Yearly Archives: 2021

  • 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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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 phig@cms.hhs.gov 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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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.

    3Automate 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

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    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

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    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

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    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

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    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

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    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 brice@sneaky.scam. 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

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    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

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    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

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    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

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    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

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    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

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    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

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    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

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    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.”

  • 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

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    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

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    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.

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