture of their new employ­er. Onboard­ing is dif­fer­ent from train­ing in that train­ing focus­es on the poli­cies and pro­ce­dures of the job while onboard­ing is more focused on inte­grat­ing the new hire to the team and help­ing them devel­op rela­tion­ships with­in the work­place.  Remote onboard­ing has the same focus but every­thing is done online through Zoom or oth­er vir­tu­al meet­ing plat­forms. Onboard­ing is also not a one-time event. It’s a process that takes mul­ti­ple days and an ongo­ing com­mit­ment to tru­ly accli­mate the new employ­ee to the department.

    Chal­lenges of remote onboarding

    Con­nect­ing vir­tu­al­ly with oth­ers can have its chal­lenges. Coor­di­nat­ing the entire team’s sched­ule to wel­come new hires as they arrive on the team can be hard. This same chal­lenge hap­pens as the team attempts to con­tin­ue to build cama­raderie with some in-per­son team mem­bers and oth­er remote team mem­bers. As many of us have come to under­stand, work­ing remote­ly can be very iso­lat­ing. Throw in join­ing a new team, and your new hire can feel extreme­ly unen­gaged. Anoth­er chal­lenge is tech­nol­o­gy set up in a remote envi­ron­ment. When onboard­ing in per­son, the IT depart­ment can phys­i­cal­ly be there to issue com­pa­ny tech­nol­o­gy. Remote onboard­ing relies on the new employ­ee set­ting up their own tech­nol­o­gy or walk­ing through set-up with an IT rep­re­sen­ta­tive online.

    Tips for remote onboard­ing success

    Despite the chal­lenges, remote onboard­ing can be a suc­cess­ful expe­ri­ence. Here are some tips to over­come some of these obsta­cles and make your new hire feel engaged and part of the team by the end of their remote onboard­ing process.

    1. Set up a kick-off video call with your entire team to wel­come the new mem­ber. By hav­ing a video call, you make it eas­i­er for names and faces to con­nect. Video wel­come calls also allow the new hire to see the enthu­si­asm in the faces of their new team and begin to build an emo­tion­al connection.
    2. Pro­vide an orga­ni­za­tion­al chart so that the remote employ­ee under­stands the report­ing lines in the com­pa­ny. Addi­tion­al­ly, con­sid­er includ­ing pic­tures of those includ­ed on the chart so they can put faces to names. Anoth­er great way to go to the next lev­el to con­nect with the new hire would be to pre-record quick wel­come videos by the high-lev­el execs and send them via email.
    3. Intro­duce the new employ­ee to the com­pa­ny via email or social media. Do a sim­ple “Get­ting to Know You” inter­view with them so you can share some inter­est­ing facts about this new team member.
    4. Reg­u­lar­ly check-in via quick chat mes­sages or video call with your remote new hire to find out if they have any ques­tions or con­cerns in their first week(s). By hav­ing sched­uled times where you con­nect with your new employ­ee, they will have less of a chance to feel alone and will begin to learn your man­age­ment style.

    Accord­ing to Ser­vi­ceNow, “enthu­si­asm for a job peaks at the start of the job and wanes by 22% short­ly there­after.” Now is the time to cap­ture your new hire’s enthu­si­asm and encour­age its growth. While remote onboard­ing can be a chal­lenge, it is pos­si­ble to over­come the obsta­cles it presents with some care­ful plan­ning and ded­i­ca­tion to its success.

  • The Power of Praise

    April 5, 2021

    Tags: , ,

    Think for a minute about all you have done today. Now, from that list of tasks, how many would you say you have done well? Again, from the list of tasks you feel you’ve done a good job on, how many were you praised for by your man­ag­er or even a co-work­er? We all crave approval and praise from oth­ers in our life. The work­place is no excep­tion. Praise moti­vates us to do well and to improve. Praise is nec­es­sary and praise is pow­er­ful. Fol­low these easy steps to build an effec­tive habit of praise in your organization.

    The WHY of Praise

    Before we can get into the HOW of praise, let’s touch on the WHY. Accord­ing to Gallup.com, “Recog­ni­tion for good work releas­es dopamine in the brain, which cre­ates feel­ings of pride and plea­sure.” Peo­ple want to feel like oth­ers see them and appre­ci­ate them. The praise-giv­er also receives ben­e­fits from this exchange. By giv­ing praise, you get the same sense of sat­is­fac­tion as you get when mak­ing a char­i­ta­ble gift or help­ing oth­ers. An envi­ron­ment of praise-giv­ing is one where indi­vid­u­als work, not just to com­plete a task and be done, but they work to do a good job and to please their man­ag­er with hard work that is done well. Also, in terms of employ­ee engage­ment, a man­ag­er who reg­u­lar­ly prais­es their team, is one who is

    The HOW of Praise

    Giv­ing praise is easy and, if you fol­low these sim­ple tips, it is also an effec­tive tool to moti­vate and encour­age those in your workplace.

    Make it QUICK

    When you notice some­thing that should be rec­og­nized with praise, do it imme­di­ate­ly. The more time that pass­es between the event and the recog­ni­tion, the less pow­er­ful the praise becomes. Make it a habit that when you see good work or good behav­ior, you stop what you are doing and give praise.

    Make it SPECIFIC

    Now that you have rec­og­nized the behav­ior or project that deserves praise, you’ll want to make the praise spe­cif­ic. Offer­ing a vague com­pli­ment like, “You did good” doesn’t tru­ly speak to the spe­cif­ic action that is praise-wor­thy. Instead, make your words of affir­ma­tion ones that point to a spe­cif­ic instance like, “The logo you cre­at­ed for the Mile­stone mar­ket­ing project was clean and real­ly inventive.”

    Make it GENUINE

    You may be tempt­ed to adopt this new praise pol­i­cy and start dol­ing out com­pli­ments left and right like a praise shot­gun, but, don’t. Disin­gen­u­ous praise is almost as bad, if not worse, than no praise at all. You can tell if some­one is mak­ing a forced com­ment or one that has no thought behind it. Instead, make sure the praise is giv­en with a gen­uine heart and tone.

    Cre­ate a CULTURE of praise

    As you fine tune the act of giv­ing praise in your work­place, your final task is to cre­ate a cul­ture of praise-giv­ing. When you build this cul­ture, and every­one is active­ly involved in rec­og­niz­ing their peers, you will find the morale and engage­ment in your office is lift­ed high­er. Increased morale and engage­ment also increase pro­duc­tiv­i­ty, low­ers absen­teeism, and low­ers turnover.

    Praise is incred­i­bly pow­er­ful. Praise has the pow­er to moti­vate, encour­age, and build. By fol­low­ing the sim­ple tips out­lined here, you can unleash the pow­er of praise in your orga­ni­za­tion and in your life and reap the ben­e­fits to both the giv­er and receiver.

  • Back to Basics 3 Simple Tips for Building Healthy Kids

    March 31, 2021

    Tags: , ,

    Do these promis­es sound familiar?

    “When I have kids, I’ll nev­er let them eat XYZ.”

    “My kids will always eat what­ev­er I put in front of them.”

    “Our fam­i­ly will nev­er eat out all the time.”

    We’ve all said them at some point in our lives and, whether we’ve start­ed a fam­i­ly or are still in the process of build­ing one, we’ve prob­a­bly all bro­ken those same promis­es! We read the books. We talk to oth­er par­ents. We watch all the edu­ca­tion­al pro­grams. And, the truth we uni­ver­sal­ly learn is that rais­ing healthy kids is hard work! Between get­ting them to eat healthy foods and encour­ag­ing them to get enough exer­cise, it’s a full-time job.  So, what can we do to make it sim­pler? Let’s get back to basics and look at 3 tips that can get our kids on track to healthy living.

    1. FOOD CHOICES—DON’T FEED THE ADDICTION

    Per­haps the eas­i­est way to help kids make bet­ter food choic­es is to con­trol what food is stocked in your home. If your pantry is full of sug­ary (albeit deli­cious) foods, then guess what the lit­tle humans in your home are going to eat when they are hun­gry (or bored)? Sug­ar is addic­tive and so the habit of reach­ing for food filled with this ingre­di­ent a by-prod­uct of this addic­tion. Remove the sug­ar-filled food and like Ole Moth­er Hub­bard, when they go to fetch a sug­ar snack, they’ll find the cup­board is bare. Replace the sug­ar-filled food with gra­nola bars, low-fat chips, eas­i­ly-acces­si­ble cut-up fruits and veg­gies, yogurt, etc. and they’ll learn to grab these health­i­er options when they are hungry!

    1. BE A ROLE MODEL—SHOW UP AND SHOW OUT

    The folks under your roof tend to watch what you do. They watch what you eat and why you eat it. Be a role mod­el for your peo­ple and make smart food choic­es regard­ing the type of food you put on your plate and how much of it you con­sume. If you are always eat­ing high-fat, high-calo­rie, fast food then guess what they assume is the right things to eat? Did you know those eyes are also watch­ing WHY you eat? If you use food to help you de-stress or when you are sad, they will fol­low your exam­ple. Do you assign your feel­ings of hap­pi­ness to food? You will have kids who will think food makes them hap­py. Make sure that how you behave around food points those who are close­ly watch­ing you towards healthy actions.

    1. INVOLVE THEM—PLAN, MAKE, MOVE 

    Make kids a part of the deci­sion-mak­ing process for meals dur­ing the week. Chil­dren will be more like­ly to eat the food you place in front of them if they get to help plan out some of the meals. Make a “Fam­i­ly Favorites” list that every­one gets to con­tribute a cou­ple ideas towards whether it’s favorite break­fasts, din­ners, or even snacks. Next, ask the idea-gen­er­a­tor to assist in mak­ing that food choice for the fam­i­ly. Hav­ing a hand in cre­at­ing the meal gets you buy-in from your assis­tant. Final­ly, get every­one up and mov­ing whether it’s to vis­it a new park after school, take an after-din­ner walk, or go explor­ing on some local trails over the week­end. Move togeth­er and you’ll make mem­o­ries as you do it!

    You can start build­ing healthy kids by fol­low­ing these 3 sim­ple tips. By stock­ing your home with healthy food choic­es, being a food-behav­ior mod­el, and involv­ing your fam­i­ly in plan­ning, mak­ing, and mov­ing, you will find your­self on the path to success!

    BONUS CONTENT:

    Here are some use­ful links to help you take the first steps towards rais­ing healthy kids.

    Healthy Break­fasts

    Healthy Lunch­es

    MyPlate Kids

  • Exploring Year-Round Benefits Engagement

    March 22, 2021

    Tags: ,

    Just as with any good, healthy rela­tion­ship, com­mu­ni­ca­tion with employ­ees is key. Only com­mu­ni­cat­ing with employ­ees regard­ing their ben­e­fits pack­age dur­ing open enroll­ment will most def­i­nite­ly result in them not tak­ing full advan­tage of all it has to offer. In an effort to assist employ­ees in under­stand­ing and max­i­miz­ing their ben­e­fits, com­pa­nies should use a year-round ben­e­fits engage­ment strat­e­gy.  Let’s explore some sim­ple ways to set up your annu­al com­mu­ni­ca­tion plan.

    START WITH THE END IN MIND

    As you begin craft­ing your engage­ment plan, think of the over­all goal you want to accom­plish. Per­haps you sim­ply want your employ­ees to be bet­ter edu­cat­ed on their plan offer­ings. Maybe you’d like to reduce the num­ber of ques­tions that employ­ees ask dur­ing open enroll­ment meet­ings. Or, maybe you want your employ­ees to uti­lize a cer­tain plan ben­e­fit that has been his­tor­i­cal­ly under­used result­ing in high­er costs to the employ­ee or the com­pa­ny. What­ev­er the case, first set your goal for the com­mu­ni­ca­tion plan.

    CREATE A CALENDAR

    Now that you have an end-goal in mind, start think­ing of how fre­quent­ly you want to com­mu­ni­cate.  Sched­ule your com­mu­ni­ca­tion moments to post con­sis­tent­ly. Maybe you start a “Ben­e­fits Minute” that hits the first Mon­day of the month. Or, start a “Ben­e­fits Blog” that posts every oth­er Fri­day. What­ev­er the case, make the com­mu­ni­ca­tion hap­pen on a sched­ule so that employ­ees know when to expect it and know what it’s called.

    KEEP IT SIMPLE

    Wordy emails, drawn-out meet­ings, and for­ev­er long phone mes­sages will quick­ly get ignored and delet­ed. Instead, fol­low this sim­ple for­mu­la when craft­ing your communication:

    1. Here’s what you need to know about your benefits.

    Give a quick overview of the ben­e­fit you are focus­ing on for this par­tic­u­lar communication.

    1. Here’s why it’s impor­tant that you know this.

    In a few short sen­tences, explain how this ben­e­fit ben­e­fits the employ­ee whether it be a cost sav­ings, time sav­ings, or sim­ply a great help to them.

          3.  Here’s what you need to do to find out more.

    Pro­vide a way to find out more infor­ma­tion on this ben­e­fit by giv­ing a link, an email address, or a phone number.

    MIX UP YOUR COMMUNICATION STYLE

    Com­mu­ni­ca­tion isn’t one-size-fits-all. Peo­ple learn in dif­fer­ent ways—some may be visu­al learn­ers while oth­ers may be oral learn­ers. Make sure you mix up the way you com­mu­ni­cate to cov­er both types. Also, change up the method of com­mu­ni­ca­tion. Try emails, explain­er videos, print­ed fly­ers, and quick, stand-up meet­ings. By using a vari­ety of meth­ods, you are able to engage a broad­er audi­ence since your com­pa­ny is com­prised of a range of ages, gen­ders, learn­ers, and tech users.

    Engag­ing in a reg­u­lar, year-round com­mu­ni­ca­tion strat­e­gy for explain­ing employ­ee ben­e­fits will sup­port both the com­pa­ny as well as the employ­ee. Set your strat­e­gy in motion by fol­low­ing the sim­ple tips shared here. And, when you do this, you will see that your employ­ees will reap the ben­e­fits of a healthy under­stand­ing of their ben­e­fit plan.

  • How to Help Employees Communicate More Effectively

    March 15, 2021

    Tags: ,

    In an ide­al world, com­mu­ni­ca­tion would be easy. We’d imme­di­ate­ly know exact­ly what to say or write. Emails, Slack mes­sages, and reply threads would prac­ti­cal­ly write them­selves. And there’d be no con­fu­sion about what any­one meant, ever.

    Of course, com­mu­ni­ca­tion nev­er works that way. We stare at the com­put­er screen try­ing to decide how to begin an email. We mis­s­peak or gar­ble our words. We don’t always con­vey exact­ly what we intend. We mis­un­der­stand, over­look, or for­get infor­ma­tion we’ve been giv­en. We also some­times read emo­tions into words that weren’t what the writer was feel­ing. Or we pack our speech with such an emo­tion­al punch that it dis­tracts from the point we’re try­ing to make.

    Writ­ten com­mu­ni­ca­tion often exac­er­bates these issues, a fact that has many lead­ers wor­ried since more peo­ple are work­ing remote­ly and rely­ing on the writ­ten word to do their jobs. It’s no secret that we spend far too much time on email and oth­er com­mu­ni­ca­tion tools.

    For­tu­nate­ly, you don’t nec­es­sar­i­ly need to hire a writ­ing coach to teach your employ­ees bet­ter writ­ing skills—although this can in some cas­es be a good idea. You can sig­nif­i­cant­ly improve com­mu­ni­ca­tion in your orga­ni­za­tion by ask­ing your employ­ees to con­sid­er the fol­low­ing prac­tices in their writ­ten communications:

    Break up long sen­tences and para­graphs. A big unbro­ken block of text is like­ly to befud­dle your read­er before they even get to the first word. Long sen­tences and para­graphs also make com­pre­hen­sion and reten­tion of infor­ma­tion much more dif­fi­cult. Note the dif­fer­ences in these two communications:

    Sam­ple 1: I sup­port the goals out­lined in the pro­pos­al you sent to me yes­ter­day, espe­cial­ly the need to bet­ter define appro­pri­ate met­rics around the solic­i­ta­tion of cus­tomer sat­is­fac­tion scores, and I want to thank you for the thought you gave to propos­ing work­able solu­tions, but I’m not sure if all of the pro­posed solu­tions will work at this time. Let’s dis­cuss it all at our next check-in.

    Sam­ple 2: Thank you for send­ing the pro­pos­al yes­ter­day. I appre­ci­ate the thought you put into it. I agree with you about the goals, espe­cial­ly what you wrote about cus­tomer sat­is­fac­tion scores. The solu­tions you pro­posed, how­ev­er, may be a chal­lenge to imple­ment right away. Let’s dis­cuss the pro­pos­al at our next check-in.

    These sam­ples pro­vide the same infor­ma­tion, but the sec­ond is eas­i­er to fol­low and digest.

    Use clear, con­crete terms. Vague words, con­vo­lut­ed ideas, and broad gen­er­al­iza­tions make for easy mis­com­mu­ni­ca­tion. Your read­er will be more like­ly to under­stand your mean­ing if your lan­guage is spe­cif­ic. Remem­ber too that just because some­thing is clear to you doesn’t nec­es­sar­i­ly mean it will be clear to your read­er. Com­pare these two statements:

    Sam­ple 1: Would you be able to review the thing I sent you earlier?

    Sam­ple 2: Here’s the let­ter for Anil I told you about this morn­ing. Would you be able to proof­read it for typos by the end of the day?

    The first sam­ple is like­ly to cause con­fu­sion and frus­tra­tion if the recip­i­ent has recent­ly received a lot of “things” from the writer or oth­er peo­ple. In con­trast, the sec­ond sam­ple makes the con­text and the request­ed task clear to the reader.

    Pro­vide con­text and direc­tion when adding some­one to a con­ver­sa­tion. Most of us have had the expe­ri­ence of receiv­ing a for­ward­ed email that we’re not imme­di­ate­ly sure what to do with. Should we keep it as a ref­er­ence? Read through the thread? Respond in some way? We haven’t been told. Don’t do this. You should clue the read­er in to what the con­ver­sa­tion entails and what they need to know and do in response. Compare:

    Sam­ple 1: Please see below. What do you think?

    Sam­ple 2: Please read through the con­ver­sa­tion below and note the prod­uct request from Oliv­er. Is that some­thing you can add to your work this week?

    The first sam­ple is like­ly to prompt the recip­i­ent to weigh in on the wrong sub­ject or ask the writer for clar­i­fi­ca­tion before respond­ing, wast­ing valu­able time either way. The sec­ond sam­ple gives clear instruc­tion, sav­ing time.

    Avoid unnec­es­sary details. While some con­text is use­ful, too much can over­whelm the read­er and add to the time it takes for the com­mu­ni­ca­tion to be writ­ten, read, and act­ed on.

    Sam­ple 1: I ran into Lind­say in the lunch­room and asked her about the Pater­son deal. She asked me to fol­low up with her after her lunch break, which I did, and she gave me per­mis­sion to start on the out­line. She seemed a lit­tle aggra­vat­ed that I inter­rupt­ed her lunch. Any­way, I need to respond to a few emails before I get start­ed on it, but I will get to it after and have it to you and her by close of busi­ness today.

    Sam­ple 2: I got the go ahead from Lind­say on the Pater­son deal. I’m work­ing on the out­line and will email it to you and her by close of busi­ness today.

    The first sam­ple like­ly has too much infor­ma­tion. The writer may have felt like includ­ing the extra details because they felt bad about ask­ing Lind­say to work on her lunch break, but unless there’s a good rea­son for the recip­i­ent to know those details, they’re best left out.

    Save dif­fi­cult or emo­tion­al­ly intense con­ver­sa­tions for calls, video con­fer­ences, or in-per­son meet­ings. These con­ver­sa­tions usu­al­ly require more finesse than writ­ten text can pro­vide. If you antic­i­pate a strong emo­tion­al response to what you have to say, or if you believe the per­son with whom you’ll be com­mu­ni­cat­ing may read strong emo­tions into what you have to say, don’t write to them. Talk it through instead. Let them hear your voice and lis­ten care­ful­ly to theirs.

    By Kyle Cupp

    Orig­i­nal­ly post­ed on Thinkhr.com

  • There’s a mandate – wait, there’s a mandate? I thought the federal…..no, this is for the state | by Jordan Shields, Partner

    March 12, 2021

    Tags: ,

    Despite the actions tak­en by the Trump admin­is­tra­tion to over­ride the Afford­able Care Act require­ments of hav­ing cit­i­zens have and show med­ical cov­er­age, the state of Cal­i­for­nia passed its own man­date.  The penal­ties are not par­tic­u­lar­ly oner­ous but are larg­er than what the ACA had.

     

     

  • Ways Leadership Affects Culture and Culture Affects Leadership

    March 8, 2021

    Tags: ,

    There has been so much writ­ten on lead­er­ship in the last year, it’s hard to keep track of it all. Lead­ers should be sto­ry­tellers, com­mu­ni­ca­tors, holis­tic, strate­gic, encour­ag­ing, cre­ative, con­ser­v­a­tive, risk tak­ing, eth­i­cal, com­pet­i­tive, inspir­ing and a whole host of oth­er attributes.

    There are count­less books cur­rent­ly avail­able on the sub­ject, and it would not sur­prise me if there were close to over half a mil­lion arti­cles on the sub­ject. It is the bread and but­ter of every con­sult­ing firm through­out the world. With so much con­tent offer­ing thought and insight, you have to won­der why lead­er­ship still an issue?

    The answer lies with cul­ture. The entire pur­pose of lead­er­ship is to cre­ate a cul­ture. In a large and well-estab­lished orga­ni­za­tion, it can be dif­fi­cult for an out­sider to imple­ment a new cul­ture. So, does lead­er­ship cre­ate a cul­ture or does cul­ture cre­ate lead­er­ship? The answer to both ques­tions is yes.

    Culture Affecting Leadership

    “I have been here 25 years,” said the direc­tor of a large munic­i­pal­i­ty. “I have out­last­ed three city man­agers so far, and I will out­last this one.” This is the atti­tude many lead­ers face, espe­cial­ly when they are brought in from out­side orga­ni­za­tions to run or man­age large, well-estab­lished ones.

    The neg­a­tive cul­tures can espe­cial­ly under­mine pos­i­tive lead­er­ship as ini­tia­tives are active­ly under­mined by man­agers who have a stake in the old cul­ture or strug­gle to accept the changes inher­ent in the mod­ern work­place. Whether it’s through manip­u­la­tion or com­pla­cen­cy, neg­a­tive cul­tures can cre­ate sig­nif­i­cant chal­lenges for change. At the same time, pos­i­tive lead­er­ship can over­come neg­a­tive cul­ture and turn the tide over time. A few encour­ag­ing results and pos­i­tive expe­ri­ences can go a long way.

    Neg­a­tive lead­er­ship, how­ev­er, can have a fast, dra­mat­ic effect on a pos­i­tive cul­ture. World­Com was a tele­com leader and had a very inno­v­a­tive cul­ture until Bernie Ebbers took over. While squeez­ing every cent he could from the envi­ron­ment and putting pres­sure on employ­ees to work hard­er with less, he was pil­lag­ing the com­pa­ny. Turnover soared and, with­in a few years, World­Com was bankrupt.

    Culture as a Function of Leadership

    Com­pa­nies reflect the ethics of the lead­ers who run them. We’ve seen in recent times the reac­tion employ­ees and the pub­lic have to com­pa­nies who fail to address their stance on social issues, harass­ment, pay gaps and whose polit­i­cal lean­ings go against what employ­ees view to be the com­mon good.

    As a result, lead­ers find them­selves hav­ing to pub­licly make state­ments con­demn­ing sys­temic racism, polit­i­cal vio­lence and oth­er top­ics that aren’t easy to talk about with­out offend­ing some­one or putting one­self at risk. But ulti­mate­ly, the eth­i­cal stands a leader takes becomes a part of the organization’s culture.

    Bob Page felt like an out­sider and had to hide his sex­u­al­i­ty. When he built Replace­ments, Ltd., he ensured every­one it would be a place that accept­ed diversity—not just of lifestyle but of thought—and would invest in build­ing their com­mu­ni­ty. Ani­ta Rod­dick found­ed The Body Shop to build an envi­ron­men­tal­ly-friend­ly cor­po­ra­tion, which reflect­ed her com­mit­ment to envi­ron­men­tal activism. Jim Good­night’s com­mit­ment to work-life bal­ance is part of the cul­ture at SAS, the largest pri­vate­ly-held com­pa­ny in the world. Jack Welch’s com­mit­ment to being the best cre­at­ed an envi­ron­ment of excel­lence at Gen­er­al Elec­tric. In each of these cas­es, the ethics of the leader became a cen­tral part of the culture.

    The Obstacles to Culture Change

    The real obsta­cles to cul­ture change are inter­nal obsta­cles. False ego, fear, com­pla­cen­cy and pre­con­ceived ideas cre­ate a neg­a­tive envi­ron­ment. When change is intro­duced there is resis­tance, even when the change is pos­i­tive. Peo­ple learn dif­fer­ent cop­ing mech­a­nisms to avoid the change, such as hid­ing behind pro­ce­dures, “water cool­er” talk or active­ly under­min­ing the initiative.

    The remote work land­scape changes some of this as employ­ee com­mu­ni­ca­tions can be more eas­i­ly mon­i­tored and there are few­er “water cool­er” moments on offer to begin with. But neg­a­tiv­i­ty can me a bit like try­ing to con­tain water in an enclosed space. If there’s a place for it to leak through, it like­ly will. The ques­tion then becomes how lead­er­ship can have a pos­i­tive impact on the cul­ture of an organization?

    Ways Leadership Can Positively Affect Culture

    Peo­ple are inspired by vision. They want to fol­low a leader who shows con­cerns and val­ues that are impor­tant to them. A pos­i­tive leader will inspire 100% effort from every­body. Here are some signs of a good leader and how the leader affects the culture:

    • Vision­ar­ies and strate­gic thinkers: A boss tells you what to do, while a leader inspires you to want to do it. Lead­ers who lay out a vision that peo­ple buy into and a strat­e­gy that they under­stand will cre­ate a cul­ture of engage­ment. Peo­ple know where the orga­ni­za­tion is head­ed, how it will get there and their role in help­ing achieve the vision.
    • Ethics that sup­port val­ues: Peo­ple look at what you do and not what you say. Val­ues are words, ethics are actions. When lead­ers demon­strate val­ues through their actions, they lead by exam­ple and cre­ate an eth­i­cal culture.
    • Empow­er­ment: There are three require­ments for: respon­si­bil­i­ty, account­abil­i­ty and author­i­ty. Lead­ers who empow­er peo­ple to make deci­sions that affect their lives, give them the author­i­ty to act and make them take respon­si­bil­i­ty for con­se­quences cre­ate lead­er­ship on all lev­els of the orga­ni­za­tion. Micro­manag­ing means peo­ple are not entrust­ed to be lead­ers and very lit­tle gets done because all deci­sions need to be made by one person.

    Orig­i­nal­ly post­ed on hrexchangenetwork.com

  • They are continuing what they have been continuing…Emergency Paid Sick Leave | by Jordan Shields, Partner

    March 5, 2021

    Tags: , , ,

    Sono­ma and San Fran­cis­co coun­ties have both passed emer­gency paid sick leave ordinances.

    Sono­ma Coun­ty is in effect through June 30 and it applies to ALL employ­ers (was pre­vi­ous­ly orga­ni­za­tions of 500 or more employ­ees).  It is a one-time ben­e­fit so employ­ers do not need to pro­vide a new bank of leave.  There are some lim­it­ed excep­tions for health care providers.

    Employ­ers are sup­posed to post a notice of employ­ee rights in a promi­nent place.

    San Fran­cis­co made an amend­ment to their plan, but it still only applies to those of 500+.

  • 8 Small Steps Toward Financial Protection

    March 3, 2021

    Tags:

    About half of all Amer­i­cans make New Year’s res­o­lu­tions. Along with exer­cis­ing more and eat­ing bet­ter, many peo­ple aim to get a bet­ter han­dle on their finances.

    If you’re in that camp, we’re here to help. Here are some sure­fire steps to cre­ate a more finan­cial­ly secure future for you and your loved ones.

    1. Cre­ate a budget.

    The first step toward get­ting finan­cial­ly fit is to cre­ate a bud­get. Every­one needs an under­stand­ing of how much they’re earn­ing, how much they’re spend­ing, and how they’re going to meet their cur­rent and future finan­cial goals. The Fed­er­al Trade Com­mis­sion has infor­ma­tion on how to cre­ate a bud­get. Once you out­line your bud­get, make sure to stick to it. Also make sure to reg­u­lar­ly revis­it it and adjust it as needed.

    1. Con­trol and min­i­mize debt.

    Your bud­get will help you keep track of where your mon­ey is going. It will also help you iden­ti­fy areas where you’re over­spend­ing. It’s crit­i­cal to cut out any excess spend­ing. Also work to min­i­mize your debt load. So long as you have debt, you’ll be respon­si­ble for pay­ing inter­est. (So def­i­nite­ly make an effort to pay more than the min­i­mum on your cred­it card each month!) Set goals to pay off your debt and track your progress.

    3. Auto­mate an emer­gency fund.

    An emer­gency fund is mon­ey you set aside for unfore­seen expens­es. They could be an unex­pect­ed home or car repair or a job loss. Most finan­cial pro­fes­sion­als rec­om­mend hav­ing three to six months of basic liv­ing expens­es in an emer­gency fund. How­ev­er, it takes time to build those funds. Auto­mate the process by hav­ing part of your pay­check deposit­ed into a spe­cial emer­gency fund account. You can also have your bank auto­mat­i­cal­ly trans­fer funds to a sav­ings account ear­marked for emer­gency expens­es. Even a small amount each week can help you get there.

    1. Get life insur­ance to pro­tect your loved ones and review it annually.

    Life insur­ance pro­vides your loved ones with mon­ey to main­tain their lifestyle if you die. This mon­ey is known as the death ben­e­fit and it can replace your income, pay off debts like a mort­gage, and cov­er funer­al costs. It can also help with future expens­es like col­lege tuition, retire­ment, and much more. Experts rec­om­mend hav­ing life insur­ance that equals between 10 to 15 times your gross income. For a work­ing idea of how much you need, use an online cal­cu­la­tor like the Life Insur­ance Needs Cal­cu­la­tor. Then work with an insur­ance pro­fes­sion­al to explore your options and get the right cov­er­age. Make sure to review your life insur­ance annu­al­ly or after a big life change like buy­ing a new house, hav­ing a baby, or chang­ing jobs.

    1. Pro­tect your pay­check with dis­abil­i­ty insur­ance and review it annually.

    Dis­abil­i­ty insur­ance is one of the best ways to pro­tect your most impor­tant asset: your pay­check. Dis­abil­i­ty insur­ance typ­i­cal­ly replaces 50% to 70% of your earn­ings if you’re unable to work due to a dis­abling ill­ness or injury. An easy way to cal­cu­late how much you might need is to use an online cal­cu­la­tor like the Dis­abil­i­ty Insur­ance Needs Cal­cu­la­tor. Make sure to review your cov­er­age with your HR depart­ment or insur­ance pro­fes­sion­al as your salary increases.

    1. Keep ben­e­fi­cia­ries up to date.

    It’s impor­tant to update the ben­e­fi­cia­ries on your finan­cial accounts like your life insur­ance or 401(k). This is espe­cial­ly true after major life events such as a mar­riage, divorce, birth, or death. Not hav­ing the right ben­e­fi­cia­ry can lead to mon­ey going to the wrong per­son or delays in dis­burs­ing money.

    1. Put a will in place.

    A will is a doc­u­ment that allows you to spec­i­fy cer­tain things after you die. They can include how your assets will be dis­trib­uted, who will make sure your wish­es are car­ried out, and who will take care of any minor chil­dren. With­out a will, the state could decide who gets your chil­dren and more. For­tu­nate­ly, the process of cre­at­ing a will is not as com­pli­cat­ed as many peo­ple believe. And it’s well worth it since it spares your loved ones from all kinds of headaches. A lawyer can help you cre­ate a will and dis­cuss oth­er issues like pow­er of attorney.

    8. Save for retirement.

    Tap into any  avail­able resources to help grow your retire­ment nest egg. That includes enrolling in your company’s 401(k) plan or look­ing into oth­er retire­ment sav­ings options like an IRA. Def­i­nite­ly take advan­tage of any “match­ing funds” your com­pa­ny makes to your 401(k) con­tri­bu­tions. Match­ing funds are like “free mon­ey.” What’s more, the con­tri­bu­tions you make to your 401(k) reduce your tax­able income.

    Make 2021 the year you become finan­cial­ly fit by fol­low­ing these steps. Each one will cre­ate a bet­ter, more pro­tect­ed future for you and your loved ones.

    By Mar­vin Feldman

    Orig­i­nal­ly post­ed on lifehappens.org

  • A Note on Requiring COVID-19 Vaccines

    February 24, 2021

    Tags: ,

    With COVID-19 vac­ci­na­tions under­way and wide­spread avail­abil­i­ty in sight, many employ­ers want to know whether they can require their employ­ees to get the vaccine.

    While recent EEOC guid­ance implies that they expect many employ­ers to require a vac­cine, there are already sev­er­al states where bills are being intro­duced to pre­vent employ­ment dis­crim­i­na­tion against those who refuse a vac­cine (MN, NJ, SC), and it’s like­ly bills like this will be intro­duced in more states soon. Addi­tion­al­ly, we antic­i­pate that there will be state and fed­er­al law­suits from indi­vid­u­als, which may result in rul­ings that impact the law in indi­vid­ual states or entire cir­cuits (for instance, the Ninth Cir­cuit, which cov­ers AL, AR, CA, HI, ID, MT, NV, OR, WA, or the Eleventh Cir­cuit, which cov­ers AL, FL, GA).

    Giv­en the legal risks here, and since many Amer­i­cans will not have access to a vac­cine until Spring or even Sum­mer, we believe it would be pru­dent for most employ­ers to wait to see how things play out in courts and leg­is­la­tures across the coun­try before decid­ing to require vaccinations.

    Orig­i­nal­ly post­ed on ThinkHR

  • An Opinion (a good start) on Individual Coverage Health Reimbursement Arrangements | by Jordan Shields, Partner

    February 19, 2021

    Tags: , ,

    An Opin­ion is some­thing that can be cit­ed to see how the gov­ern­men­tal body (in this case, the Equal Employ­ment Oppor­tu­ni­ty Com­mis­sion) feels about an issue – at least you get a sense of direc­tion.  Here, the EEOC said, on Jan­u­ary 7, that where an employ­er-paid a flat amount or a per­cent­age of pre­mi­um toward indi­vid­ual health plans pur­chased under the aegis of an ICHRA, it would not vio­late the dis­crim­i­na­tion rules set up under the ADEA:

    • Flat amount is fine because it is the same for every­one, and not con­tin­gent on the age of the employ­ee (even though an indi­vid­ual plan is more expen­sive for old­er appli­cants), espe­cial­ly since enroll­ment through an ICHRA is vol­un­tary on the part of the employee.
    • Per­cent­age of pre­mi­um is fine so long as the per­cent­age is the same for every­one, even though the actu­al dol­lar amount will end up different

    Over­all – the con­tri­bu­tions are not a con­di­tion of employ­ment, but only an offer made at that time.  There­fore, the invol­un­tary nature of the par­tic­i­pa­tion ren­ders it out­side the scope of EEOC reg­u­la­tions per­tain­ing to age dis­crim­i­na­tion under the ADEA.

     

  • Exploring EAPs

    February 16, 2021

    Tags: ,

    Employ­ee Assis­tance Pro­grams (EAP) are com­pa­ny-spon­sored pro­grams that pro­vide assis­tance to employ­ees for a vari­ety of per­son­al issues that may be hin­der­ing or adverse­ly affect­ing their work per­for­mance. Typ­i­cal­ly offered through third-par­ty admin­is­tra­tors, EAPs can pro­vide their ser­vices online or via tele­phone and can some­times be a part of the employee’s health­care plan, how­ev­er it is not a replace­ment to the health­care plan.

    Exam­ples of EAP Services

    There is an assort­ment of ser­vices that EAPs offer to employ­ees. All these ser­vices have a cen­tral pur­pose: aid the employ­ee so that their per­son­al prob­lems are resolved, and their work per­for­mance is unaf­fect­ed. For exam­ple, Karen has been strug­gling dur­ing the COVID-19 pan­dem­ic with depres­sion. To sooth her anx­i­ety, she has begun drink­ing every day. It’s grad­u­al­ly esca­lat­ed to the point where she is late to work, has fre­quent absences, and is miss­ing dead­lines. She knows she needs to talk with some­one who can offer her alco­hol abuse resources. She access­es her com­pa­ny spon­sored EAP.

    Here are some oth­er com­mon ser­vices includ­ed in EAPs:

    • Alco­hol and sub­stance abuse counseling
    • Health and well­ness counseling
    • Child or elder care resources
    • Legal aid
    • Mar­i­tal and fam­i­ly counseling
    • Finan­cial counseling

    Ben­e­fits of EAP Services

    There are a num­ber of ben­e­fits to the employ­ee and the employ­er when the EAP is uti­lized in the work­place. First, uti­liz­ing the EAP ser­vice is com­plete­ly vol­un­tary. Sec­ond, the ser­vices are pro­vid­ed free of charge to the employ­ee. Third, the coun­selor that speaks with the employ­ee is entire­ly con­fi­den­tial. This allows the employ­ee to be com­plete­ly hon­est with­out feel­ing a threat that the employ­er would retal­i­ate on any­thing said in a session.

    Uti­liz­ing your company’s EAP not only pro­vides ser­vices and care to you and your fam­i­ly, but it also ben­e­fits your com­pa­ny. No longer car­ry­ing the bur­den of your per­son­al prob­lems solo, an EAP coun­selor can give you sound advice and steps to fol­low to achieve suc­cess when tack­ling a prob­lem.  Employ­ers will ben­e­fit by there being no dis­rup­tion in the work­flow of their employ­ee due to over­whelm­ing per­son­al issues. Access your EAP and attack those per­son­al prob­lems today!

  • Plan Sponsor Reporting in California – the rules are different than federal | by Jordan Shields, Partner

    February 12, 2021

    Tags: ,

    For ful­ly insured plans, the car­ri­ers are respon­si­ble for send­ing Form 1094‑C and 1095‑C.

    For self-insured plans, the plan spon­sor is respon­si­ble for send­ing these forms to the State of Cal­i­for­nia as fur­ther­ance of ACA com­pli­ance.  The forms are the same (in design) as the fed­er­al forms, and an employ­er may sub­mit the fed­er­al form for state report­ing purposes.

    How­ev­er, while fed­er­al forms are due March 2, 2021, the state forms are due Feb­ru­ary 1.

  • Be Alert: Employers Are Seeing a Spike in Phishing Scams

    February 9, 2021

    Tags: ,

    Phish­ing emails are a type of scam designed to obtain infor­ma­tion or prompt cer­tain behav­ior from their tar­gets. To that end, they typ­i­cal­ly appear to come from a per­son or enti­ty we trust.

    In most cas­es, care­ful inspec­tion will reveal cracks in the façade, lit­tle signs that the mes­sage is not what it pur­ports to be. But, of course, most of us don’t thor­ough­ly ana­lyze every email we receive from a col­league or super­vi­sor. When we get an email from our CEO, Lizzy Beth, we don’t hov­er the mouse over her con­tact card to ver­i­fy that the mes­sage came from her actu­al com­pa­ny email and not [email protected] We see the email, assume Lizzy Beth wants us to send her the request­ed infor­ma­tion, and send it.

    A suc­cess­ful scam can be a cost­ly data breach with legal con­se­quences. Busi­ness­es are gen­er­al­ly required to take rea­son­able pre­cau­tions to pro­tect per­son­al infor­ma­tion in their pos­ses­sion. In the event of a breach, many states require that notice be giv­en to those whose infor­ma­tion was com­pro­mised. This notice might need to include the cause and nature of the data breach as well as what pro­tec­tions are afford­ed to those affected.

    One of the best ways to pro­tect your com­pa­ny from these sorts of scams is to have a pol­i­cy and prac­tice of nev­er email­ing sen­si­tive employ­ee infor­ma­tion. The lan­guage below may serve as an effec­tive reminder:

    “Employ­ees should not under any cir­cum­stance email sen­si­tive employ­ee infor­ma­tion such as W‑2s, ben­e­fit enroll­ment forms, com­plet­ed cen­sus forms, or any­thing with social secu­ri­ty or cred­it card num­bers. Email is inher­ent­ly inse­cure, and scam­mers may pose as com­pa­ny exec­u­tives or employ­ees to steal infor­ma­tion. If you receive a request to email any such sen­si­tive infor­ma­tion, do not respond to it. Instead, inform your man­ag­er immediately.”

    You can help pro­tect your orga­ni­za­tion by giv­ing employ­ees exam­ples of the kinds of emails and oth­er com­mu­ni­ca­tions (texts, calls, etc.) that are like­ly sus­pi­cious. Here are a few:

    • A notice from your email provider sug­gest­ing you change your password.
    • A mes­sage from the IRS ask­ing you to click a link, open an attach­ment, or pro­vide information.
    • A mes­sage ask­ing you to click a link to pay fines or penalties.
    • A request for W‑2s or pay­roll records.
    • A request for names, birth dates, home address­es, salaries, and social secu­ri­ty numbers.
    • A request for con­tact information.
    • A request to pur­chase gift cards and email the sender the card numbers.
    • A request for login information.
    • A com­mu­ni­ca­tion with glar­ing typos.
    • A com­mu­ni­ca­tion that says “EMERGENCY” in the subject.
    • A LinkedIn con­nec­tion from some­one you don’t rec­og­nize even though they pur­port to work at your com­pa­ny and have con­nect­ed with some of your colleagues.

    By Kyle Cupp

    Orig­i­nal­ly post­ed on thinkhr.com.

     

  • Well it almost worked until it didn’t – Haven finds no haven in health care | by Jordan Shields, Partner

    February 5, 2021

    Tags:

    The high­ly tout­ed project com­bin­ing the resources of Ama­zon, JPMor­gan Chase and Berk­shire Hath­away has fold­ed its tent fol­low­ing the depar­ture of their CEO sev­er­al months ago (who now has an advi­so­ry posi­tion in the Biden admin­is­tra­tion).  Haven was look­ing to change how health care was deliv­ered in the Unit­ed States, start­ing with the thou­sands of employ­ees that worked for the three found­ing com­pa­nies.  Trou­ble began when the ideas spawned at Haven were inde­pen­dent­ly used by each of the founders…without una­nim­i­ty, how could they expand?

  • COVID-19 Fraud Protection

    February 1, 2021

    Tags: , ,

    The COVID-19 cri­sis has not only stolen the health and well-being of peo­ple all over the world, but now, it seems, it has opened the door to crim­i­nals who want to steal your mon­ey and your iden­ti­ty. His­tor­i­cal­ly, when there are times of cri­sis, the crime rate increas­es. We see this with nat­ur­al dis­as­ters when stores are loot­ed or when the econ­o­my is tank­ing and theft increas­es.  Now, we are see­ing this sce­nario play out in real time as thieves use the pan­dem­ic and fear to their benefit.

    SCAMS TO WATCH OUT FOR

    Accord­ing to Forbes, Amer­i­cans have lost more than $106 mil­lion to fraud relat­ed to COVID-19. These loss­es orig­i­nate from all types of scams rang­ing from seek­ing dona­tions for non-exis­tent char­i­ties to price gaug­ing for per­son­al pro­tec­tive equip­ment. Dis­hon­est indi­vid­u­als call vic­tims and imper­son­ate health orga­ni­za­tions with a cure for COVID or prod­ucts that can pre­vent infec­tion if you just give them a cred­it card num­ber. False bank accounts have been opened for the sole pur­pose of deposit­ing unem­ploy­ment ben­e­fit checks for non-exis­tent per­sons.  With crime so ram­pant, how can you tell what’s true and what’s false per­tain­ing to this cri­sis? Here’s some big scams that you can look out for:

    • Phishing/SMishing—Emails or text mes­sages that appear to be from your bank or from an online retail­er ask you to click a link or call a num­ber so that you can ver­i­fy per­son­al information.
    • Work-from-home scams—Pos­ing as a com­pa­ny or even one of your co-work­ers, crim­i­nals email about fake oppor­tu­ni­ties to work from home and ask you to apply for a job by giv­ing out per­son­al information.
    • Med­ical fraud—Fake web­sites are launched with virus test­ing kits or med­ical sup­plies for sale and col­lect cred­it card information.
    • COVID con­tact trac­ing—In an attempt to steal per­son­al infor­ma­tion such as social secu­ri­ty num­bers, fraud­sters claim to be con­tact trac­ers and have iden­ti­fied you as a pos­si­ble close con­tact of a COVID patient. Now they ask you for your info to ver­i­fy and log your expo­sure to the virus.
    • Vac­cine scheme—Call­ing indi­vid­u­als to sign them up to receive the COVID vac­cine, the imposter asks for your per­son­al information.

    WAYS TO PROTECT YOURSELF FROM FRAUD

    • The num­ber one way to pro­tect your­self from pos­si­ble fraud relat­ed to the COVID-19 cri­sis is to nev­er give out your per­son­al infor­ma­tion in response to an unso­licit­ed email or phone call. If you haven’t called the company/bank/organization direct­ly, and some­one con­tacts you ask­ing for your birth­date, maid­en name, social secu­ri­ty num­ber, etc, don’t give it out. You have the right to decline their request so that you can feel secure in releas­ing your infor­ma­tion. Sim­ply tell the solic­i­tor that you want to call them back and then look on your bill/website/known con­tact infor­ma­tion and call that num­ber to affirm that the per­son who con­tact­ed you is indeed who they say they are.
    • If you sus­pect that your iden­ti­ty has been stolen, con­tact one of the three big cred­it bureaus: Equifax, Exper­ian, or Tran­sUnion. When you con­tact one of these agen­cies, you can request a freeze be put on your cred­it so that scam­mers can­not open any new accounts in your name.
    • “Report finan­cial iden­ti­ty theft fraud attempts to the FBI. The toll-free num­ber is easy to remem­ber: 1–800-CALL-FBI. Or you can go online to FBI.gov” reports Ter­ry Sav­age, Next Avenue pod­cast co-host. Forbes has a great tran­script of a recent episode online with lots of fan­tas­tic tips for pro­tect­ing your­self against fraud and you can access it HERE.

    In the midst of this pan­dem­ic cri­sis, the most impor­tant thing to focus on is the health and wel­fare of your­self and those you care most about. You shouldn’t have to waste time and effort chas­ing down scam­mers who have preyed on you when you are the most vul­ner­a­ble. By fol­low­ing these easy (and always applic­a­ble) tips for pro­tect­ing your iden­ti­ty and your finances, you can keep your focus on what real­ly matters.

     

  • What to Know About Life Insurance for Diabetics

    January 27, 2021

    Tags:

    Many peo­ple false­ly believe that life insur­ance for dia­bet­ics doesn’t exist. In real­i­ty, there are quite a few life insur­ance options for the 34.2 mil­lion Amer­i­cans who have diabetes.

    While dia­betes remains a health chal­lenge for many, it is still very pos­si­ble to secure good life insur­ance as a dia­bet­ic. Here are some key things to know about get­ting life insur­ance if you have diabetes.

    Insurance companies consider many factors.

    In addi­tion to know­ing whether you have dia­betes, a life insur­er may also want to know:

    • Whether you have Type 1 or Type 2 diabetes
    • The age you were diag­nosed with diabetes
    • What med­ica­tions you’re taking
    • Your height and weight
    • How well you’re con­trol­ling your diabetes
    • Your glu­cose levels
    • If you have oth­er health con­di­tions like heart dis­ease and/or high blood pressure
    • If you smoke
    • Your over­all med­ical history
    • Your fam­i­ly history

    Some life insur­ers offer some­thing known as “clin­i­cal under­writ­ing.” (Under­writ­ing is when an insur­ance com­pa­ny eval­u­ates you for cov­er­age.) This type of under­writ­ing takes a more holis­tic view of your health instead of zero­ing in on cer­tain risk fac­tors. An insur­ance pro­fes­sion­al will know more about com­pa­nies that offer clin­i­cal underwriting.

    Life insurance for diabetics underwriting varies by insurer.

    One per­son who knows a lot about life insur­ance for dia­bet­ics is Jake Irv­ing. He’s is a licensed insur­ance agent and own­er of Willamette Life Insur­ance in Beaver­ton, Ore­gon. Irv­ing spe­cial­izes in help­ing peo­ple with dia­betes get life insur­ance. He says that every insur­er has dif­fer­ent under­writ­ing guide­lines when it comes to life insur­ance for diabetics.

    Even still, Irv­ing says that most insur­ers care about your age at the diag­no­sis. “Being diag­nosed ear­li­er in life means there’s more time for relat­ed com­pli­ca­tions to devel­op,” he explains. That may make it hard­er to get coverage.

    Most insur­ers will also care about any severe dia­bet­ic com­pli­ca­tions. “Hav­ing a dia­bet­ic coma, an ampu­ta­tion, or a hos­pi­tal­iza­tion are the big three they care about,” says Irv­ing. “But hav­ing any one doesn’t mean you can’t get coverage.”

    Final­ly, peo­ple with Type 2 dia­betes typ­i­cal­ly have an eas­i­er time secur­ing life insur­ance than peo­ple with Type 1 diabetes.

    Life insurance for diabetics is often (but not always!) more expensive.

    Peo­ple in good health who don’t smoke gen­er­al­ly get bet­ter life insur­ance rates than peo­ple with health con­di­tions and smok­ers. That said, Jake says he’s had dia­bet­ics qual­i­fy for pre­ferred insur­ance rates. Pre­ferred is the best rate cat­e­go­ry avail­able for life insurance.

    Nontraditional plans are an option.

    One non­tra­di­tion­al option is grad­ed life insur­ance. With this option, your ben­e­fi­cia­ries only receive a per­cent­age of the full life insur­ance pay­out if you pass away before a set wait­ing peri­od. A typ­i­cal wait­ing peri­od is two years.

    Anoth­er option is guar­an­teed issue life insur­ance. With this option, you get a lim­it­ed amount of cov­er­age on the spot. You are not required to have a med­ical exam or even answer any med­ical ques­tions. Just know that you may only get a lim­it­ed amount of cov­er­age and that the rate may be high. There’s also often a wait­ing peri­od as well.

    Controlling your diabetes can help you get better coverage.

    Life insur­ers look more favor­ably on dia­bet­ics who are work­ing on man­ag­ing their con­di­tion. This could mean reg­u­lar­ly vis­it­ing your doc­tor, tak­ing your pre­scribed med­ica­tion, main­tain­ing a healthy weight, and hav­ing low­er A1C and glu­cose levels.

    Jake says that it may even be pos­si­ble to secure a bet­ter rate once you con­trol your dia­betes. This is espe­cial­ly true if a good amount of time has passed since a hos­pi­tal­iza­tion from dia­betes. (Just know that the inci­dent may remain on your health record and affect your rate.)

    Working with a licensed insurance agent is your best bet.

    Ide­al­ly, you want an inde­pen­dent agent who has rela­tion­ships with many dif­fer­ent life insur­ance com­pa­nies. This means they can shop around for the best pos­si­ble cov­er­age for you. It also means they can turn to oth­er car­ri­ers if your appli­ca­tion is rejected.

    You might even con­sid­er an agent like Jake who works with high-risk appli­cants. These kinds of agents are espe­cial­ly knowl­edge­able about which car­ri­ers are most like­ly to offer you the best policy.

    Start the process by learn­ing how to choose a qual­i­fied insur­ance agent. An easy way to find a qual­i­fied insur­ance pro­fes­sion­al in your area is to use our Agent Loca­tor.

    By Aman­da Austin

    Orig­i­nal­ly post­ed on LifeHappens.org

  • Compliance Requirements for a Remote Workforce

    January 20, 2021

    Tags:

    Accord­ing to Gallup, the num­ber of days employ­ees are work­ing remote­ly has dou­bled dur­ing the pan­dem­ic. Some com­pa­nies are even con­sid­er­ing mak­ing a remote work arrange­ment per­ma­nent. While there are no laws that exclu­sive­ly apply to remote work­places, remote work does come with addi­tion­al com­pli­ance risks. Below is our gen­er­al guid­ance for employers.

    Log­ging Hours and Prepar­ing Paychecks
    Make sure that employ­ees are log­ging all of their time. Keep in mind that when work­ing from home, the bound­aries between work and home life are easy to blur. Employ­ees may be rack­ing up “off the clock” work, and even over­time, that they aren’t being paid for. While this may seem harm­less enough in the moment, par­tic­u­lar­ly if the employ­ee isn’t com­plain­ing, unpaid wages can come back to bite you once the employ­ee is on their way out the door.

    Min­i­mum Wage
    Employ­ees should be paid at least the min­i­mum wage of the state where they phys­i­cal­ly work, whether this is a satel­lite office or their own home. Beyond that, it’s impor­tant to be aware that some cities and coun­ties have even high­er min­i­mum wages than the state they are locat­ed in. In gen­er­al, with most employ­ment laws, you should fol­low the law that is most ben­e­fi­cial to the employee.

    Breaks
    Remote employ­ees must take all required break and rest peri­ods required by law, as if they were in the workplace.

    Harass­ment Pre­ven­tion Considerations
    You may have employ­ees work­ing in a state that has a low­er bar for what’s con­sid­ered harass­ment or that requires harass­ment pre­ven­tion train­ing. You can find this infor­ma­tion on the State Law pages on the HR Sup­port Center.

    Remote work also comes with addi­tion­al oppor­tu­ni­ties for harass­ment (even if it doesn’t rise to the lev­el of ille­gal harass­ment) such as employ­ees wear­ing cloth­ing that cross­es the line into inap­pro­pri­ate, room­mates in the back­ground unaware that they are on cam­era, or vis­i­ble objects that oth­er employ­ees may con­sid­er offen­sive. You can pre­vent these sorts of inci­dents by hav­ing clear, doc­u­ment­ed expec­ta­tions about remote meet­ings, com­mu­ni­cat­ing those expec­ta­tions to your employ­ees, and hold­ing every­one account­able to them. It also wouldn’t hurt to occa­sion­al­ly remind every­one to be mind­ful that they and what’s behind them are vis­i­ble to cowork­ers when they’re on video. That said, going over­board with stan­dards that you’re apply­ing to employ­ees’ pri­vate homes can cause anx­i­ety and morale issues, so make sure your restric­tions have some log­i­cal busi­ness-relat­ed explanation.

    Work­place Posters
    Many of the laws relat­ed to work­place posters were writ­ten decades before the inter­net, and so their require­ments don’t always make sense giv­en today’s technology.

    The safest option to ensure you’re com­ply­ing will all post­ing require­ments in one fell swoop is to mail hard copies of any applic­a­ble work­place posters to remote employ­ees and let them do what they like with the posters at their home office. If you have employ­ees in mul­ti­ple states, you should send each employ­ee the required fed­er­al posters, plus any applic­a­ble to the state in which they work.

    Alter­na­tive­ly, more risk-tol­er­ant employ­ers often pro­vide these required notices and posters on a com­pa­ny web­site or intranet that employ­ees can access. A num­ber of new­er post­ing laws express­ly allow for elec­tron­ic post­ing, but this option is not nec­es­sar­i­ly com­pli­ant with every post­ing law out there.

    FMLA Eli­gi­bil­i­ty
    Remote employ­ees who oth­er­wise qual­i­fy will be eli­gi­ble for leave under the fed­er­al Fam­i­ly and Med­ical Leave Act (FMLA) if they report to or receive work assign­ments from a loca­tion that has 50 or more employ­ees with­in a 75-mile radius.

    Accord­ing to the FMLA reg­u­la­tions, the work­site for remote employ­ees is “the site to which they are assigned as their home base, from which their work is assigned, or to which they report.” So, for exam­ple, if a remote employ­ee work­ing in Frisco, TX, reports to their company’s head­quar­ters in Port­land, OR, and that site in Port­land has 65 employ­ees work­ing with­in a 75-mile radius, then the employ­ee in Frisco may be eli­gi­ble for FMLA. How­ev­er, if the site in Port­land has only 42 employ­ees, then the remote employ­ee would not be eli­gi­ble for FMLA. The dis­tance of the remote employ­ee from the company’s head­quar­ters is immaterial.

    Ver­i­fy­ing I‑9s
    In nor­mal cir­cum­stances, the phys­i­cal pres­ence require­ment of the Employ­ment Eli­gi­bil­i­ty Ver­i­fi­ca­tion, Form I‑9, requires that employ­ers, or an autho­rized rep­re­sen­ta­tive, phys­i­cal­ly exam­ine, in the employee’s phys­i­cal pres­ence, the unex­pired document(s) the employ­ee presents from the Lists of Accept­able Doc­u­ments to com­plete the Doc­u­ments fields in Form I‑9’s Sec­tion 2.

    How­ev­er, in March, the Depart­ment of Home­land Secu­ri­ty (DHS) tem­porar­i­ly sus­pend­ed the phys­i­cal pres­ence require­ment for employ­ers and work­places that are oper­at­ing remote­ly due to COVID-19 relat­ed pre­cau­tions. In oth­er words, employ­ers with employ­ees tak­ing phys­i­cal prox­im­i­ty pre­cau­tions due to COVID-19 (and oper­at­ing remote­ly) are not required to review the employee’s iden­ti­ty and employ­ment autho­riza­tion doc­u­ments in the employee’s phys­i­cal pres­ence. Inspec­tion should instead be done remote­ly. As of the date of this newslet­ter, this tem­po­rary rule is still in effect.

    Equip­ment
    In some states, an employ­er is required either to pro­vide employ­ees with the tools and items nec­es­sary to com­plete the job or to reim­burse employ­ees for these expens­es. How­ev­er, work­sta­tion equip­ment like desks and chairs is usu­al­ly not includ­ed in this cat­e­go­ry of nec­es­sary items.

    That said, an employ­ee might request a device or some form of fur­ni­ture as a rea­son­able accom­mo­da­tion under the Amer­i­cans with Dis­abil­i­ties Act (ADA) so they can per­form the essen­tial func­tions of their job. In such cas­es, you would con­sid­er it like any oth­er ADA request. Allow­ing them to take home their ergonom­ic office chair, for exam­ple, would prob­a­bly not be an undue hard­ship and there­fore some­thing you should do.

    Decid­ing Who Can Work from Home
    You may offer dif­fer­ent ben­e­fits or terms of employ­ment to dif­fer­ent groups of employ­ees as long as the dis­tinc­tion is based on non-dis­crim­i­na­to­ry cri­te­ria. For instance, a telecom­mut­ing option or require­ment can be based on the type of work per­formed, employ­ee clas­si­fi­ca­tion (exempt v. non-exempt), or loca­tion of the office or the employ­ee. You should be able to sup­port the busi­ness jus­ti­fi­ca­tion for allow­ing or requir­ing cer­tain groups to telecommute.

    Orig­i­nal­ly post­ed on ThinkHR

  • PCORI Tax reinstated | by Jordan Shields, Partner

    January 19, 2021

    Tags:

    First, it was here, then it wasn’t, now it is back again, rein­stat­ed under the Trump administration.

    For plans that renew between Octo­ber 1, 2019, and Octo­ber 1, 2020, the amount paid per cov­ered employ­ee is $2.54.  For 2020–21 the amount will be raised to $2.66.

  • Wait – Are health care costs going down? Well yes, since no one can use any facilities | by Jordan Shields, Partner

    January 12, 2021

    Tags: ,

    A recent car­ri­er sur­vey shows that the amount of med­ical claims will be 5% low­er than what was orig­i­nal­ly pro­ject­ed for 2020.  Den­tal and vision claims are also down rough­ly 15% and 8% respectively.

    This could con­tin­ue into 2021 depend­ing on how quick­ly the pan­dem­ic sees relief.

  • Exploring Disability Insurance

    January 11, 2021

    Tags:

    Dis­abil­i­ty insur­ance is a type of insur­ance cov­er­age that replaces a por­tion of your month­ly income in the event you are unable to per­form your work func­tions due to ill­ness or injury. This insur­ance gives both your­self, and those who are depen­dent on you and your pay­check, a sense of finan­cial secu­ri­ty while you are out of work. Let’s explore dis­abil­i­ty insurance.

    Who Qual­i­fies for Dis­abil­i­ty Insur­ance and Why?

    Accord­ing to the Social Secu­ri­ty Admin­is­tra­tion, about 1 in 4 adults, who are cur­rent­ly in their 20’s, will have some sort of dis­abling event in their life that will cause them to be out of work for at least 3 months before they hit retire­ment age. And, while most peo­ple think that dis­abil­i­ty insur­ance is most used by those with an injury due to an acci­dent, the major­i­ty of claims (90%) come from med­ical ill­ness­es. In fact, the most com­mon claims are relat­ed to can­cer, back pain, car­dio­vas­cu­lar dis­ease, injury, preg­nan­cy, and diges­tive disorders.

    Types of Dis­abil­i­ty Insurance

    There are two types of dis­abil­i­ty insur­ance than an indi­vid­ual can enroll in and one that is admin­is­trat­ed by the gov­ern­ment through the Social Secu­ri­ty Admin­is­tra­tion. First, there is short-term dis­abil­i­ty insur­ance. This type pays pay­check ben­e­fits for, as the name sug­gests, a short-term dis­abil­i­ty due to injury or ill­ness.  The time frame for these ben­e­fits is between 3–6 months and can cov­er between 40–60% of the participant’s income. Pur­chas­ing this type of insur­ance tends to be expen­sive and ben­e­fits usu­al­ly begin about 14 days after the qual­i­fy­ing incident.

    Long-term dis­abil­i­ty insur­ance pays between 60–80% of the participant’s income and typ­i­cal­ly lasts until they recov­er from the injury or ill­ness or until a pre-deter­mined num­ber of years, for instance, until they are 65.  Ben­e­fits for long-term dis­abil­i­ty insur­ance usu­al­ly begin after a 90-day wait­ing time.

    Social Secu­ri­ty Dis­abil­i­ty Insur­ance (SSDI) is admin­is­tered by the Social Secu­ri­ty Admin­is­tra­tion (SSA). To be eli­gi­ble for these ben­e­fits, the per­son must be approved through a strict list of qual­i­fi­ca­tions from the SSA, which can be found here. It is dif­fi­cult to qual­i­fy for SSDI ben­e­fits and the aver­age month­ly ben­e­fit in 2019 was $1,234.

    How to Enroll in Dis­abil­i­ty Insurance 

    When look­ing to buy dis­abil­i­ty insur­ance, first, look to see if your employ­er offers employ­er-spon­sored cov­er­age at work. Many times, employ­ers pay for all or a por­tion of the pre­mi­ums. Some employ­ers offer dis­abil­i­ty insur­ance for employ­ees to buy at a dis­count­ed rate as a vol­un­tary ben­e­fit as part of their ben­e­fits pack­age.  If you are part of a pro­fes­sion­al orga­ni­za­tion like a labor union or one for a spe­cif­ic pro­fes­sion, they may offer the abil­i­ty to pur­chase dis­abil­i­ty insur­ance at a group rate. Also, you may pur­chase insur­ance through an insur­ance bro­ker or direct­ly from an insur­ance company.

    COVID-19 and Dis­abil­i­ty Insurance

    In some instances, dis­abil­i­ty insur­ance may cov­er the par­tic­i­pant who is affect­ed by the COVID-19 pan­dem­ic. Some ben­e­fits will cov­er if you are med­ical­ly quar­an­tined because of a pos­i­tive COVID test or expo­sure to the coro­n­avirus and you can­not com­plete your work func­tion. This does not include state man­dat­ed “work from home orders.” Also, some COVID-19 sur­vivors have lin­ger­ing symp­toms such as fatigue, headaches, and pain and these symp­toms pre­vent them from being able to work. In these cas­es, short-term dis­abil­i­ty insur­ance may kick in. Check with your HR team or insur­ance bro­ker to ver­i­fy your cov­er­age and eligibility.

    Dis­abil­i­ty insur­ance pro­vides the finan­cial secu­ri­ty need­ed by your­self and those who depend on you. In these uncer­tain times, hav­ing a back­up plan in place will give you the con­fi­dence that an unfore­seen ill­ness or injury will not deplete your bank accounts while you get back on your feet. Check into dis­abil­i­ty insur­ance plans at your work­place, pro­fes­sion­al orga­ni­za­tion, or through a local bro­ker. You and your fam­i­ly will be glad you did.

    The infor­ma­tion and con­tent pro­vid­ed here­in is for edu­ca­tion­al pur­pos­es only, and should not be con­sid­ered legal, tax, invest­ment, or finan­cial advice, rec­om­men­da­tion, or endorsement. 

     

  • Summary of Legislative Changes in 2020 | by Jordan Shields, Partner

    January 7, 2021

    • Repeal
      Health Insur­ance Tax – may be revis­it­ed under Biden presidency

     

    • Repeal
      Cadil­lac Tax – may be revis­it­ed under Biden presidency

     

    • Rein­stat­ed
      Patient Cen­tered Out­come Research Tax – self-fund­ed plans only

     

    • New
      Price Trans­paren­cy rules
      Indi­vid­ual Health Care Reim­burse­ment Arrangement
      New SBC Tem­plate required
      Car­ri­ers may decide whether to count drug coupons to out of pock­et allowance
      Cost of Liv­ing Increas­es apply across the board to retire­ment and oth­er programs

     

    • New Under
      Over the counter med­ica­tions are cov­ered under FSA or HSA

     

    • CARES Act
      Tele­health is a cov­ered pro­gram under health plans, FSA and HSA
      COVID test­ing is cov­ered at 100% under plans and also under FSA and HSA
      COVID immunizations
      Flex­i­ble Spend­ing Account rollovers allowed up to $550

  • 3 Tips for Effective Goal Setting

    January 6, 2021

    Tags: ,

    There is nev­er a bet­ter time to look towards the future than right now. Goal set­ting does not need to be con­strained to the start of a new year. So, let’s look at three help­ful tips for effec­tive goal setting.

    First, what is a goal? A goal is defined as “the object of a person’s ambi­tion or effort; an aim or desired result.” Goals can be for the short-term or long-term. And, many times, short-term goals can be used to achieve your long-term ones. Goals are not a one-and-done activ­i­ty, too. They are an active under­tak­ing that require ded­i­ca­tion and work.

    TIPS FOR GOALS

    1. Set goals with high value.

    We all dream big dreams for our life. In order to make those dreams a real­i­ty, you have to put in some work. This is where goals come in. Make a list of the dreams you have and rank them by pri­or­i­ty and fea­si­bil­i­ty. When you have made your ranked dream list, you can now set goals that relate to the things that have the high­est pri­or­i­ty in your life. When you do so, you give the goals high val­ue. High-val­ue goals moti­vate you to put in the hard work to achieve them.

    2. Fol­low the SMART method of goal setting.

    When you work on your goal set­ting, make sure you fol­low the SMART method. By doing so, you ensure that your goals are ones that are clear and well thought out. Here’s the break­down of the SMART method:

    • Spe­cif­ic—Make sure your goals are clear and well-defined. Don’t be vague and say “I’d like to learn how to play the gui­tar.” Instead, say “I will take a week­ly gui­tar lesson.”
    • Mea­sur­able—Use spe­cif­ic amounts, dates, etc. As you craft your goals, assign specifics to them that can be mea­sured like “I will take week­ly gui­tar lessons for three months.”
    • Attain­able—Cre­ate goals that are pos­si­ble to achieve. Don’t set goals for your­self that you have no way to accom­plish or you will feel defeat­ed and reluc­tant to set goals in the future.
    • Rel­e­vant—Set goals that line up with your life and career. In oth­er words, set goals that align with the things that mat­ter in your life.
    • Time-bound—Your goals must have a dead­line. Open-end­ed goals lead to unachieved goals because there is no urgency to them. Give your goals an end date so you have some­thing to work towards.

    3. Be accountable.

    Find an account­abil­i­ty part­ner to keep you on track. When you have some­one that is reg­u­lar­ly check­ing in on you to see how you are doing with accom­plish­ing your goals, you will work hard­er to stay on pace to achieve them!

    BONUS TIP!

    You can track your progress on accom­plish­ing your goals through goal track­er apps. Check out these three: Strides, Repeat Habit Track­er, and Way of Life.

    Set­ting goals not only gives you focus for the future, but it also allows you to see just how much you are capa­ble of.  When you look at where you are now com­pared to where you were at the ini­tial time of your goal set­ting, you’ll be amazed at what you have achieved. Take the time to set SMART goals and, as Success.com says, “Make sure that the great­est pull in your life is the pull of the future.”

  • Are Your Healthcare Benefits Contributing to the Labor Shortage?

    December 27, 2021

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    Employ­ee ben­e­fits are a major bar­gain­ing chip for com­pa­nies look­ing to attract tal­ent. The prob­lem is health­care costs are sky­rock­et­ing, and it’s dif­fi­cult for employ­ers to offer the same lev­el of cov­er­age. High­er costs are either result­ing in less cov­er­age or small­er wages for employees.

    Find out what’s hap­pen­ing with health­care and recruit­ment, and get tips on what com­pa­nies can do to stay competitive:

    The Rising Costs of Healthcare

    It’s no secret that health­care costs have been increas­ing for years. Accord­ing to the research, it will con­tin­ue to increase. One study from the Peter­son Cen­ter on Health­care and the Kaiser Fam­i­ly Foun­da­tion (KFF) found that $3.8 trillion—or $11,582 per per­son— was spent on health­care in 2019. By 2028, indi­vid­ual Amer­i­cans will be spend­ing around $18,000 on healthcare.

    While the issue is com­plex, experts agree that the major fac­tors in this spike include an aging pop­u­la­tion, a rise in chron­ic dis­ease, and high­er prices for med­ical ser­vices and drugs. Costs are ris­ing so rapid­ly that insur­ers are increas­ing deductibles, not cov­er­ing cer­tain ser­vices, or apply­ing caps. As a result, health­care pack­ages are play­ing a larg­er role when cho­sen can­di­dates are decid­ing whether to accept a new job.

    How Important Are Competitive Healthcare Packages?

    As health­care costs con­tin­ue to rise, a new debate has emerged. Should employ­ers or employ­ees take more respon­si­bil­i­ty for cov­er­ing healthcare?

    One of two things are hap­pen­ing with work­place health­care. Either employ­ees are leav­ing their cur­rent posi­tion for a job with bet­ter health­care cov­er­age or their annu­al salary increas­es are being eat­en up by high­er health­care pre­mi­ums being passed on to employees.

    A recent sur­vey found that 42% of employ­ees are think­ing about leav­ing their cur­rent posi­tion because of inad­e­quate benefits.

    “The ris­ing price of health care costs fam­i­lies thou­sands of dol­lars a year in fore­gone wages, out-of-pock­et costs, and increased tax­es,” said Josh Bivens, research direc­tor at the Eco­nom­ic Pol­i­cy Insti­tute, in an inter­view with Mar­ket­Watch.

    He said the effect may not be appar­ent, but it’s one of the main rea­sons wages have remained stag­nant. If you spot a num­ber of para­dox­es here, then you aren’t alone. Low­er salaries won’t attract top tal­ent, and pass­ing on the costs of health­care to cur­rent employ­ees won’t retain them. This quandary for employ­ers is com­pound­ed by the cur­rent labor short­age, which is often referred to as the Great Resignation.

    What Can Companies Do?

    It’s clear that health­care is impor­tant to job can­di­dates. To attract new tal­ent, com­pa­nies should rev­o­lu­tion­ize the way they treat well­ness in the workplace.

    Pro­mot­ing health and well­ness ini­tia­tives not only improves employ­ee morale and decreas­es absen­teeism, but a health­i­er work­force is less like­ly to use their insur­ance. This may even­tu­al­ly equate to low­er premiums.

    Anoth­er easy way to curb costs is by com­mu­ni­cat­ing with employ­ees about what plans are avail­able. Health insur­ance is often a com­plex top­ic, and some employ­ees may acci­den­tal­ly choose the wrong plan because they don’t under­stand the difference.

    Proac­tive­ly high­light­ing avail­able ser­vices can assist employ­ees before a med­ical issue spins out of con­trol. Men­tal health ser­vices are an exam­ple of this. Let­ting employ­ees know about Employ­ee Assis­tance Pro­grams or low-cost tele­health options could offer help before a more seri­ous inter­ven­tion is needed.

    There are many options avail­able for com­pa­nies to make their ben­e­fit pack­ages more com­pet­i­tive to attract top tal­ent. Some com­pa­nies are con­sid­er­ing Health Sav­ings Accounts or HSAs that help employ­ees pay med­ical bills while enrolled in cheap­er, high deductible plans.

    Direct Pri­ma­ry Care is anoth­er tech­nique being used by com­pa­nies to con­trol costs. DPC allows employ­ees to pay fixed month­ly, quar­ter­ly, or annu­al fees to cov­er pri­ma­ry care, con­sul­ta­tions, care coor­di­na­tion, and com­pre­hen­sive care man­age­ment. Not only does DPC result in cost-sav­ings, but it fos­ters a bet­ter rela­tion­ship between patient and doctor.

    Leveraging Your Benefits

    Even though health­care costs con­tin­ue to rise, it’s pos­si­ble for com­pa­nies to con­trol costs by pro­mot­ing well­ness ini­tia­tives and help­ing employ­ees select the best ben­e­fit pack­age for their needs.

    Being proac­tive with health­care and mak­ing smart finan­cial deci­sions can keep health­care prices rea­son­able, and ensure that com­pa­nies will be able to attract talent.

    By Mcken­zie Cassidy

    Orginal­ly post­ed on HR Exchange Network

  • IRS Announces 2022 Retirement Plan Contribution Limits

    December 21, 2021

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    On Novem­ber 4, 2021, the Inter­nal Rev­enue Ser­vice (IRS) released Notice 2021–61 announc­ing cost-of-liv­ing adjust­ments affect­ing dol­lar lim­its for pen­sion plans and oth­er retire­ment-relat­ed items for tax year 2022. Many pen­sion plan lim­its will change next year because the increase in the cost-of-liv­ing index met the statu­to­ry thresh­olds that trig­ger their adjust­ment. Oth­er items, how­ev­er, will not increase for 2022. Here is a sum­ma­ry of the lim­its for 2022.

    For 401(k), 403(b), and most 457 plans and the fed­er­al government’s Thrift Sav­ings Plans:

    • The elec­tive defer­ral (con­tri­bu­tion) lim­it increas­es from $19,500 for 2021 to $20,500 for 2022.
    • The catch-up con­tri­bu­tion lim­it for employ­ees aged 50 and over who par­tic­i­pate in these plans will stay the same at $6,500 for 2022.

    For indi­vid­ual retire­ment arrange­ments (IRAs):

    • The lim­it on annu­al con­tri­bu­tions will not change for 2022. It remains $6,000.
    • The addi­tion­al catch-up con­tri­bu­tion lim­it for indi­vid­u­als aged 50 and over is not sub­ject to an annu­al cost-of-liv­ing adjust­ment so it remains $1,000 for 2022.

    For sim­pli­fied employ­ee pen­sion (SEP) IRAs and individual/solo 401(k) plans:

    • Elec­tive defer­rals increase to $61,000 for 2022, based on an annu­al com­pen­sa­tion lim­it of $305,000 (up from the 2021 amounts of $58,000 and $290,000).
    • The min­i­mum com­pen­sa­tion that may be required for par­tic­i­pa­tion in a SEP remains unchanged at $650.

    For sav­ings incen­tive match plan for employ­ees (SIMPLE) IRAs:

    • The con­tri­bu­tion lim­it on SIMPLE IRA retire­ment accounts increas­es from $13,500 for 2021 to $14,000 for 2022.
    • The SIMPLE catch-up lim­it remains unchanged at $3,000 for 2022.

    For defined ben­e­fit plans:

    • The basic lim­i­ta­tion on the annu­al ben­e­fits under a defined ben­e­fit plan increas­es from $230,000 for 2021 to $245,000 for 2022.

    Oth­er items:

    • The thresh­old for deter­min­ing “high­ly com­pen­sat­ed employ­ees” increas­es from $130,000 for 2021 to $135, 000 for 2022.
    • The thresh­old for offi­cers who are “key employ­ees” in a top-heavy plan increas­es from $185,000 for 2021 to $200,000 for 2022.
    • In a sep­a­rate announce­ment, the Social Secu­ri­ty Admin­is­tra­tion stat­ed that the 2022 tax­able wage base will increase to$147,000, an increase of $4,200 from the 2021 tax­able wage base of $142,800. Thus, the max­i­mum Social Secu­ri­ty tax lia­bil­i­ty will increase for both employ­ees and employers.

    The IRS announce­ment is need­ed infor­ma­tion for employ­ers that spon­sor 401(k) plans and oth­er types of retire­ment and sav­ings plans. For those inter­est­ed in health and wel­fare plans, the IRS will release a sep­a­rate announce­ment on the 2022 ben­e­fit lim­its for health flex­i­ble spend­ing accounts (HFSAs) and tran­sit ben­e­fit pro­grams which we’ll cov­er sep­a­rate­ly on this blog.

    By Kath­leen A. Berg­er, CEBS

    Orig­i­nal­ly post­ed on Min­er­al

  • How Health Insurance Can Win the War for Talent

    December 13, 2021

    Tags:

    The COVID-19 pan­dem­ic shined a spot­light on the impor­tance of employ­er-pro­vid­ed health ben­e­fits. Not only have employ­ees been request­ing an expan­sion of their ben­e­fits for months, but report after report has indi­cat­ed that com­pre­hen­sive plans that also cov­er men­tal health or include paid parental leave, for exam­ple, are the key to get­ting peo­ple back to work. But are employ­ers listening?

    The 2021 Employ­ee Ben­e­fits Trends Study from MetLife start­ed col­lect­ing data on what com­pa­nies planned to do about ben­e­fits going for­ward. It found that 80% of the sur­veyed employ­ers agreed that ben­e­fits play a huge role in employ­ee resilience and well-being.

    Most com­pa­nies have seen the writ­ing on the wall and they’re ready to do what’s need­ed to get work­ers back and ensure they stay hap­py, healthy, and productive.

    What Techniques Are Companies Implementing?

    For some com­pa­nies, com­mu­ni­ca­tions have grown mud­dled by the remote envi­ron­ment. Oth­ers may have rec­og­nized they weren’t explain­ing ben­e­fits enough pre-COVID and decid­ed it was time to make a change.

    Accord­ing to the study, 80% of the employ­ers sur­veyed are increas­ing their ben­e­fits com­mu­ni­ca­tions. Most Amer­i­cans select the wrong type of insur­ance for their indi­vid­ual needs, which results in more bills and a prof­it loss for their employer.

    One study cit­ed by CNBC found that only 4% of Amer­i­cans could cor­rect­ly iden­ti­fy the terms deductible, co-pay, coin­sur­ance, and out-of-pock­et max­i­mum. Increas­ing the com­mu­ni­ca­tions about ben­e­fits will help employ­ees bet­ter under­stand what’s avail­able and how to pick the right plan for them. It should decrease out-of-pock­et costs and elim­i­nate the stress of prov­ing to the insur­ance com­pa­ny that cer­tain treat­ments are needed.

    It’s also impor­tant to con­sid­er that employ­ees are 177% more like­ly to be “holis­ti­cal­ly well” when they receive clear com­mu­ni­ca­tions on a reg­u­lar basis.

    Hav­ing a strong com­mu­ni­ca­tion strat­e­gy is more impor­tant than ever as employ­ers are deal­ing with more remote and hybrid employ­ees. The nature of these work modes requires clear expec­ta­tions and reg­u­lar follow-up.

    Besides edu­cat­ing employ­ees on the plans avail­able, 75% of com­pa­nies also said they intend­ed to offer more cus­tomiza­tion of ben­e­fits. Not every­one needs to be cov­ered for the same things. There’s no rea­son to force every­one to get a “one-size-fits-all” plan.

    How Employers Feel About Health Benefits Expansion

    Health insur­ance isn’t cheap and most com­pa­nies would rather focus on cut­ting costs than adding new ben­e­fits. But there are cre­ative ways to help employees.

    For instance, 74% of employ­ers are offer­ing more added-val­ue ser­vices. These may include telemed­i­cine, med­ical bill-sav­ing assis­tance, employ­ment assis­tance pro­grams, and even iden­ti­ty theft pro­tec­tion. Some offer perk ben­e­fits like com­muter spend­ing accounts, cafe­te­ria food plans, or employ­ee dis­counts at local businesses.

    Over­all, employ­ers are strong­ly con­sid­er­ing more vol­un­tary ben­e­fits for employ­ees. Accord­ing to the MetLife study, 66% of employ­ers are expand­ing the range of “employ­ee paid” or vol­un­tary benefits.

    These vol­un­tary ben­e­fits aug­ment what cov­er­age is cur­rent­ly avail­able, but they also sup­port the finan­cial well-being of employ­ees, cut com­pa­ny insur­ance costs, and bet­ter retain cur­rent employees.

    At this moment in time, the big con­cern among employ­ers is reten­tion. Research indi­cates that 78% of employ­ees will decide to stay with a com­pa­ny because of its ben­e­fits program.

    Shifting Attitudes Toward Health Insurance

    Ben­e­fits have always been a key part of com­pet­i­tive job offers, yet how employ­ers view them is shift­ing. More employ­ers believe they have a respon­si­bil­i­ty for the health of their employ­ees. Accord­ing to the study, they see a direct cor­re­la­tion between employ­ee health and productivity.

    The Great Res­ig­na­tion has shown com­pa­nies that a high­er salary isn’t always enough to keep employ­ees on the job. They also need ben­e­fit options to pro­tect their men­tal and phys­i­cal well-being.

    By Mcken­zie Cassidy

    Orig­i­nal­ly post­ed on HR Exchange Network

  • IRS Announces 2022 Limits for Health FSAs and Transit Benefits

    December 8, 2021

    Tags: ,

    Today, the Inter­nal Rev­enue Ser­vice (IRS) announced annu­al infla­tion adjust­ments for more than 50 tax pro­vi­sions, includ­ing an increase in vol­un­tary employ­ee con­tri­bu­tions to employ­er-spon­sored health­care flex­i­ble spend­ing arrange­ments (HFSAs) to $2,850 for plan years begin­ning in 2022, up from the 2021 lim­it of $2,750.

    For HFSAs that include a car­ry­over pro­vi­sion, up to $570 may be car­ried over from the 2022 plan year to the next plan year. Note that HFSAs had the option of allow­ing an unlim­it­ed car­ry­over for the 2021 plan year due to fed­er­al COVID-19 relief pro­vi­sions. For unused HFSA funds at the end of the 2022 plan year, how­ev­er, the plan can­not allow more than $570 to be car­ried over for use in the fol­low­ing year.

    The IRS also announced an increase in the 2022 month­ly lim­its for qual­i­fied trans­porta­tion fringe ben­e­fits under Code § 132(f). For trans­porta­tion in a com­muter high­way vehi­cle and mass tran­sit pass­es, the lim­it will be $280 (up from $270 this year). The sep­a­rate month­ly lim­it for qual­i­fied park­ing also will increase to $280.

    Details of this announce­ment can be found in Rev­enue Pro­ce­dure 2021–45.

    By Kath­leen A. Berg­er, CEBS

    Orig­i­nal­ly post­ed on Min­er­al

  • Tips for Managing the Holiday Blues

    December 1, 2021

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    “Chil­dren laugh­ing, peo­ple pass­ing, meet­ing smile after smile” stirs hap­py mem­o­ries of singing Christ­mas car­ols for some, but for oth­ers, the hol­i­days can be the most stress­ful and loneli­est time of the year.  The hol­i­days often present a dizzy­ing array of demands — shop­ping, bak­ing, and enter­tain­ing to name a few.  For those deal­ing with men­tal health con­di­tions like depres­sion or or anx­i­ety, the hol­i­days can be even harder.

    Hol­i­day depres­sion can be mis­in­ter­pret­ed as being noth­ing more than the win­ter blues.  So, when it comes to the hol­i­days, peo­ple are more focused on their phys­i­cal health issues instead of their men­tal health issues. They are more inter­est­ed in los­ing weight than tak­ing care of their men­tal health.  Being unaware that there is a prob­lem can make hol­i­day depres­sion evolve into major depres­sion.  Coun­sel­ing and med­ica­tion are good avenues to seek if you are liv­ing with symp­toms of depression.

    Here are 9 tips that you can use to help you with hol­i­day depression:

    1. Be real­is­tic – Hol­i­days change just as peo­ple change. Kids grow old­er, peo­ple move, and new peo­ple will become a part of your life.  Focus on those con­nec­tions, new tra­di­tions and remem­ber past hol­i­days with fond­ness while still enjoy­ing the one right in front of you.
    2. Sched­ule Some Down-Time – Even 15–20 min­utes a day to enjoy some qui­et time, take a bath, lis­ten to music or read a book can do won­ders for your stress lev­els. Plus, it’s ok to say no: you don’t have to attend every par­ty or fam­i­ly event.
    3. Don’t Iso­late Your­self – Look for ways that you can enjoy social con­nec­tions, even if you aren’t able to go home for the hol­i­days. If you are feel­ing lone­ly, ask a friend to come over for a heart to heart or vol­un­teer for some­thing that inter­ests you.
    4. Drink Only in Mod­er­a­tion – Alco­hol is a depres­sant and can exac­er­bate neg­a­tive feelings.
    5. Exer­cise Reg­u­lar­ly – While hit­ting the gym can be tough when you are stressed and busy, try going for a short walk. Did you know that exer­cise can help relieve symp­toms of depression?
    6. Focus on the Pos­i­tives – Today is a gift. That is why it’s called the present! Being pos­i­tive and prac­tic­ing grat­i­tude has a strong pos­i­tive impact on psy­cho­log­i­cal well-being. It increas­es self-esteem, enhances pos­i­tive emo­tions and makes us more optimistic.
    7. Keep Expec­ta­tions Man­age­able – Try to set real­is­tic goals for your­self and your fam­i­ly. Pace your­self.  Orga­nize your time and make a list and pri­or­i­tize the impor­tant activities.
    8. Let Peo­ple Close to You Know What’s Going On – Don’t try to hide your hol­i­day depres­sion from your friends and fam­i­ly. Hid­ing your prob­lem can make your men­tal health worse.  Instead, be hon­est with them and let them know what you are going through and make sure you let them know that you don’t expect them to make it better.
    9. Seek Pro­fes­sion­al Help if You Need It – You may find your­self feel­ing per­sis­tent­ly sad or anx­ious, unable to sleep, unable to face rou­tine chores or irri­ta­ble and hope­less despite your best efforts. If these feel­ings last for a while, talk to your doc­tor or a men­tal health professional.

    Avoid beat­ing your­self up if you are not full of the “joy of the sea­son.”  With some plan­ning, self-care and social con­nec­tions, it’s pos­si­ble to tack­le depres­sion around the hol­i­days and still enjoy the sea­son.  Be gen­tle with your­self, have real­is­tic expec­ta­tions, and don’t aban­don your healthy habits just because it’s the hol­i­day sea­son.  By active­ly work­ing to man­age your men­tal health, you will be able to make the best of the holidays!

    If you are expe­ri­enc­ing these symp­toms over a peri­od of sev­er­al weeks, you may be depressed. Talk­ing with a men­tal health pro­fes­sion­al or tak­ing a men­tal health screen­ing test can help you under­stand how well you are cop­ing with recent events. Seek help.

     

  • Biden-Harris Administration Issues Third Rule To Implement No Surprises Act

    November 29, 2021

    Tags:

    WASHINGTON – The Biden-Har­ris admin­is­tra­tion – through the depart­ments of Labor, Health and Human Ser­vices, Trea­sury and the Office of Per­son­nel Man­age­ment – today issued an inter­im final rule with com­ment peri­od to con­tin­ue imple­men­ta­tion of the No Sur­pris­es Act, a con­sumer pro­tec­tion law that helps curb the prac­tice known as “sur­prise billing” for med­ical care.

    The inter­im final rule details the fed­er­al arbi­tra­tion process – or the inde­pen­dent dis­pute res­o­lu­tion process as it’s also known – that providers, facil­i­ties or providers of air ambu­lance ser­vices, and health plans or issuers will use to deter­mine final pay­ment beyond allow­able patient cost-shar­ing for cer­tain out-of-net­work health­care ser­vices in sit­u­a­tions where the No Sur­pris­es Act pro­hibits sur­prise billing. The rule also requires that cer­tain providers and facil­i­ties pro­vide a good faith esti­mate of the charges to unin­sured (or self-pay) indi­vid­u­als so they can know what costs to expect when seek­ing healthcare.

    Today’s rule is the third in a series that the depart­ments are using to imple­ment the No Sur­pris­es Act, a pri­or­i­ty for Pres­i­dent Biden. In July, the Pres­i­dent direct­ed HHS to pri­or­i­tize and imple­ment this law as part of the Exec­u­tive Order on Pro­mot­ing Com­pe­ti­tion in the Amer­i­can Econ­o­my. In the same month, the depart­ments issued an inter­im final rule on con­sumer pro­tec­tions against sur­prise billing. In ear­ly Sep­tem­ber, they issued a pro­posed rule to help col­lect data on the air ambu­lance provider indus­try. The two inter­im final rules take effect on Jan. 1, 2022, and ban sur­prise billing for emer­gency ser­vices and ancil­lary care at in-net­work facil­i­ties, and lim­it high out-of-net­work cost shar­ing for emer­gency and non-emer­gency ser­vices, such that it can­not be high­er than if such ser­vices were pro­vid­ed in-network.

    “Fear of sur­prise billing should nev­er be a bar­ri­er to receiv­ing med­ical care,” said U.S. Sec­re­tary of Labor Mar­ty Walsh. “At the Depart­ment of Labor, we are com­mit­ted to empow­er­ing all work­ers and their fam­i­lies, includ­ing by help­ing to make sure they receive the health­care ben­e­fits they are legal­ly enti­tled to. Today’s rule­mak­ing is anoth­er step by the Biden-Har­ris admin­is­tra­tion that will help pro­tect Amer­i­cans from sur­prise billing that can dis­cour­age need­ed med­ical care or lead to finan­cial peril.”

    “No one should have to go bank­rupt over a sur­prise med­ical bill,” said U.S. Sec­re­tary of Health and Human Ser­vices Xavier Becer­ra. “Today’s rule helps ensure that Amer­i­cans get a bet­ter deal from a more com­pet­i­tive health­care sys­tem. We are build­ing on our ongo­ing efforts to deliv­er on Pres­i­dent Biden’s Com­pe­ti­tion Exec­u­tive Order by pro­mot­ing trans­par­ent out-of-net­work costs, expos­ing inflat­ed health care costs and tak­ing con­sumers out of the mid­dle ulti­mate­ly to help low­er their bills.”

    To pro­tect patients from sur­prise bills and remove them from the mid­dle of pay­ment dis­putes between out-of-net­work providers, facil­i­ties, or providers of air ambu­lance ser­vices and health plans or issuers, on July 1, 2021, the depart­ments and OPM issued an inter­im final rule with com­ment peri­od. The inter­im final rule states that, begin­ning in 2022, patients will only be required to pay cost shar­ing based on in-net­work rates for cer­tain out-of-net­work emer­gency ser­vices, out-of-net­work non-emer­gency ser­vices at in-net­work facil­i­ties and out-of-net­work air ambu­lance services.

    Today’s rule builds on this work and details how the total pay­ment to an out-of-net­work provider or facil­i­ty will be deter­mined. In some cas­es – based on the law – state law or appli­ca­tion of a state All-Pay­er Mod­el Agree­ment will deter­mine this amount. Where nei­ther applies, the rule sets forth the fed­er­al process that will apply for deter­min­ing the amount. When a pay­ment dis­pute for items/services that fall under sur­prise billing pro­tec­tions occur, either a provider, facil­i­ty, or air ambu­lance provider or plan/issuer may ini­ti­ate a 30-day open nego­ti­a­tion peri­od. If open nego­ti­a­tion fails, either par­ty may ini­ti­ate the fed­er­al inde­pen­dent dis­pute res­o­lu­tion process. This rule details how this process ini­ti­ates, what is eli­gi­ble for this process and how inde­pen­dent dis­pute res­o­lu­tion enti­ties should con­sid­er fac­tors when deter­min­ing a pay­ment amount.

    The depart­ments will cer­ti­fy inde­pen­dent dis­pute res­o­lu­tion enti­ties on a rolling basis. Enti­ties seek­ing cer­ti­fi­ca­tion by Jan. 1, 2022 should sub­mit their appli­ca­tion by Nov. 1, 2021. Learn more about the cer­ti­fi­ca­tion process or apply to be a cer­ti­fied inde­pen­dent dis­pute res­o­lu­tion entity.

    In added con­sumer pro­tec­tions, today’s rule out­lines key require­ments relat­ed to unin­sured (or self-pay) indi­vid­u­als (self-pay indi­vid­u­als are indi­vid­u­als who have cov­er­age but do not choose to have their care billed to their health plan or issuer). When indi­vid­u­als sched­ule an item or ser­vice with cer­tain providers and facil­i­ties, those providers and facil­i­ties will be required to inquire about the individual’s health cov­er­age sta­tus, and if the indi­vid­ual wants their care billed to their health plan or issuer.

    The provider or facil­i­ty must pro­vide a good faith esti­mate of expect­ed charges for the care they are sched­ul­ing for indi­vid­u­als deemed unin­sured (or self-pay). An unin­sured (or self-pay) indi­vid­ual may also request a good faith esti­mate, with­out sched­ul­ing an item or ser­vices. The rule also estab­lish­es a process for unin­sured (or self-pay) indi­vid­u­als to ini­ti­ate a pay­ment dis­pute res­o­lu­tion process if they are ulti­mate­ly billed sub­stan­tial­ly in excess of the good faith esti­mate they received.

    To find fact sheets on today’s rule, visit:

    Require­ments Relat­ed to Sur­prise Billing Part II IFR with com­ment period.
    What you Need to Know about the Biden-Har­ris Admin­is­tra­tion’s Actions to Pre­vent Sur­prise Billing

    Orig­i­nal­ly post­ed on U.S. Depart­ment of Labor

  • Understanding Alzheimer’s Disease

    November 22, 2021

    Tags: ,

    Many of us have heard of Alzheimer’s dis­ease but may not know much more than it is a dis­ease that caus­es mem­o­ry loss.  Experts sug­gest that more than 6 mil­lion Amer­i­cans, most of them age 65 or old­er, may have demen­tia caused by Alzheimer’s.  This dis­ease is cur­rent­ly ranked as the sixth lead­ing cause of death in the Unit­ed States, but recent esti­mates indi­cate the dis­or­der may rank third, just behind heart dis­ease and can­cer as a cause of death for old­er people.

    Alzheimer’s dis­ease is a pro­gres­sive brain dis­or­der that slow­ly destroys mem­o­ry and think­ing skills, and even­tu­al­ly, the abil­i­ty to car­ry out the sim­plest tasks. Changes in the brain may begin a decade or more before symp­toms appear. Dur­ing this very ear­ly stage of Alzheimer’s, tox­ic changes are tak­ing place in the brain.  Pre­vi­ous­ly healthy neu­rons stop func­tion­ing, lose con­nec­tions with oth­er neu­rons, and die.

    Signs and symp­toms of Alzheimer’s disease

    Mem­o­ry prob­lems are typ­i­cal­ly one of the first signs of cog­ni­tive impair­ment relat­ed to Alzheimer’s. Alzheimer’s dis­ease pro­gress­es in sev­er­al stages: ear­ly, mild (some­times called mild cog­ni­tive impair­ment), mod­er­ate, and severe.

    In the Ear­ly stage, a per­son begins to expe­ri­ence mem­o­ry loss and oth­er cog­ni­tive dif­fi­cul­ties, though the symp­toms appear grad­ual to the per­son and their family.

    Dur­ing the Mild Cog­ni­tive Impair­ment(MCI), stage dam­age occurs in areas of the brain that con­trol lan­guage, rea­son­ing, sen­so­ry pro­cess­ing, and con­scious thought. Con­di­tions such as dia­betes, depres­sion, and stroke may increase a person’s risk for MCI.

    Some of the signs of MCI include:

    • Los­ing things often
    • For­get­ting to go to events or appointments
    • Hav­ing more trou­ble com­ing up with words than oth­er peo­ple of the same age

    MCI can be man­aged by see­ing a doc­tor or spe­cial­ist every 6 to 12 months.  A doc­tor can help track any changes in mem­o­ry and think­ing skills over time.  Peo­ple with MCI might also con­sid­er par­tic­i­pat­ing in clin­i­cal tri­als or studies.

    The Mod­er­ate stage of Alzheimer’s dis­ease requires more inten­sive super­vi­sion and care becomes necessary.

    Symp­toms may include:

    • Increased mem­o­ry loss and confusion
    • Inabil­i­ty to learn new things
    • Dif­fi­cul­ty with speech and prob­lems read­ing, writ­ing and work­ing with numbers
    • Dif­fi­cul­ty orga­niz­ing thoughts and log­i­cal thinking
    • Short­ed atten­tion span
    • Prob­lems cop­ing with new situations
    • Dif­fi­cul­ty car­ry­ing out mul­ti­step tasks, such as get­ting dressed
    • Prob­lems rec­og­niz­ing fam­i­ly and friends
    • Hal­lu­ci­na­tions, delu­sions, and paranoia
    • Impul­sive behavior
    • Inap­pro­pri­ate out­bursts of anger
    • Rest­less­ness, agi­ta­tion, anx­i­ety, wan­der­ing in the late after­noon or evening
    • Repet­i­tive state­ments or movement

    Peo­ple with Severe Alzheimer’s can­not com­mu­ni­cate and are com­plete­ly depen­dent on oth­ers for care.  The per­son may also be in the bed most or all the time as the body shuts down.

    Symp­toms often include:

    • Inabil­i­ty to communicate
    • Weight loss
    • Seizures
    • Skin infec­tions
    • Dif­fi­cul­ty swallowing
    • Groan­ing, moan­ing, or grunting
    • Increased sleep­ing
    • Loss of bow­el and blad­der control

    How is Alzheimer’s dis­ease treated?

    Cur­rent­ly, there is no cure for Alzheimer’s, though there are med­i­cines that can help treat the symp­toms of the dis­ease.  Most med­i­cines work best for peo­ple in the ear­ly or mid­dle stages of Alzheimer’s. Researchers are explor­ing oth­er drug ther­a­pies and oth­er inter­ven­tions to delay or pre­vent the dis­ease as well as treat its symp­toms.  Some of those include phys­i­cal activ­i­ty, diet, cog­ni­tive train­ing, and a com­bi­na­tion of these.

    Alzheimer’s is com­plex and it is there­fore unlike­ly that any one drug or oth­er inter­ven­tion will suc­cess­ful­ly treat it in all peo­ple liv­ing with the dis­ease.  It is impor­tant to talk to your doc­tor if you expe­ri­ence any signs or symp­toms of the dis­ease so that appro­pri­ate med­ical tests can be con­duct­ed.  This will not only give you peace of mind but will help you and your fam­i­ly pre­pare for the future.

    The jour­ney typ­i­cal­ly lasts for years and for most of that time, peo­ple liv­ing with Alzheimer’s can still enjoy the same things they always have.  Instead of focus­ing on what is lost, focus on what remains.  Peo­ple still enjoy beau­ty and feel emo­tions long after los­ing the abil­i­ty to store short-term mem­o­ries. Rec­og­nize each moment as an oppor­tu­ni­ty to help your loved one expe­ri­ence the joys of life.

  • California Paid Leave begs leave to make changes and leave alone other parts | by Jordan Shields, Partner

    November 18, 2021

    Tags: ,

    There will be no changes in the cal­cu­la­tions used for Paid Fam­i­ly Leave or State Dis­abil­i­ty for the year 2022, but there are changes being pro­posed in 2023.  There was an increase in ben­e­fit pro­posed, but it was vetoed by Gov­er­nor New­som.  In 2023, employ­ees earn­ing more than $1,749 in their high­est earn­ing quar­ter in the base peri­od will receive 55% of those earn­ings divid­ed by 13, up to the week­ly maximum.

  • The Root Cause of the Great Resignation Is Not What You Think

    November 17, 2021

    Tags: ,

    The­o­ries abound about why work­ers are leav­ing their jobs in record num­bers in 2021 and thus cre­at­ing what pun­dits are call­ing the Great Res­ig­na­tion. The U.S. Bureau of Labor Sta­tis­tics report­ed that 4.3 mil­lion Amer­i­cans quit their jobs in August. These res­ig­na­tions con­tin­ue to be high­er in food ser­vice, retail, and education.

    One pop­u­lar opin­ion was that peo­ple quit unex­pect­ed­ly and did not look for a new job because of the gen­er­ous unem­ploy­ment ben­e­fits insti­tut­ed dur­ing the pan­dem­ic. The claim was that the job mar­ket would return back to nor­mal once those ben­e­fits were phased out.

    Even though the ben­e­fits end­ed over Labor Day week­end, there has been no sig­nif­i­cant recov­ery in employ­ment. Twen­ty states actu­al­ly stopped the ben­e­fits over the sum­mer and have seen no improve­ment since then either.

    So what’s real­ly behind this trend? Accord­ing to econ­o­mists and labor mar­ket experts, Amer­i­can work­ers are soul-searching.The Great Res­ig­na­tion is a philo­soph­i­cal reset of work expectations.

    What Workers Really Want

    Heather Long, an eco­nom­ics cor­re­spon­dent from the Wash­ing­ton Post, spoke with CBS News recent­ly to dis­cuss her report­ing on the Great Resignation.

    She said some work­ers are still con­cerned about COVID-19, yet that fear may be wan­ing with the increase of vac­ci­na­tions cou­pled with decreased infec­tions. Many oth­ers sim­ply want to change what they’re doing with their lives.

    Low­er wage work­ers are protest­ing over sub­stan­dard pay and harsh work con­di­tions, but even mid-lev­el work­ers who earned high­er salaries and bet­ter ben­e­fits are leav­ing to open their own busi­ness­es or pur­sue their passions.

    Long said that the two biggest pri­or­i­ties for Amer­i­cans are find­ing some­thing dif­fer­ent or more ful­fill­ing, and work­ing for an employ­er that val­ues both men­tal health and work-life balance.

    What does this mean for companies?

    Offer­ing high­er salaries to job can­di­dates may seem like an obvi­ous fix to the prob­lem, but be pre­pared for the nee­dle to bare­ly move as a result. And it’s clear from the last few months that unem­ploy­ment ben­e­fits weren’t hold­ing work­ers back either.

    “The ear­ly evi­dence cer­tain­ly sug­gests that the unem­ploy­ment ben­e­fits were not the main rea­son hold­ing peo­ple back from going and seek­ing work again,” said Long.

    Instead, the Great Res­ig­na­tion has proven to be more about per­son­al val­ues and less about economics.

    The Great Reassessment of Work in America

    In her inter­view, Long described what’s hap­pen­ing as a” great reassess­ment of work in Amer­i­ca,” and one of the “biggest shake­ups of the labor mar­ket since World War II.”

    It takes a sig­nif­i­cant or trau­mat­ic event like a pan­dem­ic or world war to get peo­ple ques­tion­ing their lives and how work fits into it. So much about the work­force changed in the mid-1900s. Amer­i­cans were still reel­ing from The Great Depres­sion only a few years before the war that caused unem­ploy­ment rates to sky­rock­et to 25%.

    The start of the war actu­al­ly got things mov­ing again. Fac­to­ries were estab­lished to pro­duce weapons and sup­plies. More Amer­i­cans, includ­ing women who were pre­vi­ous­ly expect­ed to be stay-at-home wives and moth­ers, went to work to sup­port the effort. A major­i­ty of the work­force became per­ma­nent­ly indus­tri­al­ized in that decade.

    The Amer­i­can work­force was nev­er the same after World War II, and many experts are point­ing to a sim­i­lar shift today in 2021.

    Advice for HR Professionals and Companies

    Know­ing the root caus­es of “The Great Res­ig­na­tion” will help HR depart­ments and com­pa­nies tru­ly solve this labor cri­sis. Mon­ey is impor­tant. Every­one needs to pay their bills, and it would be nice to have a few extra dol­lars to take an extra vaca­tion or buy a more expen­sive car. But don’t make the mis­take of think­ing it’s all salary that will bring back workers.

    Even if some employ­ees return for a high­er salary, it will only keep them engaged in the short-term. When they even­tu­al­ly quit again because of burnout, com­pa­nies will be back to square one.

    Younger work­ers from the Mil­len­ni­al and Gen‑Z gen­er­a­tions are lead­ing this trend. Besides the mon­ey, they want to feel safe and well-com­pen­sat­ed. They want to be treat­ed with decen­cy by employ­ers, who care about their men­tal health and per­son­al downtime.

    by Mcken­zie Cassidy

    Orig­i­nal­ly post­ed on HR Exchange Network

  • What’s my incentive…or not…to get vaccinated and show up for work? | by Jordan Shields, Partner

    November 12, 2021

    Tags: ,

    Well, the agen­cies final­ly saw things com­ing after they came, and have issued joint guid­ance about what to do with unvac­ci­nat­ed employ­ees.  The Depart­ments of Labor, Trea­sure and Health/Human Ser­vices have declared the following:

    1)  HIPAA gen­er­al­ly pro­hibits a group health plan from dis­crim­i­nat­ing among sim­i­lar­ly sit­u­at­ed indi­vid­u­als based on a health fac­tor, which is how this is being described. “Well­ness” pro­grams, which allow an incen­tive or dis­in­cen­tive, are “par­tic­i­pa­to­ry” (open-end­ed with no reward based on health fac­tors, sta­tus or enroll­ment) and “con­tin­gent” (rewards based on par­tic­i­pa­tion).  For the lat­ter, the incen­tive lim­it is 30% of the premium.

    The agen­cies have deemed vac­cine pre­mi­um incen­tive pro­grams as “activ­i­ty only” say­ing that receipt of a vac­cine is a health fac­tor that trig­gers the 30% lim­i­ta­tion, and sub­ject to sev­er­al conditions:

                   a) Pro­gram is rea­son­ably designed to pro­mote health or pre­vent disease

                   b) A rea­son­able alter­na­tive must be pro­vid­ed for those for whom it is unrea­son­ably dif­fi­cult due to a med­ical con­di­tion or if it is med­ical­ly inad­vis­able to obtain a COVID 19 vaccine

                   c) The reward must not exceed 30% of the total cost of employ­ee only coverage

    2)  Con­di­tion­ing eli­gi­bil­i­ty for ben­e­fits or cov­er­age for oth­er­wise cov­ered items or ser­vices is NOT per­mis­si­ble under HIPAA

    3)  If the incen­tive is a pre­mi­um dis­count, the dis­count is treat­ed as not earned and there­fore afford­abil­i­ty is based on the assumed increased pre­mi­um cost for the par­tic­i­pant, for ACA dis­crim­i­na­tion test­ing purposes.

    The EEOC issued FAQs in May say­ing that the ADA (Amer­i­cans with Dis­abil­i­ties Act) well­ness rules do not apply where the employ­er mere­ly requests proof of vac­ci­na­tion BUT an employ­er must still pro­vide a rea­son­able accom­mo­da­tion to an employ­ee who can­not get the vac­cine due to a disability

    For GINA, the EEOC said that an incen­tive for a fam­i­ly mem­ber get­ting vac­ci­nat­ed is gen­er­al­ly per­mis­si­ble and no incen­tive lim­its apply, as long as the fam­i­ly mem­ber gets the vac­cine from a third par­ty and not the employ­er or its agent.

     

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