Lately we been discussing group health a lot in the context of workplace wellness. Wellness programs contribute to happier, healthier, more productive employees that require less sick time and place fewer demands on the medical system. Everyone wins when wellness plays a role in group health. These are a few of these most popular blogs we’ve shared on the matter:
For companies to have successful health and wellness strategies, they need to create a worksite culture that values and encourages employee wellness. It is not enough to have a wellness assessment and health coaching. Real sustainable behavior change requires a cultural shift that enables employees to discover their intrinsic motivation to improve their health. One way to accomplish this is to find creative ways to demonstrate the applicability of wellness in their employees’ day-to-day lives. There are a number of ways to achieve this. Here are a few examples:
For more, visit http://www.crawfordadvisors.com/news.
The Affordable Care Act (PPACA) includes a provision imposing an annual assessment on insurers and group health plans to fund a Patient-Centered Outcomes Research Institute (PCORI), which will assist patients, clinicians, purchasers and policy-makers in making informed health decisions by advancing comparative clinical effectiveness research.
The Institute is funded by a trust fund, which, in turn, is partially funded by fees paid by issuers of health insurance policies and sponsors of self-insured health plans. This “comparative effectiveness research fee” applies to policy/plan years ending on or after 10/1/2012.
Proposed regulations were published on April 12 and, although not yet final, this Proposed Rule provides more information on calculation, reporting and payment of the fee. Read the IRS’ proposed rules (61 pages, here): http://www.ofr.gov/OFRUpload/OFRData/2012-09173_PI.pdf. For more information, visit http://www.crawfordadvisors.com/news.
On December 2, 2011, HHS and CMS (the Departments of Health and Human Services and the Centers for Medicare & Medicaid Services) released new final rules that addresses an assortment of issues with respect to the PPACA medical loss ratio (MLR) requirements. In conjunction with the new rules, the DOL (Department of Labor) has issued a Technical Release as well. Keep in mind that PPACA’s MLR requirements do NOT apply to self-funded health plans.
According to the existing MLR standard, private health insurers are required to spend 80% to 85% of consumer’s premiums on patient care. Insurers must provide rebates to enrollees if their spending for the benefit of policyholders for clinical services and quality improving activities, in relation to the premiums charged, is less than the MLR standards established.
The new rule and related DOL guidance include information that makes fundamental changes to the existing interim rules. The releases address how plans sponsored by ERISA and non-federal governmental employers must use rebates received from insurers and how insurers must calculate the amount of rebates. The HHS final rule directs health plan issuers to provide any rebates owed to the group policyholder and it also contains information regarding the notice insurers must provide to employers and employees. For more, visit http://www.crawfordadvisors.com/news.
By Rhonda Willingham, RN, BSN
EVP Health Improvement, Alere Health
More than 70 percent of the nation’s employers have put their faith in wellness initiatives to improve health and reduce costs, yet they continue to be challenged with disappointing participation rates in their worksite wellness programs. This belief in improving wellness has been so strong that many employers are willing to pay their employees to participate. Consider the following:
Traditionally, employers have offered incentives for participation and avoided penalties, but as healthcare costs continue to escalate, many feel pressured to implement stricter measures. Increasing numbers of employers are moving from simply rewarding participation to rewarding progress in specific behaviors or clinical measures. Outcomes-based incentives are appealing as they demonstrate a tangible, real result and allow individuals to choose their own means of achieving goals. Many employers are also willing to implement penalties for non-participation and/or unhealthy behaviors. For more, visit http://www.crawfordadvisors.com/news.
Crawford Advisors Update – More Information on this and other health insurance compliance topics is available at CrawfordAdvisors.com.
Crawford Advisors provides a number of insurance and administration services to optimize the cost and effectiveness of significant and complex programs needed to keep businesses running smoothly. One such service is the COBRA process, ensuring that companies are in compliance with all regulations. COBRA regulations can be numerous and intricate, like recent ARRA and extension of benefit legislation, as well as any and all extensions or amendments likely to be added in the future. Leveraging experienced and qualified expertise in these matters can lead to a number of positive factors such as reduced liability and reduced expenditure.
Services include:
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Essential Health Benefits (“EHB”) is a set of health care service categories that must be covered by certain plans, starting in 2014. Starting with plan years or policy years that began on or after September 23, 2010, health plans can no longer impose a lifetime dollar limit on spending for these services. All plans, except grandfathered individual health insurance policies, must phase out annual dollar spending limits for EHB services by 2014.
Centers for Medicare and Medicaid Services (CMS), a department of HHS (U.S. Department of Health & Human Services), has an office called The Center for Consumer Information and Insurance Oversight (CCIIO). Strangely, in a move that some critics have called “deft” and others suggest is a “detour” CMS-CCIIO issued a “Benefits Bulletin” on Friday, December 16, 2011, called “Giving States Additional Flexibility to Implement Health Reform.”
